6-month Exercise Program Research Articles

Effects of a Long-Term Monitored Exercise Program on Aerobic Fitness in a Small Group of Children with Cystic Fibrosis.

Background: The aim of this study was to investigate the effects of a monitored exercise program on aerobic fitness in children with cystic fibrosis (CF). Methods: Six children (2f/4m) with ages ranging from 6 to 14 years (11.3 ± 3.3 years.) and a mean ppFEV1 102.5 ± 13.5% pred. participated in the partially monitored 12-month exercise program. VO2peak and Wpeak were used as parameters of aerobic fitness. Incremental Cardio-Pulmonary Exercise Tests (CPETs) were performed before the program began (T1), after 6 months (T3) of monitoring, and after a further 6 months (T4) without monitoring. Habitual physical activity (HPA) was assessed with accelerometry. Results: The values of VO2peak and Wpeak improved slightly from T1 to T3 (p > 0.05), without a further increase after monitoring was stopped (T4). However, the VO2peak and Wpeak values were higher after monitoring was stopped compared to at T1. The exercise program with and without monitoring (p > 0.05) had no or only a slight effect on the FEV1 values, steps/day, and the intensity of HPA. Conclusions: Monitoring seems to facilitate the achievement of beneficial effects on physical fitness in CF children. For that reason, continuous individual exercise monitoring programs that involve close contact with an exercise therapist should be provided to maintain long-term motivation and participation in physical activities and sport activities during leisure time.

The legacy effect of a home walking exercise programme in kidney failure patients on dialysis.

The EXerCise Introduction To Enhance performance (EXCITE) trial (J Am Soc Nephrol 28: 1259-1268, 2017) in dialysis patients showed that a 6-month home walking exercise programme improves physical function and two dimensions of the Kidney Disease Quality of Life Short Form (KDQOLSF-SF™) questionnaire. Whether improvements in physical function achieved by exercise interventions are maintained in the long term has never been tested in the dialysis population. In this post-trial study embedded in the EXCITE trial, we tested the response to the 6 min walking test (6MWT) and the 5-time Sit-To-Stand (5STS) tests and the KDQOLSF-SF™ from the 6th month (end of the trial) to the 36th month. Among the 227 patients of the EXCITE trial cohort, 162 underwent at least three out of four testing visits (baseline, 6, 18 and/or 36 months) contemplated by the study protocol and 89 during all four testing visits. In the primary analysis by the linear mixed model, the gain in walking distance achieved in the 6th month in the exercise group [between-arms difference: +36 m, 95% confidence interval (CI): 22-51, P<.001] was maintained at the 18th month (between-arms difference: +37 m, 95% CI: 19-57, P<.001) and reduced to 23 m (95% CI: -4 to 49 meters, P=.10) at the 36th month. Overall, the post-trial difference in walking distance trajectories between the two study arms was highly significant (P=.004). Furthermore, the walking distance changes at the 6th (r=0.34, P=.018) and 18th month (r=0.30, P=.043) were directly related to the number of structured exercise sessions completed during the trial (i.e. the first 6 month). No such effect was registered in the response to the 5STS or in quality of life as measured by the KDQOLSF-SF™. In dialysis patients, the benefits of a 6-month structured walking programme outlast the duration of the intervention and postpone the loss of walking performance which naturally occurs in this population, but does not affect the quality of life (QoL) and the response to the STS test.

Home-based exercise therapy for treating shoulder instability in patients with hypermobile Ehlers-Danlos syndrome/hypermobility spectrum disorders. A randomized trial

