Feasibility of a 12 Week Physical Intervention to Prevent Cognitive Decline and Disability in the At-Risk Elderly Population in Korea

Factors Influencing Recruitment, Retention, and Adherence Rates in Exercise Interventions in ESKD: A Scoping Review

Is exercise an acceptable and practical therapy for people with or cured of cancer? A systematic review

Home-based exercise programs in cystic fibrosis: Are they worth it?

Obesity is a leading modifiable contributor to breast cancer mortality due to its association with increased recurrence and decreased overall survival rate. Obesity stimulates cancer progression through chronic, low-grade inflammation in white adipose tissue, leading to accumulation of adipose tissue macrophages (ATMs), in particular, the pro-inflammatory M1 phenotype macrophage. Exercise has been shown to reduce M1 ATMs and increase the more anti-inflammatory M2 ATMs in obese adults. The purpose of this study was to determine whether a 16-week exercise intervention would positively alter ATM phenotype in obese postmenopausal breast cancer survivors. Twenty obese postmenopausal breast cancer survivors were randomized to a 16-week aerobic and resistance exercise (EX) intervention or delayed intervention control (CON). The EX group participated in 16weeks of supervised exercise sessions 3 times/week. Participants provided fasting blood, dual-energy X-ray absorptiometry (DXA), and superficial subcutaneous abdominal adipose tissue biopsies at baseline and following the 16-week study period. EX participants experienced significant improvements in body composition, cardiometabolic biomarkers, and systemic inflammation (all p<0.03 vs. CON). Adipose tissue from EX participants showed a significant decrease in ATM M1 (p<0.001), an increase in ATM M2 (p<0.001), increased adipose tissue secretion of anti-inflammatory cytokines such as adiponectin, and decreased secretion of the pro-inflammatory cytokines IL-6 and TNF- α (all p<0.055). A 16-week aerobic and resistance exercise intervention attenuates adipose tissue inflammation in obese postmenopausal breast cancer survivors. Future large randomized trials are warranted to investigate the impact of exercise-induced reductions in adipose tissue inflammation and breast cancer recurrence.

Background and Purpose: Obesity is a leading modifiable contributor to breast cancer mortality due to its association with increased recurrence and decreased overall survival rate. There are over 2.5 million breast cancer survivors, 64% of whom are overweight/obese (BMI &amp;gt;25 kg/m2). A central mechanism by which obesity stimulates cancer progression is through chronic, low-grade inflammation in white adipose tissue, leading to accumulation of adipose tissue macrophages (ATMs), in particular the pro-inflammatory M1 phenotype macrophage. Exercise has been shown to reduce M1 ATMs, and increase the more anti-inflammatory M2 ATMs in obese adults. The purpose of this study was to determine whether a 16-week exercise intervention would positively alter adipose tissue inflammation by changing ATM phenotype and cytokine secretion in obese postmenopausal breast cancer survivors. Experimental Design: Twenty obese postmenopausal breast cancer survivors were recruited from USC and randomized to either the exercise (EX) or control (CON) group. The EX group participated in 16 weeks of supervised exercise sessions 3 times/week. Sessions included total-body resistance training consisting of 8 exercises with a rest period of 45 seconds between each set of resistance exercise followed by 30 minutes of moderate-vigorous intensity (65-80% HRmax) aerobic exercise. The CON group was asked to maintain their current activity levels. Superficial subcutaneous abdominal adipose tissue biopsies were performed at baseline and following the 16-week study period. Adipose tissue samples were analyzed using fluorescence-activated cell sorting (FACS) to characterize ATM characterization (M1 vs M2). Portions (~100 mg) of each biopsy were incubated in media overnight to measure cytokine secretion. A 2x2 (group x time) repeated measures ANOVA was used to evaluate changes in adipose tissue and systemic inflammation. Summary of Results: At baseline, there were no group differences (p&amp;gt;0.05) in age (55.1±5.2 yrs), BMI (34.4±7.5 kg/m2), percent body fat (36.2±4.9%), or ATM M1 (25.4±6.7%) and M2 (4.2±0.9%) levels. EX was associated with a significant decrease in ATM M1 (-18.8±7.3%) and increase in ATM M2 (9.6±1.6%; p&amp;lt;0.01). EX increased adipose tissue secretion of the anti-inflammatory cytokines, adiponectin (14.6±5.2%), IL-12 p40 (2.4±0.8), IL-12 p70 (2.8±1.8%) and decreased secretion of IL-6 (-4.8±2.0%), and TNF-a (-2.0±0.7; p&amp;lt;0.01). The CON group did not experience any changes in ATM characterization and cytokine secretion during the study period (p&amp;gt;0.01). Conclusions: A 16-week aerobic and resistance exercise intervention attenuates adipose tissue inflammation in obese postmenopausal breast cancer survivors. Future large randomized controlled trials are warranted to investigate the impact of exercise-induced reductions in adipose tissue inflammation and breast cancer recurrence. Citation Format: Christina M. Dieli-Conwright, Jean Hughes-Parmentier, Kyuwan Lee, Darcy Spicer, Wendy Mack, Fred Sattler, Steven D. Mittelman. Adipose tissue inflammation in breast cancer survivors: Effects of a 16-week aerobic and resistance exercise intervention [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 985. doi:10.1158/1538-7445.AM2017-985

