ABSTRACT
Exercise oncology clinical trials contribute to the advancement of our scientific knowledge and to the safety and care of patients diagnosed with cancer. Nevertheless, regulatory reviewers and committees may not be familiar with the well-documented long-term health benefits and safety of the regular practice of physical activity. Moreover, they may not see how the benefits outweigh the risks in the context where patients diagnosed with cancer are typically seen as vulnerable. Therefore, we would like to provide a purpose-built overview of exercise oncology clinical trials for members involved in institutional review committees, including the Scientific Review Committee (SRC), the Institutional Review Board (IRB), and the Data Safety Monitoring Committee (DSMC) to facilitate a greater understanding of the safety and benefits of physical activity during cancer treatments. Communication is key to improve the success of exercise oncology clinical trials, which are vital for patients diagnosed with cancer.
Subject(s)
Ethics Committees, Research , Neoplasms , Humans , Medical Oncology , Neoplasms/therapy , Research Subjects , Clinical Trials as TopicABSTRACT
BACKGROUND: Multiple international organizations have called for exercise to become standard practice in the setting of oncology care. The feasibility of integrating exercise within systemic chemotherapy has not been investigated. METHODS: Patients slated to receive infusion therapy between April 2017 and October 2018 were screened for possible inclusion. The study goal was to establish the acceptability and feasibility of embedding an exercise professional into the chemotherapy infusion suite as a method of making exercise a standard part of cancer care. The exercise prescriptions provided to patients were individualized according to results of brief baseline functional testing. RESULTS: In all, 544 patients were screened, and their respective treating oncologists deemed 83% of them to be medically eligible to participate. After further eligibility screening, 226 patients were approached. Nearly 71% of these patients (n = 160) accepted the invitation to participate in the Exercise in All Chemotherapy trial. Feasibility was established because 71%, 55%, 69%, and 63% of the aerobic, resistance, balance, and flexibility exercises prescribed to patients were completed. Qualitative data also supported the acceptability and feasibility of the intervention from the perspective of patients and clinicians. The per-patient cost of the intervention was $190.68 to $382.40. CONCLUSIONS: Embedding an exercise professional into the chemotherapy infusion suite is an acceptable and feasible approach to making exercise standard practice. Moreover, the cost of the intervention is lower than the cost of other common community programs. Future studies should test whether colocating an exercise professional with infusion therapy could reach more patients in comparison with not colocating. LAY SUMMARY: Few studies have tested the implementation of exercise for patients with cancer by embedding an exercise professional directly into the chemotherapy infusion suite. The Exercise in All Chemotherapy trial shows that this approach is both acceptable and feasible from the perspective of clinicians and patients.
Subject(s)
Antineoplastic Agents/therapeutic use , Exercise , Neoplasms/therapy , Adult , Aged , Aged, 80 and over , Costs and Cost Analysis , Feasibility Studies , Female , Humans , Male , Middle Aged , Neoplasms/drug therapy , Patient Safety , Patient Selection , Physical Functional Performance , Program Development/economicsABSTRACT
OBJECTIVES: To compare the effects of power training (PWT) and a high-speed yoga program on physical performances in older patients with Parkinson disease (PD), and to test the hypothesis that both training interventions would attenuate PD symptoms and improve physical performance. DESIGN: Randomized controlled trial. SETTING: A laboratory of neuromuscular research and active aging. PARTICIPANTS: Patients with PD (N=41; mean age ± SD, 72.2 ± 6.5y). INTERVENTIONS: Two high-speed exercise interventions (specifically designed yoga program and PWT) were given for 12 weeks (twice a week), and 1 nonexercise control group. MAIN OUTCOME MEASURES: Unified Parkinson Disease Rating Scale motor score (UPDRSMS), Berg Balance Scale (BBS), Mini-Balance Evaluation Systems Test (Mini-BESTest), Timed Up and Go, functional reach, single leg stance (SLS), postural sway test, 10-m usual and maximal walking speed tests, 1 repetition maximum (RM), and peak power (PPW) for leg press. RESULTS: For the posttests, both training groups showed significant improvements (P<.05) in all physical measurements except functional reach on the more affected side, SLS, and postural sway compared with the pretests, and significantly better scores for UPDRSMS, BBS, Mini-BESTest, Timed Up and Go, functional reach on the less affected side, 10-m usual and maximal walking speed tests, 1RM, and PPW than controls, with no differences detected between the yoga program and PWT. CONCLUSIONS: Both the specially designed yoga program and PWT programs can significantly improve physical performance in older persons with PD.
