Adapted Physical Activity Program Research Articles

A bio-psycho-social approach in elderly population: outcome of adapted physical activity in patients with osteoarthritis.

The beneficial effect of physical activity on a large spectrum of diseases is well known, with particular importance for elderly people. Among the different types of activity, adapted physical activity (APA) has been applied in a number of disease-related physical deficit. The purpose of this study is to determine the outcome of a six months APA program in elder patients with osteoarthritis concerning physical and functional health and as second endpoint to determine the potential effect of AFA on reducing the risk of institutionalization. The clinical indexes used to assess the outcome included the Blaylock Risk Assessment Screening Score (BRASS), the Psychological General Well Being Index (PGWBI), the Cumulative Illness Rating Scale (CIRS), the Short Physical Performance Battery (SPPB), and the visual analogue scale (VAS). A significant difference (p = 0.047) between the pre-APA and the post-APA value was found for BRASS, and highly significant differences (p <0.0001) were found for SPBB and VAS. These findings show that a six months APA program in elder patients with osteoarthritis improves physical function, reduces pain intensity and decreases the risk of institutionalization. Moreover the positive outcome of APA we found in elder patients with osteoarthritis suggests a more frequent use of such rehabilitation approach, also evaluating its economic impact on this disease.

Adherence to an adapted physical activity program in sedentary adults

Background/Objective. Physical exercise plays a key role in the prevention and prognosis of chronic diseases. Despite this evidence, a low percentage of patients regularly perform physical activity. A better understanding of the variables associated with poor adherence may help to develop some strategies to encourage people to participate in exercise interventions. This study investigated the factors influencing adherence to an Adapted Physical Activity (APA) program in subjects suffering from Acute Coronary Syndrome (ACS) clinically stable, Type 2 diabetes, or metabolic syndrome. Secondary end point was to test the efficacy of the exercise training on fitness parameters (VO 2 , Speed and Time) by 1 km test. Methods. The program was planned in two phases. Phase 1: individual and supervised training free program for 4 weeks; Phase 2: paid training supervised program involved small groups of 4-6 participants for 8 weeks. Results. 117 patients (50-64 years, 49 men and 68 women) started the APA program, but only 32 patients (17 men and 15 women) completed phase 2. As collected during telephone interviews, the main factors that influenced adherence including health status, work commitments or family problems. Regarding the physical efficacy, an improvement of the three fitness parameters was observed in the 32 patients who completed the 12 weeks of the APA program. Conclusions. The identification of factors that can influence adherence to exercise programs is the first step in planning and improving health interventions. These parameters have an important public health interest.

Patients avec un cancer de la prostate traités par hormonothérapie : impact de l’activité physique adaptée

The purpose of this article is to present adapted physical activity (APA) and its potential impact on the androgen deprivation therapy (ADT) adverse effects, thelimits and measures to promote its use amongprostate cancer (PCa) patients treated with ADT. A non-systematic review of the literature was performedwith pubmed referenced articles, using the keywords "prostate cancer", "androgen deprivation" and "physical activity", and the main publications and recommendations of national and international health agencies, published between January 2010and June 2019. APA represents an effective action to reduce adverse effects of ADT. Its integrationinto health care of PCapatients treated with ADT remains limited. To promote a APA development in this population, a multidisciplinarycollaboration between healthcare and APA professionals is essential. This collaboration should enable implementation of standard and innovative APA programs and therapeutic education tools for patients, as well as development of information and promotion forhealthcare professionals.

The Adapted Physical Activity Program: A Theory-Driven, Evidence-Based Physical Activity Intervention for People with Brain Impairment

People with brain impairments are less active than the general population and consequently have an increased risk of chronic disease. To increase activity requires interventions that are theory driven and evidence based. Here, we describe the adapted physical activity program (APAP), a physical activity promotion program with demonstrated efficacy in community dwelling adults with brain impairments. Distinguishing features of the APAP include the following: delivery in the participants home/or community environment and the utilisation of the principals of community-based rehabilitation; the assessment of each of the domains of the International Classification of Functioning, Disability and Health (ICF) (i.e., health conditions, impairments, activity limitations, participation restrictions and personal and environmental characteristics) to determine how they will impact physical activity adoption and maintenance; the incorporation of theory-based physical activity adoption and maintenance strategies; the utilisation of lifestyle physical activity programs (including client-centred selection of activities) and/or structured exercise programs (requiring principles of exercise prescription). It is anticipated that this program description will permit researchers and/or practitioners to implement the program, replicate its evaluation and/or translate the program into multi-professional rehabilitation settings.