BackgroundThis is a preliminary study to research the efficacy of a multicomponent and structured high intensity interval physical exercise intervention (PEI) on cognitive function in the not‐demented Korean elderly.MethodWe enrolled 6 not‐demented participants over the age of 70 from a community health center (77.0±4.7 years, 33.3% female). The PEI was conducted at the community health center for 4 weeks, 3 times a week, and 1 hour a day. It was a multicomponent structured physical exercise program consisting of muscle strength, flexibility, balance and aerobic exercises using elastic bands and ladder‐shaped floor plate, which was also a high intensity interval exercise program that allowed participants to maintain a 75 percent increase in their heart rate during exercise rather than the heart rate measured at rest. The outcome of this study was the effect of our PEI and was intended to be verified by conducting the physical fitness, cognitive function evaluation and electroencephalography, which were analyzed by paired t‐tests.ResultAfter the PEI, some items of participants' physical fitness and cognitive function evaluation were improved: 30‐seconds sit‐stand test (16.2±7.0 vs 24.8±5.5, p&lt;0.05), 2‐minutes stationary march (98.3±27.2 vs 143.7±36.9, p&lt;0.05), literacy independent cognitive assessment (LICA) memory domain score (89.6±21.6 vs 111.0±19.1, p&lt;0.05), LICA executive domain score (33.3±5.3 vs 37.0±5.1, p&lt;0.05) and LICA total score (214.6±30.6 vs 241.6±22.8, p&lt;0.05). In addition, the relative theta and delta power on temporal brain region were decreased and the relative beta power on frontal brain region was increased (p&lt;0.05) after the PEI.ConclusionThis study suggests that our high intensity interval PEI program could be helpful for the elderly with cognitive brain function as well as physical fitness, lower extremity muscular and cardiopulmonary endurance.

