Implementing changing behaviour towards aerobic and strength exercise: Results of a randomised, phase I study determining the safety, feasibility, and consumer-evaluation of an online exercise program in persons with multiple sclerosis.

BACKGROUND: Many people with MS do not meet the recommended exercise regime to elicit health benefits. This study aimed to determine the feasibility, safety, acceptability, and appropriateness of an exercise intervention delivered online to persons with MS that meets current exercise recommendations and behaviour change principles. METHODS: Seventy-two participants (age: 43.3 ± 13.3 years) with mild to moderate MS were stratified according to previous exercise behaviour and block-randomised into one of three groups: Control (CON; n = 24), General Exercise (GE; n = 24) who at screening did not meet current exercise recommendations, and Advanced Exercise, (AE; n = 24) who at screening met the current exercise recommendations. GE and AE groups received a four-month online-supervised, behaviour change theory-based exercise program and were assessed at baseline, four-months, five-months, and eleven-months for physical activity participation. The feasibility of process, resources, management, and scientific outcomes was assessed. RESULTS: Of 198 potential participants, 143 met the eligibility criteria (72 %), and 72 were randomised. Fifty-three participants completed the intervention (74 % immediate retention), and 44 were retained at the six-month follow-up (61 %). Personnel time was 369 h, and total per-participant cost was Au$1036.20. Adherence rate to ≥70 % of exercise sessions was 73 % (GE) and 38 % (AE). The GE group observed a small magnitude of improvement in physical activity (d = -0.23). CONCLUSIONS: An online exercise program embedded with behaviour interventions for either GE or AE appears feasible, acceptable, appropriate and safe and may show long-term efficacy in increased exercise behaviours for persons with mild to moderate MS. TRIAL REGISTRATION: ANZCRT number ACTRN12619000228189p.

The role of exercise and hypoxia on glucose transport and regulation.

Muscle glucose transport activity increases with an acute bout of exercise, a process that is accomplished by the translocation of glucose transporters to the plasma membrane. This process remains intact in the skeletal muscle of individuals with insulin resistance and type 2 diabetes mellitus (T2DM). Exercise training is, therefore, an important cornerstone in the management of individuals with T2DM. However, the acute systemic glucose responses to carbohydrate ingestion are often augmented during the early recovery period from exercise, despite increased glucose uptake into skeletal muscle. Accordingly, the first aim of this review is to summarize the knowledge associated with insulin action and glucose uptake in skeletal muscle and apply these to explain the disparate responses between systemic and localized glucose responses post-exercise. Herein, the importance of muscle glycogen depletion and the key glucoregulatory hormones will be discussed. Glucose uptake can also be stimulated independently by hypoxia; therefore, hypoxic training presents as an emerging method for enhancing the effects of exercise on glucose regulation. Thus, the second aim of this review is to discuss the potential for systemic hypoxia to enhance the effects of exercise on glucose regulation.

Effects of graded hypoxia during exhaustive intermittent cycling on subsequent exercise performance and neuromuscular responses.

PURPOSE: This study examined the effect of graded hypoxia during exhaustive intermittent cycling on subsequent exercise performance and neuromuscular fatigue characteristics in normoxia. METHODS: Fifteen well-trained cyclists performed an exhaustive intermittent cycling exercise (EICE 1; 15 s at 30% of anaerobic power reserve interspersed with 45 s of passive recovery) at sea level (SL; FiO2 ~ 0.21), moderate (MH; FiO2 ~ 0.16) and severe hypoxia (SH; FiO2 ~ 0.12). This was followed, after 30 min of passive recovery in normoxia, by an identical exercise bout in normoxia (EICE 2). Neuromuscular function of the knee extensors was assessed at baseline, after EICE 1 (post-EICE 1), and EICE 2 (post-EICE 2). RESULTS: The number of efforts completed decreased with increasing hypoxic severity during EICE 1 (SL: 39 ± 30, MH: 22 ± 13, SH: 13 ± 6; p ≤ 0.02), whereas there was no difference between conditions during EICE 2 (SL: 16 ± 9, MH: 20 ± 14, SH: 24 ± 17; p ≥ 0.09). Maximal torque (p = 0.007), peripheral (p = 0.02) and cortical voluntary activation (p < 0.001), and twitch torque (p < 0.001) decreased from baseline to post-EICE 1. Overall, there were no significant difference in any neuromuscular parameters from post-EICE 1 to post-EICE 2 (p ≥ 0.08). CONCLUSION: Increasing hypoxia severity during exhaustive intermittent cycling hampered exercise capacity, but did not influence performance and associated neuromuscular responses during a subsequent bout of exercise in normoxia performed after 30 min of rest.

