Attrition and adherence of young women to aerobic exercise: lessons from the WISER study

The purpose of this report is to identify factors associated with attrition and adherence of young women to a 16-week randomized aerobic exercise intervention on biomarkers associated with breast cancer risk. The exercise group was prescribed a progressive weight-bearing aerobic exercise program consisting of 30 minute workouts, 5 times/wk for 16 weeks. Adherence was calculated as the average minutes of exercise per week during participation in the study. Of the total of 212 women randomized into the exercise intervention 46 dropped out, of which 82.5% dropped out during the earlier stages of exercise suggesting that reasons for withdrawal may have been related to difficulties with initiating physical activity. Time commitment or lack of time was the primary reason for withdrawal. Drop outs reported lower physical activity at baseline than study completers (p=.0007). Although 78% of the 212 randomized participants completed the exercise intervention, only 4.7% of the participants exercised for at least 150 min/wk during the entire study period. Significant predictors of adherence were self-reported physical activity at baseline and depression scores. We conclude that predictors of adherence to exercise in our population of young women are similar to those reported for older adults. We also found that young women are more likely to exercise at moderate to vigorous intensity for 90 to 120 min rather than 150 min per week, even when participating in a highly structured exercise intervention.     

An exercise trial to reduce cancer related fatigue in African American breast cancer patients undergoing radiation therapy: Design,rationale, and methods

BackgroundCancer related fatigue (CRF) is a common and debilitating side-effect of radiotherapy in breast cancer patients. Physical activity interventions can attenuate CRF but evidence in African–American women with breast cancer is lacking.Methods/designThe “Pedlar” Study is a prospective, 8-week structured moderate-intensity exercise intervention, delivered concurrently with radiotherapy, to reduce CRF and improve health-related quality of life among African American breast cancer patients. Forty African American women with breast cancer scheduled to receive radiation therapy at MedStar Washington Hospital Center will be randomized to one of the two trial arms: 1) a facility-based aerobic exercise utilizing a portable stationary pedal exerciser; and 2) a control group. Intervention arm participants will exercise at the hospital either before or after their radiation treatment. Assessments will be conducted at baseline, 4, and 8 weeks. The outcome variables are CRF, biomarkers of inflammation, and health-related quality of life.DiscussionThe Pedlar Study will provide preliminary evidence on whether a short-term moderate-intensity exercise intervention might be effective in reducing CRF in African American women undergoing radiotherapy for breast cancer, and whether this effect is mediated by inflammation.     

The effect of aerobic exercise on immune biomarkers and symptoms severity and progression in patients with COVID-19: A randomized control trial

BackgroundThe World Health Organization in March 2020 has announced that COVID-19 is a world pandemic because the number of infected cases increases rapidly. however, there are several available vaccines, their protection is limited to a certain period. Thus, the role of modalities that improve immune functions should be performed to counter COVID-19 viral load and decrease mortality rates.ObjectiveTo investigate the effect of aerobic exercise on immune biomarkers, disease severity, and progression in patients with COVID-19.DesignA randomized controlled study.ParticipantsThirty patients with COVID-19 participated in this study. Participants’ age ranged from 24 to 45 years old. Participants had a mild or moderate COVID-19. Participants were assigned randomly into two groups, exercise and control groups. There were two main dependent variables including blood immune markers and severity of respiratory symptoms.InterventionsAll participants performed 2 weeks of moderate-intensity aerobic exercise for 40 min/session, 3 sessions/week. The measurements were performed at baseline, and after 2-weeks.ResultsAt baseline measurements, there were non-significant differences between both groups in the Wisconsin scale total score, Leucocytes, Lymphocytes, Interleukin-6, Interleukin-10, Immunoglobulin-A, and TNF-α (P > .05). After the intervention, the Wisconsin scale (patient-oriented illness-specific quality-of-life) total score significantly decreased in the intervention group (P < .05); while, Leucocytes, Lymphocytes, and Immunoglobulin-A significantly increased in the intervention group (P < .05).ConclusionThe current study indicated that 2 weeks of moderate-intensity aerobic exercise decreased the severity and progression of COVID-19 associated disorders and quality of life. Also, a 2-weeks of aerobic exercise positively affected immune function by increasing the amounts of Leucocytes, Lymphocytes, Immunoglobulin A.     

