Becoming One with Nature: A Nature Intervention for Individuals Living with Cancer Participating in a Ten-Week Group Exercise and Wellness Program.

Positive outcomes for psychological and physiological health have resulted from a nature experience. However, evidence is limited for nature-based interventions and their effect on a cancer population. The purpose of this mixed-methods study was to determine if incorporating the One Nature Challenge (ONC) into a ten-week group exercise program (WE-Can) for individuals living with cancer could offer additional psychological and/or physiological benefits to those previously observed in WE-Can. For this study, two separate ONCs were implemented throughout two seasons (summer and winter) to formulate a ONC group (n = 18; 60 ± 12yrs). Previous WE-Can graduates were used as a control group (n = 160; 59 ± 11yrs) for this study. Psychological and physiological assessments were administered in a pre- and post-test. In addition, nature relatedness (NR; ones' relationship with nature) was measured at the beginning, middle, and end of WE-Can. Following five weeks, the ONC began and participants tracked the days they experienced nature for at least thirty-minutes (24 ± 6 days), for a thirty-day period. The ONC finished concurrently with WE-Can where post-evaluations and focus groups were administered immediately following. No additional gain in overall health was found between groups. However, aerobic fitness and fatigue significantly improved for the ONC group. This was supported by frequent activities and self-reported restoration of the mind while experiencing nature. In conclusion, the lack of overall improvement could be limited by sample size and the high level of NR prior to ONC, indicating participants were already 'one with nature.'

Agreement among Six Methods of Predicting the Anaerobic Lactate Threshold in Elite Cross-Country Skiers.

The anaerobic lactate threshold (LTan) is used to prescribe training intensity and measure endurance capacity. The LTan identifies a critical point where small increases in workload result in large increases in blood lactate concentration. LTan is usually predicted through visual inspection of a blood lactate (bLa) vs workload plot. Numerous other methods for predicting LTan exist, and the literature lacks a consensus regarding validity of prediction methods. The purpose of this study was to assess the agreement among visual inspection (VI), maximum distance (Dmax) and modified maximum distance (Dmod) from the lactate curve, Baldari & Guidetti (BG), Dickhuth & Heck (DH) and Keul (K) methods for predicting the LTan. Blood lactate data was gathered from 8 male elite cross country skiers across two treadmill running incremental exercise tests. The above methods were used to predict LTan. Bland-Altman limits of agreement and Lin's Concordance Correlation Coefficient analyses were used to compare methods. Agreement was defined as 95% limits of agreement falling within a maximum allowed difference of ± 0.5 mM bLa between methods. No agreement was found among any of the prediction methods. Mean LTan calculated with the Dmax method was significantly different (p < 0.05) from mean LTan calculated using each other method. We conclude that the six methods for predicting LTan used in this study are not in agreement and should not be considered equivalent for exercise testing purposes. Future studies should compare agreement between LTan methods and the maximal lactate steady state to determine the most valid LTan prediction method.

End-tidal carbon dioxide levels in patients with post-concussion syndrome during neurocognitive and physical tasks compared to a normative control group.

PRIMARY OBJECTIVE: Recent findings suggest breathing may negatively affect performance after concussion. The aim of the study was to examine group differences between individuals with and without post-concussion syndrome (PCS) in end-tidal carbon dioxide (ETCO2) and respiratory rate (RR) during neurocognitive and physical tasks. HYPOTHESIS: Individuals in the PCS group will have elevated ETCO2 and lower RR compared to the control group. METHODS: A quasi-experimental study was used in which a capnography unit collected ETCO2 and RR breathing data from 22 participants (control = 17; PCS = 5) during rest, the completion of the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT) battery and while slow and fast walking. Four repeated measures mixed factorial ANOVAs, with an alpha level set at p ≤ 0.05, were used to examine group and task differences. RESULTS: Both groups displayed similar breathing responses to cognitive and physical stress; however, PCS participants had significantly elevated ETCO2 throughout the study (during rest, the ImPACT and while walking) compared to the control. Conversely, no significant group differences were found in RR. CONCLUSION: Cerebral physiological alterations and deficits in the autonomic nervous system may cause abnormal ETCO2 in individuals after concussion. Future research evaluating breathing patterns in PCS may be warranted.

