Effectiveness of exercise intervention on physical and health outcomes in patients admitted to an acute medical ward: A systematic review and meta-analysis.

OBJECTIVE: To evaluate the effectiveness of inpatient medical ward exercise on physical and health outcomes in adults compared with usual care. DATA SOURCES: Medline, CINAHL and EMBASE were searched from inception to 20 April 2023. REVIEW METHODS: Randomised-controlled trials in English that reported physical and health outcomes of adults who received an exercise intervention on an acute medical ward were included. Two reviewers independently extracted data. Methodological quality was assessed using the PEDro and TESTEX scales. The GRADE rating assessed the quality of evidence to evaluate the certainty of effect. Meta-analyses were performed where possible. RESULTS: Thirteen studies were included, with 1273 unique participants (mean [SD] age, 75.5 [11] years), which compared exercise intervention with usual care. Low quality evidence demonstrated a significant improvement in aerobic capacity ([MD], 1.39 m [95% CI, 0.23, 2.55], p = 0.02) and maximum isometric strength ([MD], 2.3 kg [95% CI, 2.2, 2.4], p < 0.001) for the exercise intervention compared with usual care. Low quality evidence demonstrated no difference for in-hospital falls count ([OR], 1.93 [95% CI, 0.61, 6.12] p = 0.27) or mortality ([OR], 0.77 [95% CI, 0.48, 1.23], p = 0.27). Moderate quality evidence demonstrated no difference for length of stay ([MD], -0.10 days [95% CI, -0.31, 0.11] p = 0.36). CONCLUSION: Exercise prescribed during an acute medical ward stay improves aerobic capacity and maximum isometric strength but may not reduce length of stay, in-hospital falls or mortality.

The influence of playing surface on external demands and physiological responses during a soccer match simulation.

We investigated the effects of playing surfaces with different impact absorption characteristics on external demand and physiological responses. Fifteen participants completed a soccer match simulation on natural grass, synthetic turf and concrete surfaces. Accelerometry-derived PlayerLoadTM per minute (PL·min-1) and average net force (AvFNet) were used to quantify external demands at the centre of mass (CoM), upper-back, mid-back and hip. Heart rate, oxygen uptake, energy expenditure and RPE quantified physiological responses. The concrete surface exhibited the least impact absorption, with peak decelerations ~3.5x synthetic turf and ~10x natural grass (p < 0.001). Despite this, there was no differences in external demand between surfaces (surface: p ≥ 0.194; η2p≤0.092). Both AvFNet and PL·min-1 (location: p < 0.001; η2p≥0.859) were higher at the hip (613(91)N; 12.5(1.2)arb.u), reduced at the mid-back (521(67)N; 8.8(0.7)arb.u) and upper-back (502(60)N; 8.8(0.7)arb.u) when compared to CoM (576(78)N; 10.7(1.0)arb.u). Although playing surface did not influence the external demands, heart rate or oxygen uptake (p > 0.05), energy expenditure was highest on natural grass compared to synthetic turf (P = 0.034) and RPE was highest on synthetic turf compared to concrete (p = 0.026). Different playing surfaces can alter physiological responses to soccer-specific activity even when the external demands are similar.

Criterion Validity of a MARG Sensor to Assess Countermovement Jump Performance in Elite Basketballers.