Subject(s)
Exercise Therapy/methods , Parkinson Disease/physiopathology , Parkinson Disease/rehabilitation , Yoga , Aged , Female , Gait Disorders, Neurologic/physiopathology , Gait Disorders, Neurologic/rehabilitation , Geriatric Assessment , Humans , Male , Muscle Strength/physiology , Postural Balance/physiology , Treatment OutcomeABSTRACT
Potiaumpai, M, Gandia, K, Rautray, A, Prendergast, T, and Signorile, JF. Optimal loads for power differ by exercise in older adults. J Strength Cond Res 30(10): 2703-2712, 2016-Power training in older adults has been shown to increase muscle strength, power, and physical function, and decrease the risk of falls and related injuries. Although there are clear indications that optimal loads for power vary due to biomechanical factors, no studies have attempted to determine the optimal loads for specific exercises used to improve muscle power. Using the load that maximizes power output for individual exercises can maximize power gains, improve training efficiency, and augment gains in physical function. Seventy community-dwelling older adults (age = 70.5 ± 5.7 years) participated in strength and power testing during 2 sessions, each lasting for 1.5 hours. Participants were tested on 6 different pneumatic resistance machines to determine their one repetition maximum (1RM) and power. Power testing was performed at loads between 30 and 90% of each participant's 1RM. For the chest press and seated row, the optimal load range was between 40 and 60% 1RM, with peak power at 50% (p < 0.001) for both machines. The LAT pull-down optimal load range was between 30 and 50%, with peak power occurring at 40% (p < 0.001). The leg curl and leg press optimal load range was between 50 and 70%, with peak power occurring at 60% (p < 0.001). Peak power for the calf raise occurred at 60% (p < 0.001). We conclude that different exercise movements require the use of different optimal load ranges to maximize muscle power in older persons.
Subject(s)
Muscle Strength/physiology , Resistance Training/methods , Aged , Female , Humans , MaleABSTRACT
OBJECTIVE: To compare the effect of a custom-designed yoga program with 2 other balance training programs. DESIGN: Randomized controlled trial. SETTING: Research laboratory. PARTICIPANTS: A group of older adults (N=39; mean age, 74.15 ± 6.99 y) with a history of falling. INTERVENTIONS: Three different exercise interventions (Tai Chi, standard balance training, yoga) were given for 12 weeks. MAIN OUTCOME MEASURES: Balance performance was examined during pre- and posttest using field tests, including the 8-foot up-and-go test, 1-leg stance, functional reach, and usual and maximal walking speed. The static and dynamic balances were also assessed by postural sway and dynamic posturography, respectively. RESULTS: Training produced significant improvements in all field tests (P<.005), but group difference and time × group interaction were not detected. For postural sway, significant decreases in the area of the center of pressure with eyes open (P=.001) and eyes closed (P=.002) were detected after training. For eyes open, maximum medial-lateral velocity significantly decreased for the sample (P=.013). For eyes closed, medial-lateral displacement decreased for Tai Chi (P<.01). For dynamic posturography, significant improvements in overall score (P=.001), time on the test (P=.006), and 2 linear measures in lateral (P=.001) and anterior-posterior (P<.001) directions were seen for the sample. CONCLUSIONS: Yoga was as effective as Tai Chi and standard balance training for improving postural stability and may offer an alternative to more traditional programs.
