The Impact of Personalized versus Standardized Cardiorespiratory and Muscular Training on Health-Related Outcomes and Rate of Responders.

Recent research has shown more favorable training adaptations for inactive adults when cardiorespiratory fitness (CRF) exercise is prescribed with the use of ventilatory thresholds compared to percentages of heart rate reserve (HRR). However, there is limited research on changes in health-related outcomes with the use of these CRF methods in combination with muscular fitness exercises. The objective of this study was to compare the effectiveness of two training programs for improving CRF, muscular fitness, and cardiometabolic risk factors. Inactive men and women (n=109, aged 49.3±15.5 years) were randomized to a non-exercise control group or one of two exercise training groups. The exercise training groups consisted of 13 weeks of structured exercise with progression using either CRF exercise prescribed with the use of ventilatory thresholds and functional training for muscular fitness (THRESH group) or HRR and traditional muscular fitness training (STND group). After the 13-week protocol, there were significant differences in body weight, body composition, systolic blood pressure, high-density lipoprotein cholesterol (HDL-c), VO2max, 5-repetition maximum (RM) bench press, and 5-RM leg press for both treatment groups compared to the control group after controlling for baseline values. However, the THRESH group had significantly more desirable outcomes for VO2max, 5-RM bench press, 5-RM leg press, body composition, and HDL-c when compared to both the STND and control group. Additionally, the proportion of individuals estimated as likely to respond above 3.5 mL·kg-1·min-1 in VO2max (i.e., the minimal clinically important difference) was 76.4%, 20.8%, and 0.13% for the THRESH, STND, and control groups, respectively. While both exercise programs elicited favorable health-related adaptations after 13 weeks, these results suggest that a personalized program with exercise prescribed based on ventilatory threshold and with the use of functional muscular fitness training may yield greater training adaptations.

Unsupervised cluster analysis reveals distinct subgroups in healthy population with different exercise responses of cardiorespiratory fitness.

Background: Considerable attention has been paid to interindividual differences in the cardiorespiratory fitness (CRF) response to exercise. However, the complex multifactorial nature of CRF response variability poses a significant challenge to our understanding of this issue. We aimed to explore whether unsupervised clustering can take advantage of large amounts of clinical data and identify latent subgroups with different CRF exercise responses within a healthy population. Methods: 252 healthy participants (99 men, 153 women; 36.8 ± 13.4 yr) completed moderate endurance training on 3 days/week for 4 months, with exercise intensity prescribed based on anaerobic threshold (AT). Detailed clinical measures, including resting vital signs, ECG, cardiorespiratory parameters, echocardiography, heart rate variability, spirometry and laboratory data, were obtained before and after the exercise intervention. Baseline phenotypic variables that were significantly correlated with CRF exercise response were identified and subjected to selection steps, leaving 10 minimally redundant variables, including age, BMI, maximal oxygen uptake (VO2max), maximal heart rate, VO2 at AT as a percentage of VO2max, minute ventilation at AT, interventricular septal thickness of end-systole, E velocity, root mean square of heart rate variability, and hematocrit. Agglomerative hierarchical clustering was performed on these variables to detect latent subgroups that may be associated with different CRF exercise responses. Results: Unsupervised clustering revealed two mutually exclusive groups with distinct baseline phenotypes and CRF exercise responses. The two groups differed markedly in baseline characteristics, initial fitness, echocardiographic measurements, laboratory values, and heart rate variability parameters. A significant improvement in CRF following the 16-week endurance training, expressed by the absolute change in VO2max, was observed only in one of the two groups (3.42 ± 0.4 vs 0.58 ± 0.65 ml⋅kg-1∙min-1, P = 0.002). Assuming a minimal clinically important difference of 3.5 ml⋅kg-1∙min-1 in VO2max, the proportion of population response was 56.1% and 13.9% for group 1 and group 2, respectively (P<0.001). Although group 1 exhibited no significant improvement in CRF at group level, a significant decrease in diastolic blood pressure (70.4 ± 7.8 vs 68.7 ± 7.2 mm Hg, P = 0.027) was observed. Conclusions: Unsupervised learning based on dense phenotypic characteristics identified meaningful subgroups within a healthy population with different CRF responses following standardized aerobic training. Our model could serve as a useful tool for clinicians to develop personalized exercise prescriptions and optimize training effects.

Does sports-specific training improve measures of impairment developed for para sport classification? A multiple-baseline, single-case experiment.