Effect of increased physical activity on fructose-induced glycemic response in healthy individuals.

BACKGROUND/OBJECTIVES: The purpose of the current study was to determine whether increased physical activity (PA) altered glycemic control while ingesting an energy-balanced high-fructose diet. SUBJECTS/METHODS: Twenty-two normal-weight men and women (age: 21.2±0.6 years; body mass index: 22.6 ±0.6 kg/m(2)) participated in a randomized, cross-over design study in which they ingested an additional 75 g of fructose for 14 days while either maintaining low PA (FR+inactive) (<4500 steps/day) or high PA (FR+active) (>12,000 steps/day). Before and following the 2-week loading period, a fructose-rich meal challenge was administered and blood was sampled at baseline and for 6 h after the meal and analyzed for glucagon-like peptide-1 (GLP-1), glucose-dependent insulinotropic peptide (GIP), c-peptide, glucose and insulin concentrations. RESULTS: Plasma insulin, glucose, c-peptide, GIP and GLP-1 concentrations significantly increased in response to the test meal on all test visits (P<0.05). C-peptide incremental area under the curve (AUC) decreased by 10,208 ±120 pmol/l × min for 6 h from pre to post Fr+active intervention (P=0.02) leading to a decrease in plasma insulin total AUC (pre: 58,470.2±6261.0 pmol/l; post: 49,444.3±3883.0 pmol/l; P=0.04) resulting in a decrease Δpeak[Insulin] (P=0.009). Following the FR+active intervention, GIP total AUC significantly decreased (P=0.005) yet only males had a lower total GLP-1 AUC after both interventions (P=0.049). There were no sex differences in GIP levels. CONCLUSIONS: Increased PA attenuates the deleterious effects on glycemic control caused by a high-fructose diet. These changes in glycemic control with PA are associated with decreases in insulin and GIP concentrations.

Short-term aerobic exercise training increases postprandial pancreatic polypeptide but not peptide YY concentrations in obese individuals.

OBJECTIVE: Short-term exercise training improves glycemic control, but the effect of short-term training on postprandial satiety peptide responses or perceived satiety remains unknown. We tested the hypothesis that short-term aerobic exercise training (15 days) would alter postprandial pancreatic and gut peptide (pancreatic polypeptide (PP) and peptide YY (PYY)) responses and perceived appetite and satiety in obese individuals. SUBJECTS: Thirteen healthy obese men and women (age: 42±2 years; body mass index: 30-45 kg m(-2)). MEASUREMENTS: Subjects were studied before and after 15 days of training (walking 1 h at 70-75% VO(2peak)). On the study day, subjects consumed 1500 kcal as six meals (250 kcal: 9 g protein, 40 g carbohydrate, 6 g fat), while blood samples and satiety measurements were taken at baseline and every 20 min for 12 h. Blood was analyzed for PP, PYY, glucose and insulin levels. Appetite and satiety was assessed with a visual analog scale throughout the day. RESULTS: Incremental area under the curve (iAUC) for PP increased significantly with training (pre: 2788±753; post: 3845±830 pg ml(-1)·per min for 12 h; P<0.001), but there was no difference in the PP response to each meal. The initial PP response to the first meal increased (ΔPP(min 20-0): pre 86±25; post 140±36 pg ml(-1); P<0.05) with training. PYY iAUC showed no significant changes with training but showed a significant main effect of time across meals, with the largest response being to the first meal (P<0.005). There were no changes in satiety, glucose or insulin levels with training. CONCLUSION: Short-term exercise training increases postprandial PP concentrations in obese individuals; however, PYY levels and glycemic control remain unaffected. Both PP and PYY show meal-induced increases at all meals, but PYY has a greater response at the first meal with reduced responses at subsequent meals.