Inactivity: symptoms associated with gastrocnemius muscle disuse during pregnancy

This longitudinal study assessed change in gastrocnemius muscle metabolism across antepartum bed rest and recovery during the first 6 weeks postpartum as well as symptoms during recovery. The convenience sample consisted of 65 pregnant women, hospitalized on bed rest for a mean of 24.8 days (range 5-70 days). A dual wavelength hemoglobin/ myoglobin spectrophotometer and ergometer assessed muscle reoxygenation times after plantar flexion exercise from hospital admission through 6 weeks postpartum. The Postpartum Symptom Checklist assessed symptoms of muscle deconditioning. The time for gastrocnemius muscle reoxygenation after exercise significantly increased across antepartum bed rest (t = -2.1, P <.05) and significantly decreased during the 6-week postpartum period (t = 1.83, P <.05). Women who were on bed rest prior to hospital admission had significantly higher reoxygenation scores upon enrollment (t = -8.6, P <.05). Symptoms of postpartum muscle soreness, deconditioning, and difficulty with mobility were reported. Postpartum assessment and rehabilitation are needed to facilitate recovery and prevent long-term injury.     

Significant reduction in risk of falls and back pain in osteoporotic-kyphotic women through a Spinal Proprioceptive Extension Exercise Dynamic (SPEED) program

OBJECTIVE: To determine the outcome of intervention with a spinal weighted kypho-orthosis (WKO) and a spinal proprioceptive extension exercise dynamic (SPEED) program on the risk of falls in ambulatory community-dwelling persons older than 60 years with osteoporosis-kyphosis at risk for falls. SUBJECTS AND METHODS: The study had 3 stages. At stage 1 (baseline), the 12 women in the kyphotic group were compared with 13 healthy controls to assess the risk of falls and balance disorder in the kyphotic group. At stage 2, the 12 kyphotic women began the SPEED program with a WKO (2 supervised sessions in an outpatient clinic and a 4-week, daily home-based training program). At stage 3, baseline and follow-up data of the kyphotic group were compared to determine the effect of intervention. RESULTS: At baseline, there were significant differences between the osteoporotic-kyphotic group and the control group in balance (P=.002), gait (P<.05), and strength (P<.05). After a 4-week intervention, comparison of the kyphotic group's baseline and follow-up results showed a significant change in balance (P=.003) and several gait parameters (P<.05). Mean back extensor strength improved significantly from baseline (144.0-46.5 N) to follow-up (198.6+/-55.2 N; P<.001). Lower extremity muscle strength was not changed significantly, except for improved left ankle plantar flexors (P=.02). Back pain decreased significantly (P=.001). CONCLUSION: Balance, gait, and risk of falls improved significantly with the 4-week SPEED program.     

不同程度有氧运动对代谢综合征的疗效

目的观察不同程度长期规律有氧运动对代谢综合征(metabolic syndrome,MS)的疗效。方法将106例平时缺乏运动的MS患者按随机数字表法分为对照组和研究组,每组各53例。2组均进行规律的有氧运动训练,观察组每次持续运动46~60 min,对照组每次持续运动30~45 min。比较2组治疗前及治疗6个月后体质指数(BMI)、收缩压(SBP)、舒张压(DBP)、总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白-胆固醇(HDL-C)、低密度脂蛋白-胆固醇(LDL-C)、腰围(wc)、空腹血糖(FPG)、餐后2 h血糖(2 hPG)。结果治疗后6个月,观察组BMI、SBP、DBP、TC、TG、LDL-C、wc、FPG及2 hPG较治疗前明显下降,HDL-C明显升高(均P<0.05);对照组TC、TG、LDL-C较治疗前明显下降(均P<0.05),BMI、SBP、DBP、HDL-C、wc、FPG及2 hPG较治疗前比较差异无统计学意义(均P>0.05)。与对照组比较,观察组BMI、TC、wc、FPG及2 hPG均明显下降,HDL-C明显升高(均P<0.05);2组间血压、TG、LDL-C比较差异均无统计学意义(均P>0.05)。结论控制饮食、长期规律每次持续运动46~60 min比运动30~45 min的有氧运动可以更有效地降低MS患者的BMI、血压,调节血脂,减少wc,降低FPG及2 hPG等指标。     

A pilot phase II RCT of a home-based exercise intervention for survivors of AML

Background

Fatigue is the most common and disabling symptom affecting quality of life (QOL) and daily function in patients who have completed treatment for acute myeloid leukemia (AML). Although trials in patients with various solid tumors have reported improved fatigue and QOL following exercise interventions, there have been no studies in AML patients post treatment.