Effects of Two Types of 9-Month Adapted Physical Activity Program on Muscle Mass, Muscle Strength, and Balance in Moderate Sarcopenic Older Women.

The present study aimed to evaluate the effects of two types of 9-month adapted physical activity (APA) program, based on a muscle reinforcement training and a postural training, respectively, on muscle mass, muscle strength, and static balance in moderate sarcopenic older women. The diagnosis of sarcopenia was done in accordance with measurable variables and cut-off points suggested by the European Working Group on Sarcopenia in Older People (EWGSOP). Seventy-two participants were randomly assigned to two groups: the muscle reinforcement training group (RESISTANCE) (n=35; 69.9 ± 2.7 years) and the postural training group (POSTURAL) (n=37; 70.0±2.8 years). Body composition, muscle mass, skeletal muscle mass index (SMI), and handgrip strength (HGS) were evaluated for sarcopenia assessment, whereas Sway Path, Sway Area, Stay Time, and Spatial Distance were evaluated for static balance assessment. Sixty-six participants completed the study (RESISTANCE group: n=33; POSTURAL group: n=33). Significant increases of muscle mass, SMI, and handgrip strength values were found in the RESISTANCE group, after muscle reinforcement program. No significant differences appeared in the POSTURAL group, after postural training. Furthermore, RESISTANCE group showed significant improvements in static balance parameters, whereas no significant differences appeared in the POSTURAL group. On the whole, the results of this study suggest that the APA program based on muscle reinforcement applied on moderate sarcopenic older women was able to significantly improve muscle mass and muscle strength, and it was also more effective than the applied postural protocol in determining positive effects on static balance.

Change talk when talk has changed: theoretical and practical insights into motivational interviewing in aphasia

Background: After stroke, people may need to make diet, smoking, physical activity or lifestyle adjustments. One method used widely in encouraging behaviour change is Motivational Interviewing (MI), a counselling approach that attends to people’s “change talk”, language that indicates their readiness to change (Rollnick, Miller & Butler, 2008). MI is collaborative and guiding, useful in contexts where there is ambivalence to change. Evidence from a range of health fields suggests that, where people are ambivalent, MI is more effective at changing behaviours than traditional approaches of advising and directing towards an expert’s solution to a problem. However, people with aphasia may not be offered MI in clinical contexts and tend to be excluded from studies using MI (for example, Krishnamurthi et al., 2014) because their language impairments are assumed to prevent participation in the interviewing process. This is unsatisfactory and denies them the same opportunities to make the lifestyle adjustments offered to people without aphasia. Aims: This presentation aims to show how MI can be adapted to be an accessible approach for people with aphasia using evidence from a single case where the goal was increased physical activity. It seeks to demonstrate how MI can be offered as an alternative option within rehabilitation goal setting, and beyond, for people who may be finding it hard to engage, and be a useful way for speech pathologists to support allied health colleagues working with people with aphasia. Methods and Procedures: This study draws on a single case of a 61-year old woman, J, who had suffered a left middle cerebral artery cerebrovascular accident 6 years before, resulting in a persisting moderate-severe non-fluent aphasia, apraxia of speech and a right hemiparesis. J had a complex previous medical history including longstanding schizophrenia, depression, epilepsy, osteoporosis with several previous fractures, hypothyroidism and gastro-oesphageal reflux. As part of a PhD study on increasing physical activity in people with neuromusculoskeletal conditions (carried out by the second author, an exercise physiologist (EP)), J attended the Adapted Physical Activity Program (APAP), a lifestyle intervention that includes MI. J attended sessions 3 times each week over a 15-week period at her local community rehabilitation service, and local gym, although several days were missed due to health issues. The data for this case study are based on qualitative analysis of field notes through the APAP, a video-recorded evaluation session, records of collaborative session planning between the EP and the speech pathologist, the subsequent adaptations made to implement MI for J, and outcomes of the APAP and MI program. Outcomes and results: Through a supported MI intervention, J was able to transition from reluctance to regular gym attendance during the APAP. MI adaptations allowed ways of judging and building on “change talk” through a range of ratings, visual timelines, values card-sorting, and supported conversation techniques. The EP supported J’s attitude change to the APAP, offering genuine, client-driven choices about attendance, exercise frequency, intensity, time and type. She demonstrated progress, and individualised the program sufficiently to keep J motivated. Conclusions: This case offers an innovative demonstration of interprofessional collaboration, of making MI accessible, and of resolving ambivalence in a person with aphasia. Moreover, despite MI being an accepted, evidence based counselling approach, this is one of the first examples of its use in aphasia. People with aphasia, judged as disengaged or unmotivated by health professionals, are at risk of being discharged or overlooked but this case highlights theoretical arguments and practical solutions to encourage lifestyle adjustment and behaviour change.