High-intensity intermittent exercise attenuates ad-libitum energy intake.

OBJECTIVE: To examine the acute effects of high-intensity intermittent exercise (HIIE) on energy intake, perceptions of appetite and appetite-related hormones in sedentary, overweight men. DESIGN: Seventeen overweight men (body mass index: 27.7±1.6 kg m(-2); body mass: 89.8±10.1 kg; body fat: 30.0±4.3%; VO(2peak): 39.2±4.8 ml kg(-1) min(-1)) completed four 30-min experimental conditions using a randomised counterbalanced design. CON: resting control, MC: continuous moderate-intensity exercise (60% VO(2peak)), HI: high-intensity intermittent exercise (alternating 60 s at 100% VO(2peak) and 240 s at 50% VO(2peak)), VHI: very-high-intensity intermittent exercise (alternating 15 s at 170% VO(2peak) and 60 s at 32% VO(2peak)). Participants consumed a standard caloric meal following exercise/CON and an ad-libitum meal 70 min later. Capillary blood was sampled and perceived appetite assessed at regular time intervals throughout the session. Free-living energy intake and physical activity levels for the experimental day and the day after were also assessed. RESULTS: Ad-libitum energy intake was lower after HI and VHI compared with CON (P=0.038 and P=0.004, respectively), and VHI was also lower than MC (P=0.028). Free-living energy intake in the subsequent 38 h remained less after VHI compared with CON and MC (P≤0.050). These observations were associated with lower active ghrelin (P≤0.050), higher blood lactate (P≤0.014) and higher blood glucose (P≤0.020) after VHI compared with all other trials. Despite higher heart rate and ratings of perceived exertion (RPE) during HI and VHI compared with MC (P≤0.004), ratings of physical activity enjoyment were similar between all the exercise trials (P=0.593). No differences were found in perceived appetite between trials. CONCLUSIONS: High-intensity intermittent exercise suppresses subsequent ad-libitum energy intake in overweight inactive men. This format of exercise was found to be well tolerated in an overweight population.

Satiety, but not total PYY, Is increased with continuous and intermittent exercise.

OBJECTIVE: This study determined the hormonal and subjective appetite responses to exercise (1-h continuous versus intermittent exercise throughout the day) in obese individuals. DESIGN AND METHODS: Eleven obese subjects (>30 kg/m(2) ) underwent three 12-h study days: control condition [sedentary behavior (SED)], continuous exercise condition [(EX) 1-h exercise], and intermittent exercise condition [(INT) 12 hourly, 5-min bouts]. Blood samples (every 10 min) were measured for serum insulin and total peptide YY (PYY) concentrations, with ratings of appetite (visual analog scale [VAS): every 20 min]. Both total area under the curve (AUC), and subjective appetite ratings were calculated. RESULTS: No differences were observed in total PYY AUC between conditions, but hunger was reduced with INT (INT < EX; P < 0.05), and satiety was increased with both SED and INT conditions (INT > EX and SED > EX; P < 0.05). A correlation existed between the change in total PYY and insulin levels (r = -0.81; P < 0.05), and total PYY and satiety (r = 0.80; P < 0.05) with the EX condition, not the SED and INT conditions. CONCLUSIONS: The total PYY response to meals is not altered over the course of a 12-h day with either intermittent or continuous exercise; however, intermittent exercise increased satiety and reduced hunger to a greater extent than continuous exercise in obese individuals.

