Home-based high-intensity interval training for people with Parkinson's: Protocol for the HIIT-Home4Parkinson's randomized, controlled feasibility study.

Background: High-intensity interval training (HIIT) is feasible and beneficial for some people with Parkinson's (PwP), although adherence to extended programs may be problematic. PwP face barriers to exercise such as lack of time, expense, and difficulty with travel logistics due to motor symptoms. HIIT based in the home setting if practical, could therefore be apposite for PwP by overcoming these barriers. However, until now, no home-based HIIT program for PwP has been developed. Cocreated by PwP, clinicians, and family members, the HIIT-Home4Parkinson's (HH4P) program is an innovative, 12-week home-based HIIT program for PwP. This protocol describes a feasibility study designed to assess the feasibility and safety of the HH4P program, explore outcomes that may be sensitive to change, and inform the implementation of a potential full trial. Methods/design: Using a randomized controlled parallel group design, 24 independently mobile people with Parkinson's of mild to moderate disease severity will be randomized 1:1 to either the HH4P program plus usual care, or usual care alone. Both groups will be assessed at baseline, and upon the completion of the program. Outcomes will include feasibility and safety factors such as recruitment, completion, adverse events, and intervention fidelity with qualitative evaluation along with mechanistic, physiological, and clinical outcomes. Discussion: Results of this study will inform the rationale and methodological considerations for a full trial with long-term follow-up. Ultimately, further establishing the practicality and utility of home-based HIIT could provide an important exercise option for PwP, potentially leading to extended participation and increased health and well-being for this population.

Co-Creating a Feasible, Acceptable and Safe Home-Based High-Intensity Interval Training Programme for People with Parkinson's: The HIIT-Home4Parkinson's Study.

High-intensity interval training (HIIT) is useful and feasible for some people with Parkinson's (PwP), although long-term adherence may be problematic. If practical, undertaking HIIT in the home setting could be a way to encourage continued participation. However, no home-based HIIT programme has been developed for this population. Therefore, the objectives of this study were to co-create a feasible, accessible, and safe home-based HIIT programme for PwP, including intervention components and logic model. This supports the longer term aim to assess the practicality and utility of home-based HIIT for PwP. The study included three stages. Firstly, an initial HIIT programme and logic model proposal was developed based on existing evidence. This was refined through an iterative, co-creative process of focus groups, exercise testing and interviews involving end-users and relevant stakeholders. Finally, a draft intervention was produced with further co-creator input. During the iterative process, five focus groups, 10 exercise testing sessions and 10 post exercise interviews were undertaken, involving academic researchers, 6 PwP, one family member and two clinicians. These co-creators developed HIIT-Home4Parkinson's (HH4P), a 12-week thrice weekly home-based HIIT programme for PwP based on adaptability, individualisation, and remote support. Despite methodological limitations within the development process, the co-created HH4P programme could be feasible, safe, and useful for PwP. A feasibility study should now be undertaken to address remaining uncertainties prior to a full trial.

The feasibility, safety, physiological and clinical effects of high-intensity interval training for people with Parkinson's: a systematic review and meta-analysis.

BACKGROUND: Exercise is important for people with Parkinson's (PwP), with high-intensity interval training (HIIT) proposed as a feasible and effective exercise modality. However, no literature synthesis for PwP has been undertaken. OBJECTIVES: To evaluate the feasibility, safety, physiological and clinical effects of HIIT for PwP. METHODS: Systematic searches of Medline, Embase, CINAHL, Web of Science, and Google Scholar were undertaken. Studies that included ≥ 2 weeks of HIIT for PwP and reported sufficient detail for full quality assessment were eligible. Quality was assessed with the TESTEX scale or the Downs and Black tool according to study design. Feasibility and safety data, physiological and clinical outcomes were extracted. Meta-analyses explored the pooled effects of HIIT on VO2peak/max compared to moderate-intensity continuous exercise (MICE) and usual care. RESULTS: Eleven articles were identified (seven controlled/comparator studies and four single group) including 117 HIIT participants predominantly of mild-to-moderate disease severity. HIIT programmes were professionally supervised and between 6 weeks and 24 months. Overall, study quality was deemed to be moderate to good. Following screening, nine studies reported 90-100% programme completion; however, only one was > 12 weeks in duration. Adverse events were uncommon. HIIT improved VO2peak/max compared to usual care, but not to MICE. Increased brain-derived neurotrophic factor (BDNF) and improved motor symptoms were also reported. CONCLUSION: Up to 12 weeks of supervised HIIT appears to be feasible and safe for some people with mild-to-moderate disease severity. HIIT improves cardiorespiratory fitness and may increase BDNF and improve motor symptoms in PwP. Future studies should explore safe ways to facilitate access and long-term adherence.

