Vastly Different Exercise Programs Similarly Improve Parkinsonian Symptoms: A Randomized Clinical Trial.

OBJECTIVES: To directly compare the effects of agility exergaming (EXE) and stationary cycling (CYC) exercise training on Parkinson's disease (PD) patients' mobility and clinical symptoms. DESIGN: Randomized clinical trial. SETTING: Outpatient physiotherapy clinic in a hospital. PARTICIPANTS: Seventy-four stage 2-3, nondemented PD patients were included in this study. INTERVENTION: The groups were as follows: EXE (n = 25), CYC (n = 25), and a wait-listed control group (CON; n = 24). The EXE and CYC groups exercised 5×/week for 5 weeks, matched at 80% of the age-predicted maximal heart rate. MAIN OUTCOMES: The primary outcome was the Movement Disorders Society Unified Parkinson's Disease Rating Scale (UPDRS-II) score. Secondary outcomes were Parkinson's Disease Quastionnaire-39 (PDQ-39), the Beck Depression Inventory (BDI), the Schwab and England Activities of Daily Living (SE-ADL) scale, Euro-Quality of Life-5 Dimensions (EQ-5D) questionnaire, the Berg Balance Scale (BBS), the Balance Evaluation Systems Test (BESTest), the Tinetti Assessment Tool (TAT), the Dynamic Gait Index, the 6-min walk test (6MWT), and standing posturography. RESULTS: After treatment, UPDRS-II scores improved (mean change: EXE, -4.5 points; CYC, -3.2 points). The results for the other outcomes (EXE and CYC, respectively) were: PDQ, 13 and 17%; BDI, -2.5 and -2.1 points; 6MWT, 129.6 and 141.6 m; and EQ-5D, 12 and 9% (all p < 0.05, but there was no difference between groups). EXE vs. CYC resulted in improved SE-ADL (8.4 and 4.0 points, effect size [ES]: 0.12), BBS (8.8 and 4.2 points, ES: 0.44), and 2 measures of posturography (ES: 0.11 and 0.21) (p < 0.05). BESTtest, TAT, the Dynamic Gait Index, and 4 out of 6 posturography measures did not change (p > 0.05). CONCLUSION: Two highly different exercise programs resulted in similar improvement of most motor and clinical symptoms in PD patients.

Breast cancer survivors' preferences for technology-supported exercise interventions.

PURPOSE: The purpose of this study was to explore breast cancer survivors' interest in and preferences for technology-supported exercise interventions. METHODS: Post-treatment survivors [n = 279; M age = 60.7 (SD = 9.7)] completed a battery of online questionnaires in August 2015. Descriptive statistics were calculated for all data. Logistic regression analyses were conducted to examine relationships between survivors' interest in a technology-supported exercise interventions and demographic, disease, and behavioral factors. These same factors were examined in relation to perceived effectiveness of such interventions using multiple regression analyses. RESULTS: About half (53.4%) of survivors self-reported meeting public health recommendations for physical activity. Fewer than half reported using an exercise or diet mobile app (41.2%) or owning an activity tracker (40.5%). The majority were interested in receiving remotely delivered exercise counseling (84.6%), participating in a remotely delivered exercise intervention (79.5%), and using an exercise app or website (68%). Survivors reported that the most helpful technology-supported intervention components would be an activity tracker (89.5%), personalized feedback (81.2%), and feedback on how exercise is influencing mood, fatigue, etc. (73.6%). Components rated as least helpful were social networking integration (31.2%), group competitions (33.9%), and ability to see others' progress (35.1%). CONCLUSIONS: Preferences for technology-supported exercise interventions varied among breast cancer survivors. Nonetheless, data indicate that technology-supported interventions may be feasible and acceptable. Engaging stakeholders may be important in developing and testing potential intervention components.

[PHYSICAL EXERCISE FOR PEOPLE WITH MULTIPLE SCLEROSIS: EFFECTS, RECOMMENDATIONS AND BARRIERS].