Assessment of endothelial function and blood metabolite status following acute ingestion of a fructose-containing beverage.

AIM: Fructose intake has increased concurrent with sugar intake and this increase has been implicated in contributing to the development of metabolic syndrome risk factors. Recent evidence suggests a role for uric acid (UA) as a potential mediator via suppression of nitric oxide (NO) bioavailability. The aim of this study was to explore this hypothesis by measuring changes in UA concentration and systemic NO bioavailability as well as endothelial function in response to acute ingestion of a glucose-fructose beverage. METHODS: Ten young (26.80 +/- 4.80 years), non-obese (body mass index: 25.1 +/- 2.55 kg m(-2); percent body fat: 13.5 +/- 6.9%) male subjects ingested either a glucose (100 g dextrose in 300 mL) or isocaloric glucose-fructose (glucose : fructose; 45 : 55 g in 300 mL) beverage. Blood was sampled pre- and every 15-min post-ingestion per 90 min and assayed for glucose, lactate, fructose, total nitrate/nitrate, UA and blood lipids. Forearm blood flow and pulse-wave velocity were recorded prior to and at 30 and 45 min time intervals post-ingestion, respectively, while heart rate, systolic and diastolic blood pressure were recorded every 15 min. RESULTS: The glucose-fructose ingestion was associated with a significant (P < 0.05) increase in plasma lactate concentration and altered free fatty acid levels when compared with glucose-only ingestion. However, UA was not significantly different (P = 0.08) between conditions (AUC: -1018 +/- 1675 vs. 2171 +/- 1270 micromol L(-1) per 90 min for glucose and glucose-fructose conditions respectively). Consequently, no significant (P < 0.05) difference in endothelial function or systemic NO bioavailability was observed. CONCLUSION: Acute consumption of a fructose-containing beverage was not associated with significantly altered UA concentration, endothelial function or systemic NO bioavailability.

Ineffective staff, ineffective supervision, or ineffective administration? Why some nursing homes fail to provide adequate care.

This study involved 530 nursing staff working in 25 for-profit and nonprofit nursing homes, two of which failed to meet resident care standards required for state recertification. Staff members' job attitudes, opinions regarding elderly residents, and perceptions of the organization climate varied between the successful for-profit and non-profit homes. The organization climate in the failed homes was significantly different from the climate in either the successful for-profit or successful nonprofit homes.

Assessing the job performance of nursing home staff.

Nursing employees at four nursing homes participated in the development of Behavioral Anchored Rating Scales (BARS) to measure the job performance of individual nurses and aides. The reliability of the BARS performance measures was examined by having the immediate supervisors evaluate the job performance of nurses and aides in ten nursing homes. The BARS evaluations had significant convergent reliability between two independent evaluations of the same employees. There were no significant differences in the employees' performance ratings provided by two independent raters. Moreover, both raters tended to agree on the direction and magnitude of the changes in job performance ratings that were recorded over a six-month interval. The BARS evaluations, however, indicated a leniency bias because the performance ratings tended to cluster in the upper half of the scale ranges. There was also a "halo" effect in the evaluations, resulting in little discriminant reliability between the employees' performance ratings on different job dimensions.

Relative deprivation and perception of financial adequacy among the aged.

This paper presents a conceptual framework that incorporates the notion of relative deprivation to explain the perceived financial adequacy among the elderly. The model not only provides a more heuristic interpretation of older people's financial satisfaction but also further clarifies the role of actual income. The relative deprivation model was evaluated by using data from the General Social Survey conducted by the National Opinion Research Ctr. from 1972 through 1977. The findings support the predictions derived from the model and were replicated with high consistency across these six data sets. According to the findings, financial satisfaction is directly related to relative deprivation while income only indirectly affects one's sense of financial well-being. Social status, income, and labor force participation have been demonstrated to be either directly or indirectly related to feelings of deprivation.