Center-based Exercise Program Research Articles

Impact Of Exercise Delivery Mode Under The Covid-19 Pandemic: A Comparison Of Face-to-face Versus Zoom In Patients With Diabetes And/or Hypertension

Patients were commonly referred to a face-to-face center-based exercise program by healthcare providers. With the recent restriction on social gathering under the impact of Covid-19 pandemic, online exercise program delivered through videoconferencing system (e.g., Zoom) may be a promising solution to overcome this barrier. To date, little information is known about the relative effectiveness of exercise program delivered through face-to-face versus online modes. PURPOSE:To compare the effectiveness of exercise training delivery between the face-to-face and online (Zoom) mode. METHODS:A total of 59 patients (age: 65.7 ± 6.9 yrs-old) with diabetes and/or hypertension completed a 12-week exercise program (60 minutes/session, one session/week) delivered through either a face-to-face (n = 27) or videoconferencing system (Zoom) (n = 32). Health-related physical fitness including handgrip (muscular strength), 30-second chair stand test (lower body strength), chair sit-and-reach test (lower limb flexibility), and 2-minute step test (aerobic endurance) were measured at the baseline and post-intervention. RESULTS:Both groups demonstrated significant improvement in all health-related fitness parameters (p < .05) except the 30-second chair stand test on face-to-face group. Only the 30-second chair-stand test found significant interaction (p < .001). Score of 30-second chair stand test for online group improved from 13.8 ± 0.7 reps to 18.5 ± 0.8 reps (p < .001). CONCLUSIONS:Besides traditional face-to-face exercise delivery mode, online-exercise delivery mode may be an alternative option to improve similar health related outcomes among patients with diabetes and/or hypertension, especially under restriction of social interaction such as the Covid-19 pandemic.

Efficacy Of Telerehabilitation On Exercise Capacity And Frailty In Veterans With Chronic Pulmonary Obstructive Disease

Chronic obstructive pulmonary disease (COPD) affects nearly 5 percent of US Veterans. Reduced exercise capacity and increased vulnerability are key features associated with COPD. Center-based exercise programs are effective treatments, however efficacy of the delivery of exercise programs through telemedicine is largely unknown. PURPOSE: To investigate the efficacy of 12-week pulmonary telerehabilitation on exercise capacity and vulnerability in Veterans with COPD. METHODS: Veterans with COPD (n = 41 [39 men]; age = 68.1 ± 8.7 years; body-mass index = 30.06 ± 5.34 kg/m2; forced volume in one second [FEV1] = 46 ± 15%; forced volume in one second/forced vital capacity [FEV1/FVC] = 53 ± 14%; oxygen saturation [SPO2] = 93 ± 3%) participated after signing a written informed consent. Participants received exercise treatment consisted of strengthening and balance exercises, respiratory exercise and related educations (i.e., smoking cessation, nutrition, sleep hygiene) provided by a physical therapist and a respiratory therapist through Veterans Affairs telehealth service. Outcome measures were 6-minute walk distance (exercise capacity measure) and Fried frailty phenotype (vulnerability measure). RESULTS: Results for the outcome measures are shown in Table 1. Across all participants, 6-minute walk distance increased by 15.7% after the telerehabilitation program (p < 0.001; medium effect size). For frailty status, compared to baseline, eight more Veterans (19.5% of all participants) were classified as non-frail after the telerehabilitation program, however, these improvements did not reach a statistically significant level (p = 0.069). CONCLUSIONS: The 12-week cardiopulmonary telerehabilitation is effective in improving exercise capacity and may also be effective in treating vulnerability in Veterans with COPD.

Effects of a home based exercise intervention on cardiac biomarkers, liver enzymes, and cardiometabolic outcomes in CABG and PCI patients.

