12-wk Program Research Articles

Feasibility of nutrition counseling for breast cancer survivors: Results from the force trial.

e24054 Background: Certain dietary choices and body mass index (BMI) are associated with increased risk of breast cancer (BC) recurrence. Most patients (pts) consider nutrition very important but also report feeling confused about nutrition information. Many do not have access to a registered dietitian (RD) and nutrition education in medical schools is often lacking. Health coaching, education, goal-setting, and motivation are factors that can improve healthy habits and increase adherence to lifestyle modifications. We aimed to evaluate the feasibility of a 12-week (wk) pilot program of individualized nutrition counseling by a RD for BC survivors in a community oncology setting. Methods: We conducted a single-center, prospective, single arm trial to evaluate the feasibility of individualized nutrition counseling by a RD in pts with stage I-IV BC. Counseling focused on the American Cancer Society healthy eating pattern recommendations. Stage I-III BC pts must have completed all planned surgery, chemotherapy and radiation. Pts with stage IV/metastatic BC were eligible at any point during their treatment. Participants had three planned visits over a 12-week (wk) period: baseline, 4 wk follow-up visit, & 12 wk follow-up visit. Feasibility was measured by adherence to a three-visit protocol over a 12 wk period. Secondary objectives included effect of nutrition counseling on quality of life using Functional Assessment of Cancer Therapy-Breast (FACT-B) and on physical activity using Godin Leisure-Time Exercise Questionnaire (GLTEQ). Demographic and medical variables were collected. Results: N = 50 participants signed consent for the study, & all had baseline visits. Mean age 56 yrs (33-77). Pts: Stage I (N = 38); Stage II (N = 8); Stage III (N = 1); metastatic (N = 3). Mean BMI: 28.64 (17.7-48). Pts: ER+/HER2- (N = 37); ER+/HER2+ (N = 7); ER-/HER2+ (N = 2); ER-/HER2- (N = 4). 42 pts were on endocrine therapy during their participation on study. 36 pts (72%) completed the 12-wk program in its entirety. Average visit adherence for the whole cohort was 84.7%. Reasons for the 14 pts (28%) who did not complete the program included no virtual option available (N = 6); no time to attend (N = 2); not interested (N = 1) & unknown (N = 5). 9 only attended Visit 1 and 5 attended Visits 2 and 3. Pts who completed the program experienced an improvement in self-reported energy level (p = 0.01) as assessed in FACT-B from baseline to 12 wks. There was no significant difference in GLTEQ from baseline to 12 wks (p = 0.21). Remainder of QoL assessments to be presented. Conclusions: Individualized nutrition counseling in a community oncology program was feasible and led to improvement in self-reported energy levels. It is imperative to expand the reach and access of nutrition counseling to reach a more diverse patient population and maintain continuity. Future work will focus on testing this intervention in larger and more diverse populations of BC survivors and thrivers.

Long-Term Maintenance of Cardiorespiratory Fitness Gains After Cardiac Rehabilitation Reduces Mortality Risk in Patients With Multimorbidity.

The objective of this study was to characterize the impact of multimorbidity and cardiorespiratory fitness (CRF) on mortality in patients completing cardiac rehabilitation (CR). This cohort study included data from patients with a history of cardiovascular disease (CVD) completing a 12-wk CR program between January 1996 and March 2016, with follow-up through March 2017. Patients were stratified by the presence of multimorbidity, which was defined as having a diagnosis of ≥2 noncommunicable diseases (NCDs). Cox regression analyses were used to evaluate the effects of multimorbidity and CRF on mortality in patients completing CR. Symptom-limited exercise tests were completed at baseline, immediately following CR (12 wk), with a subgroup completing another test at 1-yr follow-up. Peak metabolic equivalents (METs) were determined from treadmill speed and grade. Of the 8320 patients (61 ± 10 yr, 82% male) included in the analyses, 5713 (69%) patients only had CVD diagnosis, 2232 (27%) had CVD+1 NCD, and 375 (4%) had CVD+≥2 NCDs. Peak METs at baseline (7.8 ± 2.0, 6.9 ± 2.0, 6.1 ± 1.9 METs), change in peak METs immediately following CR (0.98 ± 0.98, 0.83 ± 0.95, 0.76 ± 0.95 METs), and change in peak METs 1 yr after CR (0.98 ± 1.27, 0.75 ± 1.17, 0.36 ± 1.24 METs) were different ( P < .001) among the subgroups. Peak METs at 12 wk and the presence of coexisting conditions were each predictors ( P < .001) of mortality. Improvements in CRF by ≥0.5 METS from baseline to 1-yr follow-up among patients with or without multimorbidity were associated with lower mortality rates. Increasing CRF by ≥0.5 METs improves survival regardless of multimorbidity status.