Adapted physical activity to promote active and healthy ageing: the PoliFIT pilot randomized waiting list-controlled trial.

Physical activities can prevent disability in elderly. To evaluate the feasibility and impact on physical function of an adapted physical activity (APA) programme in community-dwelling people of ≥ 70 years old. Non-blinded randomized trial with a waiting list control. Eligible people (n = 186) were randomly allocated to 4 months of weekly APA classes of 45min or in control group performing usual lifestyle activity. time to walk 400m. short physical performance battery (SPPB), pain (visual analogic scale, McGill Questionnaire), Oswestry Disability Index (ODI), Geriatric Depression Scale (GDS), handgrip strength, accesses to Emergency Department and falls. Participants were allocated to the intervention (n = 130) or to the control (n = 56) group (80% females aged 75.6 ± 4.6years). We found statistically significant difference in the time to walk 400m only in the subgroup intervention with the lower performance at baseline (p for interaction 0.031). SPPB improved and VAS decreased more in the intervention group. No significant differences for McGill questionnaire, ODI, GDS, accesses to ER and falls were showed. Despite the good rate of attendance (71%) and satisfaction (97%), our APA programme was associated with no benefit on the time to walk 400m and small benefit on SPPB and VAS. The efficacy of the intervention was likely limited by the short duration and low intensity and by the already good performance of our population at baseline. We designed this initiative as a pilot study intending to implement research of this type in the future.

APA network in Reggio Emilia between 2011 and 2017: Promoting regular physical activity for people dealing with chronic conditions

Physical activity is a priority tool in the prevention of functional worsening. In current health services scenarios, a lot of persons deals with chronic conditions and they need training programs with structured exercise to promote healthy lifestyle, even when slight disability is present, due to aging, arthrosis, surgical intervention for hip/knee prosthesis, stroke or chronical neurological diseases such as Parkinson. Emilia-Romagna Region strongly supported the development of Adapted Physical Activity (APA) programs in the last years. In Reggio Emilia, a multidisciplinary group started a project to implement APA in 2010–2011, involving Rehabilitation Department, Local Health Care Services, General Practitioners (GPs) and sport societies. According to regional guidelines, several exercise protocols were set up and pilot APA groups started, to offer training programs to people with chronic pain for osteoarthrosis/arthritis. APA groups were supervised by instructors graduated in Physical Education. The pilot groups experience was very encouraging and a broader network was implemented between 2011–2017. The local network now involves 22 community gyms (throughout the all district) and the number of persons attending regular APA programs grew from 226 in 2011 to 1223 in 2017. No significant adverse event occurred. The participants level of satisfaction and compliance are very high. The number of GPs supporting APA grew from 106 in 2011 to 578 in 2017. Every year an update event is organized, to implement education for professionists leading APA groups and to verify exercise protocols. The development of APA network in Reggio Emilia was a strategy to create opportunities for healthy life style. The key elements of the projects were: 1. interaction between Rehabilitation Department, Local Health Care Services, sport societies and community gyms 2. Structured training for APA group leaders (at least once a year) 3. Involvement of GPs to promote regular physical activity for people dealing with chronic conditions.

