Inhospital exercise benefits in childhood cancer: A prospective cohort study

Childhood cancer patients are at risk of developing important adverse effects, mortality and disease relapse after treatments, which has a substantial economic impact on healthcare systems. The objective of this study was to determine the effects of supervised inhospital exercise on clinical endpoints during childhood cancer treatment. 169 children with a new diagnosis of cancer were divided into an exercise intervention (n = 68, 11 ± 4 years) or a control group (n = 101, 11 ± 3 years). The cohort was followed up from the start of treatment for up to five years. Supervised inhospital exercise intervention was performed during the neoadjuvant (for solid tumors) or intensive chemotherapy treatment period (for leukemias). The median duration of the intervention was 22 (interquartile range, 14-28) weeks. We assessed survival, risk of disease relapse or metastasis, and days of hospitalization (primary outcomes), and cardiovascular function, anthropometry and blood variables (secondary outcomes). No exercise-related adverse events were noted. The exercise group had significantly less days of hospitalization than the control group (P = .031), resulting in a lower (~−17%) mean total economic cost of hospitalization in the former. Moreover, echocardiography-determined left ventricular function (ejection fraction and fractional shortening) was significantly impaired in the control group after treatment compared with baseline, whereas it was maintained in the exercise group (P = .024 and .021 for the between-group differences, respectively). In conclusion, supervised inhospital exercise intervention is safe and plays a cardioprotective role, at least in the short term, in children with cancer, also reducing hospitalization time, and therefore alleviating the economic burden.     

In hip osteoarthritis,Nordic Walking is superior to strength training and home‐based exercise for improving function

This observer‐blinded, randomized controlled trial compared the short‐ and long‐term effects of 4 months of supervised strength training (ST) in a local fitness center, supervised Nordic Walking (NW) in a local park, and unsupervised home‐based exercise (HBE, control) on functional performance in 60+‐year‐old persons (n = 152) with hip osteoarthritis (OA) not awaiting hip replacement. Functional performance [i.e., 30‐s chair stand test (primary outcome), timed stair climbing, and 6‐min walk test] and self‐reported outcomes (i.e., physical function, pain, physical activity level, self‐efficacy, and health‐related quality of life) were measured at baseline and at 2, 4, and 12 months. Based on intention‐to‐treat‐analyses improvements [mean (95% CI)] after intervention in number of chair stands were equal in all three groups at 4 months [ST: 0.9 (0.2–1.6), NW: 1.9 (0.8–3.0), HBE: 1.1 (0.1–2.0)] but greater in the NW group [1.4 (0.02–2.8)] than in the ST group at 12 months. Generally, improvements in functional performance were greater (P < 0.001–P < 0.03) after NW compared with HBE and ST at all follow‐up time points. Furthermore, NW was superior (P < 0.01) to HBE for improving vigorous physical activity and to both ST and HBE for improving (P < 0.01) mental health. These data suggest that NW is the recommended exercise modality compared with ST and HBE.     

Economic evaluation of exercise‐based cardiac rehabilitation in patients with a recent acute coronary syndrome

Health care decision‐making requires evidence of the cost‐effectiveness of medical therapies. We evaluated the cost‐effectiveness of exercise‐based cardiac rehabilitation (ECR) implemented according to guidelines. All the patients (n = 204) had experienced a recent acute coronary syndrome and were randomized to a 1‐year ECR (n = 109) or usual care (UC) group (n = 95). The patients’ health‐related quality of life was followed using the 15D instrument and health care costs were collected from electronic health registries. The cost‐effectiveness of ECR was estimated based on intervention and health care costs and quality‐adjusted life years (QALYs) gained. The total average cost per patient was lower in ECR than in UC. The incremental cost was divided by the baseline‐adjusted incremental QALYs (0.045), yielding an incremental cost‐effectiveness ratio of ?€24511/QALYs. A combined endpoint of mortality, recurrent coronary event, or hospitalization for a heart failure occurred for five patients in ECR and 16 patients in UC (HR 3.9, 95% CI 1.4–10.6, P = 0.004, relative risk reduction 73%, number needed to treat eight). ECR is a dominant treatment option and decreases the occurrence of adverse cardiac events. These results are useful for decision‐making when planning optimal utilization of resources in Finnish health care.     