Background: We investigated the impact of a home-based exercise intervention (HBEI) on cardiac biomarkers, liver enzymes, cardiometabolic outcomes, and health-related quality of life (HRQL) in clinically stable patients after coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI).Materials and Methods: The study was a nonrandomized clinical trial conducted in Tehran, Iran, from July 2019 to January 2020. Forty cardiac patients (after the cardiac intervention, CABG, n = 32; PCI, n = 8) were recruited based on the study inclusion criteria and were allocated consecutively to one of two groups: (1) HBEI (n = 18) and (2) conventional center-based exercise program (CBEP, n = 22). The CBEP group performed the routine exercise program of Sadr Heart Clinic, and the HBEI group performed a home-based remotely monitored exercise protocol, both three times per week, for 8 weeks. The following variables were assessed before and after the intervention: anthropometric measures; blood pressure; lipid profile; cardiac biomarkers including cardiac troponin I, creatine kinase, and total and Mb isozyme; liver enzymes including aspartate aminotransferase and alanine aminotransferase; creatinine; urea; exercise capacity; and HRQL.Results: In comparison with pretest in both CBEP and HBEI groups, a significant improvement in all of the measured variables (P < 0.05), but not in ejection fraction was observed (P > 0.05). Moreover, in the CBEP group, a more significant decline in troponin I levels (P = 0.03), and in the HBEI group, a greater reduction in weight (P = 0.01) and body mass index (P = 0.04) occurred.Conclusion: The findings suggest that a properly designed and monitored HBEI may be as effective as conventional center-based cardiac rehabilitation (CR) exercise programs and should be encouraged in those cardiac patients who are unable or uninterested in conventional center-based CR exercise programs.

Does Home-Based Exercise Improve the Physical Function of Prefrail Older Women?

Physical exercise is a potential intervention to revert or attenuate frailty syndrome, which may be accomplished by traditional center-based and home-based programs. This study aimed to compare the effectiveness of a home-based and center-based exercise program on frailty status, physical and muscle function of frail older women. Thirty-one frail older women were allocated in two different groups: home-based group (n = 17, 71.5 ± 6.5 years) or center-based group (n = 14, 68.4 ± 6.4 years). The exercise program lasted 12 weeks (3 days/week), 60 minutes/session, including strengthening, balance, and gait exercises. Frailty status, knee, and hip strength, and physical function were assessed before and after the intervention. After the exercise program, frailty was reversed in 76% of the participants independently of the exercise group. Muscle strength and physical function improved in both groups, where the home-based program presented a high adherence rate, and the center-based program was more suitable to reverse the frailty status. In conclusion, a home-based exercise program is as effective as center based to improve strength, physical function, and to reverse frailty status.

Effects of Home- and Center-Based Exercise Programs on the Strength, Function, and Gait of Prefrail Older Women: A Randomized Control Trial.

The aims of this study were to compare the effects of a multicomponent exercise program provided at a center (CB) versus done part at home and part at a center (H+CB) on frailty status, strength, physical function, and gait of prefrail older women. Twenty-five women were randomly allocated into the CB (n = 14; 69 ± 6 years) and the H+CB (n = 11; 69 ± 7 years) groups. Both groups completed an exercise program including strengthening, balance, and gait exercises. The program was 12 weeks long, done three times per week, for 60min per session. Frailty, knee and hip muscle strength, spatiotemporal parameters of the usual and maximum speed dual-task gait, and physical function were assessed at baseline and after program completion. The exercise program reversed the prefrail status of most participants independently of the mode of delivery. Strength increased in both groups, but the CB group had more pronounced improvements in gait and physical function. H+CB exercise programs are good options for prefrail older women.