Background and Study Aim. The elderly represent a growing age group and an integral part of modern society. The aging process introduces significant health challenges, making exercise an essential component in maintaining quality of life and well-being among the elderly. This study reviews the impact of physical exercise interventions on the physical and cognitive functions of the elderly population. Material and Methods. The search for this study was conducted using the ScienceDirect and PubMed databases. The search strategy employed a combination of keywords ("Elderly Physical Exercise" AND "Physical Exercise Intervention" AND "Elderly Fitness and Cognitive" AND "Physical Exercise for Physical and Cognitive Functions" AND "Physical and Cognitive Benefits" AND "Elderly Physical Exercise Prevalence"). This search adhered to the PRISMA guidelines. Initially, 1,854 publications were identified through the database searches (ScienceDirect: 981 articles; PubMed: 873 articles). After applying the exclusion criteria, only 11 articles remained. Results. It has been found that physical exercise interventions for the elderly significantly impact their physical and cognitive functions. In the first group, exercises such as home-based e-Health programs, multicomponent exercises, moderate aerobic exercises, dance training, and balance training have been identified. All these have been shown to provide substantial benefits. These programs enhanced not only physical function but also cognitive performance and the overall quality of life for older adults without physical and cognitive health complaints. This showcases the potential of physical exercise interventions to prevent morbidity and reduce disability. The second group focused on physical exercise interventions for older adults with degenerative disease complaints, such as type 2 diabetes and multiple sclerosis. Dual-task exercise programs and tai chi chuan exercises have demonstrated improvements in cognitive function for this demographic. They also improved physical fitness. The research also points out some limitations related to the implementation and budgeting for these programs. Conclusions. The literature review suggests that physical exercise interventions play a crucial role in maintaining physical and cognitive functions in older adults. Exercise programs tailored to the specific health conditions of individuals can significantly improve the quality of life and reduce the risk of declining physical and cognitive functions in the elderly population.

Exercise Versus Pharmacological Interventions for Reducing Visceral Adiposity and Improving Health Outcomes

Puhan MA, Busching G, Schunemann HJ, VanOort E, Zaugg C, Frey M Ann Intern Med. 2006;145:816-825. Background Guidelines recommend high-intensity continuous exercise to reduce peripheral muscle dysfunction in patients with chronic obstructive pulmonary disease but acknowledge that interval exercise might be an equally effective alternative that is better tolerated by patients. Objective. To assess whether interval exercise is no less effective than high-intensity continuous exercise and whether it is tolerated better by patients with severe chronic obstructive pulmonary disease. Design. Randomized, noninferiority trial. Setting. Publicly funded rehabilitation hospital in Switzerland. Patients. 98 patients with severe chronic obstructive pulmonary disease, with or without recent exacerbations. Intervention. 12 to 15 supervised interval or high-intensity continuous exercise sessions (over 3 weeks) followed by exercise at home. Measurements. Health-related quality of life determined by using the Chronic Respiratory Questionnaire (CRQ) (scores from 1 [most severe impairment] to 7 [no impairment]) after 5 weeks and number of unintended breaks during supervised exercise. Results. Both groups experienced large improvements in health-related quality of life (increase of CRQ total scores of 1.00 [SD, 0.98] for the interval exercise group and 1.02 [SD, 1.05] for the continuous exercise group). Adjusted between-group differences between the interval exercise group and the continuous exercise group (−0.05 [95% CI, −0.42 to −0.32] for CRQ and 1.1 meters [CI, −25.4 to 27.6 meters] for 6-minute walking distance) were within the a priori defined boundaries of noninferiority (0.5 for CRQ and 45 meters for 6-minute walking distance). Twenty-one (47.9%) patients using interval exercise and 11 (24.0%) patients using continuous exercise were able to adhere to the protocol (difference, 23.9 percentage points [CI, 5.0 to 42.8 percentage points]; P = 0.014). The median number of unintended breaks lasting 1 minute or more was 2 (interquartile range, 0 to 16) for patients in the interval exercise group and 11 (interquartile range, 2 to 26) for patients in the continuous exercise group (P = 0.023). Limitations. The study focused on initiation of exercise and not on outpatient or home-based maintenance of exercise. Conclusions. Clinicians and patients can choose either of the 2 exercise plans to initiate physical exercise. Comment. The use of high-intensity exercise protocols in the initiation of pulmonary rehabilitation is well established. However, the more severely impaired patient often has difficulty with sustained exercise at the requisite workload levels (>70% of maximal exercise capacity), and this may directly affect not only the short-term outcome of exercise training but also the longer-term adherence to recommendations made during participation in pulmonary rehabilitation. This study is a well-designed randomized trial seeking to show that interval exercise (brief high-intensity bursts alternating with low-intensity exercise) is not inferior to high-intensity continuous exercise. Forty-nine and 51 patients were randomized to interval and continuous exercise groups, respectively; all had severe chronic obstructive pulmonary disease (mean FEV1, approximately 35% predicted, GOLD stage 3 and 4). At the end of 5 weeks (12 to 15 sessions), the interval group did not show less benefit in both health-related quality-of-life measures and 6-minute walk distance. Not only did the interval exercise group do at least as well using standard outcome measures, adherence to the assigned protocol was also significantly higher in this group, suggesting a higher level of patient preference. Whether the benefits would carry over into maintenance exercise training is unestablished, but the 2 protocols, interval and continuous exercise, seem to be equivalent in the initiation of pulmonary rehabilitation and can be offered as such, especially to patients with severe chronic obstructive pulmonary disease who may find the interval protocol more acceptable. SK