ABSTRACT: Staunton, CA, Stanger, JJ, Wundersitz, DW, Gordon, BA, Custovic, E, and Kingsley, MI. Criterion validity of a MARG sensor to assess countermovement jump performance in elite basketballers. J Strength Cond Res 35(3): 797-803, 2021-This study assessed the criterion validity of a magnetic, angular rate, and gravity (MARG) sensor to measure countermovement jump (CMJ) performance metrics, including CMJ kinetics before take-off, in elite basketballers. Fifty-four basketballers performed 2 CMJs on a force platform with data simultaneously recorded by a MARG sensor located centrally on the player's back. Vertical accelerations recorded from the MARG sensor were expressed relative to the direction of gravity. Jumps were analyzed by a blinded assessor and the best jump according to the force platform was used for comparison. Pearson correlation coefficients (r) and mean bias with 95% ratio limits of agreement (95% RLOA) were calculated between the MARG sensor and the force platform for jumps performed with correct technique (n = 44). The mean bias for all CMJ metrics was less than 3%. Ninety-five percent RLOA between MARG- and force platform-derived flight time and jump height were 1 ± 7% and 1 ± 15%, respectively. For CMJ performance metrics before takeoff, impulse displayed less random error (95% RLOA: 1 ± 13%) when compared with mean concentric power and time to maximum force displayed (95% RLOA: 0 ± 29% and 1 ± 34%, respectively). Correlations between MARG and force platform were significant for all CMJ metrics and ranged from large for jump height (r = 0.65) to nearly perfect for mean concentric power (r = 0.95). Strong relationships, low mean bias, and low random error between MARG and force platform suggest that MARG sensors can provide a practical and inexpensive tool to measure impulse and flight time-derived CMJ performance metrics.

Multiple short bouts of exercise are better than a single continuous bout for cardiometabolic health: a randomised crossover trial.

PURPOSE: To compare cardiometabolic responses to five consecutive days of daily postprandial exercise accumulated in three 10-min bouts or a single 30-min bout to a no-exercise control. METHODS: Ten insufficiently active adults completed three trials in a randomised order. Each trial comprised five consecutive days of 30 min of exercise either accumulated in three separate 10-min bouts (ACC) after main meals; a single 30-min bout after dinner (CONT); or a no-exercise control (NOEX). Glucose regulation was assessed from an oral glucose tolerance test. Applanation tonometry was used to assess pulse wave velocity approximately 12 h following completion of the final trial. RESULTS: Area under the 2-h glucose curve was similar for CONT (mean; 95% CI 917 mmol L-1 2 h-1; 815 to 1019) and ACC (931 mmol L-1 2 h-1; 794 to 1068, p = 0.671). Area under the 2-h insulin curve was greater following NOEX (70,328 pmol L-1 2 h-1; 30,962 to 109,693) than ACC (51,313 pmol L-1 2 h-1: 21,822 to 80,806, p = 0.007). Pulse wave velocity was lower for ACC (5.96 m s-1: 5.38 to 6.53) compared to CONT (6.93 m s-1: 5.92 to 7.94, p = 0.031) but not significantly lower for ACC compared to NOEX (6.52 m s-1: 5.70 to 7.34, p = 0.151). CONCLUSION: Accumulating 30 min of moderate-intensity walking in three bouts throughout the day is more effective at reducing markers of cardiometabolic health risk in insufficiently active, apparently healthy adults than a single daily bout. Both accumulated and single-bout walking were equally as effective at reducing postprandial glucose concentrations compared to a no-exercise control. Therefore, accumulating exercise in short bouts after each main meal might be more advantageous for overall cardiometabolic health.

Exercise Supervision Is Important for Cardiometabolic Health Improvements: A 16-Week Randomized Controlled Trial.

Hunter, JR, Gordon, BA, Bird, SR, and Benson, AC. Exercise supervision is important for cardiometabolic health improvements: a 16-week randomized controlled trial. J Strength Cond Res 34(3): 866-877, 2020-Exercise supervision enhances health and fitness improvements in clinical populations compared with unsupervised or home-based exercise, but effects of supervision type are unknown in healthy employees. Eighty-five Australian university employees (62 females; mean ± SD 43.2 ± 9.8 years) were randomized to personal (1:1; SUP, n = 28), nonpersonal (typical gym-based; NPS, n = 28) supervision or unsupervised control (CON, n = 29) exercise groups. Subjects received a 16-week individually tailored, moderate-to-high intensity aerobic and resistance exercise program completed at an onsite exercise facility (SUP and NPS) or without access to a specific exercise facility (CON). Repeated-measures ANOVA analyzed changes to cardiometabolic outcomes. Mean ± SD increases to V[Combining Dot Above]O2 peak were greater (p < 0.01) with SUP (+10.4 ± 11.1%) vs. CON (+3.8 ± 8.9%) but not different to NPS (+8.6 ± 8.2%). Compared to CON (+1.7 ± 7.7%), upper-body strength increases were greater with SUP (+12.8 ± 8.4%; p < 0.001) and NPS (+8.4 ± 7.3%; p < 0.05). Lower-body strength increases were greater with SUP (+26.3 ± 12.7%) vs. NPS (+15.0 ± 14.6%; p < 0.05) and CON (+4.1 ± 12.4%; p < 0.001), and NPS vs. CON (p < 0.01). Body fat reductions were greater with SUP (-2.2 ± 2.2%) vs. NPS (-0.6 ± 1.9%; p < 0.05) and CON (-0.7 ± 1.9%; p < 0.05). Access to an onsite exercise facility with personal or nonpersonal exercise supervision was important for improving several cardiometabolic outcomes, with greater improvements to lower-body strength and body composition from personal 1:1 exercise supervision.