Subject(s)
Accidental Falls/prevention & control , Aged/physiology , Postural Balance/physiology , Tai Ji , Yoga , Analysis of Variance , Confidence Intervals , Female , Humans , MaleABSTRACT
Background: There is limited evidence on the effects of aerobic and resistance training exercise interventions to improve physical function and patient-reported outcomes prior to autologous and allogeneic hematopoietic stem cell transplant (HSCT). IMPROVE-BMT was a single-site, pilot randomized controlled trial investigating the feasibility, acceptability, and safety of a pragmatic resistance training exercise program prior to HSCT compared to usual HSCT care. Secondary aims included differences in physical function between the exercise group (EX) and usual care control group (UC). Methods: Outcome measurements were assessed: prior to HSCT, on/around day of HSCT admission, +30 days post-HSCT, and +100 days post-HSCT. The exercise intervention was a home-based exercise program that incorporated resistance-band and bodyweight exercises. Results: Acceptability among participants was 83%; exercise adherence averaged at 92%; and there were zero exercise-related adverse or serious adverse events. The average pre-transplant exercise phase was 6.28 weeks (2.71-18.29 weeks). EX (n = 36) demonstrated larger increases in the six-minute walk test distance, short physical performance battery scores, and 30-s chair stands compared to UC (n = 38) and demonstrated significant within-group improvements for the six-minute walk test, the short physical performance battery, the 30-s chair stands, and the timed up-and-go test. Conclusions: IMPROVE-BMT demonstrates that pragmatic exercise is highly feasible for HSCT recipients and can potentially lead to enhanced recovery that may not be achievable in non-exercisers.
ABSTRACT
INTRODUCTION: Integration of exercise into standard oncology care requires a highly skilled workforce of exercise professionals; however, competency requirements have not kept pace with advancements in the field. Therefore, the aim of this study was to obtain consensus on core competencies required for an exercise professional to be qualified to work with adults undergoing active cancer treatment. MATERIALS AND METHODS: A three-round modified electronic Delphi process was used. In Round 1, an international group of 64 exercise oncology stakeholders (i.e., exercise oncology professionals (n = 29), clinical referrers (n = 21), and people with lived experience (n = 14)) responded to open-ended prompts eliciting perspectives regarding competencies needed for an exercise oncology professional to work with adults receiving active cancer treatment. Subsequently, only exercise oncology professionals participated, ranking the importance of competencies. In Round 2, professionals received summary feedback, ranked new competencies generated from open-ended responses, and reranked competencies not reaching consensus. In the final round, professionals finalized consensus ranking and rated frequency and mastery level for each. RESULTS: Consensus was reached on 103 core competencies required for exercise professionals to be qualified to deliver care to adults undergoing active cancer treatment. The core competencies represent 10 content areas and reflect the needs of clinical referrers and people with lived experience of receiving cancer treatment. CONCLUSIONS: The core competencies identified reflect significant advancements in the field of exercise oncology. Results will underpin the development of education, certification, and employment requirements for exercise oncology professionals, providing a critical step toward achieving routine integration of exercise into standard oncology care.
Subject(s)
Clinical Competence , Delphi Technique , Neoplasms , Humans , Australia , United States , Female , Male , Neoplasms/therapy , Exercise Therapy/standards , Medical Oncology/standards , Adult , Consensus , Middle AgedABSTRACT
BACKGROUND: A higher chemotherapy completion rate is associated with better outcomes including treatment efficacy and overall survival. Exercise may have the potential to improve relative dose intensity (RDI) by reducing the frequency and severity of chemotherapy-related toxicities. We examined the association between exercise adherence and RDI and possible clinical- and health-related fitness predictors of RDI. METHODS: Chemotherapy records were extracted from the electronic medical record for patients enrolled in the ENACT trial (n = 105). Chemotherapy completion was assessed using average RDI. A threshold of 85% was established for "high" versus "low" RDI. Logistic regression analyses were used to estimate the associations between the clinical- and health-related fitness predictors of RDI. RESULTS: Patients with breast cancer (BC) had a significantly higher average RDI (89.8% ± 17.6%) compared with gastrointestinal cancer (GI) (76.8% ± 20.9%, p = 0.004) and pancreatic cancer (PC) (65.2% ± 20.1%, p < 0.001). Only 25% of BC patents required a dose reduction compared to 56.3% of GI and 86.4% of PC patients. Cancer site was significantly associated with RDI. Compared with BC, patients with GI (ß = -0.12, p = 0.03) and PC (ß = -0.22, p = 0.006) achieved significantly lower RDI. Every 2.72 unit increase in overall exercise adherence led to a significant 7% decrease in RDI (p = 0.001) in GI patients. Metastatic GI patients had a 15% RDI increase for every 2.72 unit increase in exercise adherence (p = 0.04). CONCLUSION: Exercise is a supportive therapy that has potential to enhance chemotherapy tolerance and completion. The relationship between exercise adherence and RDI is influenced by factor such as cancer site and treatment type. Special attention must be paid to how exercise is prescribed to ensure that exercise adherence does not negatively affect RDI. Cancer site, exercise dosage, and multimodal interventions to address toxicities are key areas identified for future research.
