Clinical Exercise Physiology Research Articles

The Exercise Oncology Twitter Conference: Disseminating Research in the Age of Social Media

ABSTRACT Background: Scientists are using social media to amplify their scientific impact. As such, researchers are looking for novel ways to engage this medium to promote scientific findings and communicate research to a broader audience. Here, we examine the use of a Twitter conference as a means to effectively communicate advances in the field of exercise oncology. Methods: The Exercise Oncology Twitter Conference (ExOncTC) occurred in October 2018. Each presentation consisted of 6 tweets over 15 min. Attendees were able to interact during a presentation via the conference hashtag (#ExOncTC). Registration data were used to characterize presenters and participants while Twitter Analytics/Union Metrics were used to aggregate data to determine engagement and reach. Results: The ExOncTC featured 68 presenters from 13 countries and 48 institutions. Presenters varied in academic background (ranging from undergraduate students [1.5%] to terminal degree holders [46%]) and profession (including researchers [42.5%] and physicians [6%]). Participants, including researchers, physicians, students, patients, and organizations could register via the Web site (n = 231), follow the @ExOncTC Twitter handle (n = 805), and/or search the #ExOncTC hashtag. During the conference, #ExOncTC was tweeted 1,501 times by 483 unique users for 4,943 total engagements (number of times a user interacts with a tweet). Collectively, these tweets reached 453,900 distinct users with potential impressions equaling 1.8 million (number of views possible). Conclusion: Reach of the ExOncTC demonstrates the potential effectiveness of using a Twitter conference as a platform to communicate the field of exercise oncology, suggesting Twitter conferencing should be explored as a tool for scientific dissemination to the broader field of clinical exercise physiology.

Identifying Key Physical Activity Categories and Topics to Include in Health Professional Training Programs

Phenomenon: Healthcare is an important sector in promoting physical activity (PA). However, few health professional training programs include PA, nor does standardized guidance exist on implementing it in the curriculum. This study aimed to consolidate health professional expert opinion on key PA categories and topics that should be included in the curriculum of health professional training programs. Approach: A three-round, modified e-Delphi process examined the opinions of 73 experts from seven health professions (clinical nutrition, exercise physiology, medicine, nursing, occupational therapy, physical therapy, physician assistants). In Round 1, panelists reported importance, ranked, and scored five broad PA categories, and responded to open-ended prompts for additional categories. In Round 2, panelists received summary feedback, re-ranked and re-scored PA categories, and suggested key PA topics within the five categories. In the final round, panelists viewed, ranked, and scored the PA topics. Findings: Expert panelists felt that all PA categories were important, with Health Behavior Change ranking the highest (98.7%) followed by Cellular and Systemic Implications of Exercise, Clinical Exercise Physiology, and PA and Public Health. The Administrative Aspects of Integrating PA into Health Systems ranked least important (48.0%). A consensus on the key PA categories was considered reached after two rounds. Five to eight specific PA topics were generated within each PA category and ranked in order of importance. Insights: These findings highlight several key PA categories and topics that can serve as a foundation for a diverse number of health professional training programs.

A Health Fitness Professional, Group Exercise Instructor, and Clinical Exercise Physiologist Walk into a Fitness Facility…

A Health Fitness Professional, Group Exercise Instructor, and Clinical Exercise Physiologist Walk into a Fitness Facility…

Influence of Exercise on Body Composition and Patient Outcomes in a Multidisciplinary Pediatric Obesity Clinic

Background: Childhood obesity has become a global epidemic, with approximately 34% of American children affected. This study describes outcomes seen in patients of a Multidisciplinary Pediatric Obesity Clinic (MPOC) who are compliant with individualized exercise regimens conducted by a Clinical Exercise Physiologist (CEP). The goal of this study is to track body composition, physical fitness measures, laboratory results, dietary and behavioral changes over the course of the program. Methods: Prospective cohort study design was implemented. There were 8-week exercise sessions conducted. Participants were evaluated by the CEP before, after the 8-week session using a standardized physical fitness evaluation, measurement of body composition and circumferences. Results: Statistical significance was observed with the increase in height (p<0.001), weight (p=0.014), Total Lean Mass (p=0.015). Increase in percent lean mass for all ethnicities in the study group i.e. black (male and female), hispanic (male and female) and white (male). An increase in the number of push-ups (p=0.012) was also observed. Conclusion: We can conclude that the use of an MPOC, CEP, and an exercise program early in childhood can potentially prevent the complications of obesity later in life.

