American College Of Sports Medicine Research Articles

Thick Hearts Can't Keep Up: Exercise Limitations in Patients With Hypertrophic Cardiomyopathy

Patients with hypertrophic cardiomyopathy (HCM) may experience intolerance to submaximal and maximal exercise. While ejection fraction is generally preserved, reduced left ventricular end diastolic volume may limit stroke volume reserve and potentially attenuate maximal oxygen uptake (V̇O2max). Whether the relationship between supply (cardiac output, Q̇c) and demand (oxygen uptake, V̇O2) remains intact in these patients is unclear.PURPOSETo quantify the cardiac output response to a given metabolic demand during submaximal and maximal exercise in patients with HCM.METHODSEight patients with HCM (45.8±8.8 years, 75% female, left ventricular outflow tract pressure gradient 13±12mmHg) completed two bouts of submaximal steady‐state treadmill exercise (SS1 ~45% and SS2 ~60% V̇O2max), followed by an incremental treadmill test to exhaustion. V̇O2 (Douglas bag technique), Q̇c, (acetylene rebreathing), stroke volume (Q̇c/heart rate) and arterio‐venous difference (av‐O2 diff, Fick principle) were measured during rest, SS1, SS2 and maximal exercise. Stroke volume reserve was calculated as the percent increase in stroke volume from rest to maximal exercise. The relationship between Q̇c and V̇O2 (Q̇c/V̇O2 slope) was quantified using data collected at rest, submaximal and maximal exercise. Healthy sedentary adults (n=8) and subjects with left ventricular hypertrophy from hypertension (LVH, n=8) were included for age and sex‐matched comparison.RESULTSPatients with HCM had lower relative V̇O2max than healthy subjects and patients with LVH (HCM: 21.1±4.8mL/kg/min, healthy: 27.5±3.4 mL/kg/min, LVH 24.4±7.5 mL/kg/ min). The Q̇c response to a given metabolic demand was impaired in patients with HCM when compared to healthy controls and patients with LVH (HCM: 4.6, control: 5.4, LVH: 5.5; Figure 1). The blunted Q̇c/V̇O2 slope was primarily due to a smaller stroke volume reserve (HCM 28.8±27.0%, healthy 52.2±19.6%, LVH 48.6±25.0%), but also a significantly lower maximal heart rate compared to healthy controls (154±24 vs. 178±10 beats per minute, respectively; P<0.05), though 75% of HCM patients were on beta‐blockade and/or calcium channel‐blockade therapy. Remarkably, five HCM patients were able to compensate for a blunted Q̇c/V̇O2 slope (4.2±0.4) and still achieve >80% of predicted V̇O2max by significantly augmenting av‐O2 diff from rest to maximal exercise (Δav‐O2 diff 10.6±1.6 vs. 6.2±1.5 in HCM patients who did not achieve 80% of predicted V̇O2 max, P<0.05).CONCLUSIONAlthough ejection fraction is preserved, patients with HCM may be unable to sufficiently match Q̇c to metabolic demands. However, some patients appear to compensate by significantly augmenting peripheral oxygen extraction and achieve at least 80% of predicted V̇O2max.Support or Funding InformationSupported by The Center for Regenerative Science and Medicine, UTSW Medical Center, Biotronik Inc., and the Research Endowment from The American College of Sports Medicine Foundation.This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

La vigilancia como función cognitiva clave en la relación entre el ejercicio físico puntual y la cognición

En las últimas dos décadas han surgido numerosas investigaciones que han mostrado los efectos beneficiosos de la actividad física para la salud (Biddle, Fox y Boutcher, 2003; Lee y Skerritt, 2001). Lejos de creer que la actividad física tan sólo prevenía trastornos físicos [e.g., enfermedades cardiovasculares (Haskell et al., 2007)], la literatura científica argumenta que también previene trastornos mentales [e.g., depresión y reducción del estrés (Dunn et al., 2001) o ansiedad (Paluska y Schwenk, 2000)]. Además, entidades de relevancia mundial tales como la Organización Mundial de la Salud (OMS), el Centro para el Control y la Prevención de Enfermedades (CDC), el Colegio Americano de Medicina del Deporte (ACSM) o la Asociación Americana del Corazón (AHA), relacionan positivamente la actividad física con la salud general y consideran a la actividad física como algo esencial e indispensable para preservar la salud. En resumen, el presente trabajo tiene como objetivo principal estudiar los efectos del ejercicio físico puntual sobre el funcionamiento cognitivo (vigilancia y percepción), sugieren que el esfuerzo ligero-moderado aumenta la activación general y mejora la velocidad de respuesta en tareas de atención sostenida con independencia de la relevancia del estímulo objetivo. Además, no replicamos el resultado de investigaciones previas que demostraron el efecto de un entrenamiento físico en el rendimiento cognitivo

CELEBRATE SUCCESS!