Évaluation de la faisabilité d’un programme d’activité physique adaptée en hôpital de jour de cancérologie digestive : à partir du point de vue des patients

Adapted physical activity (APA) is recognized as an effective supportive care for asthenia and quality of life in oncology. Before an APA program was organized, the feasibility of such a program was evaluated among the patients. Descriptive, prospective, semi-qualitative, single-center study over a 3-month period in patients treated with ambulatory chemotherapy for digestive cancer. A self-questionnaire was offered to all patients to evaluate their practice and knowledge about APA. In ten patients, fatigue, anxiety and depression were assessed, before and after 9 weeks of hospital-based APA. The scores were compared by matched Student test. Of the 123 patients treated, 80 questionnaires (65%) were exploitable. Before the diagnosis of cancer, 40 patients (50%) were physically active, 20% after (n=16). The reasons for not practicing were: lack of interest/not the idea (42%), lack of time (34%), do not believe in profit (9%), too expensive (8%). Fifty-three patients (66%) were interested in the program. In 10 patients, the APA program significantly reduced the depression score (P=0.024) and a non-significant improvement in anxiety and fatigue. This study shows that patients treated with chemotherapy are unaware of the usefulness of APA and that medical information can improve adherence to such a program. The establishment of an intra-hospital APA program proved to be possible and relevant.

Physical exercise in cirrhotic patients: Towards prehabilitation on waiting list for liver transplantation. A systematic review and meta-analysis

Early survival after Liver Transplantation (LT) is reduced among sarcopenic patients. Despite, Adapted Physical Activity (APA) before LT is rarely proposed for the risk to impair portal hypertension and its resulting complications. To assess the effects of APA program in adults affected by End Stage Liver Disease (ESLD) on hospital stay, 1-year mortality and morbidity after LT, adverse events (Primary outcomes). Secondary outcomes were changes in VO2 peak, muscle morphology, 6minutes walking distance test (6MWD), Body Mass Index (BMI), MELD, CHILD score and Hepatic Venous Pressure Gradient (HVPG). MEDLINE, EMBASE, Google Scholar and the Cochrane Library database were explored for randomized clinical trials (RCT). Data were collected by one review author on the type of study, participants, treatments used for primary and secondary outcomes. Review Manager 5.2 was used for the analysis. Four RCT with 81 patients were included. Primary outcomes: no severe adverse event was observed, but no published data were available on hospital stay or mortality after LT. CHILD, MELD and BMI were not worsened by physical activity. No significant muscle diameter, 6MWD and VO2 peak changes were observed after exercise. Significant reduction in HVPG in the treatment group was observed in a single study (MD-2.5mmHg; 95%CI [-04.76, -0.24]; P=0.03). Knowledge in this field is still at an early stage. Evidence derived from small trials of medium quality on ESLD patients suggests that APA is safe, without increasing portal hypertension. Further research is very likely to have an important impact on our confidence in the intervention effect.

Fall-risk factors in hospitalized elderly: the role of adapted physical activity

Falls are common events in institutionalized elderly. Recent evidence suggests that several risk factors (FRFs) may be related to these falls. The aim of this study was to elucidate if some demographic and clinical factors are associated with the risk of falls in institutionalized elderly. The role of adapted physical activity (APA) in the risk of falls was also assessed. With a Kaplan–Meier statistical model, the mean survivor time (MST) to a fall event was recorded for 6 months in 128 new-admitted patients to nursing home. Demographic factors such as sex, age, stature, body mass or other FRFs such as fall recidivism, gait and balance performance, cognitive impairment, activity of daily living (ADL) levels, Parkinson’s disease, utilization of gait assistant devices, and the employment of a program of APA were considered potential co-variants. Thirty patients experienced a fall during the observation period (6 months) with an overall MST of 154.8 ± 4.6 (range 2–167) days. Moreover, history of previous fallen, reduced gait capacity, poor cognitive function, limited performance in the ADL, and Parkinson’s disease were associated with a reduced MST to a fall event. While at contrary, the employment of the APA significantly reduced the fall-risk. Our results suggest the effectiveness of an APA program for the prevention of falling in institutionalized elderly. Moreover, new-admitted patients to nursing homes with a history of previous fallen, reduced gait capacity, poor cognitive function, limited performance in the ADL, and Parkinson’s disease are associated with an increased risk of fallen.

