Effects of resistance training on quality of life, fatigue, physical function, and muscular strength during chemotherapy treatment: a systematic review and meta-analysis.

PURPOSE: To systematically review and meta-analyse the efficacy of resistance training on quality of life (QOL), fatigue, physical function, and muscular strength in people diagnosed with cancer undergoing chemotherapy. METHODS: Electronic databases PubMed, Cochrane Central, CINAHL, SCOPUS and Web of Science were systematically searched for randomised controlled trials (RCTs) that compared the effects of resistance training to control on QOL, fatigue, physical function, and lower-body and upper-body muscular strength in adults undergoing chemotherapy. Standardised mean differences (SMDs) were pooled using a random effects model. Risk of bias was assess using the risk of bias tool for randomised trials (RoB 2). RESULTS: Seven RCTs encompassing 561 participants were included. The pooled results of seven RCTs showed that resistance training during chemotherapy significantly improved lower-body strength (n = 555, SMD 0.33, 95% CI 0.12 to 0.53, moderate-quality evidence, I2 = 23%) compared to control. There was no evidence for an effect of resistance training on QOL (n = 373, SMD 0.13, 95% CI -0.15 to 0.42, low-quality evidence, I2 = 0%), fatigue (n = 373, SMD -0.08, 95% CI -0.37 to 0.22, low-quality evidence, I2 = 20%), physical function (n = 198, SMD 0.61, 95% CI -0.73 to 1.95, very low-quality evidence, I2 = 83%), or upper-body strength (n = 413, SMD 0.37, 95% CI -0.07 to 0.80, very low-quality evidence, I2 = 69%). CONCLUSIONS: Resistance training may improve lower-body strength in patients undergoing chemotherapy treatment compared to control.

Quantifying the External and Internal Loads of Professional Rugby League Training Modes: Consideration for Concurrent Field-Based Training Prescription.

Weaving, D, Jones, B, Till, K, Marshall, P, Earle, K, and Abt, G. Quantifying the external and internal loads of professional rugby league training modes: consideration for concurrent field-based training prescription. J Strength Cond Res 34(12): 3514-3522, 2020-Practitioners prescribe numerous training modes to develop the varied physical qualities that professional rugby league players must express during competition. The aim of this study was to determine how the magnitude of external and internal training load per minute of time differs between modes in professional rugby league players. These data were collected from 17 players across 716 individual sessions (mean [SD] sessions: 42 [13] per player) which were categorized by mode (conditioning [CON], small-sided games, skills, and sprint training). Derived from global positioning systems (5 Hz with 15 Hz interpolation), the distances covered within arbitrary speed and metabolic power thresholds were determined to represent the external load. Session rating of perceived exertion and individualized training impulse represented the internal load. All data were made relative to the session duration. The differences in time-relative load methods between each mode were assessed using magnitude-based inferences. Small-sided games and CON very likely to almost certainly produced the greatest relative internal and external loads. Sprint training provided players with the greatest sprinting and maximal-power distances without a concomitant increase in the internal load. The metabolic power method complements speed-based quantification of the external load, particularly during small-sided games and skills training. In practice, establishing normative loads per minute of time for each mode can be useful to plan future training by multiplying this value by the planned session duration.

Test-Retest Reliability of a Commercial Linear Position Transducer (GymAware PowerTool) to Measure Velocity and Power in the Back Squat and Bench Press.

