Prospective associations between systolic blood pressure, serum cholesterol, and physical activity behaviour and the development of cardiovascular disease.

AIMS: To systematically appraise and summarise meta-analyses of longitudinal studies to determine the effect size, and quality and certainty of the evidence summaries for systolic blood pressure (SBP), serum cholesterol, and physical activity behaviour in developing cardiovascular disease (CVD). METHODS AND RESULTS: An umbrella review was conducted by searching MEDLINE, Embase, and Scopus databases. Eligible meta-analyses were longitudinal studies investigating the association between SBP, serum cholesterol, or physical activity behaviour on CVD development. Summary risk estimates were extracted. Quality and certainty of the evidence summaries of included records were performed using AMSTAR 2 and GRADE, respectively. Forty-one eligible records were found of which thirteen related to SBP, five to cholesterol, and twenty-three to physical activity behaviour. The quality and certainty of the evidence summaries were variable, with most studies rating 'low'. Reported risk estimates for the risk of developing CVD ranged from: no change to a 68% decreased risk for lower SBP; a 21% increased risk to a 44% decreased risk for lower cholesterol; and a 1% decreased risk to a 56% decreased risk for higher physical activity levels. CONCLUSIONS: There were strong associations with CVD risk at the meta-analysis level for all three exposures, with a proportionally greater number of meta-analyses and primary studies for physical activity than SBP or serum cholesterol. Given the number of meta-analyses and similar CVD risk reductions and certainty of evidence associated with physical activity behaviour, there is a strong case for its routine assessment alongside SBP and serum cholesterol in primary CVD prevention.

Prioritising restorative care programs in light of current age care reform.

BACKGROUND: Short-term restorative care (STRC) aims to reduce the demand for long-term aged care services through 8 weeks of intensive, multidisciplinary services designed to enhance the independence of community-dwelling older Australians at risk of functional decline. Evidence surrounding the effectiveness and feasibility of STRC is limited. OBJECTIVE: This study aimed to examine the effectiveness of an existing exercise-based STRC model and help inform successful service delivery to maximise participant outcomes nationally. METHODS: An observational cohort study was conducted to evaluate the potential benefits accrued by community-dwelling older adults accessing Southern Cross Care's current exercise-based STRC model in Adelaide, South Australia. Program effectiveness was determined via improvements in outcome measures specific to functional decline risk factors from baseline (Week 0) to discharge (Week 8). RESULTS: Results demonstrated significant improvements (p < 0.001) in participants' (n = 62) lower extremity function (44.9%), depressive symptoms (52.4%), anxiety (45.8%), frailty stage (57.9%), independence in activities of daily living (17.3%) and health-related quality of life (24.0%). No significant change was found for grip strength or BMI post-intervention. The most frequent services were exercise-based (54.3% of total services), with participants receiving an average of two to three exercise services per week. CONCLUSIONS: An exercise-based STRC model is an effective mechanism to reverse functional decline and associated risk factors among community-dwelling older Australians. Adoption of multidisciplinary intervention as a standardised STRC service model could help improve client outcomes nationally and offset expected increases in community and long-term aged care demand.

A Mediterranean Diet and Walking Intervention to Reduce Cognitive Decline and Dementia Risk in Independently Living Older Australians: The MedWalk Randomized Controlled Trial Experimental Protocol, Including COVID-19 Related Modifications and Baseline Characteristics.