Methods

Forty patients aged ≥40 years who had completed treatment for AML were enrolled in a 12-week randomized phase II exercise intervention to determine feasibility (recruitment, retention, and adherence), efficacy, and safety of the intervention. Patients assigned to the exercise group received an individualized, moderate-intensity, 12-week home-based exercise program with weekly telephone support from a certified exercise physiologist. QOL, fatigue, and fitness outcomes were measured at baseline, 6 weeks, and 12 weeks. Between-group differences in 12-week change scores were calculated using linear regression adjusting for age and baseline function.

Results

Recruitment and retention rates were 38 % and 91 %, respectively. Adherence was low at 28 %. Analyses did not suggest statistically significant or clinically important benefits in QOL, fatigue, or physical fitness with the intervention. The level of adherence did not appear to impact outcomes. There were no adverse events.

Conclusion

A home-based exercise program for post-treatment AML patients age 40 years or older can be safely delivered with reasonable recruitment and high retention. However, feasibility was hampered by low adherence. Further research and program modification are needed to better understand and overcome barriers to exercise delivery and adherence in AML survivors.     

Effects of aerobic interval training on cancer patients' functional capacity

The effect of a 10-week aerobic interval-training cycle ergometer protocol on the functional capacity (VO2Lmax) of 45 women receiving chemotherapy for treatment of Stage II breast cancer was studied. Subjects were stratified by baseline functional capacity (+/- 1 MET) and randomized to experimental (EX), placebo (PL), and control (CO) groups. EX subjects completed a 10-week, 3 times/week exercise training program; PL subjects participated in 10 weeks of nonaerobic stretching and flexibility exercises; the CO group maintained normal activities. The EX group showed significant, p less than .05, improvement on pre- to posttest VO2Lmax as well as workload and test time compared to the PL and CO groups. The interval-training exercise intervention was effective in improving the functional capacity of Stage II breast cancer patients on adjuvant chemotherapy.     

Effects of a 12-week healthy-life exercise program on oxidized low-density lipoprotein cholesterol and carotid intima-media thickness in obese elderly women

[Purpose] This study examined the effects of a 12-week exercise program on plasma level of oxidized low-density lipoprotein cholesterol in obese elderly women, who are at increased risk of heart disease morbidity. [Subjects and Methods] Twenty participants were assigned into either a control (n = 10) or a supervised exercise program (n = 10) group. The 12-week exercise intervention was performed 3 days per week and involved combined aerobic exercise, resistance exercise, and traditional Korean dance. [Results] Two-factor analysis of variance revealed significant group × time interactions for body mass, diastolic blood pressure, appendicular muscle mass. For high-density lipoprotein cholesterol, oxidized low-density lipoprotein cholesterol, and the ratio of oxidized low-/high-density lipoprotein cholesterol, two-factor analysis of variance revealed significant interactions (group × time), indicating responses differed significantly between the control and exercise groups after 12 weeks. [Conclusion] A 12-week low- to moderate-intensity exercise program appears to be beneficial for obese elderly women by improving risk factors for cardiovascular disease.Key words: Exercise, Obesity, Oxidized LDL     

Cardiorespiratory responses to upper extremity aerobic training by postpolio subjects.

The cardiorespiratory responses of ten postpolio subjects participating in a 16-week upper extremity aerobic exercise program were compared to ten non-exercised controls. The subjects trained three times a week for 20 minutes per session. Exercise intensity was prescribed at 70% to 75% of heart rate reserve plus resting heart rate. Dependent variables were resting heart rate, maximal heart rate, resting and immediate-post-exercise systolic and diastolic blood pressures, maximal oxygen consumption, maximal carbon dioxide production, minute ventilation, respiratory exchange ratio, power, and exercise time. After training, the exercise group was superior to the control group in oxygen consumption, carbon dioxide production, minute ventilation, power, and exercise time. There was no reported loss of muscle strength. It was concluded that postpolio subjects can safely achieve an increase in aerobic capacity with a properly modified upper extremity exercise program. This improvement is comparable to that demonstrated by able-bodied adults.     