Implementation and Effectiveness of a Veterans Affairs-Based Comprehensive Lung Cancer Survivorship Program.

Few programs exist to address persistent impairment in functional status, quality of life, and mental health in lung cancer survivors. We aimed to determine whether a 12-wk multimodal survivorship program imparts clinical benefit. Any patient at the Durham Veterans Affairs Medical Center with lung cancer and a Karnofsky score of ≥60 could participate. Chronic obstructive pulmonary disease medications were optimized at the enrollment visit. Participants with a Hospital Anxiety and Depression Scale (HADS) score of >8 were offered pharmacotherapy and mental health referral. Participants did home-based exercise with a goal of 1 hr/d, 5 d/wk. They were called weekly to assess exercise progress and review depression/anxiety symptoms. Participants were offered pharmacotherapy for smoking cessation. Twenty-three (50%) of the first 46 enrollees completed the full 12-wk program. Paired changes from enrollment to completion (mean ± SD) were observed in 6-min walk test (73.6 ± 96.9 m, P = .002), BODE (Body mass index, airflow Obstruction, Dyspnea, and Exercise) index (-1.45 ± 1.64 points, P < .001), Duke Activity Status Index (3.84 ± 7.12 points, P = .02), Fried Frailty Index (-0.588 ± 0.939 points, P = .02), modified Medical Research Council dyspnea scale (-0.619 ± 1.284 points, P = .04), Functional Assessment of Cancer Therapy-Lung Emotional subscale score (1.52 ± 2.96 points, P = .03), HADS total score (-2.63 ± 4.34 points, P = .02), and HADS Anxiety subscale score (-1.47 ± 2.29 points, P = .01). A comprehensive Lung Cancer Survivorship Program provides clinically meaningful improvements in functional status, quality of life, and mental health.

Symptoms of Depression and Anxiety in Patients With Type 2 Diabetes in a Canadian Outpatient Cardiac Rehabilitation Program.

The objective of this study was to determine whether type 2 diabetes status is associated with an increased likelihood of depressed mood and anxiety in patients attending cardiac rehabilitation (CR) and to explore predictors of depression and anxiety after CR completion in patients with diabetes. A retrospective analysis was conducted in patients who completed a 12-wk CR program between 2002 and 2016. Patients were classified as reporting normal-to-mild or moderate-to-severe symptoms of depression and anxiety using the Hospital Anxiety and Depression Scale (HADS). Logistic regression models were used to compare predictors of depression and anxiety prior to CR enrollment and investigate predictors of post-CR HADS scores among a subset of patients with diabetes. Data from 6746 patients (mean age 61 ± 11 yr, 18% female, 18% with diabetes) were analyzed. After controlling for known predictors of depression, patients with diabetes were not more likely to report moderate-to-severe levels of depression prior to or after completing CR. In patients with diabetes, younger age predicted moderate-to-severe depression post-CR (OR = 0.95: 95% CI, 0.93-0.98). Patients with diabetes were also more likely to report moderate-to-severe levels of anxiety after completing CR (OR = 1.45: 95% CI, 1.02-2.07). Younger age (OR = 0.93: 95% CI, 0.88-0.97) and smoking status (OR = 3.3: 95% CI, 1.15-7.06) predicted moderate-to-severe post-CR anxiety in patients with diabetes. Patients with diabetes, particularly younger patients who currently smoke or recently quit, are more likely to report having anxiety following CR. These patients may therefore require additional management of anxiety symptoms during CR. Larger studies of CR patients with diabetes and more variable depression and anxiety levels are needed.