CELEBRATE SUCCESS!

Exercise as a Treatment for Chronic Pain

Exercise as a Treatment for Chronic Pain

Affective and metabolic responses to self-selected intensity cycle exercise in young men

Self-selected intensity exercise has resulted in greater affective responses (AR) compared to prescribed exercise of similar intensity and many individuals self-select intensity at a moderate level identified by metabolic analysis. As such, self-selected intensity may be an effective alternative for exercise prescription designed to promote adherence and result in health and fitness benefits. Self-selected intensity has not been well described for many subject populations and exercise modes. Therefore, the purpose of this investigation was to measure affective and metabolic responses during self-selected intensity cycle exercise in college-aged men. Thirty-three men (22.4 ± 2.2 yr) performed a peak oxygen consumption test and a 20 min self-selected trial on a cycle ergometer on separate days. Oxygen consumption (VO2) was measured continuously throughout both exercise sessions. AR were measured using the Feeling Scale and ratings of perceived exertion (RPE) using the OMNI Scale every 5 min during the self-selected trial. χ2 analysis was used to determine if a significant proportion of subjects self-selected intensity above 50% VO2 reserve (VO2R), defined as a threshold for moderate-intensity exercise and potential cardiorespiratory fitness benefits by American College of Sports Medicine. Mean self-selected intensity was 57.6 ± 11.1%VO2peak and 89.3 ± 20.2% of ventilatory threshold. Twenty eight of 33 subjects self-selected intensity above 50% VO2R (p < .05). Self-selected intensity was associated with positive AR (1.8 ± 1.4) and mean RPE of 4.0 ± 1.5. In college-aged men, self-selected intensity cycle exercise was performed at a moderate intensity level and elicited positive AR for most subjects. Therefore, self-selected intensity could be an effective component of an exercise prescription for this population.

Comparison of various active video gameplays and consoles on the energy expenditure and cardiorespiratory responses in young male adult gamers

PurposeActive video games combine pleasure and an easily accessible practice of physical activity, if they are sufficiently intense and motivating. However, it is unknown which video game consoles and video gameplays can engage the player to reach the physical activity intensity that meet the standards of the American College of Sports Medicine (ACSM). MethodsA total of 10 physically inactive male gamers (aged 26 ± 5 years), were recruited to measure the energy expenditure (EE) required by three gameplays on different consoles. The following consoles were selected: PlaystationMove and Kinect, and three categories of gameplay: dance (Just Dance 3), training (MiCoach) and action (Star Wars for Kinect and No More Heroes for PSMove). ResultsThe average and peak METS (mean ± SD) on both Kinect vs. PlayStationMove, respectively: JustDance, 6.87 ± 1.26 METS and 8.43 ± 1.35 METS vs. 5.42 ± 1.39 METS and 6.75 ± 1.37 METS; MiCoach, 5.43 ± 0.95 METS and 8.33 ± 1.49 METS vs. 5.27 ± 0.89 METS and 7.59 ± 1.16 METS; and action, 4.94 ± 1.60 METS and 7.47 ± 1.90 METS vs. 1.75 ± 0.35 METS and 3.08 ± 0.66 METS. In addition, the mean EE was significantly higher with the Kinect (495.0 ± 119.6 kcal/h for JustDance Kinect vs. 414.9 ± 9 ± 70.7 kcal/h for JustDance PS3Move. ConclusionBy ACSM standards, JustDance and MiCoach achieved a level of moderate to vigorous intensity (3 METS to ˃6 METS), and by meeting the physical activity requirements, they can provide a tool for physical activity promotion in inactive adult gamers.