Purpose To investigate the effectiveness of two home-based exercise programs for treating multidirectional shoulder instability (MDI) in patients diagnosed with Hypermobile Ehlers-Danlos syndrome (hEDS) or Hypermobility Spectrum Disorders (HSD). Methods Twenty-one hEDS/HSD patients with MDI were recruited from the Center for Medical Genetics of the Ghent University Hospital. Patients were randomly assigned to either the experimental or the control group. Both groups received a 6-month home-based exercise program. The primary outcome measure was the Western Ontario Shoulder Index (WOSI). Secondary outcomes included the Disabilities of the Arm, Shoulder and Hand (DASH), Tampa Scale for Kinesiophobia (TSK), Patient-Specific Functional Scale (PSFS), Global Rating of Change (GROC), and pain pressure thresholds. Outcomes were assessed at baseline, after 6 weeks, 12 weeks, and 24 weeks. Results Significant main effects for time were observed for all questionnaires, except for the TSK (p = 0.12). Patients improved 240 and 325 points on the WOSI after 12 (p = 0.02) and 24 weeks (p = 0.001), respectively. Additionally, patients improved 8.6 points on the DASH (p = 0.002), 4.3 points on the PSFS (p = 0.01), and 1.02 points on the GROC (p = 0.001) after 24 weeks. Conclusion No significant differences were found between group A and B. Both home-based exercise programs led to significant improvements in shoulder function. IMPLICATIONS FOR REHABILITATION Home-based exercise therapy may be effective for treating MDI in the hEDS/HSD population. Home-based training is beneficial for improving shoulder function, but a multidisciplinary, supervised approach might be more effective for altering kinesiophobia in this patient population.

The effect of a 6-month intradialytic exercise program on hemodialysis adequacy and body composition: a randomized controlled trial.

End-stage kidney disease (ESKD) is strongly associated with factors that aggravate the physical activity level and body composition status of hemodialysis patients (HD). Even though exercise in HD patients have shown remarkable benefits on hemodialysis adequacy, it is yet inconclusive if exercise can positively affect body composition parameters or if dialysis adequacy may affect body composition status. This study aimed to investigate the effect of a 6-month intradialytic exercise training program on dialysis adequacy indices and body composition parameters in HD patients. A total of 24 HD patients were randomly assigned into two equally sized groups. The exercise group (EX group) participated in a 6-month intradialytic moderate-intensity aerobic exercise training program at the beginning of the HD sessions, three times a week for 60min, and maintained a Borg's Rating of Perceived Exertion score between 13 and 14. The Control group (C group) remained untrained. At baseline, during, and at the end of the 6-month study, we assessed single-pool Kt/V, urea reduction ratio (URR), and body composition parameters, such as extracellular water (ECW)/ intracellular water (ICW) ratio, body mass index (BMI) and lean tissue mass (LTM). In all patients, the 6-min-walking test (6MWT) was performed as a marker of physical performance. A significant increase of both Kt/V (increase by 19%, p = 0.01), and URR (increase by 7%, p = 0.03) values has been observed in the EX group after the 6-month training program. Similarly, a statistically significant increase in 6MWT distance (from 442 ± 67m to 481 ± 68m, p = 0.02) in the EX group has also been found, compared to the C group (from 393 ± 59m to 427 ± 81m, p = 0.06). Neither EX nor C group has shown significant changes in body composition parameters. After training, linear regression analysis revealed a strong positive correlation between Kt/V and 6MWT changes (r = 0.74, p = 0.04) in the EX group. Six months of intradialytic aerobic exercise might increase dialysis adequacy, by increasing Kt/V and URR, and physical performance, regardless of changes in body composition indices.

Effects of a 12-month home-based exercise program on functioning after hip fracture - Secondary analyses of an RCT.

Long-term functional limitations are common after hip fractures. Exercise may alleviate these negative consequences but there is no consensus on an optimal training program. The objective was to study the effects of a 12-month home-based supervised, progressive exercise program on functioning, physical performance, and physical activity. Secondary analysis of a randomized controlled trial targeting patients with surgical repair of a hip fracture, aged ≥60 years, Mini-Mental State Examination (MMSE) score of ≥12. The participants were randomized into Exercise (n= 61) or Usual care (n= 60). Assessments at baseline, 3, 6, and 12 months included Lawton's Instrumental Activities of Daily Living (IADL), Short Physical Performance Battery (SPPB), handgrip strength, and self-reported frequency of sessions of leisure-time physical activity. Analyzed using mixed-effects models. Participants' (n=121) mean age was 81 years (SD 7), and 75% were women. The mean IADL score at baseline was 17.1 (SD 4.5) in the exercise group, and 17.4 (5.1) in the usual care group. The mean SPPB scores were 3.9 (1.6) and 4.2 (1.8), and handgrip strength was 17.7 (8.9) kg and 20.8 (8.0) kg, respectively. The age- and sex-adjusted mean changes in IADL over 12 months were 3.7 (95% CI 2.8-4.7) in the exercise and 2.0 (1.0-3.0) in the usual care group (between-group difference, p=0.016); changes in SPPB 4.3 (3.6-4.9) and 2.1 (1.5-2.7) (p < 0.001); and changes in handgrip strength 1.2 kg (0.3-2.0) and 1.0 kg (-1.9 to -0.2) (p < 0.001), respectively. We found no between-group differences in changes in the frequency of leisure-time activity sessions. A 12-month home-based supervised, progressive exercise program improved functioning and physical performance more than usual care among patients with hip fractures. However, the training did not increase leisure-time physical activity.