Factors affecting pain relief in response to physical exercise interventions among healthcare workers

The aim of this study is to identify factors associated with musculo‐skeletal pain reduction during workplace‐based or home‐based physical exercise interventions among healthcare workers. Two hundred female healthcare workers (age: 42.0, BMI: 24.1, average pain intensity: 3.1 on a scale of 0‐10) from three hospitals participated. Participants were randomly allocated at the cluster level (18 departments) to 10 weeks of (i) workplace physical exercise (WORK) performed in groups during working hours for 5 × 10 minutes per week and up to five group‐based coaching sessions on motivation for regular physical exercise, or (ii) home‐based physical exercise (HOME) performed alone during leisure‐time for 5 × 10 minutes per week. Linear mixed models accounting for cluster identified factors affecting pain reduction. On average 2.2 (SD: 1.1) and 1.0 (SD: 1.2) training sessions were performed per week in WORK and HOME, respectively. The multi‐adjusted analysis showed a significant effect on pain reduction of both training adherence (P=.04) and intervention group (P=.04) with participants in WORK experiencing greater reductions compared with HOME. Obesity at baseline was associated with better outcome. Leisure‐time exercise, daily patient transfer, age, and chronic pain did not affect the changes in pain. In conclusion, even when adjusted for training adherence, performing physical exercise at the workplace is more effective than home‐based exercise in reducing musculo‐skeletal pain in healthcare workers. Noteworthy, obese individuals may especially benefit from physical exercise interventions targeting musculo‐skeletal pain.     

Dose–response effect of exercise frequency on bone mineral density in post‐menopausal,osteopenic women

The purpose of this study was to determine the long‐term dose–response relationship of exercise frequency on areal bone mineral density (aBMD) in early post‐menopausal women with osteopenia. Based on the 12‐year results of the consequently supervised exercise group (EG) of the Erlangen Fitness and Osteoporosis Prevention Study, we retrospectively structured two exercise groups according to the overall exercise frequency. Changes in aBMD at lumbar spine and proximal femur as assessed by dual‐energy x‐ray absorptiometry technique were compared between a low‐frequency exercise group (LEF‐EG, n = 16) with 1.5–<2 sessions/week and a high‐frequency exercise group (HEF‐EG, n = 25) with ≥2–3.5 sessions/week. Changes in aBMD at the lumbar spine and proximal femur were significantly more favorable in the HEF‐EG compared with the LEF‐EG; lumbar spine: (mean value ± standard deviation) 1.1 ± 4.7% vs ?4.1 ± 3.0%; P = 0.001, ES: d' = 1.26; total hip: ?4.4 ± 3.9% vs ?6.7 ± 3.5%, P = 0.045, ES: d' = 0.70). BMD results of the LEF‐EG did not significantly differ from the data of the non‐training control group (lumbar spine: ?4.4 ± 5.2%, total hip: ?6.9 ± 5.0%). Although this result might not be generalizable across all exercise types and cohorts, it indicates that to impact bone, an overall exercise frequency of at least 2 sessions/week may be crucial, even if exercise is applied with high intensity/impact.     

The predictive value of exercise testing for survival among 75-year-old men and women

All 75‐year‐olds born in 1914 and living in the city of Jyväskylä, central Finland (n=388) were invited to study the predictive value of exercise test for mortality. Subjects who entered the laboratory (n=295) were to have a standard pre‐test evaluation and perform a cycle ergometer exercise test. Subjects with complete background, exercise‐test status and mortality data (n=282) were divided into three groups according to exercise‐test status: a non‐exercise test group (n=79), an exercise‐test termination group (n=95), and an exercise‐test completion group (n=108). Mortality was followed up for 9 years. The multivariate hazard ratio (HR) for death among the non‐exercise test group compared with exercise‐test completion group was 1.87 (CI 1.19–2.94). The multivariate HR for death among the exercise‐test termination group compared with the exercise‐test completion group was 0.95 (CI 0.58–1.54). High cycling power (W/kg body weight) in the exercise‐test completion group was associated with a decreased risk for death with a multivariate HR 0.14 (CI 0.05–0.38). Performing an exercise test serves information on the risk of death that is incremental to clinical data and traditional risk factors of death in elderly people.     

