Hybrid delivery of cluster-set resistance training for individuals previously treated for lung cancer: the results of a single-arm feasibility trial.

BACKGROUND: Individuals with non-small cell lung cancer (NSCLC) are burdened by long-lasting symptoms (e.g., dyspnea and fatigue) post-treatment. These symptoms often reduce physical activity levels and increase the risk of functional decline. Though we have previously proposed cluster-set resistance training to mitigate symptom burden in lung cancer, there is currently no data on the feasibility or acceptability of this mode of exercise in cancer. Therefore, the purpose of this study was to investigate the feasibility and acceptability of a hybrid-delivery home-based cluster-set resistance training program in individuals with NSCLC stages I-III (i.e., early stage). METHODS: This study aimed to recruit individuals with NSCLC stages I-III post-treatment to participate in 8 weeks of home-based resistance training, 3 days per week. The program included supervised sessions in the participants' homes and virtual supervision via videoconferencing. The primary outcome measure of feasibility was evaluated through recruitment, retention, and intervention fidelity (i.e., proportion of exercise completed, relative to what was prescribed). Intervention acceptability (i.e., ease and quality of virtual delivery, level of difficulty, and home-based approach) was assessed using a 4-point Likert-type scale from "strongly disagree" to "strongly agree". RESULTS: Fourteen participants were recruited over a 6-month period, with 11 completing the intervention (2 withdrew due to unrelated illness, 1 withdrew due to requiring active treatment), yielding a retention rate of 79%. Characteristics of the participants who completed the intervention (n = 11) were as follows: mean age: 71 ± 10 years, mean BMI: 29.1 ± 6.5, and average time since diagnosis was 62 ± 51 months. Of completers, 27% were male, and 36% were Black; 10 were stage I (91%), and one was stage II (9%). Mean session attendance was 86.4 ± 9.5%. Mean intervention fidelity was 83.1 ± 13.1%. With regard to acceptability, > 90% of participants positively rated all aspects of the intervention delivery. No adverse events related to exercise were recorded. CONCLUSIONS: The hybrid delivery of a home-based resistance exercise program for individuals previously treated for early-stage NSCLC was found to be safe and feasible. Adaptations to the program for future interventions are required, particularly surrounding resistance exercise programming, and intervention delivery with home visits. TRIAL REGISTRATION: ClinicalTrials.gov: NCT05014035 . Registered January 20, 2021.

Exercise-induced oxidative stress: the effects of ß-alanine supplementation in women.

The purpose of this study was to evaluate the effects of ß-alanine supplementation on markers of oxidative stress. Twenty-four women (age: 21.7±2.1 years; VO2max: 2.6±0.3 l min(-1)) were randomly assigned, in a double-blind fashion, to a ß-alanine (BA, 2×800 mg tablets, 3× daily; CarnoSyn®; n=13) or placebo (PL, 2×800 mg maltodextrin tablets, 3× daily; n=11) group. A graded oxygen consumption test (VO2max) was performed to evaluate VO2max, time to exhaustion, ventilatory threshold and establish peak velocity (PV). A 40-min treadmill run was used to induce oxidative stress. Total antioxidant capacity, superoxide dismutase, 8-isoprostane (8ISO) and reduced glutathione were measured. Heart rate and ratings of perceived exertion were recorded during the 40 min run. Separate three- [4×2×2; acute (base vs. IP vs. 2 vs. 4 h)×chronic (pre- vs. post-)×treatment (BA vs. PL)] and two- [2×2; time (pre-supplement vs. post-supplement)×treatment (BA vs. PL)] way ANOVAs were used for analyses. There was a significant increase in VO2max (p=0.009), independent of treatment, with no significant changes in TTE (p=0.074) or VT (p=0.344). Ratings of perceived exertion values were significantly improved from pre- to post-supplementation for the BA group only at 40 min (p=0.02). The ANOVA model demonstrated no significant treatment effects on oxidative stress. The chronic effects of BA supplementation demonstrated little antioxidant potential, in women, and little influence on aerobic performance assessments.

Study protocol: investigating the feasibility of a hybrid delivery of home-based cluster set resistance training for individuals previously treated for lung cancer.

BACKGROUND: Symptom burden remains a critical concern for individuals with non-small cell lung cancer (NSCLC) following the completion of treatment. The most common symptom clusters, dyspnea (shortness of breath) and fatigue, can contribute to physical decline, reductions in quality of life, and a higher risk of comorbidities and mortality. Dyspnea is a primary limiter of exercise capacity in individuals with lung cancer, resulting in exercise avoidance and an accelerated physical decline. As such, designing resistance training with cluster sets to mitigate symptoms of dyspnea and fatigue may result in improved exercise tolerance. Thus, maintaining the exercise stimulus via cluster sets, combined with improved tolerance of the exercise, could result in the maintenance of physical function and quality of life. The purpose of this study is to investigate the feasibility and preliminary efficacy of a hybrid-delivery home-based cluster-set resistance training program in individuals with NSCLC. METHODS: Individuals with NSCLC (n = 15), within 12 months of completion of treatment, will be recruited to participate in this single-arm feasibility trial. Participants will complete 8 weeks of home-based resistance training designed to minimize dyspnea and fatigue. The hybrid delivery of the program will include supervised sessions in the participants' home and virtual supervision via video conferencing. The primary outcome of feasibility will be quantified by recruitment rates, retention, acceptability, and intervention fidelity. Exploratory outcomes (dyspnea, fatigue, quality of life, physical function, and body composition) will be assessed pre- and post-intervention. DISCUSSION: This study will provide important data on the feasibility of delivering this intervention and inform procedures for a future randomized controlled trial. TRIAL REGISTRATION: Record not yet public.