Home-Based Cardiac Rehabilitation: EXPERIENCE FROM THE VETERANS AFFAIRS.

The conceptual utility of home-based cardiac rehabilitation (HBCR) is widely acknowledged. However, data substantiating its effectiveness and safety are limited. This study evaluated effectiveness and safety of the Veterans Affairs (VA) national HBCR program. Veterans completed a 12-wk HBCR program over 18 mo at 25 geographically dispersed VA hospitals. Pre- to post-changes were compared using paired t tests. Patient satisfaction and adverse events were also summarized descriptively. Of the 923 Veterans with a mean age of 67.3 ± 10.6 yr enrolled in the HBCR program, 572 (62%) completed it. Findings included significant improvements in exercise capacity (6-min walk test distance: 355 vs 398 m; P < .05; Duke Activity Status Index: 27.1 vs 33.5; P < .05; self-reported steps/d: 3150 vs 4166; P < .05); depression measured by Patient Health Questionnaire (6.4 vs 4.9; P < .0001); cardiac self-efficacy (33.1 vs 39.2; P < .0001); body mass index (31.5 vs 31.1 kg/m2; P = .0001); and eating habits measured by Rate Your Plate, Heart (47.2 vs 51.1; P < .05). No safety issues were related to HBCR participation. Participants were highly satisfied. The VA HBCR program demonstrates strong evidence of effectiveness and safety to a wide range of patients, including those with high clinical complexity and risk. HBCR provides an adjunct to site-based programs and access to cardiac rehabilitation. Additional research is needed to assess long-term effects, cost-effectiveness, and sustainability of the model.

Safety, feasibility, and efficacy of strengthening exercise in Duchenne muscular dystrophy.

This two-part study explored the safety, feasibility, and efficacy of a mild-moderate resistance isometric leg exercise program in ambulatory boys with Duchenne muscular dystrophy (DMD). First, we used a dose escalation paradigm with varying intensity and frequency of leg isometric exercise to determine the dose response and safety in 10 boys. Second, we examined safety and feasibility of a 12-wk in-home, remotely supervised, mild-moderate intensity strengthening program in eight boys. Safety measures included T2 MRI, creatine kinase levels, and pain. Peak strength and function (time to ascend/descend four stairs) were also measured. Dose-escalation revealed no signs of muscle damage. Seven of the eight boys completed the 12-wk in-home program with a compliance of 84.9%, no signs of muscle damage, and improvements in strength (knee extensors P < .01; knee flexors P < .05) and function (descending steps P < .05). An in-home, mild-moderate intensity leg exercise program is safe with potential to positively impact both strength and function in ambulatory boys with DMD.

Impact of 12 weeks of oxygen consuming preparing on visfatin levels in large ladies

Visfatin is an adipocytokine that discharge from adipocytes. It is obscure in the case of preparing likewise impacts groupings of visfatin. The reason for this examination was to look at the impacts of 12 weeks of oxygen consuming preparing on visfatin levels in fat ladies. 32 fat ladies (age = 37.8 ± 13.2 years, weight ind ex = of 39.4 ± 6.4 kg/m2 .) elected to take an interest in a 12-wk practice program. They were haphazardly relegated to either a preparation (n = 16) or control (n = 14) gathering. The preparation bunch practiced for 70 minutes for each meeting, 3 days out of every week during the multi week preparing program. The benchmark group was approached to keep up their typical every day exercises. Tests were acquired previously and toward the finish of preparing program. We use t. paire and autonomous, test for information breaks down

Effect Of Core Strength Exercise On Colon Transit Time In Female University Students

