Exercise & Sports Science Australia (ESSA) position statement on exercise and chronic kidney disease

ObjectivesChronic kidney disease (CKD) is prevalent, affecting 13% of adult Australians and poses increased risk for cardiovascular morbidity and mortality. This position article provides evidence-based guidelines on the role of exercise training for CKD patients and provides recommendations for prescribing and delivering exercise training.DesignPosition stand.MethodsSynthesis of published work within the field of exercise training and chronic kidney disease.ResultsExercise training likely to provide benefits to CKD patients, including improvements in cardio-respiratory fitness, quality of life, sympatho-adrenal activity, muscle strength and increased energy intake and possible reduction in inflammatory biomarkers. Existing studies generally report small sample sizes, brief training periods and relatively high attrition rates. Exercise training appears to be safe for CKD patients with no deaths directly related to exercise training in over 30,000 patient-hours, although strict medical exclusion criteria in previous studies resulted in 25% of patients being excluded potentially impacting the generalisability of the findings.ConclusionsAerobic exercise at an intensity of >60% of maximum capacity is recommended to improve cardio-respiratory fitness. Few data are available on resistance training and it is unclear whether this form of training retards catabolic/inflammatory processes typical of CKD. However, it should be considered important due to its proven beneficial effects on bone density and muscle mass. Due to the high prevalence and incidence of co-morbidities in CKD patients, exercise training programs should be prescribed and delivered by individuals with appropriate qualifications and experience to recognise and accommodate co-morbidities and associated complications.     

QuikQuiz

Abstract

Aerobic exercise training and diet are recommended for the primary prevention of type 2 diabetes mellitus and cardiovascular disease. The American Diabetes Association (ADA) recommends that adults with prediabetes engage in ≥ 150 minutes per week of moderate activity and target a 7% weight loss. However, traditional moderate-intensity (MI) exercise training programs are often difficult to sustain for prediabetic adults; a commonly cited barrier to physical activity in this population is the “lack of time” to exercise. When matched for total energy expenditure, high-intensity (HI) exercise training has a lower overall time commitment compared with traditional low-intensity (LI) or MI exercise training. Several recent studies comparing HI exercise training with LI and MI exercise training reported that HI exercise training improves skeletal muscle metabolic control and cardiovascular function in a comparable and/or superior way relative to LI and MI exercise training. Although patients can accrue all exercise benefits by performing LI or MI activities such as walking, HI activities represent a time-efficient alternative to meeting physical activity guidelines. High-intensity exercise training is a potent tool for improving cardiometabolic risk for prediabetic patients with limited time and may be prescribed when appropriate.     

Exercise training in obese children and adolescents: current concepts

Childhood obesity has reached epidemic proportions worldwide and is associated with increased cardiovascular mortality and morbidity in adult life. The increase in fat mass in children and adolescents has occurred concomitantly with a decline in reported time for exercise. Evidence suggests that non-physically active children are more likely to become non-physically active adults and that encouraging the development of physical activity habits in children helps establish patterns that continue into adulthood. Dietary treatment of obesity is relatively ineffective in adults and it has been suggested that prevention of obesity in childhood and adolescence should emphasise increased physical activity rather than diet because of fears relating to the adverse effects of inappropriate eating patterns. Despite this, there are very few randomised controlled studies investigating the efficacy of exercise training in obese children or adolescents and many of the extant studies have been poorly controlled and have not specifically stratified the independent effect of exercise versus dietary modification.This review focuses on the well designed controlled trials that have evaluated the effect of exercise training in obese children and adolescents on body composition, haemodynamic and metabolic variables, cardiovascular fitness, muscular strength and vascular function. These studies indicate that, although exercise training does not consistently decrease bodyweight or body mass index, it is associated with beneficial changes in fat and lean body mass, emphasising the importance of comprehensive assessment of body composition in future exercise-training studies. Exercise training improves cardiovascular fitness and muscular strength; however, it seems to have little effect on blood lipid profile or blood pressure in obese young people. Importantly, recent studies have demonstrated that exercise training improves vascular endothelial function, an important surrogate measure that may predict future atherosclerotic risk in obese children and adolescents. Given that improvement in vascular function in these training studies occurred in the absence of changes in lipid fractions, haemodynamic variables or glucose metabolism, exercise appears to have a direct beneficial effect on the vasculature, in addition to its putative benefits through risk-factor modification.     