Orange, ST, Metcalfe, JW, Marshall, P, Vince, RV, Madden, LA, and Liefeith, A. Test-retest reliability of a commercial linear position transducer (GymAware PowerTool) to measure velocity and power in the back squat and bench press. J Strength Cond Res 34(3): 728-737, 2020-This study examined the test-retest reliability of the GymAware PowerTool (GYM) to measure velocity and power in the free-weight back squat and bench press. Twenty-nine academy rugby league players (age: 17.6 ± 1.0 years; body mass: 87.3 ± 20.8 kg) completed 2 test-retest sessions for the back squat followed by 2 test-retest sessions for the bench press. GYM measured mean velocity (MV), peak velocity (PV), mean power (MP), and peak power at 20, 40, 60, 80, and 90% of 1 repetition maximum (1RM). GYM showed good reliability (intraclass correlation coefficient [ICC] and standard error of measurement percentage, respectively) for the measurement of MV at loads of 40 (0.77, 3.9%), 60 (0.83, 4.8%), 80 (0.83, 5.8%), and 90% (0.79, 7.9%) of 1RM in the back squat. In the bench press, good reliability was evident for PV at 40 (0.82, 3.9%), 60 (0.81, 5.1%), and 80% (0.77, 8.4%) of 1RM, and for MV at 80 (0.78, 7.9%) and 90% (0.87, 9.9%) of 1RM. The measurement of MP showed good to excellent levels of reliability across all relative loads (ICC ≥0.75). In conclusion, GYM provides practitioners with reliable kinematic information in the back squat and bench press, at least with loads of 40-90% of 1RM. This suggests that strength and conditioning coaches can use the velocity data to regulate training load according to daily readiness and target specific components of the force-velocity curve. However, caution should be taken when measuring movement velocity at loads <40% of 1RM.

Can sit-to-stand muscle power explain the ability to perform functional tasks in adults with severe obesity?

This study examined the relationship between sit-to-stand (STS) power and physical function in adults with severe obesity. Thirty-eight adults (age: 44 ± 12 years; body mass index [BMI]: 45.2 ± 7.8 kg/m2) completed evaluations of STS power, strength and functional performance. STS power was measured with a wearable inertial sensor, strength was assessed with the isometric mid-thigh pull, and function was measured with the timed up-and-go (TUG), six-minute walk test (6MWT) and 30-s chair STS. Power and strength (normalised to body mass) entered regression models in addition to age, gender, BMI and physical activity (daily step count). Power displayed large univariate associations with TUG (r = 0.50) and 30-s chair STS (r = 0.67), and a moderate association with 6MWT (r = 0.49). Forward stepwise regression revealed that power independently contributed to TUG (ß = -0.40, p = 0.010), 30-s chair STS (ß = 0.67, p < 0.001) and 6MWT performance (ß = 0.27, p = 0.007). Power also appeared to be a superior determinant of function compared with strength. Power generated via the STS transfer largely underpins the ability to perform functional tasks in adults with severe obesity, although intervention studies are required to investigate a potentially causal relationship.

Short-Term Training and Detraining Effects of Supervised vs. Unsupervised Resistance Exercise in Aging Adults.

Orange, ST, Marshall, P, Madden, LA, and Vince, RV. Short-term training and detraining effects of supervised vs. unsupervised resistance exercise in aging adults. J Strength Cond Res 33(10): 2733-2742, 2019-This study compared the effects of a 4-week supervised (SUP) resistance training program and unsupervised (UNSUP) resistance training program followed by 12 weeks of detraining (DET). Thirty-six healthy aging adults (age: 53.6 ± 3.6 years; body mass index: 28.3 ± 5.1 kg·m) were randomly allocated to an SUP group (n = 17) or a UNSUP group (n = 19). Participants completed 3 training sessions per week using resistance bands and body weight movements. Measures of physical performance were administered at baseline, at the end of the training program, and after the DET period. Function was assessed with the 6-minute walk test (6MWT), timed up-and-go (TUG), 30-second chair sit-to-stand (STS), stair-climb test (SCT), 40-m fast-paced walk test (FPWT) and sit-and-reach test (SRT), whereas the isometric midthigh pull (IMTP) and hand grip test were used to measure muscle strength. After training, improvements in performance were found in the 6MWT, TUG, 30-second chair STS, SCT, FPWT, SRT, and IMTP (p ≤ 0.05), with no significant differences between groups (p > 0.05). In addition, most of the training-induced improvements remained significantly above baseline values after the DET period (p ≤ 0.05). No significant between-group differences were observed after training or DET (p > 0.05). Four weeks of either SUP or UNSUP resistance training is sufficient to substantially improve muscle strength and function in aging adults, and these gains are largely preserved after prescribed exercise cessation. Home-based resistance training seems to be a practical and effective alternative to traditional SUP programs that may help circumvent many barriers to physical activity in aging adults.

Validity and Reliability of a Wearable Inertial Sensor to Measure Velocity and Power in the Back Squat and Bench Press.