This review summarizes the existing knowledge regarding the effects and recommendations for physical training (PTr) in patients with multiple sclerosis (MS). In addition, perceived benefits and barriers to PTr in this population are reviewed. One of the primary aims of rehabilitation for patients with MS is to increase their levels of activity and independence. PTr is a central component in the rehabilitation process. Nonetheless, the use of PTr in the rehabilitation of patients with MS has been a controversial issue for years. Nowadays, strong evidence exists that aerobic training in individuals with MS has a positive effect on overall physical conditioning, gait speed, fatigue, depression and cognition. Unlike aerobic training, the number of studies that investigated strength training effects in this population is limited. However, the available data show that resistance training also has beneficial effects on MS patients. It is important to note, that PTr has no deleterious effects in MS patients. In the various studies, there was diversity with regard to the duration and the frequency of PTr, while intensity was often poorly described. It is recommended that individuals with MS engage in aerobic training (at 60-80% of maximal heart rate), strength training (1-3 sets of 8-15 repetitions), the range of motion, balance and ambulation exercises. Awareness of the benefits of physical activity and sense of achievement are not sufficient to promote exercise participation in persons with MS. Factors relating to physical exertion, sports facilities availability and self-efficacy play an important role in promoting exercise participation.

Model and effectiveness of endurance exercise to increase physical fitness in intellectual disability subjects with obesity: a randomized controlled trial.

AIM: to design a model and assess the effectiveness of endurance exercise to increase physical fitness in intelectual disability (ID) patients with obesity. METHODS: a randomized-controlled clinical trial was performed in ID patients with obesity aged 10-30 years old from all Special School in DKI Jakarta, which were randomly allocated into 3 groups and then given 3 different type of exercises: lower extremity muscles endurance exercise for 20 RM followed by cardiorespiratory endurance exercise for 24-25 minutes (type I), lower extremity muscles endurance exercises for 10 RM followed by cardiorespiratory endurance exercises for 26-27 minutes (type II), and threw a tennis ball with 10 m distance for 10 minutes as control (type III). These program was performed 3 times a week for 4 months. Assesment of the exercise effectiveness was done by measuring maximum load that can be lifted and six-minutes walking test on rectangular track which was converted with the VO2 max prediction formula. Analysis was perfomed with Kruskal Wallis test. RESULTS: two hundred and twelve (212) subjects were included in the study, randomly allocated into three types (I, II, and III) of exercises groups. The type II of endurance exercise model was proved to be more effective in increasing lower extremity muscles endurance level compared to type I and III for ID patients with obesity (p<0.05). Meanwhile, type I of endurance exercise model was proved to be more effective in increasing cardiorespiratory endurance level compared to type II and III for ID patients with obesity (p<0.05). CONCLUSION: lower extremity muscles endurance exercise followed by a cardiorespiratory endurance exercise can be used to increase physical fitness in ID patients with obesity.

Subgroup effects in a randomised trial of different types and doses of exercise during breast cancer chemotherapy.

BACKGROUND: The Combined Aerobic and Resistance Exercise Trial tested different types and doses of exercise in breast cancer patients receiving chemotherapy. Here, we explore potential moderators of the exercise training responses. METHODS: Breast cancer patients initiating chemotherapy (N=301) were randomly assigned to three times a week, supervised exercise of a standard dose of 25-30 min of aerobic exercise, a higher dose of 50-60 min of aerobic exercise, or a higher dose of 50-60 min of combined aerobic and resistance exercise. Outcomes were patient-reported symptoms and health-related fitness. Moderators were baseline demographic, exercise/fitness, and cancer variables. RESULTS: Body mass index moderated the effects of the exercise interventions on bodily pain (P for interaction=0.038), endocrine symptoms (P for interaction=0.029), taxane/neuropathy symptoms (P for interaction=0.013), aerobic fitness (P for interaction=0.041), muscular strength (P for interaction=0.007), and fat mass (P for interaction=0.005). In general, healthy weight patients responded better to the higher-dose exercise interventions than overweight/obese patients. Menopausal status, age, and baseline fitness moderated the effects on patient-reported symptoms. Premenopausal, younger, and fitter patients achieved greater benefits from the higher-dose exercise interventions. CONCLUSIONS: Healthy weight, fitter, and premenopausal/younger breast cancer patients receiving chemotherapy are more likely to benefit from higher-dose exercise interventions.