A Review of Resistance Exercise Training in Obese Adolescents

Abstract

Resistance training–also known as strength or weight training–has been well recognized by several national organizations as a safe and beneficial exercise modality for the health and well-being of children and adolescents. Resistance exercise improves muscular strength and can improve body composition (eg, increase lean body mass and decrease percent body fat) provided that a sufficient exercise stimulus is prescribed. Effects of resistance exercise training on body composition and metabolic profile are well established in obese adults, but warrant further investigation in obese youth. This article reviews the rationale for including a resistance training component with interventions geared toward overweight and obese adolescents by discussing the effects on various health measures. Shortcomings in published trials, including small, ethnic minority samples of short-duration and low-frequency exercise sessions primarily conducted in prepubertal youth (rather than postpubertal adolescents) limit the generalizability of the published literature on the effectiveness of resistance exercise in obese adolescents.     

New modalities of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease

Pulmonary rehabilitation has been shown to be an important part of the management of patients with chronic obstructive pulmonary disease (COPD). Exercise training is the corner stone of a comprehensive, multidisciplinary pulmonary rehabilitation in COPD and has been shown to improve health-related quality of life and exercise capacity. Nevertheless, not every COPD patient responds well to pulmonary rehabilitation.Future trials should focus on new additions to conventional pulmonary rehabilitation programmes to optimise its effects on health-related quality of life, exercise capacity, body composition and muscle function in patients with COPD. Therefore, a patient-tailored approach is inevitable. Advantages and disadvantages of new modalities of pulmonary rehabilitation will be outlined in detail, including the following: endurance training and long-acting bronchodilatators; endurance training and technical modalities (inspiratory pressure support and inspiratory muscle training); interval training; resistance training; transcutaneous neuromuscular electrical stimulation; and exercise training and supplements (oxygen, oral creatine, anabolic steroids and polyunsaturated fatty acids).Based on well defined baseline characteristics, patients should most probably be individually selected. At present, these new modalities of pulmonary rehabilitation have been shown to improve body composition, skeletal muscle function and sometimes also exercise capacity. However, the translation to an improved health-related quality of life is mostly lacking, and cost effectiveness and long-term effects have not been studied. Moreover, future trials should study the effects of pulmonary rehabilitation in elderly patients with restrictive pulmonary diseases.     

Development of common training units for forensic staff

ABSTRACT

The Victoria Police Forensic Services Department (VPFSD) has prepared guidelines to assist forensic practitioners to develop a common training unit across multiple disciplines.     

Concurrent brain endurance training improves endurance exercise performance

ObjectivesMental fatigue impairs endurance exercise. Brain endurance training (BET) – engaging in cognitively fatiguing tasks during exercise - can develop resilience to mental fatigue and improve physical performance over physical training alone. The mechanism for this effect is unknown.This experiment examines if BET enhances performance over physical training and investigates potential underlying physiological mechanisms.DesignA mixed design randomised control trial.MethodsPre- and post-testing: 36 participants completed dynamic rhythmic muscular endurance handgrip tasks requiring generation of as much force as possible once a second for 300 s, performed under 3 counterbalanced conditions: following 600 s of a 2-back memory/attention task (subsequent); while performing a 2-back task (concurrent); and on its own (solo). Cardiac activity, electromyographic forearm activity, pre-frontal cerebral haemodynamics (near infrared spectroscopy), and force were recorded. Training: Participants (randomised to a Control or BET group) completed 24 (6 weeks) submaximal hand contractions sessions. The BET group also completed concurrent cognitive tasks (2-back, Stroop). Measures of motivation, physical and mental exertion and mental fatigue were collected throughout.ResultsEndurance performance, across the 3 tasks, improved more following BET (32%) than Control (12%) (p < 0.05). The better performance following BET occurred with a higher pre-frontal oxygenation during the post-training physical tasks over time relative to Control (p < 0.05).ConclusionsConcurrent BET improved endurance performance over physical training alone. This was accompanied by a training-induced maintenance of pre-frontal oxygenation, suggestive of reduced mental effort during physical activity.     