Orange, ST, Metcalfe, JW, Liefeith, A, Marshall, P, Madden, LA, Fewster, CR, and Vince, RV. Validity and reliability of a wearable inertial sensor to measure velocity and power in the back squat and bench press. J Strength Cond Res 33(9): 2398-2408, 2019-This study examined the validity and reliability of a wearable inertial sensor to measure velocity and power in the free-weight back squat and bench press. Twenty-nine youth rugby league players (18 ± 1 years) completed 2 test-retest sessions for the back squat followed by 2 test-retest sessions for the bench press. Repetitions were performed at 20, 40, 60, 80, and 90% of 1 repetition maximum (1RM) with mean velocity, peak velocity, mean power (MP), and peak power (PP) simultaneously measured using an inertial sensor (PUSH) and a linear position transducer (GymAware PowerTool). The PUSH demonstrated good validity (Pearson's product-moment correlation coefficient [r]) and reliability (intraclass correlation coefficient [ICC]) only for measurements of MP (r = 0.91; ICC = 0.83) and PP (r = 0.90; ICC = 0.80) at 20% of 1RM in the back squat. However, it may be more appropriate for athletes to jump off the ground with this load to optimize power output. Further research should therefore evaluate the usability of inertial sensors in the jump squat exercise. In the bench press, good validity and reliability were evident only for the measurement of MP at 40% of 1RM (r = 0.89; ICC = 0.83). The PUSH was unable to provide a valid and reliable estimate of any other criterion variable in either exercise. Practitioners must be cognizant of the measurement error when using inertial sensor technology to quantify velocity and power during resistance training, particularly with loads other than 20% of 1RM in the back squat and 40% of 1RM in the bench press.

Effect of Accommodating Resistance on the Postactivation Potentiation Response in Rugby League Players.

Scott, DJ, Ditroilo, M, and Marshall, P. Effect of accommodating resistance on the post-activation potentiation response in rugby league players. J Strength Cond Res 32(9): 2510-2520, 2018-This study examined the postactivation potentiation (PAP) response of 2 conditioning activities (CA), the hex bar deadlift and back squat, combined with accommodating resistance; this adds a percentage of the total resistance during the exercise. Twenty amateur rugby league players performed 2 experimental trials and a control trial without a CA. Participants performed a countermovement jump (CMJ) before and 30, 90, and 180 seconds after 1 set of 3 repetitions of each CA at 70% 1 repetition maximum (RM), with up to an additional 23% 1RM from accommodating resistance. Peak power output (PPO), force at PPO, velocity at PPO, and jump height were calculated for each CMJ. Surface electromyography (EMG) of the vastus lateralis (VL), rectus femoris (BF), tibialis anterior (TA), and gastrocnemius medialis (GM) was also measured. Repeated-measures analysis of variance revealed no significant (p > 0.05) PAP response for either exercise condition when comparing CMJ variables with baseline values nor were there any significant (p > 0.05) differences between exercise conditions. However, individualized recovery intervals (baseline vs. maximum potentiation response) demonstrated significant (p ≤ 0.05) improvements in PPO (3.99 ± 4.99%), force at PPO (4.87 ± 6.41%), velocity at PPO (4.30 ± 5.86%), jump height (8.45 ± 10.08%), VL EMG (20.37 ± 34.48%), BF EMG (22.67 ± 27.98%), TA EMG (21.96 ± 37.76%), and GM EMG (21.89 ± 19.65%). Results from this study must be interpreted with caution; however, it is conceivable that athletic performance can be acutely enhanced when complex training variables are individualized.

Multiple Measures are Needed to Quantify Training Loads in Professional Rugby League.

This study aims to investigate the effect of training mode (conditioning and skills) on multivariate training load relationships in professional rugby league via principal component analysis. Four measures of training load (internal: heart rate exertion index, session rating of perceived exertion; external: PlayerLoad™, individualised high-speed distance) were collected from 23 professional male rugby league players over the course of one 12 wk preseason period. Training was categorised by mode (skills or conditioning) and then subjected to a principal component analysis. Extraction criteria were set at an eigenvalue of greater than 1. Modes that extracted more than 1 principal component were subject to a varimax rotation. Skills extracted 1 principal component, explaining 57% of the variance. Conditioning extracted 2 principal components (1st: internal; 2nd: external), explaining 85% of the variance. The presence of multiple training load dimensions (principal components) during conditioning training provides further evidence of the influence of training mode on the ability of individual measures of external or internal training load to capture training variance. Consequently, a combination of internal and external training-load measures is required during certain training modes.