Effects of an adapted physical activity program on psychophysical health in elderly women.

BackgroundSeveral studies have shown the positive effects of adapted physical activity (APA) on physical and mental health (MH) during the lifetime. The aim of this study was to assess the effectiveness of a specific APA intervention program in the improvement of the health-related quality of life (QOL) and functional condition of spine in elderly women.MethodsThirty women were recruited from a senior center and randomly assigned to two groups: control group (CG; age: 69.69±7.94 years, height: 1.57±0.06 m, weight: 68.42±8.18 kg, body mass index [BMI]: 27.88±2.81) and trained group (TG; age: 68.35±6.04 years, height: 1.55±0.05 m, weight: 64.78±10.16 kg, BMI: 26.98±3.07). The APA program was conducted for 8 weeks, with two training sessions/week. CG did not perform any physical activity during the study. Spinal angles were evaluated by SpinalMouse® (Idiag, Volkerswill, Switzerland); health-related QOL was evaluated by SF-36 Health Survey, which assesses physical component summary (PCS-36), mental component summary (MCS-36), and eight subscales: physical functioning, role-physical, bodily pain, general health perception, role-emotional, social functioning, vitality, and MH. All measures were recorded before and after the experimental period.ResultsIn TG, compared to CG, the two-way analysis of variance with repeated measures with Bonferroni post hoc test showed a relevant improvement in lumbar spinal angle (°) and in SF-36 outcomes after the intervention period. We showed a significant increase in physical functioning, bodily pain, and MH subscales and in PCS-36 and MCS-36 scores in TG compared to CG. In particular, from baseline to posttest, we found that in TG, the PCS-36 and MCS-36 scores increased by 13.20% and 11.64%, respectively.ConclusionWe believe that an 8-week APA intervention program is able to improve psychophysical heath in elderly people. During the aging process, a dynamic lifestyle, including regular physical activity, is a crucial factor for public and health care systems to improve QOL and physical fitness in aging people.

Pre-service teachers' self-efficacy towards children with disabilities: An Irish perspective

The purpose of this study was to examine the effects of a 10-week adapted physical activity (APA) programme on the self-efficacy levels of pre-service teachers (PSTs) towards teaching children and young people with disabilities (ages 5 to 21) during a weekly 1-hour APA programme. Participants included 64 PSTs (ages 19-25) in their 3rd year of a physical education initial teacher education (PE-ITE) programme at a university within the Republic of Ireland. PSTs completed the Self-Efficacy Scale for Physical Education Teacher Education Majors toward Children with Disabilities (SE-PETE-D) questionnaire both before and after their participation in the APA programme followed by a focus group interview (n=4). Repeated-measure ANOVAs showed that self-efficacy scores significantly increased after participation in the programme than those prior to participation in the programme. Results of the focus group discussion also confirmed the findings from the questionnaire to be true and accurate.

Rationale and design of the Adapted Physical Activity in advanced Pancreatic Cancer patients (APACaP) GERCOR (Groupe Coopérateur Multidisciplinaire en Oncologie) trial: study protocol for a randomized controlled trial.