A randomized controlled feasibility trial of a home-based walking behavior–change intervention for people with intermittent claudication

Walking treatment is recommended for improving intermittent claudication (IC), a debilitating symptom of leg pain caused by peripheral arterial disease. However, center-based exercise programs offered in a community or hospital setting are often not implemented or adhered to. We developed a home-delivered behavior-change intervention, MOtivating Structured walking Activity in Intermittent Claudication (MOSAIC), to increase walking in people with IC. A feasibility randomized controlled trial with nested qualitative interviews involving a subsample of trial participants was conducted. Feasibility criteria evaluated participant recruitment and retention; suitability of proposed outcome measures; and acceptability and adherence to the intervention and trial. Participants (adults aged ≥18years diagnosed with IC identified from vascular outpatient clinics) were randomized 1:1 to receive MOSAIC treatment (two 60-minute home-based sessions and two 20-minute booster telephone calls incorporating behavior-change techniques) or an attention-control comparison. Outcomes (baseline and 16-week follow-up) included the 6-minute walking distance (meters), pedometer-assessed daily walking activity (steps/d), health-related quality of life, physical functioning, and beliefs about walking treatment, peripheral arterial disease, and self-regulatory processes. Twenty-four participants (mean age: 66.8±9.4years, 79% male) were included. Feasibility criteria achieved were recruitment rate (25%), participant retention (92%), and adherence to assigned treatment or attention-control sessions (71%). Missing data rates were <10% for all outcomes except for baseline daily walking activity (36%). The trial protocol and interventions were acceptable to participants and the clinician. In conclusion, the MOSAIC trial was feasible to conduct, with the exception of high missing pedometer data. The intervention is an acceptable approach to facilitate walking among people with IC.

A Home- and Community-Based Physical Activity Program Can Improve the Cardiorespiratory Fitness and Walking Capacity of Stroke Survivors

The cardiorespiratory fitness of stroke survivors is low. Center-based exercise programs that include an aerobic component have been shown to improve poststroke cardiorespiratory fitness. This pilot study aims to determine the feasibility, safety, and preliminary efficacy of an individually tailored home- and community-based exercise program to improve cardiorespiratory fitness and walking capacity in stroke survivors. Independently ambulant, community-dwelling stroke survivors were recruited. The control (n = 10) and intervention (n = 10) groups both received usual care. In addition the intervention group undertook a 12-week, individually tailored, home- and community-based exercise program, including once-weekly telephone or e-mail support. Assessments were conducted at baseline and at 12 weeks. Feasibility was determined by retention and program participation, and safety by adverse events. Efficacy measures included change in cardiorespiratory fitness (peak oxygen consumption [VO2peak]) and distance walked during the Six-Minute Walk Test (6MWT). Analysis of covariance was used for data analysis. All participants completed the study with no adverse events. All intervention participants reported undertaking their prescribed program. VO2peak improved more in the intervention group (1.17 ± .29 L/min to 1.35 ± .33 L/min) than the control group (1.24 ± .23 L/min to 1.24 ± .33 L/min, between-group difference = .18 L/min, 95% confidence interval [CI]: .01-.36). Distance walked improved more in the intervention group (427 ± 123 m to 494 ± 67m) compared to the control group (456 ± 101m to 470 ± 106m, between-group difference = 45 m, 95% CI: .3-90). Our individually tailored approach with once-weekly telephone or e-mail support was feasible and effective in selected stroke survivors. The 16% greater improvement in VO2peak during the 6MWT achieved in the intervention versus control group is comparable to improvements attained in supervised, center-based programs.

Increased physical activity, physician recommendation, and senior center participation

Physical activity is a recognized preventive health measure for seniors and an important focus for senior centers. This paper employs the Andersen Behavioral Model to explore increased physical activity and participation in three types of senior center activities: physical fitness, dance/aerobic classes, and chair exercises. Data were collected in 2006 on 798 and in 2007 on 742 participants at 21 multipurpose senior centers in a large urban county. Logistic regression analysis (PROC RLOGIST in SAS-callable SUDAAN) was employed to predict increased physical activity, with modes of center participation in physical activity as mediating factors. Predisposing and enabling factors predicted both engaging in center-based exercise programs and increases in physical activity; but the strongest predictors of increases in physical activity were needed factors: physician recommendations to increase exercise and to lose weight. Implications are that both SCs and healthcare providers are important to promote physical activity in the older population.