Subject(s)
Breast Neoplasms , Humans , Female , Breast Neoplasms/pathology , Treatment Outcome , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Retrospective Studies , Chemotherapy, AdjuvantABSTRACT
INTRODUCTION: Haematopoietic stem cell transplant (HSCT) in adults is an intensive medical procedure for a variety of haematological malignancies. Although there is a large body of evidence demonstrating the negative effects of HSCT on physical function and psychosocial parameters, there is limited evidence on the impact of HSCT on body composition and bone health. Further, aerobic and resistance-training exercise interventions aimed at improving physical function and patient-reported outcomes largely take place during the peritransplant and post-transplant period. Prehabilitative exercise, or exercise prior to medical treatment, has been successfully deployed in presurgical candidates and other tumour sites, yet there is a paucity of evidence on the effect of prehabilitation in HSCT patients. The aim of this study is to investigate the feasibility, acceptability and safety of a resistance training exercise programme in patients with haematological malignancies prior to HSCT. METHODS AND ANALYSIS: IMpact of PRehabilitation in Oncology Via Exercise-Bone Marrow Transplant is a single-site, pilot randomised controlled trial of an exercise intervention compared with usual care. The primary aim is to assess the feasibility, acceptability and safety of the resistance-training exercise intervention prior to HSCT. Secondary aims include evaluating the differences in physical function, body composition, bone mineral density and patient-reported outcomes between the exercise group and usual care control group. Outcome measurements will be assessed: prior to HSCT, on/around day of HSCT admission, +30 days post-HSCT and +100 days post-HSCT. The exercise intervention is a home-based resistance training exercise programme that incorporates resistance band and body weight exercises. The primary outcomes will be reported as percentages and/or mean values. The secondary outcomes will be analysed using appropriate statistical methods to portray within-group and between-group differences. ETHICS AND DISSEMINATION: The study has Penn State College of Medicine approval. Results will be disseminated through scientific publication and presentation at exercise-related and oncology-related scientific meetings. TRIAL REGISTRATION NUMBER: NCT03886909.
Subject(s)
Hematologic Neoplasms , Hematopoietic Stem Cell Transplantation , Humans , Adult , Preoperative Exercise , Pilot Projects , Exercise , Exercise Therapy/methods , Hematologic Neoplasms/therapy , Quality of Life , Randomized Controlled Trials as TopicABSTRACT
The evidence to support the benefits of exercise for people living with and beyond cancer is robust. Still, exercise oncology interventions in the United States are only eligible for coverage by third-party payers within the restrictions of cancer rehabilitation settings. Without expanded coverage, access will remain highly inequitable, tending toward the most well-resourced. This article describes the pathway to third-party coverage for 3 programs that address a chronic disease and utilize exercise professionals: the Diabetes Prevention Program, Supervised Exercise Training for Peripheral Artery Disease, and Cancer Rehabilitation. Lessons learned will be applied toward expanding third-party coverage for exercise oncology programming.
Subject(s)
Neoplasms , Peripheral Arterial Disease , Humans , Exercise , Exercise Therapy , Medical Oncology , Neoplasms/diagnosis , Neoplasms/epidemiology , Neoplasms/therapy , United States/epidemiologyABSTRACT
The overall goal of the annual Transdisciplinary Research in Energetics and Cancer (TREC) Training Workshop is to provide transdisciplinary training for scientists in energetics and cancer and clinical care. The 2022 Workshop included 27 early-to-mid career investigators (trainees) pursuing diverse TREC research areas in basic, clinical, and population sciences. The 2022 trainees participated in a gallery walk, an interactive qualitative program evaluation method, to summarize key takeaways related to program objectives. Writing groups were formed and collaborated on this summary of the 5 key takeaways from the TREC Workshop. The 2022 TREC Workshop provided a targeted and unique networking opportunity that facilitated meaningful collaborative work addressing research and clinical needs in energetics and cancer. This report summarizes the 2022 TREC Workshop's key takeaways and future directions for innovative transdisciplinary energetics and cancer research.