BackgroundExercise during chemotherapy is a promising strategy to reduce fatigue and improve health-related quality of life (HRQoL). It has been shown to be feasible and efficient in various cancers, including advanced-stage cancers. Effects of physical activity have never been explored in advanced pancreatic ductal adenocarcinoma (PDAC). We aim to evaluate the effects of an exercise intervention in this setting.MethodsThis randomized, national, multicenter, interventional study will examine the effectiveness of an unsupervised, home-based, 16-week adapted physical activity (APA) program. Specificities of advanced PDAC for the implementation of the APA program will be taken into account (healthy volunteer as physical activity partner instead of patient groups, nutritional management). The main inclusion criteria are: patients with histologically confirmed, unresectable PDAC; scheduled for chemotherapy; performance status 0–2; age ≥ 18; and physical activity partner. In total, 200 patients will be randomized into either the APA program (aerobic and resistance exercises) in addition to usual care (including chemotherapy at the investigator’s choice), or usual care. The primary objective will be the effect on fatigue (Multidimensional Fatigue Inventory, MFI-20) and HRQoL (European Organization for Research and Treatment of Cancer-Quality of Life-C30 questionnaire, EORTC-QLQ-C30; co-primary endpoint) at week 16. As secondary objectives, the effects of the exercise intervention on pain, anxiety, depression, nutritional status, insulin resistance, tolerance of chemotherapy, survival, and adherence to the APA program will be evaluated.DiscussionPatients with advanced PDAC are strongly affected by fatigue, and are thus likely to benefit from an exercise intervention. Moreover, exercise may have a potential beneficial effect on tumor outcome by reducing insulin resistance and insulin/insulin-like growth factor-1 (IGF-1) secretion. However, an exercise intervention may appear challenging due to multiple PDAC-related symptoms such as fatigue, depression, pain, and denutrition. We hypothesize that an APA program taking into account specific characteristics of PDAC may improve symptoms and HRQoL. If demonstrated to be feasible and effective, such APA programs will be systematically proposed to patients with advanced PDAC in addition to usual care.Trial registrationClinicalTrial.gov Registration number: NCT02184663; Registration date: 2 July 2014.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-015-0983-8) contains supplementary material, which is available to authorized users.

Pilot evaluation of physical and psychological effects of a physical trek programme including a dog sledding expedition in children and teenagers with cancer.

Aim of the studyTo evaluate the feasibility and to measure the effects of a six-week-long adapted physical activity programme (APAP), including 5 days of intense dog sledding, on the physical and psychological health of children and adolescents treated for cancer.MethodsEleven children and teenagers (4 girls, 7 boys; mean age 14.3 ± 2.9 years) participated in this monocentric pilot programme of adapted physical activities from February 2013 to March 2013. Seven were still on treatment. The programme lasted 6 weeks. A series of physical tests and psychological questionnaires were carried out before and after the programme.ResultsAll children and teenagers completed the full programme. An improvement in all physical and psychological parameters was observed. Statistically significant differences were observed for global self-esteem (6.2 ± 2.1 to 7.7 ± 1.8; p = 0.02), perceived sport competence (5.3 ± 3.2 to 7.4 ± 2; p = 0.02) and perceived physical strength (5.6 ± 2.5 to 7.1 ± 1.8; p = 0.001). Regarding physical tests, the physical training led to statistically significant improvement for sit-ups (13.8 ± 2.6 to 21.75 ± 5.4; p = 0.01), muscle tone (76 ± 23.7 to 100 ± 22.9; p = 0.01), and resting heart rate (96.1 ± 3.2 to 91.6 ± 4.5; p = 0.03).Conclusion This programme is feasible in children and adolescents even during their oncologic treatment. During the 6-week programme, children and adolescents improved their physical and psychological health, and the putative benefits of the APAP are discussed. A larger randomised trial started in 2014.

Effects of an adapted physical activity program on motor and non-motor functions and quality of life in patients with Parkinson's disease.