Exercise at an onsite facility with or without direct exercise supervision improves health-related physical fitness and exercise participation: An 8-week randomised controlled trial with 15-month follow-up.

ISSUE ADDRESSED: Physical activity and exercise participation is limited by a perceived lack of time, poor access to facilities and low motivation. The aim was to assess whether providing an exercise program to be completed at the workplace with or without direct supervision was effective for promoting health-related physical fitness and exercise participation. METHODS: Fifty university employees aged (Mean ± SD) 42.5 ± 11.1 years were prescribed a moderate- to vigorous-intensity aerobic and resistance exercise program to be completed at an onsite facility for 8 weeks. Participants were randomly allocated to receive direct exercise supervision or not. Cardiorespiratory fitness (V̇O2max ) and maximal muscular strength were assessed at baseline and 8 weeks. Self-report physical activity was assessed at baseline, 8 weeks and 15 months post-intervention. RESULTS: Attendance or exercise session volume were not different between groups. Cardiorespiratory fitness (Mean ± 95% CI); +1.9 ± 0.7 mL·kg·min-1 ; P < .001), relative knee flexion (+7.4 ± 3.5 Nm·kg-1 %; P < .001) and extension (+7.4 ± 4.6 Nm·kg-1 %; P < .01) strength increased, irrespective of intervention group. Self-reported vigorous-intensity physical activity increased over the intervention (mean ± 95% CI; +450 ± 222 MET·minutes per week; P < .001), but did not remain elevated at 15 months (+192 ± 276 MET·minutes per week). CONCLUSION: Providing a workplace exercise facility to complete an individually-prescribed 8-week exercise program is sufficient to improve health-related physical fitness in the short-term independent to the level of supervision provided, but does not influence long-term participation. SO WHAT?: Lower cost onsite exercise facility supervision is as effective at improving physical health and fitness as directly supervised exercise, however ongoing support may be required for sustained physical activity behaviour change.

A comparison of age-standardised event rates for acute and chronic coronary heart disease in metropolitan and regional/remote Victoria: a retrospective cohort study.

BACKGROUND: Acute and chronic coronary heart disease (CHD) pose different burdens on health-care services and require different prevention and treatment strategies. Trends in acute and chronic CHD event rates can guide service implementation. This study evaluated changes in acute and chronic CHD event rates in metropolitan and regional/remote Victoria. METHODS: Victorian hospital admitted episodes with a principal diagnosis of acute CHD or chronic CHD were identified from 2005 to 2012. Acute and chronic CHD age-standardised event rates were calculated in metropolitan and regional/remote Victoria. Poisson log-link linear regression was used to estimate annual change in acute and chronic CHD event rates. RESULTS: Acute CHD age-standardised event rates decreased annually by 2.9 % (95 % CI, -4.3 to -1.4 %) in metropolitan Victoria and 1.7 % (95 % CI, -3.2 to -0.1 %) in regional/remote Victoria. In comparison, chronic CHD age-standardised event rates increased annually by 4.8 % (95 % CI, +3.0 to +6.5 %) in metropolitan Victoria and 3.1 % (95 % CI, +1.3 to +4.9 %) in regional/remote Victoria. On average, age-standardised event rates for regional/remote Victoria were 30.3 % (95 % CI, 23.5 to 37.2 %) higher for acute CHD and 55.3 % (95 % CI, 47.1 to 63.5 %) higher for chronic CHD compared to metropolitan Victoria from 2005 to 2012. CONCLUSION: Annual decreases in acute CHD age-standardised event rates might reflect improvements in primary prevention, while annual increases in chronic CHD age-standardised event rates suggest a need to improve secondary prevention strategies. Consistently higher acute and chronic CHD age-standardised event rates were evident in regional/remote Victoria compared to metropolitan Victoria from 2005 to 2012.