The effects of phase III cardiac rehabilitation in serum and salivary Hs-CRP and anthropometric measurements in patients with coronary artery disease.

AIM: Cardiac rehabilitation is a key part in the treatment of coronary artery disease (CAD) by its anti-infammatory effects. However, the effect of exercise training programs on salivary concentrations of high-sensitivity C-reactive protein (hs-CRP) in patients with coronary artery disease has not been well studied. The objective of this study was to evaluate the effect of phase III cardiac rehabilitation on serum and salivary levels of hs-CRP, in relation to the anthropometric measurements of obesity and the relationship between salivary and serum levels of hs-CRP in CAD male patients. MATERIALS AND METHODS: Forty male volunteers (45-75 years) with CAD participated in 6 to 8 weeks of moderate intensity aerobic exercise training consisting of 45 minutes sessions of treadmill, stationary bicycle and arm ergometer. Anthropometric measurements of obesity, serum level of hs-CRP, stimulated and nonstimulated salivary level of hs-CRP were measured at the beginning, in the middle and at the end of exercise sessions. RESULTS: All anthropometric measurements increased (p < 0.05) following cardiac rehabilitation except waist-hip ratio. Serum hs-CRP level reduced by 36% independent to the anthropometric measurements changes. Stimulated and nonstimulated salivary hs-CRP level decreased 68 and 54%, respectively, after 24 sessions of cardiac rehabilitation. Nonstimulated salivary hs-CRP levels correlated to serum levels of hs-CRP at baseline and after 24 sessions (p < 0.05). CONCLUSION: Phase III cardiac rehabilitation seems to be effective to improve serum and salivary hs-CRP concentrations independent of anthropometric measurements. CLINICAL SIGNIFICANCE: Nonstimulated salivary hs-CRP measurement could be a surrogate for blood measurement of hs-CRP during cardiac rehabilitation in male patients with CAD.

Effect of different types of exercises on psychological and cognitive features in people with Parkinson's disease: A randomized controlled trial.

BACKGROUND: Parkinson's disease (PD) is a neurodegenerative and progressive disease marked by the presence of motor and non-motor symptoms, as psychological and cognitive impairment. Physical exercises have been prescribed as complementary therapy for PD, and the type of intervention and duration of the intervention should be taken into account. OBJECTIVE: We aimed to compare the effect of different exercise modalities (functional mobility, multimodal and cognitive) and length (4 and 8 months) on psychological and cognition in people with PD. This study followed the CONSORT extension for non-pharmacological trials. METHODS: In this randomized controlled trial, we assessed 107 participants between 2011 and 2013. At the end of 3 years, participants with PD (mild to moderate stages) who achieved the criteria were assessed considering 3 different groups of exercise: Multimodal (n=38), Functional Mobility (n=33) and Mental/Leisure (n=36). All 3 interventions were performed for 32 weeks, twice a week, with 60min for each session (64 sessions in total). Psychological and cognitive function were assessed at baseline and after 4 and 8 months. RESULTS: The Functional Mobility and Mental/Leisure training had a potential effect on maintaining cognitive function (executive function, attention and work memory). The Multimodal training did not show a benefit for cognitive features and was not even able to delay the progressive decline in cognitive functions; however, this modality had a positive effect on physical stress after 8 months of exercise. CONCLUSIONS: An intervention that requires high complexity and specific activities, such as locomotor and cognitive exercise, provides a maintenance effect against the degeneration in cognition associated with the progression of PD and thus can delay the progressive decline in cognitive function in PD.

The effects of a 12-week jump rope exercise program on body composition, insulin sensitivity, and academic self-efficacy in obese adolescent girls.