A009 Rethinking Cardiac Rehabilitation

The nature of Cardiac Rehabilitation (CR) and healthcare have changed dramatically in recent years. Most evidence relating to the change in rehabilitation practices point to growing disruptions in traditional health service systems and structures, ways of working, forms of technologically-mediated care, and prognoses for people recovering from major cardiovascular illness. It is argued that integrated care is key to contemporary healthcare policy, and healthcare providers are moving away from care centered around discipline specialisation towards multi-disciplinary teams (MDT) (Liberati, Gorli, & Scaratti, 2016). Foucauldian discourse analysis was used in this study to interrogate the many competing and contested truths and power relations inherent in everyday CR practice. New approaches to clinical practice, healthcare budgets and societal expectations are changing in the way cardiac disease, patients and health professionals now view the role of CR. 1.The growth of interdependent practice systems raises concerns of power, boundary tensions and control amongst health professionals. Such changes pose significant challenges for cardiac physiotherapists practicing within a traditional healthcare paradigm.2.Furthermore, CR is a comprehensive programme that was traditionally colonised by physiotherapists. However, physiotherapists' monopoly over the care of patients in CR has been challenged by professions such as the clinical exercise physiologists with overlapping skills and roles and physiotherapists are under threat of losing it. Boundary tensions have been under-theorised and this study uses ruptures and key events to understand the boundary tensions within CR.

Time to Elevate the Education of Clinical Exercise Physiologists: A Professional Doctorate Model

ABSTRACT The increasing prevalence of noncommunicable diseases and multimorbidity negatively affects an individual’s quality of life and health trajectory; this trend and resultant personal and clinical outcomes are of significant concern. Healthy living (HL) behaviors (physical activity, dietary modification, smoking cessation, and medication compliance) are known to provide substantial health benefits that slow the progression or in some cases reverse the deleterious effects associated with inactivity and consumption of a diet high in sodium, fat content, added sugars, and energy-dense foods. However, it is becoming increasingly clear that a one-size-fits-all approach to HL interventions in populations at risk for or diagnosed with noncommunicable diseases is inadequate to promote optimization of health outcomes. Practitioners implementing HL interventions, such as clinical exercise physiologists (CEP), must instead understand the complexity or multimorbidity phenotypes and be able to effectively tailor programs for each condition. Although CEP may receive master’s level training in this area, the rise in patients with complex multimorbidity warrants consideration of elevating the professional expectations to better prepare CEP in training to deliver highly effective primary and secondary prevention HL interventions. Many licensed allied health professions (i.e., physical therapy, pharmacy, occupational therapy, nursing, nutrition, etc.) have recognized the call to move toward professional doctoral degree programs to better prepare practitioners within their field. This article proposes a professional doctorate degree program aimed at enhancing the training of CEP to become highly effective practitioners.

The Health Benefits of Exercise in Overweight and Obese Patients.

More than 30% of U.S. adults are obese or overweight. A program of regular physical activity is recommended as part of an effective lifestyle intervention for weight loss and weight management. However, more than 40% of adults do not engage in sufficient physical activity to realize these beneficial effects on body weight. Physicians may encounter many barriers to counseling physical activity, such as lack of knowledge or self-efficacy for counseling patients about physical activity. Obese individuals may be reluctant to exercise because of weight stigma, physique anxiety, and other factors; therefore, referral to a weight management specialist or clinical exercise physiologist can be helpful in facilitating exercise and assisting in achieving a clinically meaningful weight loss. Exercise has many benefits on physical and mental health and well-being that go well beyond weight loss, and it is for these reasons that exercise is particularly important for overweight and obese individuals.