The immediate and lasting balance outcomes of clinical falls-prevention programs: A non-randomised study.

PURPOSE: Exercise-based falls-prevention programs are cost-effective population-based approaches to reduce the risk of falling for older adults. The aim was to evaluate the short-term and long-term efficacy of three existing falls-prevention programs. METHODS: A non-randomized study design was used to compare the immediate-post and long-term physical outcome measures for three falls prevention programs; one high-level land-based program, one low-level land-based program and a water-based Ai Chi program. Timed-up-and-go (TUG), five-times sit-to-stand (5xSTS), six-minute walk test (6MWT) and six-meter walk test were assessed at baseline, post-program, and at six-months follow-up. Linear mixed models were used to analyze between- and within- group differences, with the high-level land-based program used as the comparator. RESULTS: Thirty-two participants completed post-program assessment and 26 returned for follow-up. There was a difference in the age (years) of participants between programs (p = 0.049). The intercept for TUG and six-meter walk test time was 47.70% (23.37, 76.83) and 32.31s (10.52, 58.41), slower for the low-level group and 40.49% (17.35, 69.89) and 36.34s (12.75, 64.87), slower for the Ai Chi group (p < 0.01), compared with the high-level group. Mean time taken to complete the TUG was less both immediately post-program and at 6-month follow-up (p = 0.05). Walking speed for the six-meter walk test was only faster at six-months (p < 0.05). The 5xSTS duration was significantly reduced only at post-intervention (p < 0.05). CONCLUSION: These results indicate land-based and water-based falls-prevention programs improve physical outcome measures associated with falls-risk and many improvements are maintained for six months after the completion of the program. (Retrospective trial registration: ACTRN1262300119069).

Coagulation activity and thrombotic risk following high-volume endurance exercise in recreationally active cyclists.

Despite the prognostic effect of physical activity, acute bouts of high-volume endurance exercise can induce cardiac stress and postexercise hypercoagulation associated with increased thrombotic risk. The aim of this study was to explore the effect of high-volume endurance exercise on coagulation and thrombotic activity in recreational cyclists. Thirty-four recreational cyclists completed 4.8 ± 0.3 h of cycling at 45 ± 5% of maximal power output on a bicycle ergometer. Intravenous blood samples were collected preexercise, immediately postexercise, 24 and 48 h postexercise, and analyzed for brain natriuretic peptide (BNP), cardiac troponin (cTn), C-reactive protein (CRP), D-dimer, thrombin-antithrombin (TAT) complex, tissue factor (TF), tissue factor pathway inhibitor (TFPI), and TF-to-TFPI ratio (TF:TFPI). An increase in cTn was observed postexercise (P < 0.001). CRP concentrations were increased at 24 and 48 h postexercise compared with preexercise concentrations (P ≤ 0.001). TF was elevated at 24 h postexercise (P < 0.031) and TFPI was higher immediately postexercise (P < 0.044) compared with all other time points. TF:TFPI was increased at 24 and 48 h postexercise compared with preexercise (P < 0.025). TAT complex was reduced at 48 h postexercise compared with preexercise (P = 0.015), D-dimer was higher immediately postexercise compared with all other time points (P ≤ 0.013). No significant differences were observed in BNP (P > 0.05). High-volume endurance cycling induced markers of cardiac stress among recreational cyclists. However, plasma coagulation and fibrinolytic activity suggest no increase in thrombotic risk after high-volume endurance exercise.NEW & NOTEWORTHY In this study, a high-volume endurance exercise protocol induced markers of cardiac stress and altered plasma coagulation and fibrinolytic activity for up to 48 h in recreationally active cyclists. However, analysis of coagulation biomarkers indicates no increase in thrombotic risk when appropriate hydration and rest protocols are implemented.