MO870: The Legacy Effect of a Home Walking Exercise Program in Kidney Failure Patients on Dialysis

Abstract BACKGROUND AND AIMS The EXCITE trial (JASN 28: 1259–1268, 2017) in dialysis patients showed that a 6-month home walking exercise program increases the walking distance covered during the 6 min walking test (6MWT), improves the response to the 5 times sit-to-stand test (5STS) and the cognitive function and quality of social interaction scores of the KDQOLSF-SF™ questionnaire. METHOD In this post-trial study embedded in the EXCITE trial, we tested the response to the 6MWT and the 5STS tests and the KDQOLSF-SF™ from the 6th month (end of the trial) to the 36th month. RESULTS Among the 227 patients of the EXCITE trial cohort, 162 underwent at least three out four testing visits (baseline, 6, 18 and/or 36 month) contemplated by the study protocol and 89 all four testing visits. In the primary analysis by the linear mixed model, the gain in walking distance achieved at 6th month in the exercise group {between-arms difference: +36 m, [95% confidence interval (95% CI): 22–51]; P &amp;lt; 0.001} was maintained at the 18th month (between-arms difference: +37 m, 95% CI: 19–57; P &amp;lt; 0.001) to reduce to 23 m (95% CI: –4 to 49 m; P = 0.10) at 36th month. Overall, the post-trial difference in walking distance trajectories between the two study arms was highly significant (P = 0.004). Furthermore, the walking distance changes at the 6th (r = 0.34; P = 0.018) and 18th month (r = 0.30; P = 0.043) were directly related with number of structured exercise sessions completed during the trial (i.e. the first 6 months). No such an effect was registered in the response to the 5STS or in quality of life as measured by the KDQOLSF-SF™. CONCLUSION In dialysis patients the benefits of a 6-months structured walking program outlast the duration of the intervention and postpone the loss of walking performance, which naturally occurs in this population.

Effect of an Exercise and Nutrition Program on Quality of Life in Patients With Atrial Fibrillation: The Atrial Fibrillation Lifestyle Project (ALP)

BackgroundStudies of separate exercise and weight loss interventions have reported improvements in quality of life (QoL) or reduction in atrial fibrillation (AF) burden. We investigated the impact of a structured exercise, nutrition, and risk-factor-modification program on QoL and AF burden. MethodsIn this trial, 81 successive patients with body mass index > 27 kg/m2 and nonpermanent AF were randomized to an intervention (n = 41) or control group (n = 40). The intervention consisted of cardiovascular risk management and a 6-month nutrition and exercise program, followed by a 6-month maintenance program. All participants received usual AF care. The primary end-point was QoL at 6 and 12 months. ResultsAt 6 months, we observed improved QoL among patients in the intervention group, relative to that among control-group patients (intervention (I) n = 34, control (C) n = 38) in the 36-item Short Form Survey Instrument scores on the subscales of vitality (I: 13.2 ± 20.4; C: 1.0 ± 14.9, P < 0.001), social functioning (I: 14.7 ± 24.1; C: 2.4 ± 21.2, P = 0.018), emotional well-being (I: 5.5 ± 14.1 ; C: –1.0 ± 13.3, P = 0.017), and general health perceptions (I: 8.1 ± 12.3; C: 2.7 ± 13.3, P = 0.009). At the 6-month follow-up, improvement in the scores on the subscales of vitality (P = 0.021) and emotional well-being (P = 0.036) remained significant. The burden of AF as measured by Holter monitor and Toronto AF symptom score was not significantly changed. ConclusionsA structured exercise and nutrition program resulted in significant sustained improvements in QoL, without reduction in AF burden. This type of program may provide an additional treatment for people with impaired QoL due to AF.