Subject(s)
Medicine , Neoplasms , Humans , Interdisciplinary Research , Neoplasms/diagnosis , Neoplasms/therapy , Neoplasms/epidemiology , Program Evaluation/methods , Research Personnel/educationABSTRACT
BACKGROUND: There is strong evidence supporting the efficacy of exercise oncology programs to improve physical and psychosocial outcomes during active treatment. However, there is a paucity of evidence on the effect of exercise on healthcare utilization and cost analyzes of exercise oncology programs. AIMS: Our objective was to assess the effects of a pragmatic exercise oncology program (ENACT) during active chemotherapy treatment on healthcare utilization and associated costs. METHODS: We conducted post-hoc analyzes on 160 ENACT participants and 75 comparison participants matched on cancer site, stage, age range, and gender. We obtained complete healthcare utilization histories for each patient (specific to emergency department [ED] visits and hospital admissions) coinciding with their participation in ENACT. A sub-analysis was conducted for advanced stage breast, gastrointestinal, and pancreatic cancer patients. RESULTS: Healthcare costs for patients who participated in the ENACT exercise oncology intervention were numerically lower than healthcare costs for the comparison group, even after accounting for the cost of the intervention. However, the differences were not statistically significant. CONCLUSION: Our findings suggest that an exercise oncology program during active chemotherapy treatment are at least cost neutral for all cancer patients, including advanced stage cancers. Additional research is warranted to evaluate the potential for exercise oncology programs to reduce healthcare utilization, particularly in advanced cancer patients.
Subject(s)
Exercise , Neoplasms , Female , Health Care Costs , Humans , Male , Neoplasms/drug therapy , Neoplasms/therapy , Patient Acceptance of Health Care , Pragmatic Clinical Trials as TopicABSTRACT
BACKGROUND: With an aging population, rising incidence of breast cancer, improved survival rates, and obesity epidemic, there will be a growing population of older adult breast cancer survivors with obesity. This complex population, often with multimorbidity, is at risk for several poor health outcomes, including recurrence, cardiovascular disease, dementia, and diabetes, and a number of deleterious symptoms, including a worsened inflammatory profile, breast cancer- related lymphedema, mobility disability, cognitive impairment, anxiety, and depressive symptoms. A wealth of meta-analytic and randomized controlled trial evidence show that adherence to World Health Organization and 2018 United States Physical Activity guidelines-based levels of moderate-to-vigorous physical activity (MVPA) reduces risk of all-cause mortality, and improves symptoms. However, few survivors engage in recommended levels of MVPA, and symptoms related to their multimorbidity may preclude engaging in sufficient levels of MVPA. Additional research of MVPA in this population is warranted; however, understudied light-intensity physical activity (LIPA) may be a more pragmatic target than MVPA among this complex population facing extensive challenges meeting MVPA recommendations. Large benefits are likely to occur from increasing these survivors' total activity, and LIPA prescriptions may be a more pragmatic approach than MVPA to aid this transition. METHODS: We present a broad, narrative review of the evidence for MVPA and LIPA in this population on an array of health outcomes across the translational science spectrum (clinical, implementation, and public health), and identify a number of directions for future research focused on understanding the potential diverse health effects of LIPA. CONCLUSION: Additional LIPA research is warranted, as LIPA prescriptions may be a pragmatic strategy to effectively promote physical activity to this complex population.