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C-07 Thematic Poster - Clinical Exercise Physiology: Exercise and Type 2 Diabetes Thursday, May 30, 2019, 9: 30 AM - 11: 30 AM Room: CC-101B

Utility of Mobility in Post Open-Heart Surgery Patients: A Pilot Trial

ABSTRACT Background: As the role of the clinical exercise physiologist expands, early mobility is an area of potential focus. A rural Midwestern intensive care unit began a mobility program alongside its open-heart surgery program. The mobility specialist, who was trained as a clinical exercise physiologist, was tasked to ambulate the open-heart surgery patients. The purpose of this pilot study was to determine the effectiveness of a mobility specialist on ambulation frequency and distance on post open-heart surgery patients. Methods: Data were collected retrospectively for 1 month on ambulation frequency and distance to determine the mobility specialist's impact on the variables. Results: Data was collected on 18 patients (15 male, 3 female) over the month. Overall, when the mobility specialist was present, patients ambulated further (M = 421 feet versus 189 feet, P = 0.039) and more often (M = 3.32 versus 1.43 ambulations per day, P &amp;lt; 0.001). Conclusion: In this study, having a mobility specialist with a background in exercise physiology led to more frequent and distant ambulation. Therefore, a mobility specialist should be considered an integral member of a multidisciplinary clinical team in rural intensive care units.

Lifestyle and Exercise Interventions for Lumbopelvic Pain and Pelvic Floor Dysfunction: A New Protocol

PURPOSE: The purpose of this study was to evaluate whether a protocol that included the implementation of lifestyle modifications and a specialized exercise program would improve the symptoms of pelvic floor dysfunction and mild pelvic organ prolapse in women. METHODS: The five-week IRB-approved study included 23 female subjects aged 43.0 + 9.0 years (Mean + S.D.) who exhibited symptoms of pelvic floor dysfunction as defined by 3 assessments (the Pelvic Floor Distress Inventory [PFIQ-7], the Oswestry Low Back Pain Disability, and the Pelvic Floor Impact [PFDI-SF20] questionnaires). The study also included InBody570 body composition measurements, pelvic alignment assessments, diastasis recti assessments, and manual external pelvic floor muscle activation assessments. Participants were instructed in specific lifestyle modifications and participated in an exercise program over the course of seven live group sessions, 45 minutes each, led by one or both of the investigator clinicians. They were also taught to perform a home exercise program at least 5 days per week and completed compliance forms that were returned at the next live group session. The clinicians were a licensed physical therapist and a clinical exercise physiologist. RESULTS: IBM SPSS version 24 statistical programming was utilized and non-parametric Wilcoxon “related-items” analyses were employed. A 0.05 level of significance was applied. The study results of the pre- and post- values indicated significant improvements of lower back pain (Oswestry, z(23) = -3.67, p < .05), significant improvements of the quality of life subjective emotional gauge (PFDI -20, z(23) = -4.11, p < .05), and significant improvements of bladder, bowel, and prolapse symptoms (PFIQ - 7, z(23) = -3.74, p < .05). CONCLUSIONS: The study was highly labor- and time-intensive, and the sample was not large enough to eliminate statistical bias. However, the successful results warranted a continuation of the study to include 40 female volunteers with no modifications to the study’s protocol using the same clinicians. Researchers are currently recruiting volunteers to complete the study.

Improving Research Dissemination and Reach: Impact of a Daily Twitter Campaign in Exercise Oncology