Conceptually, sports-specific training should not influence measures of impairment used to classify Para athletes. This study evaluated the extent to which measures of strength, range of movement and coordination developed for Para swimming classification changed in response to a performance-focused swimming programme. A five-phase multiple-baseline, single-case experimental research design was utilized. Three participants with cerebral palsy and high support needs completed the 64-week study, which included two 16-week performance-focused swimming training blocks. Swimming speed, isometric shoulder extension strength, shoulder flexion range of movement and upper limb coordination were monitored throughout.Interrupted Time-Series Simulation Method analysis demonstrated large, significant changes in swimming speed (m/s) during the first (d = 2.17; 95% CI 0.45-3.88; p = 0.01) and second (d = 2.59; 95% CI 1.66-3.52; p = 0.00) training blocks. In contrast, changes in strength, range of movement and coordination were predominantly trivial and non-significant. This was the first study to investigate training responsiveness of measures developed for Para sport classification. Results indicate that despite significantly improved swimming performance, impairment measures remained relatively stable, and therefore these measures of impairment may be valid for the purposes of Para swimming classification. Further research is required in elite athletes, different sports and different impairment types.

Predicting Working Memory Training Responsiveness in Parkinson's Disease: Both "System Hardware" and Room for Improvement Are Needed.

Background. Patients with Parkinson's disease (PD) are highly vulnerable to develop cognitive dysfunctions, and the mitigating potential of early cognitive training (CT) is increasingly recognized. Predictors of CT responsiveness, which could help to tailor interventions individually, have rarely been studied in PD. This study aimed to examine individual characteristics of patients with PD associated with responsiveness to targeted working memory training (WMT). Methods. Data of 75 patients with PD (age: 63.99 ± 9.74 years, 93% Hoehn & Yahr stage 2) without cognitive dysfunctions from a randomized controlled trial were analyzed using structural equation modeling. Latent change score models with and without covariates were estimated and compared between the WMT group (n = 37), who participated in a 5-week adaptive WMT, and a waiting list control group (n = 38). Results. Latent change score models yielded adequate model fit (χ2-test p > .05, SRMR ≤ .08, CFI ≥ .95). For the near-transfer working memory composite, lower baseline performance, younger age, higher education, and higher fluid intelligence were found to significantly predict higher latent change scores in the WMT group, but not in the control group. For the far-transfer executive function composite, higher self-efficacy expectancy tended to significantly predict larger latent change scores. Conclusions. The identified associations between individual characteristics and WMT responsiveness indicate that there has to be room for improvement (e.g., lower baseline performance) and also sufficient "hardware" (e.g., younger age, higher intelligence) to benefit in training-related cognitive plasticity. Our findings are discussed within the compensation versus magnification account. They need to be replicated by methodological high-quality research applying advanced statistical methods with larger samples.

A Systematic Review on Predictors of Working Memory Training Responsiveness in Healthy Older Adults: Methodological Challenges and Future Directions.

Background: Research on predictors of working memory training responsiveness, which could help tailor cognitive interventions individually, is a timely topic in healthy aging. However, the findings are highly heterogeneous, reporting partly conflicting results following a broad spectrum of methodological approaches to answer the question "who benefits most" from working memory training. Objective: The present systematic review aimed to systematically investigate prognostic factors and models for working memory training responsiveness in healthy older adults. Method: Four online databases were searched up to October 2019 (MEDLINE Ovid, Web of Science, CENTRAL, and PsycINFO). The inclusion criteria for full texts were publication in a peer-reviewed journal in English/German, inclusion of healthy older individuals aged ≥55 years without any neurological and/or psychiatric diseases including cognitive impairment, and the investigation of prognostic factors and/or models for training responsiveness after targeted working memory training in terms of direct training effects, near-transfer effects to verbal and visuospatial working memory as well as far-transfer effects to other cognitive domains and behavioral variables. The study design was not limited to randomized controlled trials. Results: A total of 16 studies including n = 675 healthy older individuals with a mean age of 63.0-86.8 years were included in this review. Within these studies, five prognostic model approaches and 18 factor finding approaches were reported. Risk of bias was assessed using the Quality in Prognosis Studies checklist, indicating that important information, especially regarding the domains study attrition, study confounding, and statistical analysis and reporting, was lacking throughout many of the investigated studies. Age, education, intelligence, and baseline performance in working memory or other cognitive domains were frequently investigated predictors across studies. Conclusions: Given the methodological shortcomings of the included studies, no clear conclusions can be drawn, and emerging patterns of prognostic effects will have to survive sound methodological replication in future attempts to promote precision medicine approaches in the context of working memory training. Methodological considerations are discussed, and our findings are embedded to the cognitive aging literature, considering, for example, the cognitive reserve framework and the compensation vs. magnification account. The need for personalized cognitive prevention and intervention methods to counteract cognitive decline in the aging population is high and the potential enormous. Registration: PROSPERO, ID CRD42019142750.