Subject(s)
Breast Neoplasms , Cancer Survivors , Humans , Aged , Female , Sedentary Behavior , Breast Neoplasms/epidemiology , Exercise , Obesity/epidemiology , Randomized Controlled Trials as TopicABSTRACT
INTRODUCTION: Previous studies have observed an inverse relationship between exercise and breast cancer risk. However, there is interindividual variability in response to exercise training interventions. We investigated whether increasing the dose of aerobic exercise (150 or 300 min·wk-1), while keeping intensity of exercise constant (70%-80% HRmax), decreases the number of exercise nonresponders and further decreases associated risk for cancer mortality in our study population of women genetically predisposed for breast cancer. METHODS: Healthy premenopausal women at elevated risk of breast cancer were randomized into control (<75 min·wk-1, n = 47), low-dose exercise (150 min·wk-1, n = 39), and high-dose exercise groups (300 min·wk-1, n = 39) for approximately 6 months. We assessed 1) clinical effectiveness (CE), defined as an improvement in predicted VËO2max of ≥1 mL·kg-1·min-1, and twice the typical error (2× TE) of VËO2max as thresholds to classify exercise "nonresponders"; 2) CE and 2× TE relative to exercise adherence levels; and 3) related changes in VËO2max to predicted cancer mortality risk. RESULTS: After our 6-month intervention, we observed that 23.5% of women in the low-dose group and 5.6% of women in the high-dose group were clinical nonresponders (P = 0.04). Clinical nonresponder status was independent of adherence level. Associated reduction in risk for cancer mortality was observed among 87.2% of women in the low-dose group and 94.9% in the high-dose group (P = 0.43). CONCLUSION: Increasing volume (not intensity) of exercise via time spent exercising significantly decreases the number of "nonresponders." True nonresponders were observed as some women did not improve their fitness capacity despite high exercise adherence levels. Lastly, it appears 150 min·wk-1 is sufficient to decrease the predicted risk of cancer mortality.
Subject(s)
Breast Neoplasms/mortality , Exercise/physiology , Oxygen Consumption/physiology , Adult , Analysis of Variance , Body Mass Index , Breast Neoplasms/genetics , Female , Genetic Predisposition to Disease , Heart Rate/physiology , Humans , Patient Compliance/statistics & numerical data , Physical Fitness/physiology , Premenopause , Risk , Time FactorsABSTRACT
BACKGROUND: The effect of a peritransplant multidirectional walking intervention to target losses in physical function and quality of life (QOL) has not been investigated. PURPOSE: This study examined the effects of a novel multidirectional walking program on physical function and QOL in adults receiving a hematopoietic stem cell transplant (HSCT). METHODS: Thirty-five adults receiving an autologous or allogeneic HSCT were randomized to a multidirectional walking (WALK) or usual care (CONT) group. The WALK group received supervised training during hospitalization; the CONT group received usual care. Patients were assessed at admission (t0), 3 to 5 d post-HSCT (t1), and 30 d post-HSCT (t2). Physical function measures included the 6-min walk test (6MWT), the Physical Performance Test, and the Timed Up and Go test. Health-related QOL was collected using the Functional Assessment of Cancer Therapy-Bone Marrow Transplant (FACT-BMT) questionnaire. RESULTS: There were no significant between-group changes for physical function or QOL. However, after the intervention (t1 to t2), the WALK group showed significant improvement in aerobic capacity (6MWT, P = 0.01), physical (P < 0.01) and functional well-being (P = 0.04), and overall QOL scores (P < 0.01). The CONT group saw no significant changes in physical function or QOL. Effect sizes showed the WALK group had a larger positive effect on physical function and QOL. Minimal clinically important differences in the 6MWT and FACT-BMT were exceeded in the WALK group. CONCLUSION: A multidirectional walking program during the transplant period may be effective at increasing aerobic capacity and QOL for patients receiving HSCT compared with no structured exercise.
Subject(s)
Exercise Therapy/methods , Hematologic Neoplasms/therapy , Hematopoietic Stem Cell Transplantation , Physical Functional Performance , Quality of Life , Walking , Female , Hematologic Neoplasms/physiopathology , Humans , Male , Middle Aged , Patient Reported Outcome Measures , Transplantation, Autologous , Transplantation, HomologousABSTRACT
OBJECTIVES: Cognition, along with aerobic and muscular fitness, declines with age. Although research has shown that resistance and aerobic exercise may improve cognition, no consensus exists supporting the use of one approach over the other. The purpose of this study was to compare the effects of steady-state, moderate-intensity treadmill training (TM) and high-velocity circuit resistance training (HVCRT) on cognition, and to examine its relationships to aerobic fitness and neuromuscular power. METHODS: Thirty older adults were randomly assigned to one of three groups: HVCRT, TM, or control. Exercise groups attended training 3â¯days/wk for 12â¯weeks, following a 2â¯week adaptation period. The NIH Cognitive Toolbox was used to assess specific components of cognition and provided an overall fluid composite score (FCS). The walking response and inhibition test (WRIT) was specifically used to assess executive function (EF) and provided an accuracy (ACC), reaction time (RT) and global score (GS). Aerobic power (AP) and maximal neuromuscular power (MP) were measured pre- and post-intervention. Relationships between variables using baseline and mean change scores were assessed. RESULTS: Significant increases were seen from baseline in ACC (MDâ¯=â¯14.0, SEâ¯=â¯4.3, pâ¯=â¯.01, dâ¯=â¯1.49), GS (MDâ¯=â¯25.6, SEâ¯=â¯8.0, pâ¯=â¯.01, dâ¯=â¯1.16), and AP (MDâ¯=â¯1.4, SEâ¯=â¯0.6, pâ¯=â¯.046, dâ¯=â¯0.31) for HVCRT. RT showed a trend toward a significant decrease (MDâ¯=â¯-0.03, SEâ¯=â¯0.016, pâ¯=â¯.068, dâ¯=â¯0.32) for HVCRT. No significant within-group differences were detected for TM or CONT. Significant correlations were seen at baseline between AP and FCS, as well as other cognitive domains; but none were detected among change scores. Although no significant correlation was evident between MP and FCS or GS, there was a trend toward higher MP values being associated with higher FCS and GS scores. CONCLUSIONS: Our results support the use of HVCRT over TM for improving cognition in older persons, although the precise mechanisms that underlie this association remain unclear.