The influence of considering individual resistance training variables as a whole on muscle strength: A systematic review and meta-analysis protocol.

Examinations of the effect of resistance training (RT) on muscle strength have attempted to determine differences between prescriptions, mostly examining individual training variables. The broad interaction of variables does not appear to be completely considered, nor has a dose-response function been determined. This registered (doi.org/10.17605/OSF.IO/EH94V) systematic review with meta-analysis aims to determine if the interaction of individual training variables to derive RT dose, dosing, and dosage can influence muscle strength and determine if an optimal prescription range exists for developing muscle strength. To derive RT dose, the following calculation will be implemented: number of sets × number of repetitions × number of exercises × exercise intensity, while RT dosing factors in frequency and RT dosage considers program duration. A keyword search strategy utilising interchangeable terms for population (adult), intervention (resistance training), and outcomes (strength) will be conducted across three databases (CINAHL, MEDLINE, and SPORTDiscus). Novel to the field of exercise prescription, an analytical approach to determine the dose-response function for continuous outcomes will be used. The pooled standardised mean differences for muscle strength will be estimated using DerSimonian and Laird random effects method. Linear and non-linear dose-response relationships will be estimated by fitting fixed effects and random effects models using the one-stage approach to evaluate if there is a relationship between exercise dose, dosing and dosage and the effect on muscle strength. Maximised log-likelihood and the Akaike Information Criteria will be used to compare alternative best fitting models. Meta regressions will investigate between-study variances and a funnel plot and Egger's test will assess publication bias. The results from this study will identify if an optimal prescription range for dose, dosing and dosage exists to develop muscle strength.

Barriers and enablers to health service access amongst people with diabetes: An exploration of the perceptions of health care staff in regional Australia.

Healthcare staff are in a unique position of understanding client experiences, physiological impacts of client behaviour, the local healthcare system and the physical environment in which the services operate. Their perspectives may provide insights into the feasibility and effectiveness of existing models of diabetes care and suggestions for improvements to models of care (MoC). The objective of this qualitative study was to explore the experiences of healthcare staff delivering care for people with diabetes at the request of an existing healthcare service. Semi-structured interviews were conducted with 21 healthcare staff from three community health centres in one region of Victoria, Australia, in 2018. Interviews were audio-recorded and transcribed verbatim. Data were subject to qualitative content analysis and, subsequently, emerging themes were classified at individual, relationship, community and societal levels of the social-ecological model (SEM). Perceived barriers of access to health services using the current MoC included a lack of public transport, low socioeconomic status, job insecurity (resulting in an inability to take time away from work) and inflexible appointment times, all of which negatively impact diabetes management. Perceived enablers included having a co-located, multidisciplinary team, a holistic approach to diabetes management and motivation resulting from improvement in diabetes-related health outcomes. The findings indicate that there is potential to improve the service in this region by adopting a more integrated, team-focused and accessible MoC.

Sympathovagal Balance Is a Strong Predictor of Post High-Volume Endurance Exercise Cardiac Arrhythmia.