The effect of rowing on endothelial function and insulin action in healthy controls and in patients with type 2 diabetes

Patients with type 2 diabetes (T2DM) have an increased risk for cardiovascular disease. We examined the effects of 8 weeks of home‐based rowing training (heart rate corresponding to 65–70% of VO_{2 peak}) on endothelial function and glucose clearance (local and systemic effects) in male subjects with T2DM (n=9) and matched controls (n=8). Before and after training (30 min every other day), all subjects underwent sequential graded brachial artery infusions of non‐insulin vasodilators (acetylcholine; sodium nitroprusside; adenosine). Forearm blood flow was improved by training in controls (without and with insulin: P=0.003 and 0.05, respectively) but not in subjects with T2DM. Likewise, whole body glucose clearance increased in response to training in controls (P=0.05) but not in T2DM. However, in both groups, the capacity for local forearm glucose extraction (controls: P=0.001; T2DM: P=0.002) and clearance (controls: P<0.001; T2DM: P=0.01) were positively affected by exercise. While the subjects with T2DM did not respond to the same degree as controls to 8 weeks of home‐based exercise, there are clear benefits as illustrated by improvements in local glucose disposal. Training of higher intensity or duration may be required in order to elicit a response similar to controls.     

High-intensity resistance and cardiovascular training improve physical capacity in cancer patients undergoing chemotherapy

The purpose of the study was to examine the effects of a supervised high- and low-intensity structured training program in cancer patients concurrently undergoing chemotherapy. Seventy patients, in different stages of the disease and with different diagnoses (48 females, 22 males), between 18 and 65 years of age (mean age 42.8) participated in a 9-h weekly training program over 6 weeks. The intervention involved physical exercise, relaxation, massage, and body-awareness training. Physical capacity (one-repetition maximum tests (1RM), VO2max) and body composition (weight, skin-fold) were compared before and after the exercise intervention. The average increase in muscular strength was 41.3% (P<0.001) and 14.5% in aerobic fitness (pre: 2.27+/-0.597 L/min, post: 2.56+/-0.644 L/min, (P<0.001). The exercise intervention significantly increased the weight of the subjects by 1% (pre: 72.62+/-13.42 kg, post: 73.25+/-13.44 kg, P=0.016). There was a significant decrease in skin-fold measurements by 3% (P=0.031). The exercise intervention was well tolerated, provided that daily screening criteria were adhered to. The effects of resistance and cardiovascular training observed in this short-term study support the theory that exercise is a beneficial intervention strategy for increasing muscle strength and aerobic fitness during antineoplastic chemotherapy. This type of exercise program can be an important component of complementary treatment for cancer patients undergoing chemotherapy.     

The effect of exercise for improving bone health in cancer survivors — A systematic review and meta-analysis

ObjectiveTo evaluate the effectiveness of exercise for improving bone-related outcomes among cancer survivors.DesignSystematic review and meta-analysis.MethodsAn electronic search using the following databases: SPORTDiscus, Science Direct, CINAHL, MEDLINE, Cochrane, Pubmed, Ebscohost, ProQuest Nursing and Allied Health Source.Randomised, controlled, exercise trials involving cancer survivors were eligible. Effect data on bone mineral content (BMC) and density (BMD) outcomes were extracted. Risk of bias was assessed using the Physiotherapy Evidence Database tool. Standardised mean differences (SMD) were calculated to compare differences between exercise and usual care. Subgroup analyses were conducted to assess whether effect differed by exercise mode, intervention length, supervision, treatment, cancer type and risk of bias.ResultsTwenty-six trials were included, with intervention durations ranging between 12 weeks and 2 years. Most trials involved breast cancer (n = 13, 50%), and most interventions were supervised (n = 18, 69%) and evaluated mixed-mode (i.e., combined aerobic and resistance) exercise (n = 13, 50%). Significant effects in favour of exercise (aerobic, resistance, mixed-mode and other exercise) were observed for whole body BMD, hip BMD, trochanter BMD and femoral neck BMD (SMD range: 0.19–0.39, all p < 0.05) compared to usual care.ConclusionParticipation in various modes (aerobic, resistance, mixed-mode and other) of supervised and unsupervised exercise is associated with improvements in BMD. The present results provide evidence for clinicians and other health care professionals (e.g., exercise physiologists and physiotherapists) to recommend exercise for cancer survivors to prevent bone loss during and following treatment.     