Different levels of physical activity and anthropometric profile in patients infected with hepatitis C virus

Abstract Study aim: To verify the relationship between different durations of regular practice of physical activity in aspects related to the anthropometric profile and hepatic function of patients infected by hepatitis C virus (HCV). Material and methods: 125 patients (aged 55.2 ± 10.4 years) participated in the study. Clinical data were obtained through medical records available at the Pernambuco Liver Institute. Physical activity levels were obtained through the International Physical Activity Questionnaire (IPAQ) short form to classify the patients according to the guidelines of the American College of Sports Medicine (ACSM). Results: Significant differences were found in GGT 141 (28-378 U/L) and HDL 39 (27-56 mg/dL) respectively in insuffi­ciently active and physically active groups, AST 71 (26-268 U/L), ALT 83 (36-452 U/L), GGT 78 (3-532 U/L), alkaline phos­phatase 74 (47-302 mg/dL) and total bilirubin 0.7 (0.1-2.8 mg/dL) in insufficiently active and very physically active groups. Anthropometric data showed significant differences in chest (p &lt; 0.01), abdomen (p &lt; 0.02) and waist measurement (p &lt; 0.01) between insufficiently active and very physically active groups. Conclusion: Physical activity, when practiced regularly for more than 300 minutes per week, can improve the clinical and an­thropometric profile in patients infected with HCV.

The Effect of Dietary Protein on Protein Metabolism and Performance in Endurance-trained Males.

This study aimed to determine how varying protein intakes, including a new tracer-derived safe intake, alter whole body protein metabolism and exercise performance during training. Using a double-blind randomized crossover design, 10 male endurance-trained runners (age, 32 ± 8 yr; V˙O2peak, 65.9 ± 7.9 mL O2·kg·min) performed three trials consisting of 4 d of controlled training (20, 5, 10, and 20 km·d, respectively) while consuming diets providing 0.94 (LOW), 1.20 (MOD), and 1.83 (HIGH) g protein·kg·d. Whole body protein synthesis, breakdown, and net balance were determined by oral [N]glycine on the first and last day of the 4-d controlled training period, whereas exercise performance was determined from maximum voluntary isometric contraction, 5-km time trial, and countermovement jump impulse (IMP) and peak force before and immediately after the 4-d intervention. Synthesis and breakdown were not affected by protein intake, whereas net balance showed a dose-response (HIGH > MOD > LOW, P < 0.05) with only HIGH being in positive balance (P < 0.05). There was a trend (P = 0.06) toward an interaction in 5-km Time Trial with HIGH having a moderate effect over LOW (effect size = 0.57) and small effect over MOD (effect size = 0.26). IMP decreased with time (P < 0.01) with no effect of protein (P = 0.56). There was no effect of protein intake (P ≥ 0.06) on maximum voluntary isometric contraction, IMP, or peak force performance. Our data suggest that athletes who consume dietary protein toward the upper end of the current recommendations by the American College of Sports Medicine (1.2-2 g·kg) would better maintain protein metabolism and potentially exercise performance during training.

Improving Walking Ability in People With Neurologic Conditions: A Theoretical Framework for Biomechanics-Driven Exercise Prescription

The purpose of this paper is to discuss how knowledge of the biomechanics of walking can be used to inform the prescription of resistance exercises for people with mobility limitations. Muscle weakness is a key physical impairment that limits walking in commonly occurring neurologic conditions such as cerebral palsy, traumatic brain injury, and stroke. Few randomized trials to date have shown conclusively that strength training improves walking in people living with these conditions. This appears to be because (1) the most important muscle groups for forward propulsion when walking have not been targeted for strengthening, and (2) strength training protocols have focused on slow and heavy resistance exercises, which do not improve the fast muscle contractions required for walking. We propose a theoretical framework to improve exercise prescription by integrating the biomechanics of walking with the principles of strength training outlined by the American College of Sports Medicine to prescribe exercises that are specific to improving the task of walking. The high angular velocities that occur in the lower limb joints during walking indicate that resistance exercises targeting power generation would be most appropriate. Therefore, we propose the prescription of plyometric and ballistic resistance exercise, applied using the American College of Sports Medicine guidelines for task specificity, once people with neurologic conditions are ambulating, to improve walking outcomes. This new theoretical framework for resistance training ensures that exercise prescription matches how the muscles work during walking.