Stability of dyspnea ratings after exercise training in patients with COPD

PURPOSE: The purpose of this study was to examine whether patients with chronic obstructive pulmonary disease (COPD) would report similar ratings of dyspnea at the same relative exercise intensity after participation in pulmonary rehabilitation. METHODS: Forty-two patients with COPD performed incremental cardiopulmonary exercise testing before and after completion of a 6-wk exercise-training program. Subjects rated dyspnea on the 0-10 category-ratio (CR-10) scale each minute of the exercise test. RESULTS: Both responders (21 patients who exhibited an increase in [OV0312]O(2peak) after pulmonary rehabilitation) and nonresponders (21 patients who had no increase in [OV0312]O(2peak)) reported slightly lower ratings of dyspnea ( approximately 0.5 on the CR-10 scale) at the same relative (50% and 75% of [OV0312]O(2peak)) exercise intensities. These changes in dyspnea ratings after pulmonary rehabilitation were not significantly different between responders and nonresponders. CONCLUSION: The study suggests that patients with COPD can use the same ratings of dyspnea to monitor training at the same relative exercise intensity whether they achieve a physiological training response or not.     

Acute effects of intense interval versus aerobic exercise on children's behavioral and neuroelectric measures of inhibitory control

ObjectivesDetermine the acute effect of high-intensity interval training as an alternative of moderate-intensity aerobic exercise on behavioral and neuroelectric measures of inhibitory control in preadolescent children.DesignA randomized controlled trial.MethodsSeventy-seven children (8–10 years) were randomly assigned to three groups to complete a modified flanker task to measure behavioral and neuroelectric (N2/P3 of event-related potential and frontal theta oscillations) outcomes of inhibitory control before and after a 20-min session of high-intensity interval training (N = 27), moderate-intensity aerobic exercise (N = 25), and sedentary reading activity (N = 25).ResultsThe accuracy of the inhibitory control performance improved over time across three groups but response time was selectively improved only for the high-intensity interval training group. Analysis on N2 showed a time-related decrease in N2 latency selectively for the high-intensity interval training but not the other groups. Analysis on P3 showed a time-related decrease in P3 amplitude for the sedentary and high-intensity interval training groups while the moderate-intensity aerobic exercise group exhibited maintained P3 amplitude from the pretest to the posttest and a larger P3 amplitude compared with the high-intensity interval training group at the posttest. While there was evidence of conflict-induced modulation of frontal theta oscillations, such an effect was unaffected by exercise interventions.ConclusionsA single bout of high-intensity interval training has facilitating effects on the processing speed involving inhibitory control in preadolescent children but not neuroelectric index of attention allocation that only benefited from moderate-intensity aerobic exercise.     

Exercise improves reaction time without compromising accuracy in a novel easy-to-administer tablet-based cognitive task

ObjectivesModerate intensity aerobic exercise is known to facilitate cognitive performance but new technologies enable increasing opportunities to investigate this phenomenon under different circumstances. This study aimed to describe the effect of exercise on executive function assessed though a novel tablet-based test.DesignTwenty healthy, active participants volunteered to take part in the randomised fully controlled trial.MethodsParticipants undertook an initial test of maximal aerobic capacity as well as ventilatory threshold during an incremental cycle test. A touch screen tablet computer was placed in the middle of the handlebars at an angle of approximately 45°, and participants were asked to complete the response-inhibition cognitive task (Speed Match, Lumos Labs Inc.) at set time points. A full familiarisation trial was performed prior to subsequent visits, in which participants completed either the control (no exercise) and exercise (90% ventilatory threshold (VT)) trials in a randomised order. During the 1 h trials, the cognitive task was performed prior to, during and post the intervention. Reaction time and accuracy of participant responses were recorded.ResultsPerforming the cognitive task resulted in elevated heart rates and ventilation rates during control and exercise. Exercise facilitated performance in the executive function task such that reaction time was enhanced with no change in accuracy. A range of reliability measures are also reported.ConclusionsThis method of assessing executive function during exercise displays face validity and provides promise for further investigation of cognitive function using a simple, short duration, easily administered and widely available test.     