Is Aerobic or Resistance Training the Most Effective Exercise Modality for Improving Lower Extremity Physical Function and Perceived Fatigue in People With Multiple Sclerosis? A Systematic Review and Meta-analysis.

OBJECTIVE: The purpose of this systematic review was to investigate whether aerobic training (AT) or resistance training (RT) is most effective in terms of improving lower limb physical function and perceived fatigue in persons with multiple sclerosis (PwMS). DATA SOURCES: Nine databases (MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health, Allied and Complementary Medicine Database, Physiotherapy Evidence Database, SPORTDiscus, PsycINFO, Web of Science, and Scopus) were electronically searched in April 2020. STUDY SELECTION: Included studies were randomized controlled trials (RCTs) involving PwMS attending 1 of 2 exercise interventions: AT or RT. Studies had to include at least 1 objective or self-reported outcome of lower extremity physical function and/or perceived fatigue. DATA EXTRACTION: Data were extracted using a customized spreadsheet, which included detailed information on patient characteristics, interventions, and outcomes. The methodological quality of the included studies was independently assessed by 2 reviewers using the Tool for Assessment of Study Quality for Reporting on Exercise rating scale. DATA SYNTHESIS: Twenty-seven articles reporting data from 22 RCTS (AT=14, RT=8) including 966 PwMS. The 2 modalities were found to be equally effective in terms of improving short walk test (AT: effect size [ES]=0.33 [95% confidence interval (CI), -1.49 to 2.06]; RT: ES=0.27 [95% CI, 0.07-0.47]) and long walk test performance (AT: ES=0.37 [95% CI, -0.04 to 0.78]; RT: ES=0.36 [95% CI, -0.35 to 1.08]), as well as in reducing perceived fatigue (AT: ES=-0.61 [95% CI, -1.10 to -0.11]; RT: ES=-0.41 [95% CI, -0.80 to -0.02]). Findings on other functional mobility tests along with self-reported walking performance were sparse and inconclusive. CONCLUSIONS: AT and RT appear equally highly effective in terms of improving lower extremity physical function and perceived fatigue in PwMS. Clinicians can thus use either modality to target impairments in these outcomes. In a future perspective, head-to-head exercise modality studies are warranted. Future MS exercise studies are further encouraged to adapt a consensus "core battery" of physical function tests to facilitate a detailed comparison of results across modalities.

Technologies to Support Assessment of Movement During Video Consultations: Exploratory Study.