BACKGROUND: Several clinical trials have examined diet and physical activity lifestyle changes as mitigation strategies for risk factors linked to cognitive decline and dementias such as Alzheimer's disease. However, the ability to modify these behaviors longer term, to impact cognitive health has remained elusive. OBJECTIVE: The MedWalk trial's primary aim is to investigate whether longer-term adherence to a Mediterranean-style diet and regular walking, delivered through motivational interviewing and cognitive-behavioral therapy (MI-CBT), can reduce age-associated cognitive decline and other dementia risk factors in older, independently living individuals without cognitive impairment. METHODS: MedWalk, a one-year cluster-randomized controlled trial across two Australian states, recruited 60-90-year-old people from independent living retirement villages and the wider community. Participants were assigned to either the MedWalk intervention or a control group (maintaining their usual diet and physical activity). The primary outcome is 12-month change in visual memory and learning assessed from errors on the Paired Associates Learning Task of the Cambridge Neuropsychological Test Automated Battery. Secondary outcomes include cognition, mood, cardiovascular function, biomarkers related to nutrient status and cognitive decline, MI-CBT effectiveness, Mediterranean diet adherence, physical activity, quality of life, cost-effectiveness, and health economic evaluation.Progress and Discussion:Although COVID-19 impacts over two years necessitated a reduced timeline and sample size, MedWalk retains sufficient power to address its aims and hypotheses. Baseline testing has been completed with 157 participants, who will be followed over 12 months. If successful, MedWalk will inform interventions that could substantially reduce dementia incidence and ameliorate cognitive decline in the community. TRIAL REGISTRATION: Registered on the Australia New Zealand Clinical Trials Registry ANZCTR 12620000978965 (https://www.anzctr.org.au).

How do practitioners prescribe exercise to patients with breast cancer? Professional perspectives on the key considerations for aerobic exercise in patients with breast cancer undergoing chemotherapy.

OBJECTIVES: This study aimed to understand the key factors experienced accredited exercise physiologists (AEPs) and medical professionals consider when prescribing/recommending aerobic exercise to patients with breast cancer undergoing chemotherapy. DESIGN: Modified Delphi Survey. METHODS: A four-round, two-phase survey was conducted. Following a Delphi approach, four cancer-specific AEPs, four oncologists, and one breast cancer surgeon (median 13-yr breast-cancer-specific experience) completed phase one. Eighty-four AEPs (median 5-yr experience) completed phase two. Phase one participants answered open- and close-ended questions regarding key considerations for aerobic exercise in patients with breast cancer undergoing chemotherapy, and what information should be collected to guide exercise prescription. All questions and considerations agreed upon in phase one (>70 % rating 7-9 on a 0-9 Likert Scale) were rated by AEPs in phase two. RESULTS: Key considerations for exercise assessment and prescription aligned closely with exercise guidelines for cancer survivors. Common strategies for exercise individualisation were identified by AEPs, including separating aerobic exercise into 5-to--9-minute bouts when required and avoiding exercising to complete exhaustion. Exercise intensity and duration should be adjusted throughout chemotherapy to improve tolerance and adherence. Novel considerations for subjective questioning and objective assessments to tailor exercise prescription were outlined. CONCLUSIONS: This study identifies how professionals approach exercise assessment and prescription in patients with breast cancer undergoing chemotherapy. Findings can guide AEPs in practice when prescribing tailored exercise to breast cancer patients undergoing chemotherapy and inform future guidelines.

Recommendations for objective cardiovascular assessment to inform clinical exercise prescription: An Exercise Physiologist and Physiotherapist expert consensus.

OBJECTIVES: Exercise is beneficial in managing cardiovascular health. Objective assessments of cardiovascular function assist in identifying the presence or absence of exertional symptoms, and functional and physiological thresholds necessary to inform safe and effective exercise programmes. This study aimed to generate expert consensus on assessments of cardiovascular function to support clinical decision-making for professionals providing clinical exercise services. DESIGN: Three-round e-Delphi. METHODS: Expert Exercise Physiologists and Physiotherapists were recruited to participate in an e-Delphi. Experts were asked to list all objective cardiovascular assessments deemed necessary to inform safe and effective exercise prescription. In subsequent e-Delphi rounds, experts rated the importance of each item, provided a rationale to support their assertions, and reconsidered others' ratings and rationale to shift or reaffirm their position. These results were then translated into a clinical guidance document by the authors in consultation with a Cardiologist and an experienced Exercise Physiologist with expertise in cardiovascular assessment. RESULTS: Thirty-one experts participated in the e-Delphi and fourteen participants completed all three rounds. Forty objective assessments were initially suggested. Six items reached consensus by the end of Round 2 (resting and exercise heart rate, resting, exercise, and recovery blood pressure, and peak exercise-induced rating of perceived exertion). One additional item reached consensus in Round 3 (exercise oxygen saturation). CONCLUSIONS: In the absence of research evidence, the collective experience and insights of an expert panel can inform an evidence gap. Further research is required to determine the feasibility of implementing these seven assessments in practice where CV assessment is indicated.