Decreased levels of the neuroprotective growth factors, low-grade inflammation, and reduced neurocognitive functions during aging are associated with neurodegenerative diseases, such as Alzheimer's disease. Physical exercise modifies these disadvantageous phenomena while a sedentary lifestyle promotes them. The purposes of the present study included investigating whether both aerobic and resistance exercise produce divergent effects on the neuroprotective growth factors, inflammatory cytokines, and neurocognitive performance, and further exploring whether changes in the levels of these molecular biomarkers are associated with alterations in neurocognitive performance. Fifty-five older adults with amnestic MCI (aMCI) were recruited and randomly assigned to an aerobic exercise (AE) group, a resistance exercise (RE) group, or a control group. The assessment included neurocognitive measures [e.g., behavior and event-related potential (ERP)] during a task-switching paradigm, as well as circulating neuroprotective growth factors (e.g., BDNF, IGF-1, VEGF, and FGF-2) and inflammatory cytokine (e.g., TNF-α, IL-1β, IL-6, IL-8, and IL-15) levels at baseline and after either a 16-week aerobic or resistance exercise intervention program or a control period. Aerobic and resistance exercise could effectively partially facilitate neurocognitive performance [e.g., accuracy rates (ARs), reaction times during the heterogeneous condition, global switching cost, and ERP P3 amplitude] when the participants performed the task switching paradigm although the ERP P2 components and P3 latency could not be changed. In terms of the circulating molecular biomarkers, the 16-week exercise interventions did not change some parameters (e.g., leptin, VEGF, FGF-2, IL-1β, IL-6, and IL-8). However, the peripheral serum BDNF level was significantly increased, and the levels of insulin, TNF-α, and IL-15 levels were significantly decreased in the AE group, whereas the RE group showed significantly increased IGF-1 levels and decreased IL-15 levels. The relationships between the changes in neurocognitive performance (AR and P3 amplitudes) and the changes in the levels of neurotrophins (BDNF and IGF-1)/inflammatory cytokines (TNF-α) only approached significance. These findings suggested that in older adults with aMCI, not only aerobic but also resistance exercise is effective with regard to increasing neurotrophins, reducing some inflammatory cytokines, and facilitating neurocognitive performance. However, the aerobic and resistance exercise modes likely employed divergent molecular mechanisms on neurocognitive facilitation.

BackgroundThis pilot study examined long-term pulse wave velocity (PWV) and peak oxygen uptake (VO2peak) outcomes following a 12-week moderate-intensity aerobic or resistance training programme in kidney transplant recipients.MethodSingle-blind, bi-centre randomised controlled parallel trial. 42 out of 60 participants completed a 9-month follow-up assessment (Aerobic training = 12, Resistance training = 10 and usual care = 20). Participants completed 12 weeks of twice-weekly supervised aerobic or resistance training. Following the 12-week exercise intervention, participants were transitioned to self-managed community exercise activity using motivational interviewing techniques. Usual care participants received usual encouragement for physical activity during routine clinical appointments in the transplant clinic. PWV, VO2peak, blood pressure and body weight were assessed at 12 weeks and 12 months, and compared to baseline.ResultsANCOVA analysis, covarying for baseline values, age, and length of time on dialysis pre-transplantation, revealed a significant mean between-group difference in PWV of -1.30 m/sec (95%CI -2.44 to -0.17, p = 0.03) between resistance training and usual care groups. When comparing the aerobic training and usual care groups at 9-month follow-up, there was a mean difference of -1.05 m/sec (95%CI -2.11 to 0.017, p = 0.05). A significant mean between-group difference in relative VO2peak values of 2.2 ml/kg/min (95% CI 0.37 to 4.03, p = 0.02) when comparing aerobic training with usual care was revealed. There was no significant between group differences in body weight or blood pressure. There were no significant adverse effects associated with the interventions.ConclusionsSignificant between-group differences in 9-month follow-up PWV existed when comparing resistance exercise intervention with usual care. A long-term between-group difference in VO2peak was only evident when comparing aerobic intervention with usual care. This pilot study, with a small sample size, did not aim to elucidate mechanistic mediators related to the exercise interventions. It is however suggested that a motivational interviewing approach, combined with appropriate transition to community training programmes, could maintain the improvements gained from the 12-week exercise interventions and further research in this area is therefore warranted.Trial registrationstudy number: ISRCTN43892586.