Approaches to communicating health research has changed with the widespread adoption of digital and social media platforms. Knowledge exchange and research dissemination can now occur at exponential rates compared to traditional methods, providing an opportunity for improved research understanding, impact and implementation. However, it is unclear how effective scientists have been at using digital platforms for knowledge translation. The use of Twitter as a dissemination tool may prove to be an effective strategy to enhance the reach and impact of research and assist with implementation of exercise into healthcare. PURPOSE: To understand the engagement and reach of a daily academic-delivered twitter campaign focused on disseminating scientific publications specific to exercise oncology. METHODS: The Clinical Exercise Physiology Lab at the University of British Columbia (@CEPL_UBC) delivered a #365papers Twitter campaign that posted one academic paper daily specific to exercise oncology. The first 9-months of this digital campaign were analyzed in 3-months periods (first, middle, last) to understand the project reach, using Twitter metrics (engagements and impressions) and Altmetric attention scores. RESULTS: Overall, 499,899 impressions and 16,741 engagements occurred from 1 January 2018 to 30 September 2018 from 273 exercise oncology article posts. Average engagement rate increased by 35% from the first period compared to the last period (3.1 to 4.2%, p<0.001). Link clicks per daily article averaged 23.1 ±25.9 and ranged from 0 to 227 clicks. Followers increased by 296% from 229 to 677 users (p<0.01) and were predominantly female (64%) from 39 countries including United States (24%), Canada (23%), United Kingdom (23%) and Australia (10%). Altmetric attention scores indicate 76% of articles had engagement scores in the top 25% of all research outputs and high attention scores compared to outputs of the same age (85% ±12.4) and source (84% ±13.2). CONCLUSIONS: A daily exercise oncology twitter campaign was able to engage a broad international audience and provide high levels of reach, indicating that this may be an effective strategy for communication and dissemination of exercise research.

The Effectiveness Of Simulation-based Learning In Preparing Exercise Physiology Students For Emerging Clinical Practice Domains

PURPOSE Given the pivotal role exercise plays in the prevention and management of chronic diseases, developing practice-ready clinical exercise physiology (EP) students to program and prescribe exercise-based interventions across these conditions is critical. In emerging clinical domains, the lack of practicum opportunities makes it challenging to provide students with the vital opportunity to translate theory into practice. This study reports on the impact a simulation-based learning experience (SBLE) had on EP student's confidence and perception of knowledge in the clinical domain of palliative care. METHODS: 12 EP students completed a palliative care interprofessional SBLE alongside students from Dietetics (n=50), Pharmacy (n=44) and Social Work (n=7). The SBLE comprised modules on what is palliative care, effective communication for grief, and spiritual and cultural considerations in palliative care. Experienced and accredited practitioners across the range of health disciplines facilitated the SBLE which included pre-reading, briefing, simulation using simulated patients, and debriefing components. Interprofessional simulated patient interactions included initial consultations, education and treatment planning, and a multidisciplinary case conference. A post-simulation questionnaire explored the effectiveness of the SBLE in developing palliative care graduate capabilities. RESULTS: 100% of students ranked their confidence in caring for people with a life-limiting illness as moderate or higher (mean 7.6/10), while 91.7% of students ranked their knowledge and preparedness as moderate or higher (mean 7.5). 75% of students reported having one or no experience, in the past twelve months, caring for a person who has died due to a life-limiting illness in either a clinical placement, employment or personal capacity. Qualitative responses supported the quantitative data with students appreciating the opportunity of being exposed to the clinical domain in a safe and supportive environment that bridged the gap between theory and a real world setting. CONCLUSIONS: The positive impact on student confidence and perceived knowledge highlights the influence of SBLE in palliative care, suggesting a broader utility for this mode of learning in other emerging clinical domains for EP students.

Experience Implementing Supervised Exercise Therapy for Peripheral Artery Disease.

Supervised exercise therapy (SET) is a cornerstone of treatment for improving walking distance for individuals with symptomatic peripheral artery disease and claudication. High quality randomized controlled trials have documented the efficacy of SET as a claudication treatment and led to the recent Centers for Medicare and Medicaid decision to cover supervised exercise therapy (SET). However, to date, the translation of highly controlled, laboratory based SET programs in real world cardiopulmonary rehabilitation settings has been unexplored. In this article, we describe our experience integrating SET into existing cardiopulmonary rehabilitation programs, focusing on patient evaluation, exercise prescription, outcome assessments, strategies to maximize program adherence, and transitioning to home and community-based exercise training. Our team has over 3 years experience successfully implementing SET in cardiac rehabilitation settings. The experiences communicated within can serve as a model for rehabilitation therapists to follow as they begin to incorporate SET in their rehabilitation programs. CMS reimbursement has the potential to change clinical practice and utilization of SET for patients with symptomatic peripheral artery disease. The experience we have gained through implementation of SET programs across the M Health and Fairview Health Systems and in other Minnesota communities, including specific elements in our programs and the lessons learned from our clinical experience, can inform and help to guide development of new programs. The recent Centers for Medicare and Medicaid decision to cover supervised exercise therapy (SET) for beneficiaries with peripheral artery disease (PAD) has the potential to transform practice. In this article, we describe our experience integrating SET into existing cardiopulmonary rehabilitation programs, which could serve as a model for new programs.