PURPOSE: To evaluate the benefit of core strength exercise (CSE) on colonic transit time (CTT) for female university students. METHODS: Eighty women were enrolled and randomly assigned to participate in a 12-week instructor-led group CSE program (exercise group; n = 40) or to maintain their ordinary daily activities (control group; n = 40). The final groups were composed of 27 participants (age: 22.9 years) in the exercise group and 21 participants (age: 22.9 years) in the control group (CG). The CSE program consisted of 60 minute sessions, two days a week for 12 weeks. Each session included a 10-minute warm-up, 40-minute core strengthening exercises, and 10-minute cool-down. Body composition, Trunk muscle power and endurance, physical fitness and CTT were measured twice before and twice after the exercise program. CTT was measured using a multiple marker technique with a radio-opaque marker. Data were analyzed with a 2-way, repeated measures ANOVA. RESULTS: After the 12-wk core exercise intervention, decreased intestinal transit time was observed in segment CTT of the exercise group, including the right CTT (exercise: 9.0 ± 1.8 vs 6.4 ± 1.5, control: 5.3 ± 1.3 vs 6.5 ± 1.5), left CTT (exercise: 10.9 ± 2.0 vs 6.9 ± 1.8, control: 10.6 ± 2.3 vs 8.7 ± 1.5), recto-sigmoid CTT (exercise: 17.4 ± 2.9 vs 12.1 ± 2.0, control: 8.7 ± 2.3 vs 11.9 ± 2.8), and total colonic transit time (TCTT) (exercise: 37.5 ± 4.4 vs 25.5 ± 3.8, control: 24.7 ± 4.8 vs 27.2 ± 4.8). After the 12-wk core exercise period, LCTT (mean difference, -3.7 h; 95% confidence interval [CI], -6.9 to -0.6 h; P=0.02) and TCTT (mean difference, -9.4 h; 95% CI, -16.4 to -2.4 h; P=0.01) was significantly shortened within the exercise group in mean changes from baseline to 12wk follow-up. CONCLUSIONS: The CTT was reduced due to increased physical activity via a 12-wk CSE program. In addition to eating habits, water intake, and fiber intake, the increased physical activity level as a result of the 12-wk CSE reduced the CTT. Further prospective studies will need to study the effects on CTT according to dose-response, type of exercise, and intensity.

Resistance exercise training promotes fiber type-specific myonuclear adaptations in older adults.

Aging induces physiological decline in human skeletal muscle function and morphology, including type II fiber atrophy and an increase in type I fiber frequency. Resistance exercise training (RET) is an effective strategy to overcome muscle mass loss and improve strength, with a stronger effect on type II fibers. In the present study, we sought to determine the effect of a 12-wk progressive RET program on the fiber type-specific skeletal muscle hypertrophic response in older adults. Nineteen subjects [10 men and 9 women (71.1 ± 4.3 yr)] were studied before and after the 12-wk program. Immunohistochemical analysis was used to quantify myosin heavy chain (MyHC) isoform expression, cross-sectional area (CSA), satellite cell abundance, myonuclear content, and lipid droplet density. RET induced an increase in MyHC type II fiber frequency and a concomitant decrease in MyHC type I fiber frequency. Mean CSA increased significantly only in MyHC type II fibers (+23.3%, P < 0.05), but myonuclear content increased only in MyHC type I fibers (P < 0.05), with no change in MyHC type II fibers. Satellite cell content increased ~40% in both fiber types (P > 0.05). RET induced adaptations to the capillary supply to satellite cells, with the distance between satellite cells and the nearest capillary increasing in type I fibers and decreasing in type II fibers. Both fiber types showed similar decrements in intramuscular lipid density with training (P < 0.05). Our data provide intriguing evidence for a fiber type-specific response to RET in older adults and suggest flexibility in the myonuclear domain of type II fibers during a hypertrophic stimulus.NEW & NOTEWORTHY In older adults, progressive resistance exercise training (RET) increased skeletal muscle fiber volume and cross-sectional area independently of myonuclear accretion, leading to an expansion of the myonuclear domain. Fiber type-specific analyses illuminated differential adaptation; type II fibers underwent hypertrophy and exhibited myonuclear domain plasticity, whereas myonuclear accretion occurred in type I fibers in the absence of a robust hypertrophic response. RET also augmented satellite cell-capillary interaction and reduced intramyocellular lipid density to improve muscle quality.

Leucine Supplementation Has No Further Effect on Training-induced Muscle Adaptations.