Does the time of day differently impact the effects of an exercise program on postural control in older subjects? A pilot study

BackgroundThe time of day that people exercise can potentially influence the efficiency of exercises for fall prevention in older adults. The present pilot study was conducted to explore the feasibility and effects of morning versus afternoon exercising on postural control in institutionalized older adults.MethodsNine older adults completed a 3-month multimodal exercise program in its entirety (14 participants were recruited at the beginning and were initially randomly separated into two groups). One group exercised in the morning (ME; n = 4) and the other in the afternoon (AE; n = 5). Postural control was assessed with a force platform at pre and post-intervention at the following times: 8 a.m., 11 a.m., 2 p.m. and 5 p.m.ResultsPostural control significantly improved only in the AE group post-intervention. Improvements in postural control in the AE group were mainly observed in the morning.ConclusionsThe afternoon would be the best period to implement exercise sessions dedicated to improve postural control in older subjects with benefits mainly observed in the morning. Further studies are needed with a larger sample in order to confirm these results.

Effects of a Postural Exercise Program on Vertical Jump Height in Young Female Volleyball Players with Knee Valgus.

Background: Although a knee valgus position is related to the increase in injury risk in volleyball players, there is a lack of studies on the relationship between knee valgus and vertical jump (VJ) performance. Hence, the aim of this study was to investigate the effects of a postural exercise program on VJ height in young female volleyball players with knee valgus. Methods: This pilot study included 19 young female volleyball players divided into the following groups: the Valgus Experimental Group (VEG); the Valgus Control Group (VCG); and the Neutral Control Group (NCG). All three groups carried out the same volleyball training program. In addition, only the VEG underwent a 3-month postural exercise program of 30–45 min/session, twice/week. VJ performance was measured through the Sargent test before (T0), at 6 weeks (T1), and at 12 weeks (T2). Results: A significant effect from T0 to T1 (p = 0.0017) and from T0 to T2 (p = 0.0001) was found in the VEG. No significant differences were found over time in the VCG and in the NCG. Conclusion: An integrated postural exercise program might lead to a more balanced muscle efficiency inducing athletes to obtain a higher VJ performance.

Development of a reference chart for monitoring cancer-related fatigue throughout a supervised exercise program.

Cancer-related fatigue (CRF) is one of the most reported and functionally limiting symptoms experienced by individuals living with and beyond cancer. Exercise is effective at reducing CRF, though currently it is not possible to predict the magnitude and time course of improvement for an individual participating in an exercise program. To develop a reference chart of CRF improvement for individuals participating in a 3-month cancer-specific exercise program. In this retrospective cohort study, CRF was assessed every two weeks (using the FACIT - Fatigue scale, range: 0 - 52 with lower scores indicating greater fatigue) in 173 individuals participating in a 3-month supervised exercise program (741 observations). No cancer types were excluded and individuals were either undergoing chemotherapy and/or radiation, or within 6 months of completing treatment. The reference chart was developed using Generalized Additive Models for Location Scale and Shape. Each participant had an average of four CRF observations. Lower centiles demonstrated greater improvement than higher centiles (11 points over the duration of the program for the 10th and 4 points for the 90th percentiles). The population is biased to individuals self-selecting or being referred to a clinical exercise program. This reference chart provides a novel method of monitoring CRF improvement during a cancer-specific exercise program. Setting appropriate expectations and informing exercise prescription adaptation are discussed in the context of representative data from three participants. Future research can investigate improvements in clinical outcomes and the remote monitoring of CRF through the implementation of the reference chart.

Randomised controlled trial testing the feasibility of an exercise and nutrition intervention for patients with ovarian cancer during and after first-line chemotherapy (BENITA-study)

ObjectivesAdvanced ovarian cancer is a severe disease with major side effects caused by peritoneal carcinomatosis, ascites and gastrointestinal involvement as well as exhaustive treatment like debulking surgery and combination chemotherapy....