Supervised Exercise–Based Intervention to Prevent Excessive Gestational Weight Gain: A Randomized Controlled Trial

ObjectiveTo study the effect on maternal weight gain of a supervised light- to moderate-intensity exercise–based intervention performed from the ninth week of pregnancy.Participants and MethodsA total of 962 healthy pregnant women were randomly assigned to a standard care or exercise intervention group conducted between September 1, 2007, and January 31, 2011. The intervention included light- to moderate-intensity aerobic and resistance exercises performed 3 days a week (50-55 minutes per session). Excessive gestational weight gain was calculated on the basis of the 2009 Institute of Medicine (IOM) recommendations. Gestational body weight gain was calculated on the basis of the weight measured at the first prenatal visit (fifth to sixth weeks of gestation) and weight measured at the last visit to the clinic before delivery. Women were categorized into normal weight or overweight or obese.ResultsWomen in the intervention group gained less weight (adjusted mean difference, 1.039 kg; 95% CI, 0.534-1.545 kg; P<.001) and were less likely to gain weight above the IOM recommendations (odds ratio, 0.625; 95% CI, 0.461-0.847) compared with those in the standard care group. The main treatment effects according to body mass index category were that normal weight women in the intervention group gained less weight (adjusted mean difference, 1.393 kg; 95% CI, 0.813-1.972 kg; P<.001) and were less likely to gain weight above the IOM recommendations (odds ratio, 0.508; 95% CI, 0.334-0.774) than normal weight women who received standard care. No significant treatment effect was observed in overweight or obese women.ConclusionSupervised exercise of light to moderate intensity can be used to prevent excessive gestational weight gain, especially in normal weight women.Trial registrationclinicaltrials.gov Identifier: NCT01790347     

Effectiveness of a home-based exercise intervention for HIV-infected adults: a randomized trial.

The authors conducted a randomized controlled trial to assess the impact of a 15-week (20 minutes three times per week) home-based aerobic exercise intervention versus usual care on the physical endurance, immune status, and self-reported health status of 99 HIV-infected adults. In the exercise group, there was no improvement in physical endurance or health-related quality of life (HRQOL), except in the Medical Outcomes Study-HIV Health Survey Overall Health subscale (difference = 12.1, 95% confidence interval = 2.0-22.2, p = .02). Although physical endurance levels were maintained at baseline levels in the intervention group and declined in the control group, differences between the groups were small and not significant. There were also no significant changes in CD4+ T-lymphocyte counts. Exercise appears to be safe in HIV-infected patients. Improvements in physical endurance and HRQOL might result if the exercise protocol is longer or progressive. Further research is needed to establish guidelines for exercise in patients on highly active antiretroviral therapy.     

The Effects of a Home-Based Virtual Reality Rehabilitation Program on Balance Among Individuals with Parkinson's Disease

ABSTRACT

Background and Purpose: Recently, the Nintendo Wii has emerged as an innovation in rehabilitation. Although research findings to date have contributed to our understanding of the effects of implementing the Wii as a rehabilitation tool, evidence supporting the Wii for improving symptoms in Parkinson's disease (PD) remains limited. The purpose of this study, therefore, was to evaluate the effectiveness of a 12-week home-based exercise program designed around the Wii, in improving balance, balance confidence, and maintaining exercise adherence among individuals with PD. Methods: Fifteen participants were recruited to engage in 30 minutes of Wii activity 3×/week for 12 weeks. Results: Balance and balance confidence improved from baseline to midintervention, but reverted back to near baseline values at postintervention. Exercise adherence was maintained equally throughout the study. Conclusions: The Nintendo Wii has potential to be an effective treatment strategy for improving balance, balance confidence, and fostering programmatic adherence among individuals with PD.     

Robotic-Assisted Shoulder Rehabilitation Therapy Effectively Improved Poststroke Hemiplegic Shoulder Pain: A Randomized Controlled Trial

ObjectiveThe purpose of this study was to investigate the therapeutic effects of a newly developed shoulder robot on poststroke hemiplegic shoulder pain.DesignProspective, single-blind randomized controlled trial.SettingInpatient department of a tertiary university hospital.ParticipantsHemiplegic shoulder pain patients (N=38) were consecutively recruited and randomly assigned to an intervention or control group.InterventionsA newly developed robot was designed to perform joint mobilization and stretching exercises with patients lying in the supine position. Conventional physical therapy directed at both improving upper extremity mechanics and reducing neurologic injury was performed twice per day in both groups. In the intervention group, additional robotic-assisted shoulder rehabilitation therapy was administered for 30 minutes per day, 5 times per week for 4 weeks.Main Outcome MeasuresThe visual analog scale was the primary outcome, and the pain-free passive range of motion of the shoulder joint, the Korean version of the Shoulder Disability Questionnaire, and ultrasonographic grades were the secondary outcomes. The outcomes were evaluated at baseline (T0), postintervention (T1), and a 4-week follow-up (T2).ResultsSignificant time and group interaction effects were found on the visual analog scale, in the abduction passive range of motion, and on the Shoulder Disability Questionnaire (F_2,33=16.384, P=.002; F_2,33=10.609, P=.012; F_2,33=32.650, P=.008, respectively). Significantly higher improvements in these outcome measures were observed in the intervention group than in the control group at T1 after post hoc analysis (P<0.05, all). These improvements were sustained at T2 when the intervention group was compared with the control group (P<.05, all).ConclusionsA prototype shoulder rehabilitation robot as an adjuvant therapy improves hemiplegic shoulder pain and self-reported shoulder-related disability.     