Several acute studies have suggested that leucine is a key amino acid to drive muscle protein synthesis. However, there are very few studies on the long-term effects of leucine supplementation on resistance training (RT)-induced gains in muscle mass and strength. We sought to determine the impact of 10 g of leucine on muscle mass and strength in response to RT in healthy young men. Twenty-five, resistance-trained men (27 ± 5 yr; 78.4 ± 11.6 kg; 24.8 ± 3.0 kg·m) consuming 1.8 ± 0.4 g protein·kg·d, were randomly assigned to receive 2 × 5 g·d supplementation of either free leucine (LEU n = 12) or alanine (PLA n = 13) while undergoing a supervised 12-wk, twice-weekly lower-limb RT program. One-repetition maximum (leg-press 1RM) and muscle cross-sectional area (mCSA) of the vastus lateralis were determined before (PRE) and after (POST) the intervention. Additionally, three 24-h dietary recalls were also performed at PRE and POST. Protein intake was roughly double that of the RDA in both groups and remained unchanged across time with no differences detected between groups. Similar increases were observed between groups in leg-press 1RM (LEU, 19.0% ± 9.4% and PLA, 21.0% ± 10.4%, P = 0.31) and mCSA (LEU, 8.0% ± 5.6% and PLA, 8.4% ± 5.1%, P = 0.77). High-dose leucine supplementation did not enhance gains in muscle strength and mass after a 12-wk RT program in young resistance-trained males consuming adequate amounts of dietary protein.

The Effect of Exercise Timing on Glycemic Control: A Randomized Clinical Trial.

This study sought to determine the effect of diurnal exercise timing on glycemic control in individuals enrolled in a 12-wk supervised multimodal exercise training program. A secondary aim was to determine the effect of diurnal exercise timing on the circadian rhythm of wrist skin temperature. Forty sedentary, overweight adults (mean ± SD, age = 51 ± 13 yr; body mass index = 30.9 ± 4.2 kg·m; women, n = 23) with and without (n = 20) T2D diagnosis were randomly allocated to either a morning (amEX) or an evening (pmEX) exercise training group. The supervised 12-wk (3 d·wk) program, comprised 30 min of moderate-intensity walking and 4 resistance-based exercises (3 sets, 12-18 repetitions each). Glycemic outcomes (glycated hemoglobin, fasting glucose, postprandial glucose) and wrist skin temperature were assessed at baseline and postintervention. Exercise training improved (main effect of time, all P < 0.01) all glycemic outcomes; however, this was independent of allocation to either the amEX (Hedge's g, 0.23-0.90) or the pmEX (Hedge's g, 0.16-0.90) group. Accordingly, the adopted exercise training program did not alter the circadian rhythm of skin temperature. When only T2D individuals were compared, amEX demonstrated greater effects (all Hedge's g) on glycated hemoglobin (amEX, 0.57; pmEX, 0.32), fasting glucose (amEX, 0.91; pmEX, 0.53), and postprandial glucose (amEX, 1.12; pmEX, 0.71) but was not statistically different. Twelve weeks of multimodal exercise training improved glycemic control and postprandial glycemic responses in overweight non-T2D and T2D individuals. However, no distinct glycemic benefits or alterations in circadian rhythm were associated with morning versus evening exercise, when performed three times per week in this cohort.

Home-Based Pulmonary Rehabilitation for Patients With Idiopathic Pulmonary Fibrosis: A PILOT STUDY.

To evaluate the adherence and effectiveness of a home-based exergame program for patients with idiopathic pulmonary fibrosis (IPF). Patients with IPF were randomly assigned to a relatively unsupervised Wii Fit exergame intervention group or Wii video game control group (with no active whole-body movement involved). Participants in both groups were instructed to play their respective games 30 min/d, 3 d/wk for 12 wk. In addition, they were asked to perform their usual exercise/physical activities. Outcome measures were 6-min walk distance (6MWD), exercise-related dyspnea, and St George's Respiratory Questionnaire (SGRQ). The 20 participants differed significantly between intervention and control groups in baseline characteristics (forced vital capacity = 2.0 ± 0.5 vs 3.1 ± 0.7 L; forced expiratory volume in 1 sec = 1.7 ± 0.4 vs 2.5 ± 0.6 L, respectively). Participant adherence rate to the exergame program was very low (20%). There was no significant improvement in the outcome measures in either group. In fact, both the intervention and control groups had a deterioration in 6MWD (-22 ± 56 m vs -60 ± 111 m), respectively and SGRQ scores (3 ± 9 vs 1 ± 11), respectively. The home-based exergame intervention for patients with IPF did not show improvement in functional performance, dyspnea, or health-related quality of life at the completion of the 12-wk program in our 2 heterogeneous groups. In addition to the low adherence rate, insufficient frequencies and durations of exergaming may contribute to the lack of improvement. A lack of effectiveness of home-based pulmonary rehabilitation using exergaming for patients with IPF appears consistent with prior observational studies that used more traditional modes of home-based exercise.