Background Childhood obesity is strongly associated with the development of cardiovascular disease (CVD). Exercise interventions have been used for obese children and adolescents to prevent the manifestation of CVD risks, such as hypertension and insulin resistance (IR). Additionally, obesity has been shown to be linked to low self-efficacy in adolescents, which has been shown to negatively impact academic performance. Therefore, the purpose of this study was to examine the effects of a 12-week jump rope exercise program on body composition, CVD risk factors, and academic self-efficacy (ASE) in obese adolescent girls with prehypertension. Methods Adolescent girls with prehypertension and obesity (n = 48, age 14-16 years) were randomly assigned to either the jump rope exercise group (EX, n = 24) or the control group (CON, n = 24). Body composition, blood pressure (BP), blood glucose, insulin levels, homeostatic model assessment of insulin resistance (HOMA-IR) (marker of IR), and ASE were assessed before and after 12 weeks of exercise training or control. Results There were significant group × time interactions following the 12-week exercise program for body fat percent, waist circumference (WC), systolic blood pressure (SBP), blood glucose, insulin levels, and HOMA-IR, which were all significantly reduced (p < 0.05). A significant improvement (p <0.05) was observed in task difficulty preference (TDP) and self-regulatory efficacy (SRE) following exercise training. Additionally, ASE was strongly correlated (r = -0.58) with body composition. Conclusions This study provides evidence that jump rope exercise intervention can be a useful therapeutic treatment to improve CVD risk factors and ASE in obese adolescent girls with prehypertension.

Land-based versus pool-based exercise for people awaiting joint replacement surgery of the hip or knee: results of a randomized controlled trial.

OBJECTIVE: To compare the preoperative effects of multidimensional land-based and pool-based exercise programs for people awaiting joint replacement surgery of the hip or knee. DESIGN: Randomized, single-blind, before-after trial. SETTING: Physiotherapy gymnasium and hydrotherapy pool. PARTICIPANTS: Patients awaiting elective hip or knee joint replacement surgery. INTERVENTIONS: Land-based (n=40) or pool-based exercise program (n=42). Each 6-week program included an education session, twice-weekly exercise classes, and an occupational therapy home assessment. MAIN OUTCOME MEASURES: Participants were assessed immediately before and after the 6-week intervention, then 8 weeks later. Primary outcomes were pain and self-reported function (Western Ontario and McMaster Universities Osteoarthritis Index) and patient global assessment. Secondary outcomes were performance-based measures (timed walk and chair stand) and psychosocial status (Medical Outcomes Study 36-Item Short-Form Health Survey mental component score). Pain was also measured before and after each exercise class on a 7-point verbal rating scale. RESULTS: Although both interventions were effective in reducing pain and improving function, there were no postintervention differences between the groups for the primary and secondary outcomes. However, the pool-based group had less pain immediately after the exercise classes. CONCLUSIONS: While our multidimensional exercise-based interventions appeared to be effective in reducing disability in those awaiting joint replacement surgery of the hip or knee, there were no large differences in the postintervention effects of the interventions. However, pool-based exercise appeared to have a more favorable effect on pain immediately after the exercise classes.

A preliminary study to examine the effects of aerobic and therapeutic (nonaerobic) exercise on cardiorespiratory fitness and coronary risk reduction in stroke survivors.

OBJECTIVES: To compare the effects of 3 different exercise training regimens on cardiorespiratory fitness and coronary risk factor reduction in subjects with unilateral stroke. DESIGN: A cluster assignment by residential location repeated-measures design. SETTING: University-based medical center. PARTICIPANTS: Fifty-five subjects with unilateral ischemic stroke were assigned to the following groups: intensity (n=18), duration (n=19), and therapeutic exercise (n=18). INTERVENTION: A 14-week intervention with subjects randomized to 1 of 3 interventions: (1) moderate intensity, shorter duration (MISD) exercise (gradually increasing exercise intensity while keeping exercise duration constant at 30 min), (2) low-intensity, longer duration (LILD) exercise (gradually increasing duration to 60 min while keeping exercise intensity constant), or (3) conventional therapeutic exercise (TE) consisting mainly of strength, balance, and range of motion activities. All groups exercised 3 days per week. MAIN OUTCOME MEASURES: Peak oxygen consumption (VO2peak), submaximal oxygen consumption (VO2), lipid panel, and resting blood pressure. RESULTS: The MISD group attained more favorable effects on systolic (P<.04) and diastolic blood pressure (P<.002) and total cholesterol (TC) (P<.036) compared with LILD and TE groups. Both MISD (P<.029) and LILD (P<.045) showed significant reductions in triglycerides compared with TE (P<.029). There was no significant change in VO2peak and submaximal VO2 in any of the groups. CONCLUSIONS: Overall, both MISD and LILD conditions achieved greater clinical and significant gains in coronary risk reduction compared with TE.