Arthroscopic or conservative treatment of degenerative medial meniscal tears: a prospective randomised trial

In this prospective randomised study two treatments after non-traumatic medial meniscal tear diagnosed with radiological examination and magnetic resonance imaging were compared; arthroscopic partial meniscectomy followed by supervised exercise or supervised exercise alone. The aim was to evaluate knee function and physical activity. Ninety patients (mean age 56 years) were evaluated using the Knee Injury and Osteoarthritis Outcome Score, the Lysholm Knee Scoring Scale, the Tegner Activity Scale and a Visual Analogue Scale for knee pain prior to the intervention, after 8 weeks of exercise and after 6 months. According to the outcome scores arthroscopic partial medial meniscectomy combined with exercise did not lead to greater improvement than exercise alone. After the intervention both groups reported decreased knee pain, improved knee function and a high satisfaction (P < 0.0001). Forty-one per cent of the patients returned to their pre-injury activity level after 6 months. In conclusion, when evaluated with outcome scores, arthroscopic partial medial meniscectomy followed by supervised exercise was not superior to supervised exercise alone in terms of reduced knee pain, improved knee function and improved quality of life.     

Increased mast cell numbers in a calcaneal tendon overuse model

Tendinopathy is often discovered late because the initial development of tendon pathology is asymptomatic. The aim of this study was to examine the potential role of mast cell involvement in early tendinopathy using a high‐intensity uphill running (HIUR) exercise model. Twenty‐four male Wistar rats were divided in two groups: running group (n = 12); sedentary control group (n = 12). The running‐group was exposed to the HIUR exercise protocol for 7 weeks. The calcaneal tendons of both hind limbs were dissected. The right tendon was used for histologic analysis using Bonar score, immunohistochemistry, and second harmonic generation microscopy (SHGM). The left tendon was used for quantitative polymerase chain reaction (qPCR) analysis. An increased tendon cell density in the runners were observed compared to the controls (P = 0.05). Further, the intensity of immunostaining of protein kinase B, P = 0.03; 2.75 ± 0.54 vs 1.17 ± 0.53, was increased in the runners. The Bonar score (P = 0.05), and the number of mast cells (P = 0.02) were significantly higher in the runners compared to the controls. Furthermore, SHGM showed focal collagen disorganization in the runners, and reduced collagen density (P = 0.03). IL‐3 mRNA levels were correlated with mast cell number in sedentary animals. The qPCR analysis showed no significant differences between the groups in the other analyzed targets. The current study demonstrates that 7‐week HIUR causes structural changes in the calcaneal tendon, and further that these changes are associated with an increased mast cell density.     

Unfavorable influence of structured exercise program on total leisure‐time physical activity

In randomized controlled trials (RCTs), with customized structured physical exercise activity (SPEA) interventions, the dose of leisure‐time physical activity (LTPA) should exceed the LTPA dose of the nonexercising control (C) group. This increase is required to substantiate health improvements achievable by exercise. We aimed to compare the dose of SPEA, LTPA, and total LTPA (SPEA + LTPA) between a randomized Nordic walking (NW) group, a power‐type resistance training (RT) group, and a C group during a 12‐week exercise intervention in obese middle‐aged men (n = 144) with impaired glucose regulation. The dose of physical activity was measured with diaries using metabolic equivalents. No significant difference (P > 0.107) between the groups was found in volume of total LTPA. The volume of LTPA was, however, significantly higher (P < 0.050) in the C group than in the NW group, but not compared with the RT group. These results indicate that structured exercise does not automatically increase the total LTPA level, possibly, as a result of compensation of LTPA with structured exercise or spontaneous activation of the C group. Thus, the dose of total LTPA and the possible changes in spontaneous LTPA should be taken into account when implementing a RCT design with exercise intervention.     