Resistance Band Exercise: An Effective Strategy to Reverse Cardiometabolic Disorders in Women With Osteosarcopenic Obesity.

We designed to evaluate the effects of resistance elastic band exercises (REBEs) on cardiometabolic/obesity-related biomarkers in older females with osteosarcopenic obesity. Sixty-three patients (aged 65-80 years) with osteosarcopenic obesity and a body mass index exceeding 30 kg/m2 were enrolled in the study. The participants were randomly assigned to either an experimental group (REBE, n = 32) or a usual care group (n = 31). The experimental group completed a 12-week REBE program, three times a week and 60 min per session. There were decreases in lipid accumulation product (p = .033), visceral adipose index (p = .001), triglyceride-glucose-body mass index (p = .034), and atherogenic index of plasma (p = .028) in the experimental group compared with the usual care group. Our findings highlight the importance of an REBE program in improving combined cardiometabolic/obesity-related indices in older women with osteosarcopenic obesity. The incorporation of an REBE program may benefit individuals who are unable to tolerate or participate in more strenuous exercise programs.

Physical activity interventions in older people with cancer: A review of systematic reviews.

INTRODUCTION: Whilst there has been a wealth of research on benefits of physical activity (PA) in people with cancer, with three published reviews of reviews, no review of reviews has focused on older adults (65 years or older) who may have unique biological characteristics and barriers. We summarised PA effectiveness from reviews where majority of study participants were 65 years or older. METHODS: Six databases were searched for systematic reviews of randomised controlled studies (RCTs)/quasi-RCTs examining any type of PA in reviews where majority of study participants were aged 65 years or older. Two reviewers conducted the search and analysis according to PRISMA and JBI guidelines. RESULTS: Fifteen reviews involving 76 different primary studies (5404 participants) were included. The majority (3827; 71%) had prostate cancer. PA was associated with benefits across multiple physical outcomes (muscle mass, functional performance, strength), improved fatigue and health service outcomes. In contrast to younger adults, there was no improvement in anxiety and mixed findings for quality of life and depression. CONCLUSION: PA is associated with multiple benefits in older adults with cancer, with some differences compared to younger individuals which may reflect biological or behavioural determinants. Future research should focus on mechanisms underlying PA effectiveness and underrepresented populations.

What are the effects of scuba diving-based interventions for clients with neurological disability, autism or intellectual disability? A systematic review.

INTRODUCTION: Recreational scuba diving has existed for over 70 years with organisations emerging that teach individuals with disabilities to dive. It is unclear what the physical and psychosocial effects of scuba interventions might be. This systematic review explores evidence for the effects of scuba diving in individuals with neurological disability, intellectual disability and autism. METHODS: The databases Medline, EMBASE, Ovid Emcare, and SportDiscus were searched. Included papers described a scuba-based intervention for clients with a neurological disability, intellectual disability and autism, with physical or psychosocial outcomes explored in the paper. Quality of the included papers was assessed using the McMaster Appraisal Tools, with descriptive data synthesis completed to explore the physical and psychosocial effects of the interventions. RESULTS: Four papers met the inclusion criteria: a cross-sectional investigation, a phenomenological study, a case-control study and a multiple case study. The quality of the papers was low to moderate. Papers addressed the psychosocial effects of scuba diving, including motivation to participate, participant experiences, the effect on cognition and physical self-concept. One study reported an increase in self-concept for the majority of participants. An increase in understanding instructions and in visual attention was reported in another. Enjoyment of the activity was reported and motivators to be involved in scuba diving for people with disabilities included fun and excitement. No papers addressed functional outcomes. CONCLUSIONS: Whilst scuba diving interventions appear to enhance physical self-concept and are enjoyable, conclusive evidence regarding effectiveness could not be determined. Research in this area is extremely limited.

Markers of Cardiac Autonomic Function During Consecutive Day Peak Exercise Tests in People With Myalgic Encephalomyelitis/Chronic Fatigue Syndrome.