Developing evidence-based clinical guidelines for military use: case study of smoking cessation guidelines

OBJECTIVE: To develop evidence-based clinical guidelines on smoking cessation, for use throughout the British military. METHOD: A ten-member, multiprofessional smoking cessation working group met five times between October 2000 and July 2001 to develop targeted smoking cessation guidelines for use by military health professionals in the clinical setting. The guidelines were based on the best available scientific evidence at that time, mainly systematic review of controlled trials, and individual randomised trials. RESULTS: The agreed military guidelines on smoking cessation were promulgated in July 2001. Three tiers of support were defined. Military health professionals have a key role as nonsmoking models and advocates, and should be trained to use 'brief intervention' at every clinical encounter with a military smoker. 'Intermediate support' (defined as a specialist service delivered by military health professionals who have undergone specific training and continuation training) is to be available at local level. The most heavily addicted military smokers will require referral to civilian smoking cessation clinics. Effective technologies for use at any one of the three levels of care are: nicotine skin patches, nicotine gum, nicotine lozenges and bupropion. CONCLUSIONS: These are the first ever clinical guidelines for military use which meet accepted modern quality criteria. Informal monitoring of the uptake of these guidelines between July 2001 to December 2001 suggests that they have been well received by military health professionals. An audit of their impact on smoking patterns within the UK Armed Forces will commence in 2002. The guidelines will be updated 5-yearly, or sooner.     

Autism-friendly MRI: Improving radiography practice in the UK,a survey of radiographer practitioners

IntroductionAutistic individuals undergoing magnetic resonance imaging (MRI) examinations may face significant challenges, mainly due to sensory overload and MRI environment-related limitations. This study aimed to explore radiographers’ perspectives and experiences regarding MRI scanning of autistic individuals.MethodsData collection was achieved using a specifically designed mixed methods questionnaire on Qualtrics. The snowball technique was used. This UK-wide survey was electronically distributed by three main recruitment agencies between December 2020 and February 2021.Results130 valid responses were received. A lack of relevant training and knowledge related to autism was noted. Effective communication, optimisation and customisation of the MRI examination, and MRI environment adjustments facilitated the completion of a safe and effective MRI examination. Poor patient-radiographer communication, unavailability of Special Educational Needs (SEN) experts, lack of specialised radiographer training and lack of specific guidelines were identified as the main barriers to successful MRI examinations.ConclusionAlthough routine MRI safety and patient care rules will apply, MRI scanning of autistic individuals requires customisation and reasonable adjustments in communication, environment, and training of clinical teams. In addition, guidelines should be established to be used as a reference point to improve clinical practice. The adjustments proposed by radiographers were all consistent with the interventions in the wider literature.Implications for practiceMRI practice for personalised care of autistic individuals should be aligned with current evidence, to customise communication and offer workflow and environmental adjustments. Formal training related to autism, integrated within radiography academic curricula and better co-ordination and communication of interdisciplinary teams would provide the necessary skill mix to deliver safe, high quality MRI scans with optimal experience for autistic service users and their carer(s).     

Does blood flow restriction training enhance clinical outcomes in knee osteoarthritis: A systematic review and meta-analysis

ObjectiveTo systematically review the efficacy of blood flow restriction training (BFRT) on individuals with knee osteoarthritis (OA).DesignSystematic review with meta-analysis.Literature searchEight electronic databases were searched by one researcher.Study selection criteriaRandomised clinical trials (RCTs) comparing BFRT to regular resistance training (RT) for knee OA.Data synthesisOne reviewer selected the eligible RCTs and exported the data. Two reviewers evaluated study quality using the PEDro scale. We performed meta-analysis where appropriate using a random-effects model. We rated the quality of evidence using GRADE.ResultsFive studies were eligible. The key outcomes analysed were pain, self-reported function, objective physical function, strength and muscle size. Across all comparisons, there was low to moderate quality evidence of no difference between BFRT and traditional RT.ConclusionThe limited available evidence does not suggest that BFRT enhances outcomes for people with knee OA. These findings do not support clinicians using BFRT in people with knee OA. Instead, evidence-based messages regarding exercise and education should remain the mainstay of rehabilitation. Additional studies should clarify whether some people with knee OA who cannot complete an adequate exercise programme due to pain, might still benefit from BFRT to facilitate less painful exercise.     