BACKGROUND: Understanding and assessing patients' body movements is essential for physical rehabilitation but is challenging in video consultations, as clinicians are frequently unable to see the whole patient or observe the patient as they perform specific movements. OBJECTIVE: The objective of this exploratory study was to assess the use of readily available technologies that would enable remote assessment of patient movement as part of a video consultation. METHODS: We reviewed the literature and available technologies and chose four technologies (Kubi and Pivo desktop robots, Facebook Portal TV, wide-angle webcam), in addition to help from a friend or a simple mobile phone holder, to assist video consultations. We used 5 standard assessments (sit-to-stand, timed "Up & Go," Berg Balance Test, ankle range of motion, shoulder range of motion) as the "challenge" for the technology. We developed an evaluation framework of 6 items: efficacy, cost, delivery, patient setup, clinician training and guidance, and safety. The coauthors, including 10 physiotherapists, then took the roles of clinician and patient to explore 7 combinations of 5 technologies. Subsequently, we applied our findings to hypothetical patients based on the researchers' family members and clinical experience. RESULTS: Kubi, which allowed the clinician to remotely control the patient's device, was useful for repositioning the tablet camera to gain a better view of the patient's body parts but not for tracking movement. Facebook Portal TV was useful, but only for upper body movement, as it functions based on face tracking. Both Pivo, with automated full body tracking using a mobile phone, and the wide-angle webcam for a laptop or desktop computer show promise. Simple solutions such as having a friend operate a mobile phone and use of a mobile phone holder also have potential. The setup of these technologies will require better instructions than are currently available from suppliers, and successful use will depend on the technology readiness of patients and, to some degree, of clinicians. CONCLUSIONS: Technologies that may enable clinicians to assess movement remotely as part of video consultations depend on the interplay of technology readiness, the patient's clinical conditions, and social support. The most promising off-the-shelf approaches seem to be use of wide-angle webcams, Pivo, help from a friend, or a simple mobile phone holder. Collaborative work between patients and clinicians is needed to develop and trial technological solutions to support video consultations assessing movement.

Adherence and drop-out in randomized controlled trials of exercise interventions in people with multiple sclerosis: A systematic review and meta-analyses.

BACKGROUND: The short-term benefits of exercise in people with multiple sclerosis (MS) are well established. To sustain benefits exercise needs to continue long-term. Despite important clinical implications, no systematic reviews have synthesized evidence on adherence and drop-out in MS exercise interventions. OBJECTIVES: 1) To summarize reported adherence and drop-out data from randomized controlled trials (RCTs) of exercise interventions, and 2) identify moderators related to adherence and drop-out. METHODS: Nine databases were electronically searched in October 2018. Included studies were RCTs of exercise interventions in adults with MS published from January 1993 to October 2018. Abstracts and full texts were independently screened and selected for inclusion by two reviewers. Methodological quality was assessed using the TESTEX rating scale. RESULTS: Ninety three articles reporting 81 studies were included. Forty one studies (51%) reported both adherence and drop-out data during the intervention period with three (4%) also reporting follow-up data. Of the 41 studies, < 25% pre-defined adherence or described how adherence was measured. Meta-analyses of 59 interventions (41 studies) showed a pooled adherence estimate of 0.87 (95% CI 0.83 to 0.90) and 0.73 (CI 0.68-0.78) when including drop-outs. Mean age, proportion of females and intervention duration were inversely associated with adherence. CONCLUSION: Little consensus existed on definition of adherence or determination of drop-out in MS exercise studies, with reporting generally of poor quality, if done at all. Hence it is largely unknown what can moderate adherence and whether exercise continued following an exercise intervention. Researchers should ensure clear transparent measurement and reporting of adherence and drop-out data in future trials.

Impact of a novel home-based exercise intervention on health indicators in inactive premenopausal women: a 12-week randomised controlled trial.

PURPOSE: This study tested the hypothesis that a novel, audio-visual-directed, home-based exercise training intervention would be effective at improving cardiometabolic health and mental well-being in inactive premenopausal women. METHODS: Twenty-four inactive premenopausal women (39 ± 10 years) were randomly assigned to an audio-visual-directed exercise training group (DVD; n = 12) or control group (CON; n = 12). During the 12-week intervention period, the DVD group performed thrice-weekly training sessions of 15 min. Training sessions comprised varying-intensity movements involving multiplanar whole-body accelerations and decelerations (average heart rate (HR) = 76 ± 3% HRmax). CON continued their habitual lifestyle with no physical exercise. A series of health markers were assessed prior to and following the intervention. RESULTS: Following the DVD intervention, HDL cholesterol (pre: 1.83 ± 0.45, post: 1.94 ± 0.46 mmol/L) and mental well-being, assessed via the Warwick Edinburgh Mental Well-Being Scale, improved (P < 0.05). Conversely, [LDL cholesterol], [triglycerides], fasting [glucose], body composition and resting blood pressure and HR were unchanged following the DVD intervention (P > 0.05). There were no pre-post intervention changes in any of the outcome variables in the CON group (P > 0.05). CONCLUSION: The present study suggests that a novel, audio-visual-directed exercise training intervention, consisting of varied-intensity movements interspersed with spinal and lower limb mobility and balance tasks, can improve [HDL cholesterol] and mental well-being in premenopausal women. Therefore, home-based, audio-visual-directed exercise training (45 min/week) appears to be a useful tool to initiate physical activity and improve aspects of health in previously inactive premenopausal women.