Patients with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) have been shown to exhibit altered ventilatory characteristics on the second of two progressive maximal cardiopulmonary exercise tests (CPET) performed on consecutive days. However, maximal exercise can exacerbate symptoms for ME/CFS patients and cause significant post-exertional malaise. Assessment of heart rate (HR) parameters known to track post-exertional fatigue may represent more effective physiological markers of the condition and could potentially negate the need for maximal exercise testing. Sixteen ME/CFS patients and 10 healthy controls underwent a sub-maximal warm-up followed by CPET on two consecutive days. Ventilation, ratings of perceived exertion, work rate (WR) and HR parameters were assessed throughout on both days. During sub-maximal warm-up, a time effect was identified for the ratio of low frequency to high frequency power of HR variability (p=0.02) during sub-maximal warm-up, and for HR at ventilatory threshold (p=0.03), with both being higher on Day Two of testing. A significant group (p<0.01) effect was identified for a lower post-exercise HR recovery (HRR) in ME/CFS patients. Receiver operator characteristic curve analysis of HRR revealed an area under the curve of 74.8% (p=0.02) on Day One of testing, with a HRR of 34.5bpm maximising sensitivity (63%) and specificity (40%) suggesting while HRR values are altered in ME/CFS patients, low sensitivity and specificity limit its potential usefulness as a biomarker of the condition.

Satisfaction with Online Versus In-Person Yoga During COVID-19.

Introduction: During COVID-19 restrictions, yoga classes transitioned to online delivery. This report compares the perceived benefits and barriers to online and in-person yoga and determine the preferred format. A secondary aim was to compare how well each format was perceived to produce common benefits of yoga practice. Materials and Methods: A cross-sectional online survey of Australian participants. Results: In-person yoga scored highest for providing mental health/mood benefits, physical satisfaction, and feeling energized. Online yoga scored highest for convenience, mental health/mood benefits, and affordability (initial N = 156; follow-up N = 55). Conclusion: Online yoga was acceptable and perceived to provide improved mental health and mood.

Water-Based Interventions for People With Neurological Disability, Autism, and Intellectual Disability: A Scoping Review.

The purpose of this study was to produce a descriptive overview of the types of water-based interventions for people with neurological disability, autism, and intellectual disability and to determine how outcomes have been evaluated. Literature was searched through MEDLINE, EMBASE, Ovid Emcare, SPORTDiscus, Google Scholar, and Google. One hundred fifty-three papers met the inclusion criteria, 115 hydrotherapy, 62 swimming, 18 SCUBA (self-contained underwater breathing apparatus), and 18 other water-based interventions. Common conditions included cerebral palsy, spinal cord injury, Parkinson's disease, and intellectual disability. Fifty-four papers explored physical outcomes, 36 psychosocial outcomes, and 24 both physical and psychosocial outcomes, with 180 different outcome measures reported. Overall, there is a lack of high-quality evidence for all intervention types. This review provides a broad picture of water-based interventions and associated research. Future research, guided by this scoping review, will allow a greater understanding of the potential benefits for people with neurological disability, autism, and intellectual disability.

Effects of yoga on depressive symptoms in people with mental disorders: a systematic review and meta-analysis.

OBJECTIVE: To assess whether physically active yoga is superior to waitlist control, treatment as usual and attention control in alleviating depressive symptoms in people with a diagnosed mental disorder recognised by the Diagnostic and Statistical Manual of Mental Disorders (DSM). DESIGN: Systematic review and meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. DATA SOURCES: Data were obtained from online databases (MEDLINE, EMBASE, PsychINFO, CENTRAL, EMCARE, PEDro). The search and collection of eligible studies was conducted up to 14 May 2019 (PROSPERO registration No CRD42018090441). ELIGIBILITY CRITERIA FOR SELECTING STUDIES: We included randomised controlled trials with a yoga intervention comprising ≥50% physical activity in adults with a recognised diagnosed mental disorder according to DSM-3, 4 or 5. RESULTS: 19 studies were included in the review (1080 participants) and 13 studies were included in the meta-analysis (632 participants). Disorders of depression, post-traumatic stress, schizophrenia, anxiety, alcohol dependence and bipolar were included. Yoga showed greater reductions in depressive symptoms than waitlist, treatment as usual and attention control (standardised mean difference=0.41; 95% CI -0.65 to -0.17; p<0.001). Greater reductions in depressive symptoms were associated with higher frequency of yoga sessions per week (ß=-0.44, p<0.01).