Exercise capacity,daily activity,and severity of fatigue in term born young adults after neonatal respiratory failure

Little is known about long‐term effects of neonatal intensive care on exercise capacity, physical activity, and fatigue in term borns. We determined these outcomes in 57 young adults, treated for neonatal respiratory failure; 27 of them had congenital diaphragmatic hernia with lung hypoplasia (group 1) and 30 had normal lung development (group 2). Patients in group 2 were age‐matched, with similar gestational age and birth weight, and similar neonatal intensive care treatment as patients in group 1. All patients were born before the era of extracorporeal membrane oxygenation, nitric oxide administration, and high frequency ventilation. Exercise capacity was measured by cycle ergometry, daily physical activity with an accelerometry‐based activity monitor, and fatigue by the fatigue severity scale. Median (range) VO _2peak in mL/kg/min was 35.4 (19.6–55.0) in group 1 and 37.6 (15.7–52.7) in group 2. There was a between‐group P‐value of 0.65 for exercise capacity. Daily activity and fatigue were also similar in both groups. So, residual lung hypoplasia did not play an important role in this cohort. There were no significant associations between exercise capacity and perinatal characteristics. Future studies need to elucidate whether exercise capacity is impaired in patients with more severe lung hypoplasia who nowadays survive.     

Continuous vs interval training on glycemic control and macro‐ and microvascular reactivity in type 2 diabetic patients

To determine the effects of continuous aerobic exercise training (CON) vs interval aerobic exercise training (INT) on glycemic control and endothelium‐dependent vasodilatation, 43 participants with type 2 diabetes were randomly allocated to the sedentary, CON, and INT groups. The CON and INT exercise training programs were designed to yield the same energy expenditure/exercise session and included walking on treadmill for 30 and 40 min/day, 3 times/week for 12 weeks. Body fatness and heart rate at rest decreased and leg muscle strength increased (all P < 0.05) in both the CON and INT groups. Fasting blood glucose levels decreased (P < 0.05) in both exercise groups but glycosylated hemoglobin levels decreased (P < 0.05) only in the INT group. Maximal aerobic capacity, flow‐mediated dilation, and cutaneous reactive hyperemia increased significantly in both exercise groups; however, the magnitude of improvements was greater in the INT group. Only the INT group experienced reductions in erythrocyte malondialdehyde and serum von Willebrand factor and increases in plasma glutathione peroxidase and nitric oxide (all P < 0.05). We concluded that both continuous and interval training were effective in improving glycemic control, aerobic fitness, and endothelium‐dependent vasodilation, but the interval training program appears to confer greater improvements than the continuous training program.     

Effects of macronutrient intake on thigh muscle mass during home‐based walking training in middle‐aged and older women

We examined whether post‐exercise macronutrient supplementation during a 5‐month home‐based interval walking training (IWT) accelerated exercise‐induced increases in skeletal muscle mass and strength in healthy middle‐aged and older women. Thirty‐five women (41–78 years) were randomly divided into two groups: IWT alone (CNT, n = 18) or IWT plus post‐exercise macronutrient (7.6 g protein, 32.5 g carbohydrate, and 4.4 g fat) supplementation (NUT, n = 17). For IWT, all subjects were instructed to repeat five or more sets of 3‐min low‐intensity walking at 40% peak aerobic capacity (Vo_{2 peak}), followed by a 3‐min high‐intensity walking above 70% Vo_{2 peak} per day for 4 or more days per week. We determined Vo_{2 peak}, thigh muscle tissue area by computer tomography, and thigh muscle strength in all subjects before and after IWT. We found that an increase in hamstring muscle tissue area was 2.8 ± 1.2% in NUT vs ?1.0 ± 0.7% in CNT and that in isometric knee flexion force was 16.3 ± 3.7% in NUT vs 6.5 ± 3.0% in CNT; both were significantly higher in NUT than in CNT (both, P < 0.001). Thus, post‐exercise macronutrient supplementation enhanced the increases in thigh muscle mass and strength, although partially, in home‐based IWT in middle‐aged and older women.     