Meta-analysis of Exercise Training on Left Ventricular Ejection Fraction in Heart Failure with Reduced Ejection Fraction: A 10-year Update.

BACKGROUND: The role of exercise training modality to attenuate left ventricular (LV) remodeling in heart failure patients with reduced ejection fraction (HFrEF) remains uncertain. The authors performed a systematic review and meta-analysis of published reports on exercise training (moderate-intensity continuous aerobic, high-intensity interval aerobic, and resistance exercise) and LV remodeling in clinically stable HFrEF patients. METHODS: We searched MEDLINE, Cochrane Central Registry of Controlled Trials, CINAHL, and PubMed (2007 to 2017) for randomized controlled trials of exercise training on resting LV ejection fraction (EF) and end-diastolic and end-systolic volumes in HFrEF patients. RESULTS: 18 trials reported LV ejection fraction (LVEF) data, while 8 and 7 trials reported LV end-diastolic and LV end-systolic volumes, respectively. Overall, moderate-intensity continuous training (MICT) significantly increased LVEF (weighted mean difference, WMD = 3.79%; 95% confidence interval, CI, 2.08 to 5.50%) with no change in LV volumes versus control. In trials ≥6 months duration, MICT significantly improved LVEF (WMD = 6.26%; 95% CI 4.39 to 8.13%) while shorter duration (<6 months) trials modestly increased LVEF (WMD = 2.33%; 95% CI 0.84 to 3.82%). High-intensity interval training (HIIT) significantly increased LVEF compared to control (WMD = 3.70%; 95% CI 1.63 to 5.77%) but was not different than MICT (WMD = 3.17%; 95% CI -0.87 to 7.22%). Resistance training performed alone or combined with aerobic training (MICT or HIIT) did not significantly change LVEF. CONCLUSIONS: In clinically stable HFrEF patients, MICT is an effective therapy to attenuate LV remodeling with the greatest benefits occurring with long-term (≥6 months) training. HIIT performed for 2 to 3 months is superior to control, but not MICT, for improvement of LVEF.

Effects of the Schroth exercise on idiopathic scoliosis: a meta-analysis.

INTRODUCTION: The purpose of this study was to examine the effects of the Schroth exercise on idiopathic scoliosis. The overall effect size was analyzed in 15 primary studies and a subgroup analysis of the standardized mean differences of effect sizes from 15 primary studies was also conducted. EVIDENCE ACQUISITION: We used PUBMED, MEDLINE, NDSL, EMBASE, and Web of Science. The key terms used in these searches were "Schroth," "scoliosis-specific exercise," "scoliosis," and "idiopathic scoliosis." EVIDENCE SYNTHESIS: Cobb's angle, asymmetry, angle of trunk rotation (ATR), strength of back extensor, strength of trunk flexor, quality of life (QOL), balance, chest expansion, and pulmonary function were coded as outcome measures for computing effect sizes. Potential moderating variables of the Schroth exercise included: 1) pre-intervention severity of the scoliosis; 2) duration; and 3) specific types of Schroth exercise. CONCLUSIONS: The overall effect size of the Schroth exercise is high (g=0.724). In addition, Schroth exercise may be more beneficial for scoliosis patients who have a 10 to 30° Cobb's angle than for those with a greater than 30° Cobb's angle. Patients should practice the exercise for at least one month to have a better effect. Thus, therapists should consider patients' initial curve status and exercise duration before prescribing the Schroth exercise program. Core muscle strength was most influenced, and structural deformity also changed after the Schroth exercise. In sum, the Schroth exercise is a recommended treatment method for scoliosis patients.