Benefits of exercise maintenance after traumatic brain injury

Wise EK, Hoffman JM, Powell JM, Bombardier CH, Bell KR. Benefits of exercise maintenance after traumatic brain injury.ObjectiveTo examine the effect of exercise intervention on exercise maintenance, depression, quality of life, and mental health at 6 months for people with traumatic brain injury (TBI) with at least mild depression.DesignTreatment group participants were assessed at baseline, after a 10-week exercise intervention, and 6 months after completion of the intervention.SettingCommunity.ParticipantsParticipants (N=40) with self-reported TBI from 6 months to 5 years prior to study enrollment and a score of 5 or greater on the Patient Health Questionnaire-9.InterventionsTen-week exercise intervention program consisting of supervised weekly 60-minute sessions and unsupervised 30 minutes of aerobic exercises 4 times each week. Telephone follow-up was conducted every 2 weeks for an additional 6 months to promote exercise maintenance for individuals randomized to the intervention group.Main Outcome MeasureBeck Depression Inventory (BDI) comparing participant outcomes over time. Post hoc analyses included comparison among those who exercised more or less than 90 minutes per week.ResultsParticipants reduced their scores on the BDI from baseline to 10 weeks and maintained improvement over time. Many participants (48%) demonstrated increased physical activity at 6 months compared with baseline. Those who exercised more than 90 minutes had lower scores on the BDI at the 10-week and 6-month assessments and reported higher perceived quality of life and mental health.ConclusionsExercise may contribute to improvement in mood and quality of life for people with TBI and should be considered as part of the approach to depression treatment.     

Exercise self-efficacy in older women with diastolic heart failure: results of a walking program and education intervention

The purpose of this study was to evaluate exercise self-efficacy in older women with stable New York Heart Association Functional Class II and III heart failure who were enrolled in a 12-week, home-based, low- to moderate-intensity combined walking and education program. Findings indicate that participation in a 12-week, home-based walking program improved self-efficacy for exercise adherence and workload physical function. Women in the program also improved in 6-minute walk distance, depressive symptoms, and quality of life at 12 weeks, while control participants had no change on any measures. These results support that an exercise intervention that progresses gradually has potential to improve exercise self-efficacy, physical function, depressive symptoms, and quality of life in women with heart failure compared to education alone.     

The effects of an 8-week knitting program on osteoarthritis symptoms in elderly women: A pilot randomized controlled trial

BackgroundExercise therapy is effective in reducing symptoms and disability associated with hand osteoarthritis (HOA) but often has low adherence. An intervention consisting in a meaningful occupation, such as knitting, may improve adherence to treatment. This pilot randomized controlled trial (RCT) studied the adherence and clinical effectiveness of a knitting program in older females suffering from HOA to evaluate the acceptability of this intervention and assess the feasibility of a larger-scale RCT.MethodsSingle-blind, two-arm pilot RCT with a parallel group design with 37 participants (18 control, 19 intervention). Control participants were given an educational pamphlet and assigned to a waiting list. The knitting program (8-week duration) had two components: bi-weekly 20-min group knitting sessions and daily 20-min home knitting session on the 5 remaining weekdays. Measures included knitting adherence (implementation outcomes) as well as stiffness, pain, functional status, hand physical activity level, patient's global impression of change, health-related quality of life, self-efficacy, and grip strength (clinical outcomes measured throughout the 8-week program and 4 weeks after the intervention).ResultsOur protocol is feasible and the intervention was acceptable and enjoyable for participants, who showed high adherence. No difference was observed between the two groups for any of the clinical outcome measures (all p > .05).ConclusionKnitting is a safe and accessible activity for older women with HOA. However, our 8-week knitting program did not result in improvements in any of our outcome measures. Knitting for a longer period and/or with higher frequency may yield better outcomes.