Lowering of blood pressure after nitrate-rich vegetable consumption is abolished with the co-ingestion of thiocyanate-rich vegetables in healthy normotensive males.

A diet rich in vegetables is known to provide cardioprotection. However, it is unclear how the consumption of different vegetables might interact to influence vascular health. This study tested the hypothesis that nitrate-rich vegetable consumption would lower systolic blood pressure but that this effect would be abolished when nitrate-rich and thiocyanate-rich vegetables are co-ingested. On four separate occasions, and in a randomized cross-over design, eleven healthy males reported to the laboratory and consumed a 750 mL vegetable smoothie that was either: low in nitrate (∼0.3 mmol) and thiocyanate (∼5 µmol), low in nitrate and high in thiocyanate (∼72 µmol), high in nitrate (∼4 mmol) and low in thiocyanate and high in nitrate and thiocyanate. Blood pressure as well as plasma and salivary [thiocyanate], [nitrate] and [nitrite] were assessed before and 3 h after smoothie consumption. Plasma [nitrate] and [nitrite] and salivary [nitrate] were not different after consuming the two high-nitrate smoothies, but salivary [nitrite] was higher after consuming the high-nitrate low-thiocyanate smoothie (1183 ±â€¯625 µM) compared to the high-nitrate high-thiocyanate smoothie (941 ±â€¯532 µM; P < .001). Systolic blood pressure was only lowered after consuming the high-nitrate low-thiocyanate smoothie (-3 ±â€¯5 mmHg; P < .05). The acute consumption of vegetables high in nitrate and low in thiocyanate lowered systolic blood pressure. However, when the same dose of nitrate-rich vegetables was co-ingested with thiocyanate-rich vegetables the increase in salivary [nitrite] was smaller and systolic blood pressure was not lowered. These findings might have implications for optimising dietary guidelines aimed at improving cardiovascular health.

Effects of self-paced interval and continuous training on health markers in women.

PURPOSE: To compare the effects of self-paced high-intensity interval and continuous cycle training on health markers in premenopausal women. METHODS: Forty-five inactive females were randomised to a high-intensity interval training (HIIT; n = 15), continuous training (CT; n = 15) or an inactive control (CON; n = 15) group. HIIT performed 5 × 5 min sets comprising repetitions of 30-s low-, 20-s moderate- and 10-s high-intensity cycling with 2 min rest between sets. CT completed 50 min of continuous cycling. Training was completed self-paced, 3 times weekly for 12 weeks. RESULTS: Peak oxygen uptake (16 ± 8 and 21 ± 12%), resting heart rate (HR) (-5 ± 9 and -4 ± 7 bpm) and visual and verbal learning improved following HIIT and CT compared to CON (P < 0.05). Total body mass (-0.7 ± 1.4 kg), submaximal walking HR (-3 ± 4 bpm) and verbal memory were enhanced following HIIT (P < 0.05), whereas mental well-being, systolic (-5 ± 6 mmHg) and mean arterial (-3 ± 5 mmHg) blood pressures were improved following CT (P < 0.05). Participants reported similar levels of enjoyment following HIIT and CT, and there were no changes in fasting serum lipids, fasting blood [glucose] or [glucose] during an oral glucose tolerance test following either HIIT or CT (P > 0.05). No outcome variable changed in the CON group (P > 0.05). CONCLUSIONS: Twelve weeks of self-paced HIIT and CT were similarly effective at improving cardiorespiratory fitness, resting HR and cognitive function in inactive premenopausal women, whereas blood pressure, submaximal HR, well-being and body mass adaptations were training-type-specific. Both training methods improved established health markers, but the adaptations to HIIT were evoked for a lower time commitment.