Regular physical activity is important for cardiovascular health. However, high-volume endurance exercise has been associated with increased number of electrocardiogram (ECG) abnormalities, including disturbances in cardiac rhythm (arrhythmias) and abnormalities in ECG pattern. The aim of this study was to assess if heart rate variability (HRV) is associated with ECG abnormalities. Fifteen participants with previous cycling experience completed a 21-day high-volume endurance exercise cycle over 3,515 km. Participants wore a 5-lead Holter monitor for 24 h pre- and post-exercise, which was used to quantify ECG abnormalities and export sinus R-to-R intervals (NN) used to calculate HRV characteristics. As noise is prevalent in 24-h HRV recordings, both 24-h and heart rate collected during stable periods of time (i.e., deep sleep) were examined. Participants experienced significantly more arrhythmias post high-volume endurance exercise (median = 35) compared to pre (median = 12; p = 0.041). All 24-h and deep sleep HRV outcomes were not different pre-to-post high-volume endurance exercise (p > 0.05). Strong and significant associations with arrhythmia number post-exercise were found for total arrhythmia (total arrhythmia number pre-exercise, ρ = 0.79; age, ρ = 0.73), supraventricular arrhythmia (supraventricular arrhythmia number pre-exercise: ρ = 0.74; age: ρ = 0.66), and ventricular arrhythmia (age: ρ = 0.54). As a result, age and arrhythmia number pre-exercise were controlled for in hierarchical regression, which revealed that only deep sleep derived low frequency to high frequency (LF/HF) ratio post high-volume endurance exercise predicted post total arrhythmia number (B = 0.63, R 2Δ = 34%, p = 0.013) and supraventricular arrhythmia number (B = 0.77, R 2Δ = 69%, p < 0.001). In this study of recreationally active people, only deep sleep derived LF/HF ratio was associated with more total and supraventricular arrhythmias after high-volume endurance exercise. This finding suggests that measurement of sympathovagal balance during deep sleep might be useful to monitor arrhythmia risk after prolonged high-volume endurance exercise performance.

Physical Activity Participation After a 16-Week Supervised Workplace Exercise RCT With a 15-Month Follow-Up.

OBJECTIVE: To investigate the effects of exercise supervision on short- and longer-term moderate-vigorous physical activity (MVPA) participation. METHODS: Fifty-six Australian university employees completed a 16-week moderate-to-high intensity aerobic and resistance exercise intervention, and the international physical activity questionnaire (IPAQ) 15 months later. Participants received either personal (SUP; n = 21) or non-personal (NPS; n = 19) exercise supervision at an onsite facility or exercised offsite with no supervision (CON; n = 16). RESULTS: A linear mixed model identified a significant group × time interaction effect for MVPA, with increases at 15-month follow-up for CON only. Pooled data suggested more participants completed ≥500 MET-minutes of weekly MVPA at 16 weeks (66%) and 15-month follow-up (68%) compared to baseline (54%). CONCLUSIONS: A comprehensive health and fitness assessment and individually tailored exercise without personal supervision may promote ongoing MVPA.

A Comparison of the Gluco-Regulatory Responses to High-Intensity Interval Exercise and Resistance Exercise.

High-intensity interval exercise and resistance exercise both effectively lower blood glucose; however, it is not clear whether different regulatory mechanisms exist. This randomised cross-over study compared the acute gluco-regulatory and the physiological responses of high-intensity interval exercise and resistance exercise. Sixteen (eight males and eight females) recreationally active individuals, aged (mean ± SD) 22 ± 7 years, participated with a seven-day period between interventions. The high-intensity interval exercise trial consisted of twelve, 30 s cycling intervals at 80% of peak power capacity and 90 s active recovery. The resistance exercise trial consisted of four sets of 10 repetitions for three lower-limb exercises at 80% 1-RM, matched for duration of high-intensity interval exercise. Exercise was performed after an overnight fast, with blood samples collected every 30 min, for two hours after exercise. There was a significant interaction between time and intervention for glucose (p = 0.02), which was, on average (mean ± SD), 0.7 ± 0.7 mmol∙L-1 higher following high-intensity interval exercise, as compared to resistance exercise. Cortisol concentration over time was affected by intervention (p = 0.03), with cortisol 70 ± 103 ng∙mL-1 higher (p = 0.015), on average, following high-intensity interval exercise. Resistance exercise did not induce the acute rise in glucose that was induced by high-intensity interval exercise and appears to be an appropriate alternative to positively regulate blood glucose.

Relationships between Physical Activity, Work Ability, Absenteeism and Presenteeism in Australian and New Zealand Adults during COVID-19.