Changes in Running Economy, Respiratory Exchange Ratio and VO2max in Runners following a 10-day Altitude Training Camp.

Running economy (RE) and VO2max are important predictors of endurance performance for elite and semi-elite endurance athletes, with RE being an appropriate predictor in a homogenous running population. Altitude training has been observed to change RE (mL.kg-1.min-1), and VO2max due to alterations resulting from acclimatization. This study tracked changes in RE and VO2max before and after a 10-day altitude training camp at 1828 meters. VO2max, RE expressed calorically, and respiratory exchange ratio (RER), were measured below anaerobic threshold (AT) to observe differences between pre-and post-altitude training. Eight varsity cross-country runners between the ages of 18 and 22 years performed an incremental treadmill test, pre- and post-10-day altitude training. Paired samples t-tests were used to statistically analyze the data. Average RE (VO2 mL.kg-1.min-1) improved following altitude intervention (M= 56.44 ± 4.28) compared to pre-altitude training (61.30 ± 7.56). These differences were statistically significant t(7)= 2.71, p =.014. RE expressed as kcals.kg-1.km-1 improved following altitude training (16.73 ± 2.96) compared to (18.44 ± 4.04) pre-altitude training and was statistically significant t(7) =3.08, p = .008. RER taken during the last minute of steady-state was higher (0.97, ± .019) post-altitude training, compared to (0.90 ± .043) pre-altitude. These differences were statistically significant t(7) -3.62, p =.008. VO2max (mL.kg-1.min-1) was lower in 6 out of 8 participants (63.91, ± 8.65) post-altitude compared to (69.90, ± 10.80) pre-altitude and was statistically significant t(7) = 2.33, p =.026. The observed improvements in RE may be beneficial for endurance athletes competing and/or training at moderate altitudes near 1828 meters.

The Effects of a 10-day Altitude Training Camp at 1828 Meters on Varsity Cross-Country Runners.

Altitude training has been shown to alter blood lactate (BL) levels due to alterations resulting from acclimatization. This study aims to estimate the impact of altitude training on BL changes immediately following an incremental treadmill test and during recovery before and after 10-day altitude training at approximately 1828 meters. Eight varsity cross-country runners performed an incremental treadmill test (ITT), pre and post-altitude training. Resting and post-warm-up BL values were recorded. During ITT, heart rate (HR), oxygen saturation (SpO2), and time to exhaustion were monitored. BL was also measured post-ITT at 0, 2, 4, 6, and 8 minutes. The average of all BL values was higher following altitude intervention (8.8 ± 4.6 mmol/L) compared to pre-intervention (7.4 ± 3.3 mmol/L). These differences were statistically significant (t(6) = -2.40, p = .026). BL immediately (0 minutes) after the ITT was higher following the altitude intervention (13.6 ± 3.6 mmol/L) compared to pre-intervention (9.7 ± 3.8 mmol/L) and was statistically significant (t(7) = -3.30, p = .006). Average HR during the ITT was lower following the altitude intervention (176.9 ± 11.1 bpm) compared to pre (187 ± 9.5 bpm), these differences were statistically significant (t(28)= 18.07, p= <.001. Time to exhaustion was longer after the intervention, however was not statistically significant p = 0.13. These findings indicate that a 10 - day altitude intervention at 1828 meters may benefit varsity cross-country runners. The higher post-exercise BL may be attributed to more anaerobic contributions. Lower HR may suggest a larger stroke volume and/or more efficient O2 carrying capacity.

HealtheSteps™ Study Protocol: a pragmatic randomized controlled trial promoting active living and healthy lifestyles in at-risk Canadian adults delivered in primary care and community-based clinics.