Walking football as sustainable exercise for older adults - A pilot investigation.

The health benefits of playing football and the importance of exercise and social contact for healthy ageing are well established, but few older adults in the UK take enough exercise. Football is popular, flexible in format and draws players into engrossing, effortful and social exercise, but the physical demands of play at full speed may make it unsustainable for some older adults. Restricted to walking pace, will play still be engaging? Will health benefits be retained? Will physical demands remain manageable? This pilot study aims to investigate: (1) the experience of older adults playing walking football every week, is it sustainable and rewarding, (2) the intensity and locomotor pattern of walking football, (3) the scale and nature of walking football health benefits and (4) possible cognitive benefits of playing walking football through measures of processing speed, selective and divided attention and updating and inhibition components of executive function. 'Walking football' and 'waiting list' groups were compared before and after 12 weeks of one-hour per week football. Walking football was found to be engaging, sustainable for older adults and moderately intensive; however, selective health and cognitive benefits were not found from this brief intervention. Highlights Walking football is a lower impact but authentic form of football that enables older players to extend their active participation. Walking football is enjoyable and moderately demanding and may be a sustainable form of exercise for older adults. Health and cognitive benefits to playing walking football were not found.

Low-volume high-intensity swim training is superior to high-volume low-intensity training in relation to insulin sensitivity and glucose control in inactive middle-aged women.

PURPOSE: We tested the hypothesis that low-volume high-intensity swimming has a larger impact on insulin sensitivity and glucose control than high-volume low-intensity swimming in inactive premenopausal women with mild hypertension. METHODS: Sixty-two untrained premenopausal women were randomised to an inactive control (n = 20; CON), a high-intensity low-volume (n = 21; HIT) or a low-intensity high-volume (n = 21; LIT) training group. During the 15-week intervention period, HIT performed 3 weekly 6-10 × 30-s all-out swimming intervals (average heart rate (HR) = 86 ± 3 % HRmax) interspersed by 2-min recovery periods and LIT swam continuously for 1 h at low intensity (average HR = 73 ± 3 % HRmax). Fasting blood samples were taken and an oral glucose tolerance test (OGTT) was conducted pre- and post-intervention. RESULTS: After HIT, resting plasma [insulin] was lowered (17 ± 34 %; P < 0.05) but remained similar after LIT and CON. Following HIT, 60-min OGTT plasma [insulin] and [glucose] was lowered (24 ± 30 % and 10 ± 16 %; P < 0.05) but remained similar after LIT and CON. Total area under the curve for plasma [glucose] was lower (P < 0.05) after HIT than LIT (660 ± 141 vs. 860 ± 325 mmol min L(-1)). Insulin sensitivity (HOMA-IR) had increased (P < 0.05) by 22 ± 34 % after HIT, with no significant change after LIT or CON, respectively. Plasma soluble intracellular cell adhesion molecule 1 was lowered (P < 0.05) by 4 ± 8 and 3 ± 9 % after HIT and CON, respectively, while plasma soluble vascular cell adhesion molecule 1 had decreased (P < 0.05) by 8 ± 23 % after HIT only. CONCLUSIONS: These findings suggest that low-volume high-intensity intermittent swimming is an effective and time-efficient training strategy for improving insulin sensitivity, glucose control and biomarkers of vascular function in inactive, middle-aged mildly hypertensive women.

Oxidative capacity and glycogen content increase more in arm than leg muscle in sedentary women after intense training.