Feasibility of a Lifestyle Redesign®-Inspired Intervention for Well Older Adults.

We examined the feasibility of Aging Well by Design, a Lifestyle Redesign®-inspired intervention for community-dwelling older adults. The original Lifestyle Redesign program was shortened to 3 mo and implemented as a community outreach program of a major health care system. Community-dwelling older adults participated in the 12-wk program, which emphasized an occupational approach to healthy aging. Outcomes evaluated were recruitment, attendance, resource use, participant satisfaction, and subjective benefit to participants. The 13 participants, ages 66-88 yr, attended an average of 10 of 12 sessions. The intervention was completed as planned, physical resources were suitable, and financial resources were adequate. Participants expressed satisfaction with the program's facilitator, group discussions, and materials. Perceived benefits were social relationships, awareness of community resources, and change in attitude toward aging. Implementation of a 3-mo Lifestyle Redesign-inspired program within a health care system was feasible.

Resistance training with dietary intake maintenance increases strength without altering body composition in older women.

Evidence suggests that the aging process tends to lead to sarcopenia and osteoporosis which reduce the quality of life in older women. Resistance training (RT) is widely supported as a means of delaying or offsetting the decline in muscle strength and loss of bone mineral content in older women. The purpose of this investigation was to analyze the effects of a 12-wk RT program (3 times a week) with dietary intake maintenance on muscle strength and body composition of healthy, sedentary older women. Forty-four older women were randomly assigned to a RT program (N.=22, 66.3±4.8 years, 60.7±9.1 kg, 153.1±0.90 cm, 24.9±3.3 kg/m²) or a control group (N.=22, 66.4±4.0 years, 63.3±7.5 kg, 155.5±5.8 cm, 26.2±2.6 kg/m²) performing stretching exercises during the same period. One-repetition maximum test on chest press and leg extension were used to assess muscle strength. Body composition was measured by dual energy x-ray absorptiometry to determine fat mass, fat-free mass, and bone mineral content. Dietary intake was recorded using a 3-day food records. All subjects maintained their normal diet during the investigation. No significant differences were found for the body composition components within and between groups. A significant time by group interaction indicated that the RT group made greater improvements in upper and lower limb muscle strength (chest press ~12%, P=0.0001; leg extension ~13%, P<0.0001). These results suggest that RT program improves muscle strength of major muscle groups, without altering body composition in older women under dietary intake maintenance.

Achilles Tendon Adaptation During Transition to a Minimalist Running Style.

Achilles tendons (ATs) adapt to increased loading generated by long-term adoption of a minimalist shoe running style. There may be difference in the chronology and extent of adaptation between the sexes. To learn the chronology of AT adaptations in female and male runners who transitioned to a minimalist running style through a planned, progressive 12-wk transition program. Prospective cohort study of well-trained, traditionally shod runners who transitioned to minimalist shoe running. Repeated laboratory assessment at baseline and 3, 12, and 24 wk after initiating transition program. Fifteen women and 7 men (of 29 enrolled) completed the study. The authors used diagnostic ultrasound and isokinetic dynamometry to generate a force elongation curve and its derivatives at each time point. Greater adaptations were observed in men than in women, with men generating more force and having greater increases in CSA, stiffness, and Young's modulus and less elongation after 12 wk of training. Men demonstrated changes in AT properties that were consistent with increased loading of the triceps surae during exercise. The women demonstrated far smaller changes. Further investigation is warranted to understand when adaptations may occur in women and the implications of altered AT mechanical properties for performance and injury risk.