Several studies have clearly shown that strategies of health promotion, such as fitness and general exercise programs, may improve quality of life (QoL), motor and non-motor functions in Parkinson's disease (PD) patients. However, little is known about the effects of specific Adapted Physical Activity (APA) programs on PD patients. To determine the effects of an APA program on motor and non-motor symptoms, functional performances and QoL in PD patients. Nine consecutive PD patients (5 men, 4 women, 64.4 ± 6.8 years) able to ambulate independently (Hoehn and Yahr: from stage 1 to 3) and not demented, were enrolled. Patients performed an APA program, 3 sessions/week, for 9 weeks. Exercises focused on balance, walking, strength and functional activities. Functional effects were assessed by Six Minute Walking Test (6MWT), Five Time Sit to Stand Test (FTSST), Berg Balance Scale (BBS), Sit and Reach Test (SRT), and Timed Up and Go test (TUG). Motor impairment and disability were assessed using the Unified Parkinson's Disease Rating Scale - part III (UPDRS-III) and the Hoehn and Yahr Scale, respectively. Non-motor symptoms were evaluated by PD Fatigue Scale (PFS), Beck Depression Inventory II (BDI-II) and PD Quality of life scale, 8 items (PDQ-8). A significant decrease in resting HR (67.55 ± 10.85 vs 70.22 ± 12.34 bpm, p < 0.05) and a significant increase in walked distance (p < 0.0005) were observed. A significant impairment of the muscles strength was noted (FTSST, p < 0.05). BBS showed a significant increase in balance abilities (p < 0.0005) and safety with mobility (TUG, p < 0.005) was enhanced. Finally, a significant improvement in motor and non-motor symptoms was detected: UPDRS-III (p < 0.00005), PFS (p < 0.005), BDI-II (p < 0.05) and PDQ-8 (p < 0.05). A tailored exercise program in PD patients could be effective as an adjunct to conventional therapy on improving daily activities, motor and non-motor symptoms, with better QoL.

Impact of Adapted Physical Activity and Therapeutic Patient Education on Functioning and Quality of Life in Patients With Postacute Strokes

Objective. The aim of this study was to assess whether the combination of Adapted Physical Activity (APA) and Therapeutic Patient Education (TPE) improves function and quality of life in survivors of strokes. Methods. This nonrandomized controlled study enrolled patients with mild to moderate hemiparesis referred to 2 physical medicine and rehabilitation units in Emilia-Romagna, Italy, 3 to 18 months after a single unilateral mild to moderate stroke. The experimental group (n = 126) received 16 APA sessions and 3 sessions of TPE, and the control group (n = 103) received usual care; 86.9% completed treatment. The main outcome measure was a 4-month change in gait endurance (that corresponds to 2 months after intervention in the experimental group), and secondary outcomes included the Short Physical Performance Battery, Berg Balance Scale, Barthel Index, Geriatric Depression Scale, 12-item Short-Form Health Survey, and Caregiver Strain Index. Changes in scores at 4 months were compared between groups using analysis of variance and controlling for group imbalance by means of the propensity score. Results. Gait endurance, physical performance, balance, and the physical component of the quality of life score increased significantly at 4 months in the APA group and remained stable in the control group. The propensity-adjusted between-group change was significant for these scores at P < .01. Conclusions. Our results confirm that it is feasible and potentially effective to implement APA programs for elderly patients with complex clinical conditions as early as 3 months after a stroke and suggest that, when combined with TPE, the effects of a postrehabilitation APA program are relatively enduring.

Abstract P3-09-10: Adapted physical activity effect on aerobic function in patients with breast cancer treated with adjuvant or neoadjuvant chemotherapy