The hypothesis that the adaptive capacity is higher in human upper- than lower-body skeletal muscle was tested. Furthermore, the hypothesis that more pronounced adaptations in upper-body musculature can be achieved by "low-volume high-intensity" compared with "high-volume low-intensity" exercise training was evaluated. A group of sedentary premenopausal women aged 45 ± 6 yr (± SD) with expected high adaptive potential in both upper- and lower-extremity muscle groups participated. After random allocation to high-intensity swimming (HIS, n = 21), moderate-intensity swimming (MOS, n = 21), soccer (SOC, n = 21) or a nontraining control group (CON, n = 20), the training groups completed three workouts per week for 15 wk. Resting muscle biopsies were obtained from the vastus lateralis muscle and deltoideus muscle before and after the intervention. After the training intervention, a larger (P < 0.05) increase existed in deltoideus muscle of the HIS group compared with vastus lateralis muscle of the SOC group for citrate synthase maximal activity (95 ± 89 vs. 27 ± 34%), citrate synthase protein expression (100 ± 29 vs. 31 ± 44%), 3-hydroxyacyl-CoA dehydrogenase maximal activity (35 ± 43 vs. 3 ± 25%), muscle glycogen content (63 ± 76 vs. 20 ± 51%), and expression of mitochondrial complex II, III, and IV. Additionally, HIS caused higher (P < 0.05) increases than MOS in deltoideus muscle citrate synthase maximal activity, citrate synthase protein expression, and muscle glycogen content. In conclusion, the deltoideus muscle has a higher adaptive potential than the vastus lateralis muscle in sedentary women, and "high-intensity low-volume" training is a more efficient regime than "low-intensity high-volume" training for increasing the aerobic capacity of the deltoideus muscle.

The Yo-Yo IE2 test: physiological response for untrained men versus trained soccer players.

PURPOSE: This study aimed to examine the physical capacity and physiological response to the Yo-Yo Intermittent Endurance level 2 test (IE2) for untrained individuals (UTR) and trained male soccer players (TR) and to investigate the determinants of intense intermittent exercise performance. METHODS: Thirty-four healthy UTR males and 15 age-matched TR performed a maximal incremental treadmill test and a Yo-Yo IE2 test. Muscle biopsies and blood samples were obtained, and heart rate (HR) was measured before, during, and after tests. RESULTS: UTR had a 67% lower (P < 0.01) Yo-Yo IE2 performance (665 ± 271 vs 2027 ± 298 m; effect size (ES), 4.8), 34% lower V˙O2max (P < 0.01), and 19% lower resting muscle glycogen (P < 0.05) than those of TR. Blood lactate concentration and HR during the first 560 m of the Yo-Yo IE2 test were higher (P < 0.01) in UTR than those in TR (560 m, 7.4 ± 2.8 vs 2.4 ± 0.8 mM; ES, 1.7-2.8; 188 ± 11 vs 173 ± 8 bpm; ES, 0.9-1.5), with no differences at exhaustion. Time >95% HRmax was lower (P < 0.01) in UTR than that in TR (1.0 ± 1.1 vs 6.3 ± 2.9 min; ES, 3.1). Mean rates of muscle creatine phosphate utilization (16.5 ± 9.5 vs 4.3 ± 2.7 mmol·kg d.w·min), muscle lactate accumulation (16.8 ± 9.1 vs 4.2 ± 2.9 mmol·kg d.w.·min), and glycogen breakdown (29.6 ± 14.2 vs 7.7 ± 5.4 mmol·kg d.w.·min) were fourfold higher (P < 0.01; ES, 1.4-1.7) in UTR than those in TR. For UTR, correlations (P < 0.01) were observed between Yo-Yo IE2 performance and V˙O2max (r = 0.77), incremental treadmill test performance (r = 0.79), and muscle citrate synthase activity (r = 0.57) but not for TR (r = -0.12 to 0.50; P > 0.05). CONCLUSIONS: The Yo-Yo IE2 test was shown to possess high construct validity by showing large differences in performance, HR, and anaerobic metabolism between UTR and TR. In addition, V˙O2max seemed to be important for intermittent exercise performance in UTR but not for TR.