Physical Activity and Diabetes.

PURPOSE: The purpose of this study is to evaluate the preventive effects of different exercise interventions on sarcopenia in elderly women by take exercise intervention on Chinese female elderly population. METHODS: Subjects: 260 sarcopenia female subjects were from China (61.2 ± 10.1 yrs) and 48 of them were lost to follow-up. They were randomly divided into Aerobic Exercise(AE) intervention group (n = 75), Resistance Exercise(RE) intervention group (n = 68) and Control group (n = 69). All signed informed consent.Intervention methods: 3 times a week, 60 minutes/per, 12 weeks. AE: Walking, jogging, swimming, tai chi and aerobics. RE: With the help of a chair,elastic belt,dumbbell for large muscle groups and multi-joint training, respectively by 40%, 50%, 60% 1RM exercise for 4 weeks. Test indicators: Height, Weight, Muscle Mass, Grip Strength (GS), Chair Sit to Stand (STS), Timed Up and Go (TUG). They were tested before intervention and 12 weeks after training. ANOVA by using SPSS20.0. RESULTS: 1. RE can significantly increase muscle mass. The muscle mass increased by 2.8% in the RE group significantly higher than that in the other two groups (P < 0.05). The body fat rate of AE group decreased by 2.3%, which was significantly higher than other two groups (P < 0.05). 2. RE can significantly increase muscle strength. The GS in the RE group increased by 13.1%, higher than that AE group (increased by 8.4%) and control group (increased by 3.6%) (P < 0.05). RE and AE can significantly improve physical activity function. Compared with the control group, the STS in the AE group and RE group were significantly improved (-18.1% and -15.6%), and the TUG were significantly reduced (1.7% and 11.0%) (P < 0.05). CONCLUSIONS: Exercise intervention has a positive prevention and treatment effect on sarcopenia in elderly women. Resistance exercise can improve muscle mass, muscle strength and physical activity function, aerobic exercise can improve the physical activity function of elderly women. Research supported by National Health Commission “Preventive intervention for disability caused by sarcopenia in the elderly” (No. 2019120876)

Medial temporal lobe cortical changes in response to exercise interventions in people with early psychosis: A randomized controlled trial

No conclusions have been drawn regarding the relative attrition and adherence rates associated with sustained vs. intermittent exercise programs. The study aims to systematically examine randomized controlled exercise intervention trials that report attrition and/or adherence rates to sustained vs. intermittent aerobic exercise programs. A comprehensive literature search was conducted, and references from qualifying articles were searched for additional papers. Fourteen articles met inclusion criteria, capturing 783 (76% female) enrolled and 599 (74% female) retained participants (mean age = 42.3 ± 6.6years). Study durations ranged from 8weeks to 18months (mean duration = 22.7 ± 21.9weeks). Although results varied, no consistent differences in attrition or adherence rates between sustained and intermittent exercise protocols were revealed. Given the universally low rate of regular exercise participation and the ongoing problem of adherence to exercise protocols, the field may benefit from randomized controlled trials examining sustained vs. intermittent exercise programs in greater depth.