Inter-Individual Variability in Metabolic Syndrome Severity Score and VO2max Changes Following Personalized, Community-Based Exercise Programming.

This study sought to examine the effectiveness of a personalized, community-based exercise program at reducing MetS severity and consequently Type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD) risk. One-hundred and fifty physically inactive participants (aged 18-83 years) were randomized to a non-exercise control group (n = 75; instructed to continue their usual lifestyle habits) or treatment group (n = 75). Participants randomized to the treatment group completed a 12 week personalized exercise training program based on the American Council on Exercise (ACE) Integrated Fitness Training (IFT) model guidelines. Z-scores were derived from levels of metabolic syndrome risk factors to determine the severity of MetS (MetS z-score). After 12 weeks, the treatment group showed a significant favorable change in MetS z-score, whereas the control group demonstrated increased severity of the syndrome (between-group difference, p < 0.05). The proportion of MetS z-score responders (Δ > -0.48) was greater following the exercise intervention (71%, 50/70) compared to control (10%, 7/72) (between group difference, p < 0.001). The inter-individual variability in VO2max change also showed a similar trend. These findings provide critical translational evidence demonstrating that personalized exercise programming based upon the ACE IFT model guidelines can be successfully implemented within the community setting to reduce T2DM and CVD risk.

Can runners maintain a newly learned gait pattern outside a laboratory environment following gait retraining?

BACKGROUND: Previous peak tibial shock gait retraining programs, which were usually conducted on a treadmill, were reported to be effective on impact loading reduction in runners. However, whether the trained runners can translate the training effect at different running modes (treadmill/overground), or running slopes (uphill/downhill), remains unknown. RESEARCH QUESTION: Is the training effect from a treadmill-based gait retraining translatable to unconstrained running conditions, including overground and uphill/downhill running? METHODS: The peak tibial shock was measured during treadmill/overground running, as well as level/uphill/downhill running before and after a course of treadmill-based gait retraining. The 8-session training aimed to soften footfalls using real-time biofeedback of tibial shock data. Repeated measures ANOVA was used to examine the effect of training, running mode, and running slope, on a group level. Reliable change index of each participant was used to assess the individual response to the training protocol used in this study. RESULTS: Eighty percent of the participants were responsive to the gait retraining and managed to reduce their peak tibial shock following training. They managed to translate the training effect to treadmill slope running (Level: p < 0.05, Cohen's d = 1.65; Uphill: p = 0.001, Cohen's d = 0.91; Downhill: p < 0.05; Cohen's d = 1.29) and overground level running (p = 0.014, Cohen's d = 0.85). However, their peak tibial shock were not reduced during overground slope running (Uphill: p = 0.054; Cohen's d = 0.62; Downhill p = 0.12; Cohen's d = 0.48). SIGNIFICANCE: Our findings indicated that a newly learned gait pattern may not fully translate to running outside of the laboratory environment.

Changes in Metabolic Syndrome Severity Following Individualized Versus Standardized Exercise Prescription: A Feasibility Study.

This study sought to investigate the efficacy of standardized versus individualized exercise intensity prescription on metabolic syndrome (MetS) severity following a 12-week exercise intervention. A total of 38 experimental participants (47.8 ± 12.2 yr, 170.7 ± 8.0 cm, 82.6 ± 18.7 kg, 26.9 ± 6.7 mL·k-1·min-1) were randomized to one of two exercise interventions (exercise intensity prescribed using heart rate reserve or ventilatory threshold). Following the 12-week intervention, MetS z-score was significantly improved for the standardized (-2.0 ± 3.1 to -2.8 ± 2.8 [p = 0.01]) and individualized (-3.3 ± 2.3 to -3.9 ± 2.2 [p = 0.04]) groups. When separating participants based on prevalence of MetS at baseline and MetS z-score responsiveness, there were six and three participants in the standardized and individualized groups, respectively, with three or more MetS risk factors. Of the six participants in the standardized group, 83% (5/6) of the participants were considered responders, whereas 100% (3/3) of the individualized participants were responders. Furthermore, only 17% (1/6) of the participants with MetS at baseline in the standardized group no longer had symptoms of MetS following the intervention. In the individualized group, 67% (2/3) of participants with baseline MetS were not considered to have MetS at week 12. These findings suggest that an individualized approach to the exercise intensity prescription may ameliorate the severity of MetS.