Complex Training: The Effect of Exercise Selection and Training Status on Postactivation Potentiation in Rugby League Players.

This study compared the postactivation potentiation (PAP) response of the hex bar deadlift (HBD) and back squat (BS) exercises. The PAP response between different levels of athletes was also compared. Ten professional and 10 amateur rugby league players performed 2 experimental sessions. Participants performed a countermovement jump (CMJ) before and 2, 4, 6, 8, 10, 12, 14, and 16 minutes after a conditioning activity (CA) that contained 1 set of 3 repetitions at 93% 1 repetition maximum of either HBD or BS. A force platform determined peak power output (PPO), force at PPO, velocity at PPO, and jump height of each CMJ. Surface electromyography (EMG) of the vastus lasteralis, rectus femoris, tibialis anterior, and gastrocnemius medialis of each participant's dominant leg was recorded during each CMJ. A further 10 participants performed a control trial without a CA. The HBD expressed PAP between 2 and 6 minutes post-CA, whereas the BS did not. The HBD exhibited a significantly (p ≤ 0.05) greater PAP response than the BS for PPO. There were no significant (p > 0.05) differences between stronger and weaker players. There were no significant (p > 0.05) changes in the EMG variables. These results suggest that HBD is a suitable CA for eliciting PAP in stronger and weaker athletes. Strength and conditioning coaches should consider the CA and time frame between the CA and the plyometric exercise for optimal PAP responses.

'I'm a failure again, I can't do it': Attitudes towards, and experiences of, exercise participation in adults with class III obesity.

OBJECTIVES: Living within a larger body brings unique challenges to exercise participation, which are poorly understood. This qualitative study explored the attitudes towards, and experiences of, exercise participation in adults with class III obesity. DESIGN: Individual semi-structured qualitative interviews. METHODS: We recruited 30 adults with class III obesity (body mass index: 45.8 ± 8.6 kg/m2) from a specialist multidisciplinary weight management service. Participants took part in semi-structured interviews while participating in a 6-month home-based aerobic and resistance exercise intervention. Open-ended questions were used flexibly to explore their views and experiences of exercise, encompassing barriers, motives and perceived benefits. Transcripts were analysed using reflexive thematic analysis. RESULTS: Three themes were developed: (1) a web of barriers; (2) tailored exercise facilitates positive experiences; and (3) a desire to live a normal life. People with class III obesity perceived that they were unable to do exercise; a view that was attributed to perceived judgement, low physical function, pain during everyday activities and failed weight loss attempts. These complex physical and psychosocial barriers to exercise were described as contributing to exercise avoidance. High value was placed on tailored exercise that accommodates the unique needs of moving in a larger body. A desire to carry out everyday tasks underpinned motivations for exercise. CONCLUSIONS: Our findings suggest that multi-component obesity interventions should move away from generic exercise prescriptions designed to maximize energy expenditure, and instead move towards addressing the unique physical and psychosocial needs of people who have class III obesity with tailored person-centred and weight-neutral exercise prescriptions.

Telerehabilitation for patients who have been hospitalised with covid-19: a qualitative study.

PURPOSE: The aim of this qualitative study was to explore the views of participants of a group-based, supervised, telerehabilitation programme, following discharge from hospital with Covid-19. This study was part of a single-centre, fast-track (wait-list), randomised, mixed-methods, feasibility trial of telerehabilitation (Registration: Clinicaltrials.gov reference:285205). METHODS: Semi-structured interviews were conducted over a virtual teleconference platform with 10 participants who took part in a telerehabilitation programme following Covid-19 after discharge from an acute hospital. Data were transcribed verbatim and analysed using thematic analysis. RESULTS: Five themes were important from the participant perspective: telerehabilitation programme as part of the Covid-19 journey; the telerehabilitation programme design and delivery; peer aspects; the role of the instructor; and the role of technology and online delivery. CONCLUSIONS: Overall, the telerehabilitation programme was a positive experience for participants. The instructors were central to this positive view as was the group nature of the programme. The group aspect was particularly important in supporting the broader perceived wellbeing gains, such as the sense of enjoyment and reduced social isolation. Several participants would have liked to have continued with the exercises beyond the six-week intervention indicating that the programme could be a way to help people sustain a physically active lifestyle.IMPLICATIONS FOR REHABILITATIONParticipants who were recovering from Covid-19 following hospital admission perceived the telerehabilitation to be a positive experience overall.The group aspect of the telerehabilitation programme was important in supporting the broader perceived wellbeing gains such as the sense of enjoyment and reduced social isolation.Telerehabilitation programmes for Covid-19 may need to include pathways for participants to continue to engage in exercise beyond the time-limited six-week intervention to support ongoing self-management.