Physical activity in wheelchair-using youth with spina bifida: an observational study

BackgroundEven though typically developing youth are already at risk for physical inactivity, youth with spina bifida may be even at higher risk as a consequence of their reduced mobility. No objective data is available for youth with spina bifida who use a manual wheelchair, so the seriousness of the problem is unknown. The purpose of this observational study was to quantify physical activity in wheelchair-using youth with spina bifida and evaluate the intensity of activities.MethodsFifty-three children and adolescents (5–19 years) with spina bifida who use a manual wheelchair for daily life, long distances or sports were included. To assess time spent in several types of activities VitaMove data of 34 participants were used and were presented as time spent sedentary and time spent physically active. This was compared to reference data of typically developing youth. To assess time spent in several intensities Actiheart data of 36 participants were used. The intensities were categorized according to the American College of Sports Medicine, ranging from very light intensity to near to maximal intensity. Data of 25 participants were used to combine type of activity and intensity.ResultsChildren and adolescents with spina bifida who use a manual wheelchair were more sedentary (94.3% versus 78.0% per 24 h, p < 0.000) and less physically active (5.0% versus 12.2% per 24 h, p < 0.000) compared to typically developing peers. Physical activity during weekend days was worse compared to school days; 19% met the Guidelines of Physical Activity during school days and 8% during weekend days. The intensities per activity varied extensively between participants.ConclusionsChildren and adolescents with spina bifida who use a manual wheelchair are less physically active and more sedentary than typically developing youth. The physical activity levels on school days seem to be more favorable than the physical activity levels on a weekend day. The low levels of physical activity need our attention in pediatric rehabilitation practice. The different intensities during activities indicate the importance of individually tailored assessments and interventions.

Strategies for Partnering with Health Care Settings to Increase Physical Activity Promotion

Strategies for Partnering with Health Care Settings to Increase Physical Activity Promotion

Exercise in Persons with Unilateral Lower-Limb Amputation and Contralateral Limb Knee Injury: A Pilot Study

Introduction Exercise habits and return to exercise in individuals with lower-limb amputation (LLA) have been reported in up to 11% to 61% of individuals with amputation, but it is unclear if these individuals meet American College of Sports Medicine (ACSM) exercise guidelines and if there are any negative consequences associated with exercise. This pilot study investigated the exercise habits of individuals with unilateral nonvascular LLA to ascertain adherence to ACSM exercise guidelines and any relationships to contralateral (intact)-limb limb knee injuries. Methods A telephone survey was conducted with 25 individuals (n = 7, female) 22 to 90 years of age (M = 47) with nonvascular unilateral LLAs (2 transmetatarsal/Syme [TM], 13 transtibial [TT], 7 transfemoral [TF], 3 hip disarticulation [HD]) from a university hospital population. Weekly reported exercise before and after amputation (including type, frequency, duration and intensity, based on talk test correlating to intensity) as well as any history of intact-limb knee injuries was obtained. Data were analyzed using χ2 and one-way analysis of variance tests. Results Sixty-eight percent met the recommended ACSM guidelines for cardiorespiratory (CR) exercise before amputation and 48% of individuals met CR guidelines after amputation, and, of those, 41.7% reported sustaining intact-limb knee injuries (there were no injuries in those not meeting CR guidelines; P = 0.009). Respondents who met CR guidelines were at significantly higher risk of knee injury (P = 0.05). Also, those engaged in greater than moderate intensity CR exercise had significantly higher rates of intact knee injury compared with those exercising at low or moderate intensities (P = 0.01). Conclusions This pilot study suggests that engaging in an exercise routine at greater than moderate intensity may significantly increase the risk of intact-limb knee injury in individuals with unilateral LLAs. A larger study involving more subjects would be beneficial in clarifying the risk of knee injury from exercise in patients with amputation.

Quality of resistance training description in COPD trials: study protocol for a systematic review

IntroductionLimb muscle dysfunction is a common manifestation in patients with chronic obstructive pulmonary disease (COPD). Optimising of limb muscle function is therefore an important goal during pulmonary rehabilitation of patients...

Prevalence of female athlete triad in Bulgaria

As female athletic participation has increased, the positive effects of exercise on health have become evident. However, with this growth in sports activity, a set of health problems unique to the female athlete has emerged. The female athlete triad as first described in 1992 by the American College of Sports Medicine consisted of disordered eating, amenorrhea, and osteoporosis; the definition was updated in 2007 to include a spectrum of dysfunction related to energy availability, menstrual function, and bone mineral density. For this review, a comprehensive search of databases—MEDLINE In-Process & Other Non-Indexed Citations, MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and Scopus, from earliest inclusive dates to January 2013—was conducted by an experienced librarian with input from the authors. Controlled vocabulary supplemented with keywords such as female athlete triad, amenorrhea, oligomenorrhea, fracture, osteopenia, osteoporosis, bone disease, anorexia, bulimia, disordered eating, low energy availability was used to search for articles on female athlete triad. Articles addressing the prevalence, screening, and management of the female athlete triad were selected for inclusion in the review. This article reviews the current definitions of the triad components, epidemiology, pathophysiology, and recommended screening and management guidelines. The lack of efficacy of current screening of athletes is highlighted. Low energy availablity, from either dietary restriction or increased expenditure, plays a pivotal role in development of the triad. Athletes involved in “lean sports” (those that emphasize weight categories or aesthetics, such as ballet, gymnastics, or endurance running) are at highest risk. Treatment is centered on restoring energy availability to reverse adverse changes in the metabolic milieu. Prevention and early recognition of triad disorders are crucial to ensure timely intervention. Caregivers and physicians of female athletes must remain vigilant in education, recognition, and treatment of athletes at risk.