Is yoga considered exercise within systematic reviews of exercise interventions? A scoping review.

OBJECTIVE: Yoga is an increasingly popular choice of exercise for the Western population, with people engaging in yoga for a range of physical and mental health and well-being reasons. The aim of this scoping review is to examine whether yoga is considered an exercise modality within relevant leading journals, as evidenced by its consideration in systematic reviews (SRs) of exercise interventions for health-related outcomes. METHODS: Design: Scoping review. DATA SOURCES: Three leading sources (Sports Medicine, British Journal of Sports Medicine and Cochrane Collaboration) were searched. Eligibility criteria for selecting studies: The ten most recently published systematic reviews of exercise interventions for health-related outcomes from each journal were included (N = 30) that met these criteria: systematic review studying humans participating in general exercise and measuring a health-related outcome. Exercise interventions with any specific qualifying terms (e.g. aquatic, strength, aerobic) were excluded. RESULTS: The articles retrieved were published between 2007 and 2019, and collectively included 991 interventions. Seven reviews explicitly stated that yoga was to be included/excluded while twenty-three studies made no mention of how yoga was being considered in the methodology. Five studies included yoga in the search strategy, implying its inclusion. Post-hoc analyses found that the definitions of exercise in general were also variable. Exercise definition specificity was not associated with whether or not yoga was assessed for inclusion. CONCLUSIONS: Systematic reviews of exercise and physical activity interventions for health-related outcomes do not consistently make clear whether or not they include or exclude yoga as a form of exercise.

Approaches to determining occlusion pressure for blood flow restricted exercise training: Systematic review.

Low-intensity exercise with blood flow restriction (BFR) is an increasingly common method of improving muscular strength and hypertrophy, and improving aerobic fitness, in clinical and athletic populations. The aim of this systematic review was to describe common approaches to determining occlusion pressures for BFR exercise. A comprehensive literature search yielded 1389 results, of which 129 were included. Studies were predominantly randomised control trials (86.7%) with modest sample sizes (average number of 11.4 ± 6.2 participants per BFR group/s) of young adults (average age of 34.6 ± 17.9). Five different approaches for determining occlusion pressure were identified: arbitrary pressures (56.6%), percentage of limb occlusion pressure (25.6%), brachial systolic blood pressure (10.9%), perceived tightness (3.9%) and other (3%). From 2016 to 2018, the number of published papers using a percentage of limb occlusion pressure increased yearly, paralleling a decrease use of arbitrary pressures. Of the studies included in this review, the most common approach to determining occlusion pressure was using a non-individualised, arbitrary pressure. Given the safety concerns associated with arbitrary pressures, continual dissemination regarding the optimal applications of BFR for safety and efficacy is required.

Heart rate acceleration at relative workloads during treadmill and overground running for tracking exercise performance during functional overreaching.

Maximal rate of heart rate (HR) increase (rHRI) as a measure of HR acceleration during the transition from rest to exercise, or during an increase in workload, tracks exercise performance. rHRI assessed at relative rather than absolute workloads may track performance better, and a field test would increase applicability. This study therefore aimed to evaluate the sensitivity of rHRI assessed at individualised relative workloads during treadmill and overground running for tracking exercise performance. Treadmill running performance (5 km time trial; 5TTT) and rHRI were assessed in 11 male runners following 1 week of light training (LT), 2 weeks of heavy training (HT) and a 10-day taper (T). rHRI was the first derivative maximum of a sigmoidal curve fit to HR data collected during 5 min of treadmill running at 65% peak HR (rHRI65%), and subsequent transition to 85% peak HR (rHRI85%). Participants ran at the same speeds overground, paced by a foot-mounted accelerometer. Time to complete 5TTT likely increased following HT (ES = 0.14 ± 0.03), and almost certainly decreased following T (ES = - 0.30 ± 0.07). Treadmill and field rHRI65% likely increased after HT in comparison to LT (ES ≤ 0.48 ± 0.32), and was unchanged at T. Treadmill and field rHRI85% was unchanged at HT in comparison to LT, and likely decreased at T in comparison to LT (ES ≤ - 0.55 ± 0.50). 5TTT was not correlated with treadmill or field rHRI65% or rHRI85%. rHRI65% was highly correlated between treadmill and field tests across LT, HT and T (r ≥ 0.63), but correlations for rHRI85% were trivial to moderate (r ≤ 0.42). rHRI assessed at relative exercise intensities does not track performance. rHRI assessed during the transition from rest to running overground and on a treadmill at the same running speed were highly correlated, suggesting that rHRI can be validly assessed under field conditions at 65% of peak HR.