Abstract Background. Past twenty years, clinical research focuses on the fatigue and the place of physical activity during the treatment of women with breast cancer. Use of cardiopulmonary exercise test (CPET) for determination of peak oxygen consumption (VO2peak) provides the gold standard assessment of aerobic capacity. Our first pilot study was designed to evaluate the effects of a training program during chemotherapy in women with breast cancer showed a significant improvement of VO2peak after treatment (1). So, we performed a phase III study, to assess the effects of a home-based adapted physical activity (APA) program in women treated by adjuvant or neoadjuvant chemotherapy and radiotherapy for breast cancer versus control group (without APA). The main criterion was cardiopulmonary function, measured by VO2peak, at 27 weeks after radio-chemotherapy (RT-CT) between the 2 groups. Methods. Participants were randomized into 2 groups: Arm A (aerobic and strength training) during the 27 weeks of treatment (RT-CT); Arm B (control group). This study included 3 assessments phases (T0: before RT-CT; T1: week 27; and T2: final evaluation at the 54th week). These assessments included: cardiopulmonary exercise test (CPET) with maximal oxygen uptake test (VO2peak), 6 Minutes Walking Test (6MWT) and health-related quality of life. The APA program consisted in 2 sessions of endurance (walking and/or cycling) and 1 session of resistance (elastic band) per week. Training endurance intensity was based on the first ventilator threshold and coached by a specialist. Results. Forty-four subjects were included from June 2012 to June 2013. At baseline (T0), the average age was 52,3 ± 11,7 years for Arm A versus 48,8 ± 8 years for Arm B. Before treatment VO2peak was 23,2 ± 4,9 ml.kg-1.min-1 for Arm A and 22,9 ± 5,4 ml.kg-1.min-1 for Arm B. After treatment (T1), VO2peak was significantly different between the two groups (3.5 ml.kg-1.min) with 24.6 ± 5 ml.kg-1.min-1 vs 20.97 ± 4.8 ml.kg-1.min-1 for Arm A and Arm B respectively (P = . 048). Walking distance on 6MWT improved by 19,7m (P = .016) for training group and decreased by 20,7m (P = .043) for control group. At 6 months (T2), VO2peak was not different between the two groups (P = .069). Arm A continued to increase (26,2 ± 5,6 ml.kg-1.min-1) while Arm B recovered his baseline value (22,3 ± 5,6 ml.kg-1.min-1). Similar results was showed in 6MWT, compared with T1, the two Arms A and B increased by 12,9m (P = .063) and 17,6m (P = .27) respectively. Conclusion. Home-based APA program improved aerobic function and exercise capacity during RT-CT. The exercise during treatment is feasible, safe, and provides a real benefit of physical fitness. In addition, this activity has been performed at home. Keywords. Cardiorespiratory Fitness, VO2peak, Breast Cancer, Adjuvant or Neoadjuvant Chemotherapy, Physical Function, Adapted Physical Activity. Reference. 1. F.Vincent JL.Labourey, S.Leobon, MT.Antonini, S. Lavau-Denes, N. Tubiana-Mathieu. Effects of a home-based walking training program on cardiorespiratory fitness in breast cancer patients receiving adjuvant chemotherapy a pilot study. Eur J Phys Rehabil Med. 2013 Jun;49(3):319-29. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-09-10.

Reduction of health risk factors through an adapted physical activity program in patients with breast cancer

After a breast cancer diagnosis, patients are at high risk of reducing their physical activity and gaining weight. Lack of physical activity and weight gain are known negative but modifiable prognostic factors. An observational study of a 3-month adapted physical activity (APA) program was performed to assess its effectiveness in improving physical activity level and reducing risk factors related to health during or after breast cancer treatments. Height, weight, and waist circumference (WC) were measured at the beginning and end of the 26-session program. Body mass index (BMI) and WC to height ratio (WHtR) were calculated. Physical activity profile, aerobic capacity, and usual average daily energy expenditure were estimated. Median values were compared using nonparametric tests. Sixty-one (61) voluntary breast cancer patients attended 80% of the sessions. At baseline, median (minimum-maximum) BMI was 23.3 (16.1-36.8) kg.m(-2) and WC and WHtR showed metabolic risks. After 3 months, anthropometric data remained stable. Moderate physical activity significantly improved (+13 min/day) and sedentary tended to decrease (-18 min/day). A 3-month APA program allows patients to limit risk factors related to health such as physical inactivity and metabolic risks. This study reinforces the need to promote physical activity as early as possible in cancer patients' care.

Design of a randomised controlled trial of adapted physical activity during adjuvant treatment for localised breast cancer: the PASAPAS feasibility study

IntroductionAfter a diagnosis of localised breast cancer, overweight, obesity and weight gain are negatively associated with prognosis. In contrast, maintaining an optimal weight through a balanced diet combined with regular...