The Obesity Paradox in Cardiovascular Diseases

The Obesity Paradox in Cardiovascular Diseases

Association of locomotive activity with sleep latency and cognitive function of elderly patients with cardiovascular disease in the maintenance phase of cardiac rehabilitation

BackgroundBecause of the advanced age of patients with cardiovascular disease (CVD), prevention of sleep disorder and dementia is a priority for cardiac rehabilitation (CR) during their long-term care. This study aimed to investigate the association of physical activity with sleep quality and cognitive function in elderly patients with CVD in the CR maintenance phase. MethodsWe conducted a multicenter study through the Clinical Exercise Physiology Association Japan network, which included 102 elderly patients (mean age, 74±7.4 years) with CVD undergoing phase III CR at 6 institutions. Physical activity was assessed using a triaxial accelerometer for 7 consecutive days and was classified as locomotive and household activities. Physical fitness was assessed via 6-min walking distance (6MD), hand grip power, 10-m walking speed, one leg standing time with eyes open, and 10 times sit-to-stand tests. Sleep quality and cognitive function were evaluated using the Pittsburgh sleep quality index (PSQI) and mini-mental state examination (MMSE) scores, respectively. ResultsThe patients performed 5506.8±3743.6 steps/day and scored 5.8±3.5 points in the PSQI and 28.4±1.7 points in the MMSE. Sleep latency and MMSE scores correlated with locomotive activity, but not with household activity. Locomotive activity and 6MD were independent predictors of sleep latency and MMSE score, respectively. When patients with heart failure were excluded, the relationship between sleep latency and locomotive activity was preserved, but the relationship between exercise tolerance and cognitive function disappeared. ConclusionLocomotive activity and exercise tolerance are associated with sleep latency and cognitive function in elderly patients with CVD continuing phase III CR. However, in this study, the relationship between exercise tolerance and cognitive function was offset by the presence of heart failure.

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

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

Effects of Resistance Training on Arterial Stiffness in Persons at Risk for Cardiovascular Disease: A Meta-analysis.

Arterial stiffness (AS) is a key measure in predicting risk for cardiovascular disease (CVD) and related events, independent of other risk factors. Resistance training (RT) has been shown to increase AS in young healthy subjects. However, the effects of RT on AS in persons with or at risk for CVD remain unclear; this uncertainty is a barrier to RT prescription in this population. Considering RT may be as effective as or superior to aerobic exercise prescription in treating some co-morbidities associated with CVD, it would be helpful to clarify whether RT does lead to clinically meaningful increases(detrimental) in AS in those with CVD or CVD risk factors. The aim of this study was to (1) assess the effects of RT on measures of AS in at-risk populations, and (2) discuss the implications of the findings for clinical exercise physiologists. The electronic databases PubMed, Web of Science, SPORTDiscus, and Google Scholar were searched from inception to February 2018. The reference lists of eligible articles and reviews were also checked. Inclusion criteria were: (1) the trial was a randomized controlled trial; (2) exercise prescription of RT or a combination of resistance and aerobic exercise for at least 8weeks; (3) control group characteristics allowed for comparison of the main effects of the exercise prescription; (4) subjects had known CVD or a risk factor associated with CVD according to the American College of Sports Medicine (ACSM) guidelines; (5) article measured at least carotid to femoralpulse wave velocity (PWV) or augmentation index (AIx). Initially, 1427 articles were identified. After evaluation of study characteristics, quality and validity data from 12 articles and 13 cohorts involving 651 participants (223 women, 338 men, 90 unknown) were extracted for the meta-analysis. To enable comparisons between assessments, and to infer clinical significance, standardized mean differences (SMD) were calculated. When data were not available, values were estimated according to Cochrane guidelines. According to the JADAD scale, the mean quality of studies was 3out of 5. The duration of the included studies ranged from 8weeks to 24months. RT trended towards decreasing(improving) PWV (SMD = - 0.168, 95% CI - 0.854 to 0.152, p = 0.057). There were no significant differences in AIx (SMD = - 0.286), diastolic blood pressure (SMD = - 0.147), systolic blood pressure (SMD = - 0.126), or central systolic blood pressure (SMD = - 0.405). The available evidence suggests that RT does not increase(worsen) AS in patients who have or are at risk for CVD. Considering RT may be as effective as or superior to aerobic exercise prescription in treating some co-morbidities associated with CVD, these findings suggest that RT is a suitable exercise prescription in primary and secondary prevention settings.