Exercise as cardiovascular medicine.

BACKGROUND: Physical inactivity is a major modifiable contributor to the global burden of cardiovascular disease (CVD) morbidity and mortality. OBJECTIVE: In this article, a clinical case study is used to provide practical approaches for general practitioners and their teams to individualise exercise prescriptions for patients with hypertension who are at risk of CVD. The case presented describes a sedentary, overweight male with newly diagnosed hypertension - a common scenario in general practice. DISCUSSION: The many benefits of exercise are supported by an expanding body of research. Blood pressure can be safely and effectively reduced through physical activity, leading to a lower CVD risk. Value-based goal setting and the 'FITT' framework may be used to facilitate sustainable physical activity among patients. The engagement of allied health professionals such as exercise physiologists may also be beneficial.

Evaluation of an implementation project: The exercise physiology in aged care program.

AIM: It is important for older adults to maintain the ability to be physically active, and to experience the benefits that physical activity brings. This study evaluates a 12-week Accredited Exercise Physiologist-led exercise program for vulnerable older adults living with dementia, delivered in a residential aged care facility in South Australia. The value of the program was also evaluated from the perspective of partners-in-care (family members and care staff). METHODS: Participants (n = 59) were randomized to either an intervention or control group, based on their functional and cognitive status. Physical function, cognitive function and habitual physical activity were assessed at baseline and post-intervention. In total, 51 family members and 44 care staff completed surveys or participated to understand their perspectives of residents' capacity to exercise, as well as their perceptions of the impact of the program. RESULTS: Repeated measures ANOVA identified evidence for maintenance of physical function (timed-up-and-go [ɳ2 = 0.19], handgrip strength [ɳ2 = 0.13]); however, there were no differences for objectively measured habitual activity or cognitive function. Evidence for a dose effect was demonstrated for the 2-min walk and timed-up-and-go associated with the number of individual sessions attended by a participant. Partners-in-care perceived greater improvement compared with deterioration across all measured factors [(P < 0.01, partial eta2 (ɳ2 ) =0.19] ranged from 0.35 to 0.78) post-intervention. Perceptions and expectations of who could benefit from participation were changed (P < 0.05) and indicated that all but the most severely declined residents would be likely to benefit. CONCLUSIONS: Data supporting the maintenance for some physical functions suggest that this type of program should be considered for older adults living with dementia in residential aged care facilities. Geriatr Gerontol Int 2020; ••: ••-••.

Lack of Cited Evidence Underpinning Recommendations for Objective Assessment of Cardiovascular Function to Inform Exercise Prescription: A Systematic Review.

BACKGROUND: The effectiveness of exercise in managing cardiovascular (CV) health and function is well established. Less clear is the process for optimising the safety and efficacy of an intervention, particularly how objective assessments might inform this process. OBJECTIVE: The aim of this review was to investigate the cited evidence underpinning recommendations for assessing CV function to inform the safe and effective prescription of exercise in populations with established CV disease, as published in documents to guide practice authored by prominent organisations in cardiology and sports medicine. METHODS: A systematic review of position statements and guiding documents on exercise prescription for CV health was conducted. Included documents were published between 1997 and 2016. RESULTS: Following removal of duplicates, 3158 documents were considered, with full-text screening required for 334. Twenty-seven documents were included which provided 106 individual recommendations for specific objective assessments. Of the total number of recommendations, 60% had no accompanying citation and 28% of recommendations provided citations that did not directly support the statement made. Additionally, 52% of included documents did not state the methods of document development. That is, it was not clear if there was a literature review and/or expert consensus that was used to form recommendations included within. CONCLUSION: Almost no cited evidence underpinning the extracted recommendations from the included guiding documents, nor any acknowledgement of this deficiency was established. There were limited explanations found for the methods involved in developing such guiding documents.