Aerobic Exercise Training-Induced Changes on DNA Methylation in Mild Cognitively Impaired Elderly African Americans: Gene, Exercise, and Memory Study - GEMS-I.

BackgroundDNA methylation at CpG sites is a vital epigenetic modification of the human genome affecting gene expression, and potentially, health outcomes. However, evidence is just budding on the effects of aerobic exercise-induced adaptation on DNA methylation in older mild cognitively impaired (MCI) elderly African American (AAs). Therefore, we examined the effects of a 6-month aerobic exercise-intervention on genome-wide DNA methylation in elderly AA MCI volunteers.DesignElderly AA volunteers confirmed MCI assigned into a 6-month program of aerobic exercise (eleven participants) underwent a 40-min supervised-training 3-times/week and controls (eight participants) performed stretch training. Participants had maximal oxygen consumption (VO2max) test and Genome-wide methylation levels at CpG sites using the Infinium HumanMethylation450 BeadChip assay at baseline and after a 6-month exercise program. We computed false discovery rates (FDR) using Sidak to account for multiplicity of tests and performed quantitative real-time polymerase chain-reaction (qRT-PCR) to confirm the effects of DNA methylations on expression levels of the top 5 genes among the aerobic participants. CpG sites identified from aerobic-exercise participants were similarly analyzed by the stretch group to quantify the effects of exercise-induced methylation changes among the group of stretch participants.ResultsEleven MCI participants (aerobic: 73% females; mean age 72.3 ± 6.6 years) and eight MCI participants (stretch: 75% female; mean age 70.6 ± 6.7 years) completed the training. Aerobic exercise-training was associated with increases in VO2max and with global hypo- and hypermethylation changes. The most notable finding was CpG hypomethylation within the body of the VPS52 gene (P = 5.4 × 10–26), a Golgi-associated protein, involved in intracellular protein trafficking including amyloid precursor protein. qRT-PCR confirmed a nearly twofold increased expression of VPS52. Other top findings with FDR q-value < 10–5, include hypomethylations of SCARB1 (8.8 × 10–25), ARTN (6.1 × 10–25), NR1H2 (2.1 × 10–18) and PPP2R5D (9.8 × 10–18).ConclusionWe conclude that genome-wide DNA methylation patterns is associated with exercise training-induced methylation changes. Identification of methylation changes around genes previously shown to interact with amyloid biology, intracellular protein trafficking, and lipoprotein regulations provide further support to the likely protective effect of exercise in MCI. Future studies in larger samples are needed to confirm our findings.

Effects of Different Doses of Exercise on Inflammation Markers Among Adolescents With Overweight/Obesity: HEPAFIT Study.