“I think we need to empower people to manage it better themselves”: A qualitative interview study exploring UK healthcare practitioners’ perspectives on treating young adults following a sport-related knee injury

ObjectivesTo elicit healthcare practitioners’ views on treatment following sport-related knee injury in young adults (18–35) and the potential for individuals to self-manage joint health.DesignSemi-structured interviews were audio-recorded, transcribed and analysed systematically using an inductive approach.SettingSouth West UK.ParticipantsTwelve healthcare practitioners with experience of treating young adults.Main outcome measuresUnderstanding how healthcare practitioners treat young adults following knee injury and to what extent individuals may be able to self-manage knee health.ResultsParticipants’ perceptions were encapsulated in three consistent themes: [1] Treating patients; [2] Maintaining physical activity; and [3] Education and support. All participants described how staying physically active and maintaining a healthy weight were integral to conserving knee health, and that post-injury education was necessary to “empower” patients to self-manage knee health. A need for greater access to support, advice and guidance for patients was also articulated.ConclusionsHealthcare practitioners should tailor their treatment to young adults to account for individual characteristics, aspirations for sport and exercise participation, and their emotional wellbeing. Fulfilment of individuals’ educational and supportive needs is key to the establishment of self-management behaviours that may help to conserve knee health.     

Compression force variability in mammography in Ghana – A baseline study

IntroductionBreast compression during mammographic examinations improves image quality and patient management. Several studies have been conducted to assess compression force variability among practitioners in order to establish compression guidelines. However, no such study has been conducted in Ghana. This study aims to investigate the compression force variability in mammography in Ghana.MethodsThis retrospective study used data gathered from 1071 screening and diagnostic mammography patients from January, 2018–December, 2019. Data were gathered by seven radiographers at three centers. Compression force, breast thickness and practitioners' years of work experience were recorded. Compression force variability among practitioners and the correlation between compression force and breast thickness were investigated.ResultsMean compression force values recorded for craniocaudal (CC) (17.2 daN) and mediolateral oblique (MLO) (18.2 daN), were within the recommended values used by western countries. Most of the mammograms performed – 80% – were within the National Health Service Breast Screening Programme (NHSBSP) range. However, 65% were above the Norwegian Breast Cancer Screening Programme (NBCSP) range. Compression forces varied significantly (p = 0.0001) among practitioners. Compression forces increased significantly (p = 0.0001) with the years of work experience. A weak negative correlation (r = ?0.144) and a weak positive correlation (r = 0.142) were established between compression force and breast thickness for CC and MLO projections respectively.ConclusionThis initial study confirmed that although wide variations in compression force exist among practitioners in Ghana, most practitioners used compression forces broadly within the range set by the NHSBSP. As no national guidelines for compression force currently exist in Ghana, provision of these may help to reduce the range of variations recorded.Implications for practiceConfirmation of variations in compression will guide future practice to minimize image quality disparities and improve quality of care.     

Olympic Lifting Movements Endanger Adolescents

In brief: Beta-blockers and exercise training are recommended for treating cardiovascular disease and hypertension, and researchers have tried to determine the interaction of these two treatment modalities. Data from four studies conducted on 93 subjects over the past five years show that beta-blockade exerts a differential effect on the exercise capacity of subjects of different levels of health and fitness: It increases the capacity of angina patients; decreases the capacity of highly trained, fit individuals; and has little or no effect on the capacity of healthy, untrained individuals.     

Systematic review of exercise training in colorectal cancer patients during treatment

Colorectal cancer surgery results in considerable postoperative morbidity, mortality and reduced quality of life. As many patients will undergo additional (neo)adjuvant therapy, it is imperative that each individual optimize their physical function. To elucidate the potential of exercise in patient optimization, we investigated the evidence for an exercise program before and after surgical treatment in colorectal cancer patients. A systematic review was conducted according to the Cochrane Handbook for Systematic Reviews of Interventions, the guidelines of the Physical Therapy Journal and the PRISMA guidelines. No literature pertaining to exercise training during preoperative neoadjuvant treatment was found. Seven studies, investigating the effects of regular exercise during adjuvant chemotherapy for patients with colorectal cancer or a mixed population, were identified. A small effect (effect size (ES ) 0.4) of endurance/interval training and strength training (ES 0.4) was found in two studies conducted in patients with colorectal and gastrointestinal cancer. In five studies that included a mixed population of cancer patients, interval training resulted in a large improvement (ES 1.5; P ≤.05). Endurance training alone was found to increase both lower extremity strength and endurance capacity. The effects of strength training in the lower extremity are moderate, whereas, in the upper extremity, the increase is small. There is limited evidence available on exercise training during treatment in colorectal cancer patients. One study concluded exercise therapy may be beneficial for colorectal cancer patients during adjuvant treatment. The possible advantages of training during neoadjuvant treatment may be explored by prehabilitation trials.