Systematic literature review of treatment interventions for upper extremity hemiparesis following stroke.

The primary purpose of this review article is to critically analyse the literature from 1999 to 2005 regarding effective interventions for upper extremity hemiparesis following stroke. The researchers narrowed the scope of the review based on inclusion and exclusion criteria, which yielded 11 pertinent studies congruent with the selection criteria. Studies were categorized using Sackett's levels of evidence, level I being the highest degree of certainty and level V the lowest. Grades of recommendations were then developed, grade A being highly recommended, grade B discretionary and grade C not endorsed. Two studies were endorsed as level I - grade A, six were level II - grade B, and three were level III - grade C. Clinical recommendations inferred from the present evaluation are as follows:* Electrical stimulation can be used to improve upper limb outcomes in patients with moderate to severe upper limb dysfunction and is feasible for home-based interventions.* Therapy that utilizes goal-directed reaching behaviours promotes more typical reaching patterns than non-goal-directed interventions.* Reach-to-grasp movements show greater improvement when compensatory trunk movements are reduced.* As an addition to regular exercise therapy time, Arm BASIS training may enhance selective movements of the upper extremity (i.e. reaching).* When performed in conjunction with active neuromuscular stimulation, random and blocked practice may improve pre-motor, motor and total reaction times of the upper extremity.

Prescribing exercise at varied levels of intensity and frequency: a randomized trial.

BACKGROUND: Regular physical activity produces beneficial effects on health, but the exercise prescription needed to improve cardiovascular disease risk factors in free-living sedentary individuals remains unclear. METHODS: Sedentary adults (N = 492, 64.0% women) were randomized to 1 of 4 exercise-counseling conditions or to a physician advice comparison group. The duration (30 minutes) and type (walking) of exercise were held constant, while exercise intensity and frequency were manipulated to form 4 exercise prescriptions: moderate intensity-low frequency, moderate intensity-high frequency (HiF), hard intensity (HardI)-low frequency, and HardI-HiF. Comparison group participants received physician advice and written materials regarding recommended levels of exercise for health. Outcomes included 6- and 24-month changes in cardiorespiratory fitness (maximum oxygen consumption), high-density lipoprotein cholesterol (HDL-C) level, and the total cholesterol-HDL-C ratio. RESULTS: At 6 months, the HardI-HiF, HardI-low-frequency, and moderate-intensity-HiF conditions demonstrated significant increases in maximum oxygen consumption (P < .01 for all), but only the HardI-HiF condition showed significant improvements in HDL-C level (P < .03), total cholesterol-HDL-C ratio (P < .04), and maximum oxygen consumption (P < .01) compared with physician advice. At 24 months, the increases in maximum oxygen consumption remained significantly higher than baseline in the HardI-HiF, HardI-low-frequency, and moderate-intensity-HiF conditions and in the HardI-HiF group compared with physician advice (P < .01 for all), but no significant effects on HDL-C level (P = .57) or total cholesterol-HDL-C ratio (P = .64) were observed. CONCLUSIONS: Exercise counseling with a prescription for walking at either a HardI or a HiF produced significant long-term improvements in cardiorespiratory fitness. More exercise or the combination of HardI plus HiF exercise may provide additional benefits, including larger fitness changes and improved lipid profiles.

Spinal-Exercise Prescription in Sport: Classifying Physical Training and Rehabilitation by Intention and Outcome.