ProposeObesity-related metabolic risk factors in adolescents who are overweight/obese may be associated with systemic low-grade inflammation; therefore, we investigated whether 6 months of exercise training altered markers of inflammation.MethodsSecondary analyses of a randomized controlled exercise-based intervention trial (September 2017-December 2018). Adolescents aged 11 to 17 years (Tanner stage II-V), 70% girls, with a body mass index z-score at or above the 85th percentile, and/or with excess of adiposity (body fat ≥ 30%). The participants were randomly assigned to the following 4 groups for 6 months: (1) standard physical education lessons, as a control (CTRL); (2) high-intensity physical education class (HIPE); (3) low-to-moderate intensity physical education class (LIPE); (4) a combined group (PLUS). Inflammatory markers and immune molecules including chemokines, cytokines, and growth factors (n = 65 biomarkers) were determined by cytokine antibody array.ResultsOf the 120 randomly assigned participants, 95 were included in the analysis. Considering these 22 proteins, the LIPE group shows statistical significance in 9 proteins with log-fold change (logFC) and P < 0.05 (in BLC, eotaxin, fibroblast growth factor-6 [FGF-6], GCP-2, I-309, IGFBP-4, MCP-4, NAP-2, and PARC), followed by the PLUS group in 9 proteins (BLC, pro-epidermal growth factor, eotaxin, FGF-6, MCP-4, NAP-2, osteopontin, PARC, and RANTES), the HIPE group in 7 proteins (FGF-4, FGF-7, GCP-2, IGF-1, IGFBP-1, IGFBP-4, and MIP-1 delta), and the CTRL group in 6 proteins (FGF-4, IP-10, Leptin, MCP-1, MIG, and MIP-1 delta). However, subanalysis performed to detect differentially expressed proteins at baseline and after intervention, with significance at an adjusted P value ≤ 0.05 and absolute log fold-change (logFC) ≥ 1.0, showed 3 downregulated proteins in the LIPE group (BLC(logFC) = 1.27, eotaxin(logFC) = 1.18, and MCP-4(logFC) = 1.14), and 4 proteins in the HIPE group (BLC(logFC) = 1.45, FGF-6(logFC) = 1.20, MCP-4(logFC) = 1.50, and PARC(logFC) = 1.33), supporting that the changes we observed in the exercise groups were not time-related changes but occurred in response to exercise.ConclusionsImplementing a 6-month physical exercise program in overweight/obese adolescents, based on LIPE and PLUS groups, significantly change several circulating inflammatory levels. Interventions involving supervised physical exercise may reduce the associated effects of systemic low-grade inflammation, thus preventing the development of obesity-related metabolic diseases in adolescents with overweight/obesity.

The Effects of Rehabilitation Following Anterior Cervical Microdiscectomy and Fusion Surgery.

To determine the effects of physical therapy and exercise programs that was performed after anterior cervical discectomy and fusion (ACDF) surgery on patient?s pain treatment, a retrospective study was designed. Of the 127 patients without neurological deficit who underwent ACDF surgery in our clinic in 2019 and 2020 for single-level cervical disc herniation, 40 patients (including 23 men and 17 women) were enrolled. The mean age of the patients was 45.5 years. The patients were separated into two groups. Group A comprised 20 patients who did not apply for a post-ACDF physical therapy and exercise program. Group B comprised 20 patients who applied for a 6-month post-ACDF physical therapy and exercise program and complied with it. The Oswestry Deficiency Index (ODI), visual analog pain scale (VAS), and C2-7 cervical lordosis angle were evaluated. The C2-7 cervical lordosis angles were individually calibrated and calculated for each patient using Surgimap. The relationships between the results were compared using Wilcoxon biostatistics test. The ODI, VAS, and C2-7 cervical lordosis angle parameters of Groups A and B were statistically compared. No significant differences in the ODI, VAS, and C2-7 cervical lordosis angle 2 days after surgery and C2-7 cervical lordosis angle 6 months after surgery were observed between the two groups; however, significant differences were observed in VAS and ODI values 6 months after physical therapy in Group B and in VAS and ODI values 6 months after surgery in Group A. No significant difference in C2-7 cervical lordosis angle 6 months after surgery was observed between post-physical therapy Group B and postoperative Group A. Physical therapy and exercise program performed early after ACDF enhances and improves pain management and does not cause any changes in the restoration of cervical misalignment.

Exercise dose on hepatic fat and cardiovascular health in adolescents with excess of adiposity.

The HEPAFIT study was aimed at examining the impact of a 6-month physical education intervention, considering various levels of exercise intensity, on hepatic fat and cardiometabolic health outcomes in adolescents with excess adiposity. Adolescents (n=120), 11-17 years with excess adiposity by body fat >30%, were randomly assigned to one of the following 4 groups for 6months: (1) standard physical education lessons, control (CTRL); (2) high-intensity physical education (HIPE); (3) low-to-moderate intensity physical education (LIPE) and (4) combined HIPE and LIPE (PLUS). The primary outcome was hepatic fat content measured by vibration-controlled transient elastography (controlled attenuation parameter [CAP]). Secondary outcomes were traditional cardiovascular health markers (body composition, serum lipids, aminotransferases and health-related physical fitness components). Adjusted mixed effects linear models revealed a significant decrease in CAP levels in HIPE (-20.02 dB/m, p<0.0001) (p=0.001 vs. CTRL group) and PLUS (-16.25 dB/m, p=0.005) groups. Body fat decreased in the HIPE (-2.88%, p < 0.001) (p=0.001 vs. CTRL group) and LIPE (-1.26%, p=0.022) groups. The physical fitness components were increased in the HIPE and PLUS group relative to the baseline (p < 0.05), and the HIPE group showed a reduction in the total cholesterol and low-density lipoprotein cholesterol (LDL-C) levels (p < 0.05). Implementation of a 6-month physical education exercise program, particularly high-intensity or combined high and low-intensity, improves hepatic fat storage and significantly reduces cardiometabolic markers in adolescents with excess of adiposity. Interventions involving supervised physical exercise may help to improve metabolism and fat deposition at the hepatic level, thus preventing the development of non-alcoholic fatty liver disease in adolescents.