Validation of field-based running tests to determine maximal aerobic speed in professional rugby league.

Practitioners place importance on high-speed running (HSR) to monitor training practice and match-play demands, whilst attempting to maximise fitness and minimize the risk of injury occurrence. Practitioners apply various methods to quantify HSR, such as absolute thresholds, percentage of maximum sprint speed and maximal aerobic speed (MAS). A recent survey demonstrates the 5-minute run and 1200m shuttle test (ST) to be implemented among rugby league practitioners to quantify HSR by incorporating MAS. However, it is unclear as to how valid these methods are to accurately quantify MAS. Therefore, the aim of this study was to assess the validity of the 5-minute run and 1200m ST when compared to a gold standard measure for MAS. Twenty 1st team professional rugby league players competing in the European Super League participated in this study. Players were required to complete an incremental treadmill test, 5-minute run and 1200m ST over a two-week period in pre-season. MAS, peak heart rate (HRmax), peak lactate (Lapeak) and rating of perceived exertion (RPE) where collected upon completion of each test. Results demonstrated the 1200m ST to have a higher correlation for MAS than the 5-minute run (1200m ST: r = 0.73, 5-minute run: r = 0.64). However, when assessing validity using the level of agreement between data, the 5-minute run underreported MAS by 0.45 m·s-1 whereas the 1200m ST underreported MAS by 0.77 m·s-1. Ultimately, both field-based tests used in this study underreport MAS when compared to an incremental treadmill test, although the 5-minute run provides a closer agreement and therefore a more valid measurement for MAS than the 1200m ST.

The Effect of Complex Training on Physical Performance in Rugby League Players.

PURPOSE: To compare the effects of variable-resistance complex training (VRCT) versus traditional complex training (TCT) on strength, power, speed, and leg stiffness (Kleg) in rugby league players during a 6-week mesocycle. METHODS: Twenty-four rugby league players competing in the British University and Colleges Sport Premier North Division were randomized to VRCT (n = 8), TCT (n = 8), or control (CON; n = 8). Experimental groups completed a 6-week lower-body complex training intervention (2×/wk) that involved alternating high-load resistance exercise with plyometric exercise within the same session. The VRCT group performed resistance exercises at 70% of 1-repetition maximum (1RM) + 0% to 23% of 1RM from band resistance with a 90-second intracontrast rest interval, whereas the TCT group performed resistance exercise at 93% of 1RM with a 4-minute intracontrast rest interval. Back-squat 1RM, countermovement jump peak power, reactive strength index, sprint times, and Kleg were assessed pretraining and posttraining. RESULTS: VRCT and TCT significantly improved 1RM back squat, countermovement jump peak power, and 5-m sprint time (all P < .05). VRCT also improved Kleg, whereas TCT improved 10- and 20-m sprint times (all P < .05). Between groups, both VRCT and TCT improved 1RM back squat compared with CON (both P < .001). Additionally, VRCT improved Kleg compared with CON (right leg: P = .016) and TCT improved 20-m sprint time compared with CON (P = .042). CONCLUSIONS: VRCT and TCT can be implemented during the competitive season to improve strength, power, and 5-m sprint time. VRCT may lead to greater improvements in reactive strength index and Kleg, whereas TCT may enhance 10- and 20-m sprint times.

The Effect of Complex Training on Muscle Architecture in Rugby League Players.