Subject(s)
Circuit-Based Exercise/methods , Cognitive Aging , Executive Function , Physical Fitness , Resistance Training/methods , Aged , Cognition , Exercise Test , Female , Humans , Male , Middle Aged , Neuropsychological TestsABSTRACT
The presence of cardiometabolic syndrome (CMS) confers an increased risk for cardiovascular disease (CVD) and mortality and is associated with reduced health-related quality of life (HRQoL). Although the effects of exercise on biomarkers, HRQoL, and future risk have been studied, no study has measured the effects on all three components. The present study compared the effects of steady-state, moderate-intensity treadmill training (TM) and high-velocity circuit resistance training (HVCRT) on biological markers, HRQoL, and overall CVD risk in adults with CMS and CVD risk factors. Thirty participants (22 females, 8 males) were randomly assigned to 1 of 3 groups: HVCRT, TM, or control. Participants in the exercise groups attended training 3 days/week for a total of 12 weeks. Of the 30 participants who began the study, 24 (19 females, 5 males) were included in the final analysis. Primary outcome measures included CMS criteria, hemodynamic measures, Framingham Risk Score (FRS), and HRQoL. All variables were measured pre- and post-intervention. CMS z score significantly decreased for HVCRT (p = 0.03), while there were no significant changes for TM or control. FRS significantly decreased for HVCRT compared with TM (p = 0.03) and control (p = 0.03). Significant decreases in systolic (p < 0.01) and diastolic blood pressures (p < 0.01) for HVCRT accompanied significant increases from baseline in stroke volume (p = 0.03) and end-diastolic volume (p < 0.01). Systemic vascular resistance significantly decreased (p = 0.05) for HVCRT compared with control. Emotional well-being significantly improved following HVCRT and TM compared with control (p = 0.04; p = 0.03). HVCRT represents a novel training modality that improved factors in each of the 3 components assessed.
Subject(s)
Aging , Hemodynamics , Metabolic Syndrome/prevention & control , Quality of Life , Resistance Training/methods , Walking , Age Factors , Aged , Aging/blood , Aging/psychology , Biomarkers/blood , Blood Pressure , Emotions , Exercise Tolerance , Female , Florida , Humans , Male , Metabolic Syndrome/blood , Metabolic Syndrome/physiopathology , Metabolic Syndrome/psychology , Middle Aged , Stroke Volume , Time Factors , Treatment Outcome , Vascular ResistanceABSTRACT
OBJECTIVES: To compare the difference in muscle activation between high-speed yoga and standard-speed yoga and to compare muscle activation of the transitions between poses and the held phases of a yoga pose. DESIGN: Randomized sequence crossover trial SETTING: A laboratory of neuromuscular research and active aging Interventions: Eight minutes of continuous Sun Salutation B was performed, at a high speed versus a standard-speed, separately. Electromyography was used to quantify normalized muscle activation patterns of eight upper and lower body muscles (pectoralis major, medial deltoids, lateral head of the triceps, middle fibers of the trapezius, vastus medialis, medial gastrocnemius, thoracic extensor spinae, and external obliques) during the high-speed and standard-speed yoga protocols. MAIN OUTCOME MEASURES: Difference in normalized muscle activation between high-speed yoga and standard-speed yoga. RESULTS: Normalized muscle activity signals were significantly higher in all eight muscles during the transition phases of poses compared to the held phases (p<0.01). There was no significant interaction between speed×phase; however, greater normalized muscle activity was seen for highspeed yoga across the entire session. CONCLUSIONS: Our results show that transitions from one held phase of a pose to another produces higher normalized muscle activity than the held phases of the poses and that overall activity is greater during highspeed yoga than standard-speed yoga. Therefore, the transition speed and associated number of poses should be considered when targeting specific improvements in performance.