Inglês

The popularity of strength training among children and adolescents has grown more and more, a part of these youngpeople seek this activity because of health issues, as they lead a sedentary life, where the only activities are video games,computers and a super caloric diet, another part because they play sports such as soccer, fights and athletics, seek to improvetheir performance with gains in strength and muscular endurance, and still have those who are influenced by friends, society andthe media that value individuals with a healthy body. We Physical Education professionals should be especially attentive to theselast two groups, because in the eagerness to want a result in the short term it ends up seriously damaging their health. Studies ofthe American Academy of Pediatrics (1990), American College of Sports Medicine (1993), American Orthopedic Society forSports Medicine (1998) and National Strength and Conditioning Association (1996), which is supported by the American Collegeof Sports Medicine ), has shown that well supervised strength training for children and adolescents is effective and safe. (Fleck &Kraemer, 2006).

The 2019 Physical Activity Readiness Questionnaire for Everyone (PAR-Q+) and electronic Physical Activity Readiness Medical Examination (ePARmed-X+): 2019 PAR-Q+

This article contains the current 2019 CONSENSUS PANEL APPROVED AND OFFICIAL version of the Physical Activity Readiness Questionnaire for Everyone (PAR-Q+). The new PAR-Q+ and ePARmed-X+ were introduced officially at the 3rd International Congress on Physical Activity and Public Health in Toronto, Ontario, Canada (May 5-8, 2010) by Drs. Darren Warburton, Norman Gledhill, Veronica Jamnik, and Shannon Bredin. The first peer reviewed article containing the PAR-Q+ was published in the Health & Fitness Journal of Canada and subsequent updates have been made through this journal. Owing to the evidence-based nature of the PAR-Q+ and ePARmed-X+ both forms require routine update as the evidence expands. These ongoing revisions are made by the PAR-Q+ Collaboration and evaluated by an international consensus committee. This article contains the 2019 PAR-Q+ that includes significant changes from our original version. This version replaces all previous versions. This is the current evidence-based and consensus panel approved version of the PAR-Q+. We are indebted to the support provided by the American College of Sports Medicine and other international partners in the ongoing evaluation of the 2019 PAR-Q+.

Myofascial Training Paradigm

Aim : According to Worldwide Survey of Fitness Trend which was conducted by the American College of Sport Medicine, SMR exercises are in the first twenty places among fitness trends of the last 3 years. Although SMR exercises are frequently preferred by trainers/athletes, effects of SMR exercises on athletes performance are contradictory. In this review, it was aimed to investigate the effects of SMR exercises on athletes performance. Methods: In accordance with the aim of the study; PubMed, Google, Google Scholar database were searched during November 2018 using “Fascia”, “Fascia and Adaptability to Mechanical Loading”, “Self Myofascial Release”, “Foam Roller”, “Self Myofascial Release and Flexibility”, “Self Myofascial Release and ROM”, “Self Myofascial Release and Performance”, “Self Myofascial Release and Performance Testing” keywords. Results : According to results obtained from literature , it may be accepted that SMR exercises increase flexibility and Range of Motion (ROM). Moreover, use of SMR exercises combined with SS may be more effective in increasing flexibility/ROM than treatment of SS or SMR alone . SMR exercises may be used for warm-up tools as SMR exercises have no detrimental effects for subsequent performance. Although the effects of SMR exercises on myofascial system and performance cannot be fully explained, Thixotropy property of fascia or activation of kinesthetic and mechanical receptors in myofascial system might be accepted as possible mechanisms. Conclusion : Some studies suggest that muscular performance could be affected negatively after SMR exercises. Therefore, the results of these studies should be considered necessary by trainers/athletes . As there is no any universal guide which explains how SMR exercises should be applied. Trainers/athletes should apply SMR exercises in accordance with their experiences or they should remove SMR exercises from their training programme.