BACKGROUND: Physical inactivity is one of the leading causes of chronic disease in Canadian adults. With less than 50% of Canadian adults reaching the recommended amount of daily physical activity, there is an urgent need for effective programs targeting this risk factor. HealtheSteps™ is a healthy lifestyle prescription program, developed from an extensive research base to address risk factors for chronic disease such as physical inactivity, sedentary behaviour and poor eating habits. HealtheSteps™ participants are provided with in-person lifestyle coaching and access to eHealth technologies delivered in community-based primary care clinics and health care organizations. METHOD/DESIGN: To determine the effectiveness of Healthesteps™, we will conduct a 6-month pragmatic randomized controlled trial with integrated process and economic evaluations of HealtheSteps™ in 5 clinic settings in Southwestern Ontario. 110 participants will be individually randomized (1:1; stratified by site) to either the intervention (HealtheSteps™ program) or comparator (Wait-list control). There are 3 phases of the HealtheSteps™ program, lasting 6 months each. The active phase consists of bi-monthly in-person coaching with access to a full suite of eHealth technology supports. During the maintenance phase I, the in-person coaching will be removed, but participants will still have access to the full suite of eHealth technology supports. In the final stage, maintenance phase II, access to the full suite of eHealth technology supports is removed and participants only have access to publicly available resources and tools. DISCUSSION: This trial aims to determine the effectiveness of the program in increasing physical activity levels and improving other health behaviours and indicators, the acceptability of the HealtheSteps™ program, and the direct cost for each person participating in the program as well as the costs associated with delivering the program at the different community sites. These results will inform future optimization and scaling up of the program into additional community-based primary care sites. TRIAL REGISTRATION: NCT02413385 (Clinicaltrials.gov). Date Registered: April 6, 2015.

Effect of Low Frequency Neuromuscular Electrical Stimulation on Glucose Profile of Persons with Type 2 Diabetes: A Pilot Study.

The purpose of this study was to examine the effect of low-frequency neuromuscular electrical stimulation (NMES) on glucose profile in persons with type 2 diabetes mellitus (T2DM). Eight persons with T2DM (41 to 65 years) completed a glucose tolerance test with and without NMES delivered to the knee extensors for a 1-hour period at 8 Hz. Three blood samples were collected: at rest, and then 60 and 120 minutes after consumption of a glucose load on the NMES and control days. In NMES groups glucose concentrations were significantly lower (P<0.01) than in the control conditions. Moreover, a significant positive correlation (r=0.9, P<0.01) was obtained between the intensity of stimulation and changes in blood glucose. Our results suggest that low-frequency stimulation seem suitable to induce enhance glucose uptake in persons with T2DM. Moreover, the intensity of stimulation reflecting the motor contraction should be considered during NMES procedure.

Identifying Feasible Physical Activity Programs for Long-Term Care Homes in the Ontario Context.

BACKGROUND: Structured exercise programs for frail institutionalized seniors have shown improvement in physical, functional, and psychological health of this population. However, the 'feasibility' of implementation of such programs in real settings is seldom discussed. The purpose of this systematic review was to gauge feasibility of exercise and falls prevention programs from the perspective of long-term care homes in Ontario, given the recent changes in funding for publically funded physiotherapy services. METHOD: Six electronic databases were searched by two independent researchers for randomized controlled trials that targeted long-term care residents and included exercise as an independent component of the intervention. RESULTS: A total of 39 studies were included in this review. A majority of these interventions were led by physiotherapist(s), carried out three times per week for 30-45 minutes per session. However, a few group-based interventions that were led by long-term care staff, volunteers, or trained non-exercise specialists were identified that also required minimal equipment. CONCLUSION: This systematic review has identified 'feasible' physical activity and falls prevention programs that required minimal investment in staff and equipment, and demonstrated positive outcomes. Implementation of such programs represents cost-effective means of providing long-term care residents with meaningful gains in physical, psychological, and social health.

Managing heart failure in the long-term care setting: nurses' experiences in Ontario, Canada.