Resistance Exercise Training Alters Mitochondrial Function in Human Skeletal Muscle.

Loss of mitochondrial competency is associated with several chronic illnesses. Therefore, strategies that maintain or increase mitochondrial function will likely be of benefit in numerous clinical settings. Endurance exercise has long been known to increase mitochondrial function in the skeletal muscle. Comparatively little is known regarding the effect of resistance exercise training (RET) on skeletal muscle mitochondrial respiratory function. The purpose of the current study was to determine the effect of chronic resistance training on skeletal muscle mitochondrial respiratory capacity and function. Here, we studied the effect of a 12-wk RET program on skeletal muscle mitochondrial function in 11 young healthy men. Muscle biopsies were collected before and after the 12-wk training program, and mitochondrial respiratory capacity was determined in permeabilized myofibers by high-resolution respirometry. RET increased lean body mass and quadriceps muscle strength by 4% and 15%, respectively (P < 0.001). Coupled mitochondrial respiration supported by complex I, and complex I and II substrates increased by 2- and 1.4-fold, respectively (P < 0.01). The ratio of coupled complex I-supported respiration to maximal respiration increased with RET (P < 0.05), as did complex I protein abundance (P < 0.05), whereas the substrate control ratio for succinate was reduced after RET (P < 0.001). Transcripts responsible for proteins critical to electron transfer and NAD production increased with training (P < 0.05), whereas transcripts involved in mitochondrial biogenesis were unaltered. Collectively, 12 wk of RET resulted in qualitative and quantitative changes in skeletal muscle mitochondrial respiration. This adaptation was accompanied by modest changes in mitochondrial proteins and transcript expression. RET seems to be a means to augment the respiratory capacity and intrinsic function of skeletal muscle mitochondria.

Exercise training decreases activation of the mitochondrial fission protein dynamin-related protein-1 in insulin-resistant human skeletal muscle.

Defects in mitochondrial dynamics, the processes of fission, fusion, and mitochondrial autophagy, may contribute to metabolic disease including type 2 diabetes. Dynamin-related protein-1 (Drp1) is a GTPase protein that plays a central role in mitochondrial fission. We hypothesized that aerobic exercise training would decrease Drp1 Ser(616) phosphorylation and increase fat oxidation and insulin sensitivity in obese (body mass index: 34.6 ± 0.8 kg/m(2)) insulin-resistant adults. Seventeen subjects performed supervised exercise for 60 min/day, 5 days/wk at 80-85% of maximal heart rate for 12 wk. Insulin sensitivity was measured by hyperinsulinemic-euglycemic clamp, and fat oxidation was determined by indirect calorimetry. Skeletal muscle biopsies were obtained from the vastus lateralis muscle before and after the 12-wk program. The exercise intervention increased insulin sensitivity 2.1 ± 0.2-fold (P < 0.01) and fat oxidation 1.3 ± 0.3-fold (P < 0.01). Phosphorylation of Drp1 at Ser(616) was decreased (pre vs. post: 0.81 ± 0.15 vs. 0.58 ± 0.14 arbitrary units; P < 0.05) following the intervention. Furthermore, reductions in Drp1 Ser(616) phosphorylation were negatively correlated with increases in fat oxidation (r = -0.58; P < 0.05) and insulin sensitivity (rho = -0.52; P < 0.05). We also examined expression of genes related to mitochondrial dynamics. Dynamin1-like protein (DNM1L; P < 0.01), the gene that codes for Drp1, and Optic atrophy 1 (OPA1; P = 0.05) were significantly upregulated following the intervention, while there was a trend towards an increase in expression of both mitofusin protein MFN1 (P = 0.08) and MFN2 (P = 0.07). These are the first data to suggest that lifestyle-mediated improvements in substrate metabolism and insulin sensitivity in obese insulin-resistant adults may be regulated through decreased activation of the mitochondrial fission protein Drp1.