PURPOSE: To compare the effects of variable-resistance complex training (VRCT) versus traditional complex training (TCT) on muscle architecture in rugby league players during a 6-week mesocycle. METHODS: Twenty-four rugby league players competing in the British University & Colleges Sport (BUCS) Premier North Division were randomized to VRCT (n = 8), TCT (n = 8), or control (n = 8). Experimental groups completed a 6-week lower-body complex training intervention (2×/wk), which involved alternating high-load resistance exercise with plyometric exercise in the same session. The VRCT group performed resistance exercises at 70% of 1-repetition maximum (1RM) + 0% to 23% of 1RM from band resistance with a 90-second intracontrast rest interval, whereas the TCT group performed resistance exercise at 93% of 1RM with a 4-minute intracontrast rest interval. Muscle thickness (MT), pennation angle, and fascicle length (Lf) were assessed for the vastus lateralis (VL) and gastrocnemius medialis using ultrasound imaging. RESULTS: Both TCT and VRCT groups significantly improved VL MT and VL Lf compared with control (all P < .05). Standardized within-group changes in MT and Lf (Cohen dav ± 95% CI) were moderate for TCT (dav = 0.91 ± 1.0; dav = 1.1 ± 1.1) and unclear for VRCT (dav = 0.44 ± 0.99; dav = 0.47 ± 0.99), respectively. Differences in change scores between TCT and VRCT were unclear. CONCLUSIONS: VRCT and TCT can be utilized during the competitive season to induce favorable MT and Lf muscle architecture adaptations for the VL. TCT may induce greater muscle architecture adaptations of the VL, whereas VRCT may be of more practical value given the shorter intracontrast rest interval between resistance and plyometric exercises.

Digital Health Solutions for Weight Loss and Obesity: A Narrative Review.

Personal exercise programmes have long been used and prescribed for weight loss and the improvement of quality of life in obese patients. While individualised programmes are usually the preferred option, they can be more costly and challenging to deliver in person. A move to digital programmes with a wider reach has commenced, and demand has increased due to the SARS-CoV-2 pandemic. In this review, we evaluate the current status of digital exercise programme delivery and its evolution over the past decade, with a focus on personalisation. We used specific keywords to search for articles that met our predetermined inclusion and exclusion criteria in order to provide valuable evidence and insights for future research. We identified 55 studies in total in four key areas of focus, from the more recent development of apps and personal digital assistants to web-based programmes and text or phone call interventions. In summary, we observed that apps may be useful for a low-intensity approach and can improve adherence to programmes through self-monitoring, but they are not always developed in an evidence-based manner. Engagement and adherence are important determinants of weight loss and subsequent weight maintenance. Generally, professional support is required to achieve weight loss goals.

Group-based pulmonary telerehabilitation is feasible, safe, beneficial and well-received in patients who have been hospitalised with COVID-19.

Introduction: Coronavirus disease 2019 (COVID-19) has caused worldwide mass hospitalisation. The need for multidisciplinary post-hospitalisation rehabilitation is becoming increasingly apparent, and telerehabilitation has been endorsed. The aim of study was to investigate the feasibility and efficacy of pulmonary telerehabilitation for COVID-19 survivors. Methods: This was a single-centre, mixed-methods, fast-track (wait-list), randomised controlled trial of telerehabilitation for patients who had been hospitalised with COVID-19. 40 patients discharged from two university teaching hospitals in the north of England were recruited. Telerehabilitation consisted of 12 exercise classes, six education events and opportunity for peer support. Patients commenced telerehabilitation 14 days after randomisation in the fast-track group and 56 days after randomisation in the wait-list group. Outcome measures and results: Descriptive and statistical improvements were noted in several clinical outcome measures. Exercise capacity increased from a median (interquartile range) 20 (14-24) sit-to-stand repetitions in 1 min at baseline to 25 (24-30) post-telerehabilitation. Breathlessness rated using the Medical Research Council dyspnoea scale changed from 3.5 (3-4) at baseline to 2 (1.5-3) post-telerehabilitation, with additional favourable outcomes noted in respiratory symptoms measured using numerical rating scales and visual analogue scales (VAS). Quality of life measured using the EuroQol VAS improved from 55 (60-70) units at baseline to 70 (55-80) units following telerehabilitation. Improvements in fatigue (modified Functional Assessment of Chronic Illness Therapy: Fatigue) and mood (Hospital Anxiety and Depression Scale - Depression) were also observed. Natural recovery was observed in the wait-list group prior to receiving telerehabilitation; however, improvements were accelerated by early telerehabilitation in the fast-track group. Conclusions: We have shown that group-based telerehabilitation is feasible, safe, beneficial and well-received in this population.