BACKGROUND: Implementation of heart failure guidelines in long-term care (LTC) settings is challenging. Understanding the conditions of nursing practice can improve management, reduce suffering, and prevent hospital admission of LTC residents living with heart failure. OBJECTIVE: The aim of the study was to understand the experiences of LTC nurses managing care for residents with heart failure. METHODS: This was a descriptive qualitative study nested in Phase 2 of a three-phase mixed methods project designed to investigate barriers and solutions to implementing the Canadian Cardiovascular Society heart failure guidelines into LTC homes. Five focus groups totaling 33 nurses working in LTC settings in Ontario, Canada, were audiorecorded, then transcribed verbatim, and entered into NVivo9. A complex adaptive systems framework informed this analysis. Thematic content analysis was conducted by the research team. Triangulation, rigorous discussion, and a search for negative cases were conducted. Data were collected between May and July 2010. RESULTS: Nurses characterized their experiences managing heart failure in relation to many influences on their capacity for decision-making in LTC settings: (a) a reactive versus proactive approach to chronic illness; (b) ability to interpret heart failure signs, symptoms, and acuity; (c) compromised information flow; (d) access to resources; and (e) moral distress. DISCUSSION: Heart failure guideline implementation reflects multiple dynamic influences. Leadership that addresses these factors is required to optimize the conditions of heart failure care and related nursing practice.

Themes associated with exercise adherence in persons with Parkinson's disease: a qualitative study.

ABSTRACT The purpose of this study was to examine motivators important to exercise adherence in a group of older adults with Parkinson's disease (PD). Four participants with PD completed a 6-week hydrotherapy program, followed by participation in a focus group along with their caregivers (n = 4) to examine motivators that were important to exercise adherence. A semi-structured focus group was transcribed verbatim and analyzed using content analysis to identify common patterns and themes. Multiple themes were found that were important to exercise adherence. Constant reassurance and support from the exercise leader was a primary theme for remaining enrolled in an exercise program. Exercising in a group environment and social interaction with other persons with PD were also the themes. Perceived changes in physical ability increased participants' confidence and motivation to continue to exercise. The findings suggest that the perceived needs of PD exercise participants can be influenced and addressed by exercise leaders, provide opportunities to improve physical function, and support social interaction. Future exercise programs should be designed to provide a venue where the symptoms of PD are not a deterrent to exercise participation.

Exercise is an effective treatment modality for reducing cancer-related fatigue and improving physical capacity in cancer patients and survivors: a meta-analysis.

The use of exercise interventions to manage cancer-related fatigue (CRF) is a rapidly developing field of study. However, results are inconsistent and difficult to interpret across the literature, making it difficult to draw accurate conclusions regarding the true effectiveness of exercise interventions for CRF management. The aims of this study were to apply a meta-analysis to quantitatively assess the effects of exercise intervention strategies on CRF, and to elucidate appropriate exercise prescription guidelines. A systematic search of electronic databases and relevant journals and articles was conducted. Studies were eligible if subjects were over the age of 18 years, if they had been given a diagnosis of or had been treated for cancer, if exercise was used to treat CRF as a primary or secondary endpoint, and if the effects of the intervention were evaluated quantitatively and presented adequate statistical data for analysis. A total of 16 studies, representing 1426 participants (exercise, 759; control, 667) were included in a meta-analysis using a fixed-effects model. The standardized mean difference effect size (SMD) was used to test the effect of exercise on CRF between experimental and control groups. The results indicate a small but significant effect size in favour of the use of exercise interventions for reducing CRF (SMD 0.26, p < 0.001). Furthermore, aerobic exercise programs caused a significant reduction in CRF (SMD 0.21, p < 0.001) and overall, exercise was able to significantly improve aerobic and musculoskeletal fitness compared with control groups (p < 0.01). Further investigation is still required to determine the effects of exercise on potential underlying mechanisms related to the pathophysiology of CRF.

Starting with the "right" foot minimizes sprint start time.

Although asymmetries in hand and foot performance have been examined using a variety of movement tasks that require the fine control of the timing and amplitude of force generation, foot asymmetries in a functional gross motor movement task, such as the track and field sprint start, have yet to be examined. Twenty individuals (10 experienced, 10 inexperienced) were assessed for pedal asymmetries using the track and field sprint start. Each participant performed 48 starts (24 right foot starts and 24 left foot starts). The pattern of pedal asymmetries was consistent with that of manual asymmetries in that a left foot (i.e., left foot in rear position) reaction time advantage was found while there was a right foot (i.e., right foot in rear position) advantage for movement time and total response time (time from stimulus presentation until the end of the movement). These results are consistent with a right hemisphere specialization for spatio-temporal and attentional processes, and a left hemisphere specialization for movement execution.

Is physical exercise beneficial for persons with Parkinson's disease?