Minimally supervised multimodal exercise to reduce falls risk in economically and educationally disadvantaged older adults.

Few studies have evaluated the benefit of providing exercise to underprivileged older adults at risk for falls. Economically and educationally disadvantaged older adults with previous falls (mean age 79.06, SD = 4.55) were randomized to 4 mo of multimodal exercise provided as fully supervised center-based (FS, n = 45), minimally supervised home-based (MS, n = 42), or to nonexercise controls (C, n = 32). Comparing groups on the mean change in fall-relevant mobility task performance between baseline and 4 mo and compared with the change in C, both FS and MS had significantly greater reduction in timed up-and-go, F(2,73) = 5.82, p = .004, η2 p = .14, and increase in tandem-walk speed, F(2,73) = 7.71, p < .001 η2 p = .17. Change in performance did not statistically differ between FS and MS. In community-dwelling economically and educationally disadvantaged older adults with a history of falls, minimally supervised home-based and fully supervised center-based exercise programs may be equally effective in improving fall-relevant functional mobility.

A Targeted Home- and Center-Based Exercise Program for People After Total Hip Replacement: A Randomized Clinical Trial

Galea MP, Levinger P, Lythgo N, Cimoli C, Weller R, Tully E, McMeeken J, Westh R. A targeted home- and center-based exercise program for people after total hip replacement: a randomized clinical trial. Objective To examine the physical function, gait, and quality of life of patients after total hip replacement (THR) randomly assigned to either a targeted home- or center-based exercise program. Design Randomized controlled trial. Setting Rehabilitation research center in Australia. Participants Twenty-three patients with unilateral THR were randomly assigned to a supervised center-based exercise group (n=11) or an unsupervised home-based exercise group (n=12). Intervention The center-based group completed an 8-week targeted exercise program while under the direct supervision of a physiotherapist. After initial instruction, the home-based group completed the 8-week targeted exercise program at home without further supervision. Main Outcome Measures Quality of life, physical function, and spatiotemporal measures of gait. Results No significant interaction (group by time) or main effects of grouping were found. Within each group, quality of life, and stair climbing improved significantly ( P<.05) as did Timed Up & Go test and 6-minute walk test performances ( P<.05). Walking speed increased by 16cm/s ( P<.01), cadence by 8 steps/min ( P<.05), step length by 4.7cm ( P<.05), and double-support time reduced by a factor of 16%. Step length symmetry showed significant improvement ( P<.05) over time. Step length differential between the affected and unaffected limbs reduced from 4.0 to 2.7cm. Conclusions The targeted strengthening program was effective for both the home- and center-based groups. No group differences were found in the majority of the outcome measures. This finding is important because it shows that THR patients can achieve significant improvements through a targeted strengthening program delivered at a center or at home.

Relations of Self-Motivation, Perceived Physical Condition, and Exercise-Induced Changes in Revitalization and Exhaustion with Attendance in Women Initiating a Moderate Cardiovascular Exercise Regimen

ABSTRACT This field investigation tested relationships between personal characteristics, feeling state changes occurring after exercise, and attendance in females (N = 50, M age = 39 years) initiating a 12-week, 3 days/week cardiovascular, community wellness center-based exercise program. Self-motivation and changes in exercise-induced revitalization demonstrated significant positive correlations with attendance (r = .28 and .31, respectively), while a significant negative correlation of exercise-induced physical exhaustion with attendance (r = −.28) was found. Entry of self-motivation and perceived physical condition into linear multiple regression analyses, along with changes in exercise-induced feelings, accounted for greater amounts of variance in attendance than either the personal characteristics or exercise-induced feeling changes alone. Substitution of an aggregate measure of exercise-induced feeling changes into regression equations further increased the explained variance in attendance to 17% and 19%. Findings suggest that researchers should account for both personal characteristics and exercise-induced feeling changes in developing a comprehensive model of physical activity behavior in women. Replication and implications for treatments intended to increase exercise were discussed.