Subject(s)
Muscle, Skeletal/physiology , Yoga/psychology , Adult , Cross-Over Studies , Electromyography/methods , Female , Humans , Male , Meditation/psychologyABSTRACT
UNLABELLED: Power-based resistance training (PWT), using low load and high velocity, can improve physical function and quality of life in older persons. Patients with Parkinson's disease (PD), exhibiting muscular weakness and reduced movement speed, have been shown to be benefit from resistance training; however, little is known about the advantages of PWT for PD. PURPOSE: To evaluate the effects of PWT on bradykinesia and muscular performance in older patients with PD. METHODS: Twenty-six patients with mild to moderate PD were randomly assigned to a PWT or control group (CON). The PWT program was three months, incorporating two sessions/wk of high-speed resistance training combined balance and agility drills. Outcome measures included: upper and lower limb bradykinesia scores, one repetition maximums (1RM) and peak powers on biceps curl, chest press, leg press, hip abduction and seated calf, and quality of life (PDQ-39). RESULTS: The PWT group produced significant improvement in both upper and lower limbs bradykinesia scores, 1RM and muscle peak power (p < .05), which surpassed the CON group except for power during the seated calf exercise. No significant correlations between changes in clinical measure of bradykinesia and muscle peak power were observed after training. Significant improvements were seen in the PDQ-39 overall score, subsections for mobility, activities of daily living and social support for the PWT group. CONCLUSION: The 3-month PWT program significantly reduced bradykinesia and increased muscle strength and power in older patients with PD. Power training is an effective training modality to improve physical function and quality of life for PD.
Subject(s)
Hypokinesia/rehabilitation , Parkinson Disease/rehabilitation , Quality of Life , Resistance Training/methods , Aged , Aged, 80 and over , Female , Humans , Hypokinesia/etiology , Male , Middle Aged , Muscle Strength/physiology , Parkinson Disease/complicationsABSTRACT
BACKGROUND: Self-report questionnaires are widely used to assess physical function in older adults. However, they often lack a clear frame of reference and hence interpreting and rating task difficulty levels can be problematic for the responder. Consequently, the usefulness of traditional self-report questionnaires for assessing higher-level functioning is limited. Video-based questionnaires can overcome some of these limitations by offering a clear and objective visual reference for the performance level against which the subject is to compare his or her perceived capacity. Hence the purpose of the study was to develop and validate a novel, video-based questionnaire to assess physical function in older adults independently living in the community. METHODS: A total of 61 community-living adults, 60years or older, were recruited. To examine validity, 35 of the subjects completed the video questionnaire, two types of physical performance tests: a test of instrumental activity of daily living (IADL) included in the Short Physical Functional Performance battery (PFP-10), and a composite of 3 performance tests (30s chair stand, single-leg balance and usual gait speed). To ascertain reliability, two-week test-retest reliability was assessed in the remaining 26 subjects who did not participate in validity testing. RESULTS: The video questionnaire showed a moderate correlation with the IADLs (Spearman rho=0.64, p<0.001; 95% CI (0.4, 0.8)), and a lower correlation with the composite score of physical performance tests (Spearman rho=0.49, p<0.01; 95% CI (0.18, 0.7)). The test-retest assessment yielded an intra-class correlation (ICC) of 0.87 (p<0.001; 95% CI (0.70, 0.94)) and a Cronbach's alpha of 0.89 demonstrating good reliability and internal consistency. CONCLUSIONS: Our results show that the video questionnaire developed to evaluate physical function in community-living older adults is a valid and reliable assessment tool; however, further validation is needed for definitive conclusions.