An investigation of the process of change in psychopathology and exercise during inpatient treatment for adults with longstanding eating disorders

BackgroundExcessive exercise is recognized as a predictor of poor outcome in eating disorders. However, little is known about how excessive exercise might affect the treatment process. The aim of this study was to describe process of weekly changes in eating disorder psychopathology, general psychopathology and exercise, and the possible interactive effects of excessive exercise on these changes during inpatient treatment of longstanding eating disorders.MethodsEighty-four patients meeting the DSM-IV criteria for Anorexia Nervosa, Bulimia Nervosa, or Eating Disorders Not Otherwise Specified received inpatient cognitive-behavioural therapy including, physical activity and nutritional counselling treatment over 12 weeks. Excessive exercise was defined as having ≥6 episodes of driven exercise during week 1 of treatment. Excessive exercisers received one additional session of individual counseling with the clinical exercise physiologist. The study used repeated measurements during treatment and collected measures of eating disorders: psychopathology (EDE-Q), general psychopathology (SCL-5), and frequencies of exercise and body mass index (BMI). Statistical analysis was performed using repeated measures ANOVA.ResultsBoth eating disorders and general psychopathology were reduced from admission to discharge in excessive exercisers and non-exercisers. There was an overall interaction effect between time (week) and excessive exercise for the process of exercise and eating disorders psychopathology reduction. This interaction effect was also found in week 10 vs 11 regarding general psychopathology. The excessive exercisers showed steep reduction at first, followed by a smaller increase towards the end of treatment in both eating disorder and general psychopathology; this pattern was not found among the non-exercisers.ConclusionThe process of change in exercise and psychopathology during inpatient treatment of longstanding eating disorders differs across excessive and non-excessive exercisers. Although excessive exercisers were given special attention for their exercise cognition and behavior during treatment, it is apparent that this part of treatment must be further developed.

Clinical Exercise Physiology and Health Care

Clinical Exercise Physiology and Health Care

Exercise Prescription Techniques in Cardiac Rehabilitation Centers in Midwest States

ABSTRACTIntroduction: Cardiac rehabilitation (CR) is a primary prescribed treatment for a variety of cardiovascular disease states, including: coronary artery disease, percutaneous coronary intervention (PCI), coronary artery bypass graft (CABG), myocardial infarction (MI), and heart failure. For this reason, exercise prescription guidelines for cardiac patients have been established. However, it is unclear how these guidelines are being administered at cardiac rehabilitation centers. The purpose of this study is to assess current exercise prescription techniques at cardiac rehabilitation clinics across several Midwest states in the United States.Methods: Fifty-eight CR programs from Michigan, Indiana, Illinois, Minnesota, Wisconsin, and Ohio were administered a questionnaire assessing clinic characteristics, aerobic and resistance exercise prescription techniques.Results: Most reported patient types were PCI, CABG, and MI. Clinical exercise physiologists were the primary exercise prescription writers (81%). Only 32% of the clinics required a clinical certification. Baseline stress tests prior to CR were performed in 33% of programs. Rating of Perceived Exertion (RPE) was the most commonly used indicator of exercise intensity, followed by heart rate reserve (HRR), and METs. Resistance exercise was practiced in 89% of CR programs. The most common intensity indicator was trial and error, and RPE.Conclusion: Results demonstrate exercise prescription variability among CR programs. This emphasizes the complexity and expertise among clinical exercise physiologists. These results also highlight the importance that academic programs place on training students across all prescription techniques, and utilization of research-based prescription guidelines published by professional organizations.