Public health movement and social restrictions imposed by the Australian and New Zealand governments in response to the COVID-19 pandemic influenced the working environment and may have affected health behaviours, work ability, and job performance. The aim of this study was to determine the associations between health behaviours and work ability and performance during COVID-19 restrictions and if health behaviours were related to demographic or population factors. A cross-sectional survey was used to gather responses from 433 adult employees in Australia and New Zealand between June and August 2020. The survey requested demographic information and used the International Physical Activity Questionnaire, Work Ability Index, and the World Health Organisation's Health and Work Performance Questionnaire. Multivariate regression models were used to explore relationships between the identified variables while controlling for several possible confounders. Being sufficiently physically active was associated with higher reported physical (aOR = 2.1; p = 0.001) and mental work abilities (aOR = 1.8; p = 0.007) and self-reported job performance (i.e., lower presenteeism) (median +7.42%; p = 0.03). Part-time employees were 56% less likely (p = 0.002) to report a good or very good mental work ability. Those with existing medical conditions were 14% less likely (p = 0.008) to be sufficiently active and 80% less likely (p = 0.002) to report rather good or very good physical work ability. Being sufficiently active was associated with higher physical and mental work abilities and better job performance during the COVID-19 pandemic. Employers should support opportunities for regular physical activity and provide specific support to individuals with medical conditions or in part-time employment.

Graduated exercise training and progressive resistance training in adolescents with chronic fatigue syndrome: a randomized controlled pilot study.

OBJECTIVE: to investigate the differential effects of aerobic graded exercise and progressive resistance training on exercise tolerance, fatigue and quality of life in adolescent patients with chronic fatigue syndrome (CFS). DESIGN: single-blind, randomized controlled pilot trial. SETTING: a major metropolitan hospital in Melbourne, Australia. SUBJECTS: twenty-two adolescents aged 13-18 years diagnosed with CFS and admitted to the inpatient chronic fatigue rehabilitation programme. INTERVENTION: patients were randomized to either graded aerobic exercise training or a progressive resistance training programme, for five days/week for four weeks. The graded aerobic training consisted of 20-40 minutes of stationary cycling and treadmill exercise. The progressive resistance training involved 16 exercises performed with single set, moderate load and high repetitions. MAIN MEASURES: exercise tolerance (time to fatigue) measured on a graded sub-maximal treadmill test, metabolic equivalents and quality of life, along with muscular strength (maximium push-ups) and endurance (sit-to-stand) and questionnaires evaluating depressive symptoms and fatigue severity. RESULTS: no intervention was significantly better than the other for any outcome. However, physical capacity and quality of life significantly improved in both groups, while fatigue severity and symptoms of depression improved only with aerobic training. CONCLUSIONS: resistance and aerobic training resulted in similar changes to physical capacity, quality of life and fatigue severity. Generally, patients who completed resistance training or aerobic training experienced significant improvements in outcomes from baseline when they entered the programme. Whether these improvements can be attributed to the treatment is unknown.

The Implementation of "McGill's Big 3" in an Individual with an Acquired Brain Injury who Ambulates Independently: A Case Report.

BACKGROUND: Improved function, through balance and mobility, has been demonstrated in individuals with an acquired brain injury (ABI) following various exercise interventions; however, the feasibility of implementing "McGill's Big 3" exercises, typically prescribed for people with back pain, to improve function in people with ABI requires investigation. OBJECTIVE: The aim of this case report was to determine the feasibility of implementing "McGill's Big 3" exercises on balance and mobility when prescribed to an individual with an ABI who ambulates independently. METHODS AND MATERIALS: A 40-year-old female with an ABI completed an 8-week exercise intervention consisting of "McGill's Big 3" exercises. Balance and mobility testing were completed pre and post intervention, including, heel-to-toe standing; the foot tap test; forward reach test; pick-up test; stand-to-floor test; and three-meter timed up-and-go. RESULTS: The results demonstrated improvement across all tests. CONCLUSIONS: These findings support the use of "McGill's Big 3" exercises in a rehabilitation program, for individuals with neurological impairments such as an ABI.

Impact of endurance exercise on the heart of cyclists: A systematic review and meta-analysis.