Effects of Physical Exercise on Cognition and Telomere Length in Healthy Older Women.

Background: Physical exercise is an effective measure for preventing the onset of cognitive decline and has a direct influence on the aging process. The purpose of this study was to assess the effect of a 6-month physical exercise program on cognition and telomere length in adults over 65 years of age. Method: Seventy-four healthy women were separated into two groups: 41 were included in the intervention group (IG) (72.70 ± 4.127 years and 8.18 ± 1.551 years of education) and 33 in the control group (CG) (71.21 ± 4.127 years and 8.42 ± 2.562). The participants included within the IG carried out three sessions of physical exercise per week for six months. Cognitive function was assessed using the Mini-Mental State Examination (MMSE), the Stroop test and the Trail Making Test (TMT). Saliva samples were taken and analyzed and relative telomere length was calculated. Those conducting the analysis were blind to the group to which the participants had been assigned. Results: An improvement was observed in global cognitive function, in both attentional and executive functions, in the group of adults doing physical exercise as compared to the control group. Six months after the physical exercise program had finished, relative telomere length was found to have increased in the participants in the intervention group. Conclusion: Physical exercise programs can lead to an improvement in both cognitive functions and telomere length.

Influence of a multidisciplinary program of diet, exercise, and mindfulness on the quality of life of stage IIa-IIb breast cancer survivors.

193 Background: Integrative oncology has proven to be a useful approach to control cancer symptoms and improve the quality of life (QoL) and overall health of patients, delivering integrated patient care at both physical and emotional levels. The objective of this randomized trial was to evaluate the effects of a triple intervention program on the QoL and lifestyle of women with breast cancer. Methods: Seventy-five survivors of stage IIA-IIB breast cancer were randomized into 2 groups. The intervention group (IG) received a 6-month dietary, exercise, and mindfulness program that was not offered to the control group (CG). Data were gathered at baseline and at 6 months postintervention on QoL and adherence to Mediterranean diet using clinical markers and validated questionnaires. Between-group differences at baseline and 3 months postintervention were analyzed using Student’s t test for related samples and the Wilcoxon and Mann-Whitney U tests. Results: At 6 months postintervention, the IG showed significant improvements versus CG in physical functioning ( p =.027), role functioning ( p =.028), and Mediterranean diet adherence ( p =.02) and a significant reduction in body mass index ( p =.04) and weight ( p =.05), with a mean weight loss of 0.7 kg versus a gain of 0.55 kg by the CG ( p =.05). Dyspnea symptoms were also increased in the CG versus IG ( p =.066). Conclusions: These results demonstrate that an integrative dietary, physical activity, and mindfulness program enhances the QoL and healthy lifestyle of stage IIA-IIB breast cancer survivors. Cancer symptoms may be better managed by the implementation of multimodal rather than isolated interventions. Keywords: integrative oncology, breast cancer, quality of life, diet, exercise, mindfulness. Clinical trial information: NCT04150484.