Exercise prehabilitation in elective intra-cavity surgery: A role within the ERAS pathway? A narrative review.

The Enhanced Recovery after Surgery (ERAS) model integrates several elements of perioperative care into a standardised clinical pathway for surgical patients. ERAS programmes aim to reduce the rate of complications, improve surgical recovery, and limit postoperative length of hospital stay (LOHS). One area of growing interest that is not currently included within ERAS protocols is the use of exercise prehabilitation (PREHAB) interventions. PREHAB refers to the systematic process of improving functional capacity of the patient to withstand the upcoming physiological stress of surgery. A number of recent systematic reviews have examined the role of PREHAB prior to elective intra-cavity surgery. However, the results have been conflicting and a definitive conclusion has not been obtained. Furthermore, a summary of the research area focussing exclusively on the therapeutic potential of exercise prior to intra-cavity surgery is yet to be undertaken. Clarification is required to better inform perioperative care and advance the research field. Therefore, this "review of reviews" provides a critical overview of currently available evidence on the effect of exercise PREHAB in patients undergoing i) coronary artery bypass graft surgery (CABG), ii) lung resection surgery, and iii) gastrointestinal and colorectal surgery. We discuss the findings of systematic reviews and meta-analyses and supplement these with recently published clinical trials. This article summarises the research findings and identifies pertinent gaps in the research area that warrant further investigation. Finally, studies are conceptually synthesised to discuss the feasibility of PREHAB in clinical practice and its potential role within the ERAS pathway.

Combining internal- and external-training-load measures in professional rugby league.

PURPOSE: This study investigated the effect of training mode on the relationships between measures of training load in professional rugby league players. METHODS: Five measures of training load (internal: individualized training impulse, session rating of perceived exertion; external-body load, high-speed distance, total impacts) were collected from 17 professional male rugby league players over the course of two 12-wk preseason periods. Training was categorized by mode (small-sided games, conditioning, skills, speed, strongman, and wrestle) and subsequently subjected to a principal-component analysis. Extraction criteria were set at an eigenvalue of greater than 1. Modes that extracted more than 1 principal component were subjected to a varimax rotation. RESULTS: Small-sided games and conditioning extracted 1 principal component, explaining 68% and 52% of the variance, respectively. Skills, wrestle, strongman, and speed extracted 2 principal components each explaining 68%, 71%, 72%, and 67% of the variance, respectively. CONCLUSIONS: In certain training modes the inclusion of both internal and external training-load measures explained a greater proportion of the variance than any 1 individual measure. This would suggest that in training modes where 2 principal components were identified, the use of only a single internal or external training-load measure could potentially lead to an underestimation of the training dose. Consequently, a combination of internal- and external-load measures is required during certain training modes.

Protected areas in tropical Africa: assessing threats and conservation activities.

Numerous protected areas (PAs) have been created in Africa to safeguard wildlife and other natural resources. However, significant threats from anthropogenic activities and decline of wildlife populations persist, while conservation efforts in most PAs are still minimal. We assessed the impact level of the most common threats to wildlife within PAs in tropical Africa and the relationship of conservation activities with threat impact level. We collated data on 98 PAs with tropical forest cover from 15 countries across West, Central and East Africa. For this, we assembled information about local threats as well as conservation activities from published and unpublished literature, and questionnaires sent to long-term field workers. We constructed general linear models to test the significance of specific conservation activities in relation to the threat impact level. Subsistence and commercial hunting were identified as the most common direct threats to wildlife and found to be most prevalent in West and Central Africa. Agriculture and logging represented the most common indirect threats, and were most prevalent in West Africa. We found that the long-term presence of conservation activities (such as law enforcement, research and tourism) was associated with lower threat impact levels. Our results highlight deficiencies in the management effectiveness of several PAs across tropical Africa, and conclude that PA management should invest more into conservation activities with long-term duration.