Patients with Diabetes in Cardiac Rehabilitation

Diabetes increases mortality after myocardial infarction, but participation in cardiac rehabilitation (CR) reduces this risk. Our objectives were to examine whether attendance at CR and changes in cardiorespiratory fitness differed according to diabetic status and sex. Retrospective cohort study of patients referred for CR in Calgary between 1996 and 2010. Cardiorespiratory fitness in metabolic equivalents (METs) was estimated by maximal exercise testing at baseline, at the end of the 12-wk CR program, and 1-yr after CR. Among 7036 nondiabetic and 1546 diabetic patients who started, 84.9% of nondiabetic versus 79.5% of diabetic patients completed CR (P < 0.0001). The difference between diabetic and nondiabetic patients was greater in women (81.7% vs 72.1%, P < 0.0001) than that in men (86.0% vs 82.5%, P = 0.004). Patients without diabetes were more likely to return for the 1-yr assessment (53.7% vs 42.7%, P < 0.0001), and nondiabetic women were more likely than diabetic women to attend the 1-yr follow-up (44.3% vs 31.7%, P < 0.0001). Change in cardiorespiratory fitness from baseline to 12 wk was +1.0 METs in nondiabetic men, +0.9 METS in diabetic men, +0.9 METs in nondiabetic women, and +0.7 METs in diabetic women (within-group change; P = 0.0009). Changes in cardiorespiratory fitness at 1 yr compared with baseline were +0.9, +0.6, +0.9, and +0.5 METS, respectively (within-group change, P = 0.0001). Patients with diabetes, especially females, were less likely than patients without diabetes to complete CR and attend follow-up. Among patients who attended 1-yr follow-up, changes in cardiorespiratory fitness were not as well maintained in diabetic patients as in nondiabetic patients. Identifying barriers and targeting CR adherence interventions to patients with diabetes may help improve outcomes.

Transcriptome signature of resistance exercise adaptations: mixed muscle and fiber type specific profiles in young and old adults

This investigation examined the effects of acute resistance exercise (RE), progressive resistance training (PRT), and age on the human skeletal muscle Transcriptome. Two cohorts of young and old adults [study A: 24 yr, 84 yr (n = 28); study B: 25 yr, 78 yr (n = 36)] were studied. Vastus lateralis biopsies were obtained pre- and 4 h post-RE in conjunction with the 1st and 36th (last) training session as part of a 12-wk PRT program in study A, whereas biopsies were obtained in the basal untrained state in study B. Additionally, the muscle fiber type specific (MHC I and MHC IIa) Transcriptome response to RE was examined in a subset of young and old women from study A. Transcriptome profiling was performed using HG U133 Plus 2.0 Arrays. The main findings were 1) there were 661 genes affected by RE during the 1st and 36th training bout that correlated with gains in muscle size and strength with PRT (termed the Transcriptome signature of resistance exercise adaptations); 2) the RE gene response was most pronounced in fast-twitch (MHC IIa) muscle fibers and provided additional insight into the skeletal muscle biology affected by RE; 3) skeletal muscle of young adults is more responsive to RE at the gene level compared with old adults and age also affected basal level skeletal muscle gene expression. These skeletal muscle Transcriptome findings provide further insight into the molecular basis of sarcopenia and the impact of resistance exercise at the mixed muscle and fiber type specific level.

Effectiveness of an Integrated Handwriting Program for First-Grade Students: A Pilot Study

We developed and piloted a program for first-grade students to promote development of legible handwriting and writing fluency. The Write Start program uses a coteaching model in which occupational therapists and teachers collaborate to develop and implement a handwriting-writing program. The small-group format with embedded individualized supports allows the therapist to guide and monitor student performance and provide immediate feedback. The 12-wk program was implemented with 1 class of 19 students. We administered the Evaluation of Children's Handwriting Test, Minnesota Handwriting Assessment, and Woodcock-Johnson Fluency and Writing Samples test at baseline, immediately after the Write Start program, and at the end of the school year. Students made large, significant gains in handwriting legibility and speed and in writing fluency that were maintained at 6-mo follow-up. The Write Start program appears to promote handwriting and writing skills in first-grade students and is ready for further study in controlled trials.