OBJECTIVE: To review existing studies evaluating the effectiveness of physical exercise on mortality, strength, balance, mobility, and activities of daily living (ADL) for sufferers of Parkinson's disease (PD). DATA SOURCES: The following databases were searched (1) Cochrane Database of Systematic Reviews, (2) Cumulative Index to Nursing and Allied Health Literature (CINAHL), (3) PubMed and (4) Medline/NARIC (National Rehabilitation Information Center) using combinations of key words Parkinson's disease and physical exercise. Only articles written in English were included. References cited were also examined. STUDY SELECTION: Studies were eligible if (1) only patients with PD were included in the intervention study (there were many studies that evaluated the benefits of exercise after stroke, cardiac arrest, sports injuries, surgery, and arthritis, but only a few for patients with PD), (2) the intervention included some form of physical or therapeutic exercise, (3) the effects of the physical exercise were evaluated, and (4) the studies were published in a refereed journal. Because few studies were found that dealt with PD patients exclusively, all studies that evaluated the effectiveness of physical exercise for only PD patients were included. Seven studies met our criteria and were selected. Three of the selected studies were randomized controlled studies, 1 was an open trial, and the other 3 relied on patients' own assessments. DATA SYNTHESIS: Outcomes in the studies were measured in terms of physical improvements in patients with PD, such as improved axial rotation, functional reach, flexibility, balance, muscle strength, short-step gait, and mobility. All studies reviewed show that exercise improves overall performance in PD patients. Improvements were measured using standardized tests and other measurement scales. CONCLUSIONS: The results of the present research synthesis support the hypothesis that patients with PD improve their physical performance and activities of daily living through exercise. Future studies should include the development of standardized exercise programs specific for problems associated with PD as well as standardized testing methods for measuring improvements in PD patients. There is also a need for longer term studies (over 1 year) to assess if improvements achieved during the intervention stage are retained long term.

The effects of antioxidant vitamin supplementation on resistance exercise induced lipid peroxidation in trained and untrained participants.

BACKGROUND: The theoretical benefits of using antioxidant vitamin supplements to quench oxygen free radicals appear large. High intensity aerobic-type exercise produces oxygen free radicals that can cause damage to lipid membranes (lipid peroxidation) that may lead to many problems such as the inactivation of cell membrane enzymes, the progression of degenerative diseases (cardiovascular disease and cancer) and lessening of the effectiveness of the immune system. The major function of vitamin E is to work as a chain-breaking antioxidant in a fat soluble environment. Little research has examined lipid peroxidation associated with high intensity resistance exercise or possible protective effects of antioxidant supplementation or the effects of training state. RESULTS: There were no significant group (trained vs untrained) or treatment (vitamin E vs placebo) effects found between the 4 groups assessed. There was only one significant difference found and that was in the main effect for time (F = 22.41, p < 0.01). CONCLUSIONS: The Resistance Exercise Test caused a significant increase in malondialdehyde in all 4 groups at 6 hours post exercise. There was no evidence that vitamin E supplementation was effective in reducing oxidative damage in comparison to the placebo group. As well, there was no difference between the trained and untrained groups with respect to their impact on lipid peroxidation measures.

Variability within individuals of plasma ionic magnesium concentrations.

BACKGROUND: With the invention of the ion-selective electrode (ISE), ionic magnesium (iMg) is a common blood assay. This could be advantageous, as iMg is the biologically active form of Mg. There is some evidence that iMg has considerable within subject variability. RESULTS: Individual ranges averaged.08 mmol/L (range.05 to.14). Coefficients of variation (CV) ranged from 3% to 7% (mean 4%) while analytical variation was determined to be 2.3%. Biological variability thus accounts for almost half of the variability, which is clinically significant, as 9 of the 13 subjects recorded at least one value below a reference range of.46 -.60 mmol/L. A significant within-day variation (p <.001) was noted, with differences between 7:00 and 10:00 as well as 10:00 and 22:00. Between day variations were not significant (p =.56). CONCLUSIONS: A plausible explanation of this data is that iMg has a circadian rhythm. Thus, cautious interpretation of single iMg values is warranted until future research determines the nature of iMg variability.