Identifying Evidence-Informed Physical Activity Apps: Content Analysis.

BackgroundRegular moderate to vigorous physical activity is essential for maintaining health and preventing the onset of chronic diseases. Both global rates of smartphone ownership and the market for physical activity and fitness apps have grown rapidly in recent years. The use of physical activity and fitness apps may assist the general population in reaching evidence-based physical activity recommendations. However, it remains unclear whether there are evidence-informed physical activity apps and whether behavior change techniques (BCTs) previously identified as effective for physical activity promotion are used in these apps.ObjectiveThis study aimed to identify English and German evidence-informed physical activity apps and BCT employment in those apps.MethodsWe identified apps in a systematic search using 25 predefined search terms in the Google Play Store. Two reviewers independently screened the descriptions of apps and screenshots applying predefined inclusion and exclusion criteria. Apps were included if (1) their description contained information about physical activity promotion; (2) they were in English or German; (3) physical activity recommendations of the World Health Organization or the American College of Sports Medicine were mentioned; and (4) any kind of objective physical activity measurement was included. Two researchers downloaded and tested apps matching the inclusion criteria for 2 weeks and coded their content using the Behavioral Change Technique Taxonomy v1 (BCTTv1).ResultsThe initial screening in the Google Play Store yielded 6018 apps, 4108 of which were not focused on physical activity and were not in German or English. The descriptions of 1216 apps were further screened for eligibility. Duplicate apps and light versions (n=694) and those with no objective measurement of physical activity, requiring additional equipment, or not outlining any physical activity guideline in their description (n=1184) were excluded. Of the remaining 32 apps, 4 were no longer available at the time of the download. Hence, 28 apps were downloaded and tested; of these apps, 14 did not contain any physical activity guideline as an app feature, despite mentioning it in the description, 5 had technical problems, and 3 did not provide objective physical activity measurement. Thus, 6 were included in the final analyses. Of 93 individual BCTs of the BCTTv1, on average, 9 (SD 5) were identified in these apps. Of 16 hierarchical clusters, on average, 5 (SD 3) were addressed. Only BCTs of the 2 hierarchical clusters “goals and planning” and “feedback and monitoring” were identified in all apps.ConclusionsDespite the availability of several thousand physical activity and fitness apps for Android platforms, very few addressed evidence-based physical activity guidelines and provided objective physical activity measurement. Furthermore, available descriptions did not accurately reflect the app content and only a few evidence-informed physical activity apps incorporated several BCTs. Future apps should address evidence-based physical activity guidelines and a greater scope of BCTs to further increase their potential impact for physical activity promotion.

Integrating Exercise into the Electronic Medical Record: A Case Series in Oncology

ABSTRACT The Exercise is Medicine campaign initiated by the American College of Sports Medicine is intended to advance the integration of exercise into formalized medical care through strategic linkages between health care systems, providers, health-related digital technologies, and available exercise programs. Exercise is established as a fundamental element of comprehensive cancer care and given the critical role of the electronic medical record (EMR) in health care communication, optimizing the use of the EMR by qualified exercise professionals and for exercise-related referrals may improve clinical outcomes. The purpose of this article is to describe the strategies, facilitators, barriers, and opportunities in implementing exercise information in the EMR in three cancer centers in North America: The University of Alabama at Birmingham, the Sylvester Comprehensive Cancer Center, and the Princess Margaret Cancer Centre. The collective experience of three cancer centers identifies the diverse opportunities and challenges in connecting exercise programming with the EMR. The implementation of exercise programming, resources, and linkages in the EMR is complex, involves numerous stakeholders, and can be mapped against the Consolidated Framework of Implementation Research. Methods of establishing communication or referral pathways to exercise programs described here can serve as precedents for similar endeavors. Further research is needed to determine whether implementation strategies that target identified implementation science constructs can facilitate the implementation of exercise programming via EMR where the Consolidated Framework for Implementation Research may serve as a useful empirical framework.

Effects of exercise and physical activity promotion: meta-analysis informing the 2018 EULAR recommendations for physical activity in people with rheumatoid arthritis, spondyloarthritis and hip/knee osteoarthritis

ObjectiveTo evaluate the effectiveness of exercise and physical activity (PA) promotion on cardiovascular fitness, muscle strength, flexibility, neuromotor performance (eg, balance) and daily PA in people with rheumatoid arthritis (RA),...