INCLUSION OF HIGH INTENSITY INTERVAL TRAINING IN CARDIOVASCULAR REHABILITATION AFTER STROKE: A RANDOMIZED CONTROL TRIAL

<h3>BACKGROUND</h3> Standard exercise prescriptions recommend moderate intensity continuous training (MICT) for stroke patients. High intensity interval training (HIIT) has emerged as a potentially effective method for increasing cardiorespiratory fitness (CRF) among clinical populations, but its effectiveness remains to be demonstrated after stroke. This study aimed to compare the effect of a 6-month exercise program with either MICT or a combination of HIIT and MICT and a control group in terms of CRF, cardiovascular risk factors, functionality, cognitive function, anxiety and depression markers with a 12-month follow-up in patients with prior ischemic stroke or transient ischemic attack (TIA). <h3>METHODS AND RESULTS</h3> This randomized controlled trial included 52 participants (mean age: 69.2 ± 10.7) divided into 3 groups: HIIT, MICT and control. Forty participants completed the 12-month follow-up. CRF and secondary outcomes were assessed at baseline after the 6-month intervention and at a 12-month follow-up. A significant interaction effect (p < 0.001) indicate that HIIT and MICT programs provide a similar increase of CRF as compared to the control group. Despite a slight decrease at the 12-month follow-up, this improvement persists 6 months post-exercise (p < 0.01). The two exercise programs also induced a comparable increase in self-reported physical activity and cognitive function as well as a decrease in anxiety and depression markers. Participants in both the HIIT and MICT programs declared a very good degree of acceptability. <h3>CONCLUSION</h3> This randomized control trial demonstrated that a 6-month combination of HIIT and MICT program or a standard MICT exercise program induced a similar improvement in CRF, self-reported physical activity, cognitive functions and anxiety and depression markers among patients prior ischemic stroke or TIA compared to with a control group, suggesting that a combination of HIIT and MICT may be an effective alternative to standard exercise recommendations.

Cluster Randomized Controlled Trial on the Effects of 12 Months of Combined Exercise Training during Hemodialysis in Patients with Chronic Kidney Disease-Study Protocol of the Dialysis Training Therapy (DiaTT) Trial.

Patients with chronic kidney disease (CKD) on hemodialysis (HD) experience treatment-related immobility and physical deconditioning, which is responsible for an increased risk of frailty and a high burden of multi-morbidity. Exercise has been shown to counteract this vicious cycle; however, its effectiveness has only been investigated in small cohorts. Therefore, the objective of the Dialysis Training Therapy (DiaTT) trial will be to assess the effects of a 12-month intradialytic exercise program on physical functioning, frailty and health economics in a large cohort of HD patients in a real-world setting. DiaTT will be a prospective, cluster-randomized (1:1), controlled, multi-center, interventional clinical trial across 28 dialysis units, aiming at the recruitment of >1100 CKD patients on HD. The intervention group will receive 12 months’ intradialytic exercise (combined aerobic and resistance training), whereas the usual care group will not receive intervention. The primary endpoint will be a change on the sit-to-stand test (STS60) result between baseline and 12 months. Secondary endpoints will include physical functioning, frailty, quality of life, 3-point MACE, hospitalizations, survival, quality of HD, health literacy and health care costs. By including almost as many patients as previously investigated in smaller trials, DiaTT will be the largest randomized, controlled trial assessing frailty, quality of life and mortality in the field of nephrology.

Effectiveness of a 3-month antifalling program in the mobility, balance confidence, and muscle performance of older adults.

This study determined the effectiveness of a 3-month group-based multicomponent exercise program in the mobility, balance confidence, and muscle performance of older adults. A total of 40 participants (mean age=70.60±6.25 years completed pre- and posttest clinical intervention measures of mobility using the Timed Up and Go (TUG) test, balance confidence using the Activities-specific Balance Confidence scale, upper limb strength (handgrip dynamometer), and lower limb function (30-sec chair rise test). Data were analyzed using paired t-test and based on TUG criteria for risk of fall (low- and high-risk groups). Significant improvements were found in all measures (All P<0.05) following the 3-month program. Measures according to the risk of fall categories were also significantly improved (P<0.01), except the left handgrip strength (P>0.05). The low-risk group showed a higher improvement in mobility (14.87% vs. 11.74%), balance confidence (34.21% vs. 26.08%), and lower limb function (96.87% vs. 21.20%) but was not significantly different from the high-risk group (P>0.05). A group-based multicomponent exercise program benefited the physical functions of older adults at low- or high risk of falls.