CONTEXT: Identification of strategies to prevent spinal injury, optimize rehabilitation, and enhance performance is a priority for practitioners. Different exercises produce different effects on neuromuscular performance. Clarity of the purpose of a prescribed exercise is central to a successful outcome. Spinal exercises need to be classified according to the objective of the exercise and planned physical outcome. OBJECTIVE: To define the modifiable spinal abilities that underpin optimal function during skilled athletic performance, clarify the effect of spinal pain and pathologic conditions, and classify spinal exercises according to the objective of the exercise and intended physical outcomes to inform training and rehabilitation. DESIGN: Qualitative study. DATA COLLECTION AND ANALYSIS: We conducted a qualitative consensus method of 4 iterative phases. An exploratory panel carried out an extended review of the English-language literature using CINAHL, EMBASE, MEDLINE, and PubMed to identify key themes and subthemes to inform the definitions of exercise categories, physical abilities, and physical outcomes. An expert project group reviewed panel findings. A draft classification was discussed with physiotherapists (n = 49) and international experts. Lead physiotherapy and strength and conditioning teams (n = 17) reviewed a revised classification. Consensus was defined as unanimous agreement. RESULTS: After the literature review and subsequent analysis, we defined spinal abilities in 4 categories: mobility, motor control, work capacity, and strength. Exercises were subclassified by functionality as nonfunctional or functional and by spinal displacement as either static (neutral spinal posture with no segmental displacement) or dynamic (dynamic segmental movement). The proposed terminology and classification support commonality of language for practitioners. CONCLUSIONS: The spinal-exercise classification will support clinical reasoning through a framework of spinal-exercise objectives that clearly define the nature of the exercise prescription required to deliver intended physical outcomes.

Immobility: geriatric self-learning module.

The Geriatric Resource Nurse Model is used at the University of Virginia to improve the competency of staff in caring for older adults. Eight self-learning educational modules were developed to address common concerns in hospitalized elders. The Immobility. Geriatric Self-Learning Module is published here, along with a post-test. This is the third in a four-part publication of self-learning modules.

Development of an Ontology to Recommend Exercises from Conceptual Maps.

The recommendation of exercise plans requires several variables to be considered (e.g., patient's conditions and preferences) and are normally complex to analyze. To facilitate this analysis we proposed the creation of an ontology to assist professionals to recommend exercises. We interviewed 2 experts and this resulted in IDEF diagram and conceptual map. The conceptual map proved to be the preferred way that experts gained more understanding compared with the IDEF diagram. In addition, we also used the conceptual map to validate the formal structure of experts' ideas. From the conceptual map we created an ontology that is being reviewed. After this, we plan to incorporate the ontology into a decision support system that will assist professionals to recommend exercises for their patients.

Exercise training intensity prescription in breast cancer survivors: validity of current practice and specific recommendations.

PURPOSE: Cancer survivors are recommended to perform 150 min/week of moderate or 75 min/week of vigorous aerobic exercise, but it remains unclear how moderate and vigorous intensities can be prescribed. Therefore, it was investigated whether and how intensity prescriptions for healthy adults by the American College of Sports Medicine (ACSM) need to be adapted for breast cancer survivors. METHODS: Fifty-two breast cancer survivors (stage 0-III, age 52 ± 9 years, BMI 25.4 ± 3.5 kg/m2) performed cardiopulmonary exercise tests at the end of primary therapy. Intensity classes defined as percentages of maximal heart rate (HRmax), heart rate reserve (HRR), and maximal oxygen uptake (VO2max) were compared to the ACSM's intensity classes using oxygen uptake reserve as reference. RESULTS: The prescriptions for moderate and vigorous exercise intensities were significantly different between breast cancer survivors and healthy adults when using VO2max (moderate 50-66 vs. 46-63 and vigorous 67-91 vs. 64-90% VO2max) or HRR (moderate 26-50 vs. 40-59 and vigorous 51-88 vs. 60-89 % HRR), but not when using HRmax (moderate 65-76 vs. 64-76 and vigorous 77-94 vs. 77-95% HRmax). CONCLUSIONS: In breast cancer survivors, intensity prescriptions for healthy adults result in considerably too intense training if HRR is used as guiding factor. Prescriptions using VO2max result in a slightly too low exercise intensity, whereas recommendations in percentages of HRmax appear valid. IMPLICATIONS FOR CANCER SURVIVORS: Cancer survivors should not uncritically adopt exercise intensity prescriptions for healthy adults. Specific prescriptions for the studied population are provided.