Ergolytic/ergogenic effects of creatine on aerobic power.

This study evaluated the effects of creatine (Cr) loading and sex differences on aerobic running performance. 27 men (mean±SD; age: 22.2±3.1 years, ht: 179.5±8.7 cm, wt: 78.0±9.8 kg) and 28 women (age: 21.2±2.1 years, ht: 166.0±5.8 cm, wt: 63.4±8.9 kg) were randomly assigned to either creatine (Cr, di-creatine citrate; n=27) or a placebo (PL; n=28) group, ingesting 1 packet 4 times daily (total of 20 g/day) for 5 days. Aerobic power (maximal oxygen consumption: VO2max) was assessed before and after supplementation using open circuit spirometry (Parvo-Medics) during graded exercise tests on a treadmill. 4 high-speed runs to exhaustion were conducted at 110, 105, 100, and 90% of peak velocity to determine critical velocity (CV). Distances achieved were plotted over times-to-exhaustion and linear regression was used to determine the slopes (critical velocity, CV) assessing aerobic performance. The results indicated that Cr loading did not positively or negatively influence VO2max, CV, time to exhaustion or body mass (p>0.05). These results suggest Cr supplementation may be used in aerobic running activities without detriments to performance.

The potential therapeutic effects of creatine supplementation on body composition and muscle function in cancer.

Low muscle mass in individuals with cancer has a profound impact on quality of life and independence and is associated with greater treatment toxicity and poorer prognosis. Exercise interventions are regularly being investigated as a means to ameliorate treatment-related adverse effects, and nutritional/supplementation strategies to augment adaptations to exercise are highly valuable. Creatine (Cr) is a naturally-occurring substance in the human body that plays a critical role in energy provision during muscle contraction. Given the beneficial effects of Cr supplementation on lean body mass, strength, and physical function in a variety of clinical populations, there is therapeutic potential in individuals with cancer at heightened risk for muscle loss. Here, we provide an overview of Cr physiology, summarize the evidence on the use of Cr supplementation in various aging/clinical populations, explore mechanisms of action, and provide perspectives on the potential therapeutic role of Cr in the exercise oncology setting.

Characterization of the work-time relationship during cross-country ski ergometry.

The purpose of this study was to examine the validity and reliability of estimated parameters of the work-time relationship during cross-country ski ergometry using the traditional multi-trial critical power (CP) test and a 3 min 'all-out' test (3MT). Fourteen recreationally active male participants (mean ± SD; age: 22.14 ± 2.85 yrs; height: 177.09 ± 6.57 cm; weight: 85.68 ± 13.56 kg) completed three testing visits. All testing was conducted using an upper-body ergometer (SkiErg, Concept2, Inc., Morrisville, VT). A graded exercise test was used to determined maximal oxygen uptake (VO2peak). Two separate 3MT sessions were used to determine oxygen uptake (VO23MT), end-test power (EP), work above end-test power (WEP) and end stroke rate (ESR). Additionally, three time trials completed in a single day at simulated distances of 300 m, 650 m and 1000 m were used to estimate CP, W' and critical stroke rate (CSR). VO2peak (3.65 ± 0.50 l · min(-1)) and VO23MT (3.59 ± 0.4 l · min(-1)) were not significantly different (p = 0.162). Intraclass correlation coefficients for EP, WEP and ESR were 0.809, 0.611 and 0.783, respectively. EP (148 ± 33 W) and CP (157 ± 49 W), were not significantly different between the testing methodologies (p = 0.290) and were highly correlated (r = 0.780). WEP (8.4 ± 3.0 kJ) and W' (8.3 ± 3.0 kJ) were similar (p = 0.947) but not related (r = 0.119), while ESR (45 ± 7 spm) and CSR (47 ± 7 spm) values were not significantly different (p = 0.238) and moderately correlated (r = 0.498). The 3MT using ski ergometry was shown to produce concurrently valid results with the traditional multi-trial CP test for CP and CSR, but not W', and elicited similar maximal oxygen uptake values when compared to a graded exercise test.

Tracking fat-free mass changes in elderly men and women using single-frequency bioimpedance and dual-energy X-ray absorptiometry: a four-compartment model comparison.

BACKGROUND/OBJECTIVES: To compare single estimations of fat-free mass (FFM) and to track FFM using single-frequency bioelectrical impedance analysis (BIA) and dual-energy X-ray absorptiometry (DXA) compared with a four-compartment (4C) model in healthy elderly Americans. SUBJECTS/METHODS: Thirty-four men and thirty-eight women (Caucasian, ≥ 65 years) were included in the study. Subjects participated in either the control group or the exercise group. All testing and training took place during the 21-week investigation. Body composition assessments using nine BIA equations, DXA and a 4C model were performed during weeks 1, 12 and 24 of the study. RESULTS: Single estimations for DXA and BIA produced high r values (0.79-0.95) and low standard error of estimate values (1.62-3.3 kg), producing subjective ratings of 'ideal' for men and 'excellent' for women. Both DXA and two BIA equations revealed the same significance when comparing groups and times with the 4C model. Individual accuracy for tracking changes was similar among BIA equations and DXA compared with the 4C model, with a total agreement of 25% for BIA and 27% for DXA compared with the 4C model. CONCLUSIONS: The current data in combination with the reliability errors for both BIA and DXA FFM estimations suggest that individual results should be interpreted with caution if FFM changes are <5 kg. However, DXA and BIA are both valid methods that can be used interchangeably to estimate FFM at a single time point or for tracking changes in FFM in small groups (15-22) of healthy American older adults.