OBJECTIVE: To compare heart structure and function in endurance athletes relative to participants of other sports and non-athletic controls in units relative to body size. A secondary objective was to assess the association between endurance cycling and cardiac abnormalities. PATIENTS AND METHODS: Five electronic databases (CINAHL, Cochrane Library, Medline, Scopus, and SPORTdiscus) were searched from the earliest record to 14 December 2019 to identify studies investigating cardiovascular structure and function in cyclists. Of the 4865 unique articles identified, 70 met inclusion criteria and of these, 22 articles presented 10 cardiovascular parameters in units relative to body size for meta-analysis and five presented data relating to incidence of cardiac abnormalities. Qualitative analysis was performed on remaining data. The overall quality of evidence was assessed using GRADE. Odds ratios were calculated to compare the incidence of cardiac abnormality. RESULTS: Heart structure was significantly larger in cyclists compared to non-athletic controls for left ventricular: mass; end-diastolic volume, interventricular septal diameter and internal diameter; posterior wall thickness, and end-systolic internal diameter. Compared to high static and high dynamic sports (e.g., kayaking and canoeing), low-to-moderate static and moderate-to-high dynamic sports (e.g., running and swimming) and moderate-to-high static and low-to-moderate dynamic sports (e.g., bodybuilding and wrestling), endurance cyclists end-diastolic left ventricular internal diameter was consistently larger (mean difference 1.2-3.2 mm/m2). Cardiac abnormalities were higher in cyclists compared to controls (odds ratio: 1.5, 95%CI 1.2-1.8), but the types of cardiac abnormalities in cyclists were not different to other athletes. CONCLUSION: Endurance cycling is associated with a larger heart relative to body size and an increased incidence of cardiac abnormalities relative to controls.

A comparison of acute glycaemic responses to accumulated or single bout walking exercise in apparently healthy, insufficiently active adults.

OBJECTIVES: To investigate the acute glyacaemic response to accumulated or single bout walking exercise in apparently healthy adults. DESIGN: Three arm, randomised crossover control study. METHODS: Ten adults (age: 50±12.6 y; BMI 29.0±5.4kgm-2) completed three separate trials comprising three 10-min walking bouts after breakfast, lunch, and dinner (APPW), a single 30-min walking bout after dinner only (CPPW), or a no-exercise control (NOEX). Participants walked on a treadmill at a moderate intensity of 55%-70% heart rate reserve. Two-hour postprandial glucose response was assessed using a continuous glucose monitor. RESULTS: There was a difference in the pattern of the glucose response between the trials during the two hours following dinner (p<0.001). Postprandial dinner glucose concentrations were not different between APPW and CPPW but were up to 1.01mmolL-1 lower than NOEX (partial eta2=0.21, p=0.041). CONCLUSIONS: Ten minutes of moderate intensity walking completed 30min after each meal lowers postprandial dinner glucose concentrations in comparison to no-exercise, and reduces glucose by a similar magnitude as a single 30-min bout after the evening meal. Short bouts of exercise after each meal may be recommended to minimise glucose elevations after dinner that might increase risk of cardiometabolic disease.

A position statement on screening and management of prediabetes in adults in primary care in Australia.

Prediabetes has a high prevalence, with early detection essential to facilitate optimal management to prevent the development of conditions such as type 2 diabetes and cardiovascular disease. Prediabetes can include impaired fasting glucose, impaired glucose tolerance and elevated HbA1c. This position statement outlines the approaches to screening and management of prediabetes in primary care. There is good evidence to implement intensive, structured lifestyle interventions for individuals with impaired glucose tolerance. The evidence for those with impaired fasting glucose or elevated HbA1c is less clear, but individuals should still be provided with generalised healthy lifestyle strategies. A multidisciplinary approach is recommended to implement healthy lifestyle changes through education, nutrition and physical activity. Individuals should aim to lose weight (5-10% of body mass) using realistic and sustainable dietary approaches supported by an accredited practising dietitian, where possible. Physical activity and exercise should be used to facilitate weight maintenance and reduce blood glucose. Moderate-vigorous intensity aerobic exercise and resistance training should be prescribed by an accredited exercise physiologist, where possible. When indicated, pharmacotherapy, metabolic surgery and psychosocial care should be considered, in order to enhance the outcomes associated with lifestyle change. Individuals with prediabetes should generally be evaluated annually for their diabetes status.