Exercise therapy – the public health message

Non‐communicable chronic diseases (NCDs), such as cardiovascular disease, diabetes, and cancer, are currently responsible for 65% of all deaths worldwide and are projected to cause over 75% of all deaths by 2030. A substantial accumulation of epidemiological and experimental evidence has established a causal relationship between NCDs and well‐known yet preventable risk factors (e.g., physical inactivity and obesity). Given that physical activity has both direct and indirect effects on the mortality and morbidity of NCDs via other risk factors (e.g., obesity, diabetes, and hypertension), it is now undeniable that sedentary lifestyles are one of the most significant public health problems of the 21st century. In 2007, the American College of Sports Medicine (ACSM) and American Medical Association (AMA) launched the Exercise is Medicine® (EIM) initiative in recognition of the fundamental importance of physical activity to health and well‐being. EIM is on the forefront of a global movement to reduce sedentary lifestyles, foster implementation of exercise counseling into clinical practice, and disseminate exercise therapy on a global scale. If the devastating human losses and financial burden of inactivity‐induced chronic disease are to be ameliorated, the wide‐ranging cost‐effective health benefits and financial feasibility of physical activity interventions must be appreciated and promoted.     

Aerobic capacity of older adults: a training study

The effects of a four month aerobic conditioning program on heart rate, blood pressure, maximal oxygen consumption (VO2max), and physical work capacity of 55-70 year old sedentary individuals were evaluated. Twenty-eight men and women participated in either 4 months of supervised fast walking or jogging at a prescribed target heart rate or stretching exercises for one hour, three days per week. Gains in VO2max (ml/kg/min) obtained during a Balke maximal treadmill test in aerobic and exercise control subjects were 27% and 9%, respectively. At posttesting subjects in both groups demonstrated improved maximal work rate, increased treadmill time, and experienced lower resting and recovery heart rates, lower resting systolic blood pressure, and fewer premature ventricular depolarizations during exercise testing. In 67 physician-supervised maximal exercise tests, only one subject did not achieve VO2max due to exercise induced arrhythmias. No events of morbidity or mortality occurred as a result of the exercise testing and training. Subjects were contacted 4 years after study participation to determine if they were adhering to an exercise program. Sixty-four percent reported exercising at least 3 days per week in large muscle activities. We conclude that four months of supervised aerobic and nonaerobic exercise training is sufficient to improve aerobic capacity and other indicators of fitness in older, sedentary men and women, and that these previously sedentary people are likely to continue exercising on an individual basis once they have experienced improved physical capacity.     

Concurrent and prospective associations among biological maturation,and physical activity at 11 and 13 years of age

This study examined concurrent and prospective associations between objective measures of biological maturation, body composition and physical activity (PA) in adolescent males (n = 671) and females (n = 680). Participants born to women recruited to the Avon Longitudinal Study of Parents and Children birth cohort study were assessed at 11 and 13 years. Percentage of predicted adult stature was used as an estimate of biological maturation. PA and time sedentary was assessed over 7 consecutive days using Actigraph accelerometers. Body composition was assessed using whole‐body DXA scans. At 11 and 13 years, maturity in males was inversely associated with accelerometer counts‐per‐minute (CPM) and time engaged in light PA, and positively associated with time sedentary. In females, maturity was inversely associated with accelerometer (CPM) at 11 but not 13 years. Adjusting for accelerometer wear times and corresponding activity levels at 11 years, maturity and percentage fat mass at 11 years did not predict any indices of PA or sedentary behavior in males or females at 13 years. Whereas advanced maturation in males is associated with less PA and more sedentary behavior at 11 and 13 years, maturity at 11 does not predict PA or sedentary behavior at 13 years in either sex.