Community-based Exercise Program Research Articles

Determinants of exercise adherence and maintenance for cancer survivors: Implementation of a community-based group exercise program. A qualitative feasibility study.

Despite verified knowledge that physical exercise plays an important part in recovery after cancer treatment, multiple studies have shown that maintaining a physically active lifestyle after cancer is challenging. There is a need for qualitative studies to increase understanding into patient experiences and perspectives, and facilitate the design of more sustainable exercise program. This qualitative descriptive feasibility study explores experiences from the implementation of a novel four-month community-based group exercise program for cancer survivors within municipality health service after completion of rehabilitation in the specialist health care service. Fourteen cancer survivors participated in focus group interviews after completing Rehabilitation: Physical activity and Coping - feasibility study. Data were analyzed using the systematic text condensation method. We identified a main category, Determinants for exercise adherence and maintenance and four subcategories: peer-support, environment, structure and knowledge. A social and supportive exercise environment promotes exercise adherence and maintenance among cancer survivors. This knowledge can be useful for further efforts to implement high quality community-based group exercise programs for cancer survivors. This study adds knowledge of survivors' experience of a novel community-based group exercise program in clinical practice and can promote the implementation of sustainable community-based exercise programs for cancer survivors.

Differences in Health-Related Quality of Life and Physical Condition of Two Community-Based Exercise Programs in Subjects with Cardiovascular Risk Factors: A Prospective Observational Cohort Study

We compared the effect of two community-based physical activity (PA) programs on health-related quality of life (HRQL) and physical condition in people with cardiovascular risk factors. Fifty-one subjects participated in the "ACTIVA Murcia" AM3 program characterized by non-individualized training loads for 3 months, and forty-two participated in the AM6 program characterized by individualized progressive training loads for 6 months. Both programs included a 6-month follow-up period without PA. HRQL was assessed with the Short Form 36 Health Survey (SF-36) and physical condition by VO2 max, strength, flexibility, and balance. Participants in the AM6 program as compared with those in the AM3 program showed significantly higher scores in the subscales of physical functioning, mental health, energy/vitality, and general health. Mental health and general health at 6 months of follow-up were also scored significantly higher by AM6 participants. VO2 max and flexibility improved more in the AM6 group, whereas strength was better in the AM3 group. Half of the participants in the AM6 program expressed a strong willingness to continue exercising vs. 38% in the AM3 program. In this study, a community-based PA program with individualized progressive training loads of 6-month duration showed a more favorable impact on HRQL than a 3-month non-individualized PA program.

Impact of COVID-19 lockdown on physical activity behaviours of older adults who participated in a community-based exercise program prior to the lockdown.

This study investigated the impact of the 2020 COVID-19 lockdown on community-dwelling older adults attending a community-based exercise program to seek strategies to keep them active during self-isolated situations. A two-phase mixed methods approach included a survey followed by in-person focus groups. Forty-eight participants, with 32 starting a community-based exercise program before the lockdown and 16 joining the program after the lockdown, completed a questionnaire survey about physical activities before and during the lockdown. This was followed by three focus groups (26 participants in total) to identify factors influencing physical activity behaviours found in the survey. The survey found that the COVID-19 lockdown had varied impact on exercise adherence of the older adults: 43% of the participants exercised less during the lockdown than pre-lockdown, but 26% exercised more. Interestingly, among the participants approximately 80% still achieved the recommended physical activity level by the WHO during the lockdown. The focus groups revealed that exercise behaviours before the lockdown directly affected the behaviours during the lockdown. Participants' recognition of the support from trustworthy people also influenced their motivation to perform exercises in an isolated environment. Remote exercise programs, such as digital and printed exercise materials, were found beneficial for the participants only when they came from the people the older adults trusted through their previous experience (i.e., the program). A sense of belonging to the exercise group was also essential for the participants to achieve self-managed exercise. It was concluded that older adults need connections to an exercise group and a trustworthy exercise instructor who could continuously support them to be physically active in isolated situations such as lockdowns, in addition to exercise knowledge and a better understanding of the benefits of exercise.

Effectiveness of Ten Weeks Community-Based Multicomponent Exercise Program on Physiological Health of Elderly Women

Background: The advancement of technology and medical science has prolonged the longevity of humans, compelling each individual to deal with old age. New health issues are cropping up, especially since lifestyle has become sedentary. Regular physical exercises are the only option for healthy aging. Purpose: The study observed the effect of 10 weeks planned community-based multicomponent exercise program (CBMCEP) on selected physiological variables of elderly women in the Indian sub-urban area. Methodology: A quasi-experimental investigation was carried out in 2019 with 30 sedentary women volunteer of 55-65 years from the middle socio-economic class who were purposively assigned into experimental group (n=15) and control group (n=15). The experimental group was given 10 weeks- 4 days/week of CBMCEP in a progressive manner that included brisk walking, resistance exercise, balance, flexibility exercise and recreational activities of 80-90 minutes duration. The control group was not exposed to such a program. Pre and post-test were conducted on physiological variables like Resting Heart Rate (RHR), Resting blood pressure (Systolic- SDP; Diastolic- DBP), Postprandial Blood Sugar level (BSpp), and Haemoglobin concentration (Hb) by the registered medical practitioner. The obtained data were statistically analyzed by independent t-test for baseline differences between the groups and paired sample t-test to obtain the CBMCEP effect on dependent variables. Result: Statistical analysis revealed 10 weeks of CBMCEP can significantly reduce the RHR (p=0.003), SBP (p=0.039), DBP (p=0.052), BSpp level (p=0.015), and Hb concentration (p=0.009). Conclusion: The CBMCEP can promote significant improvement in the physiological health of elderly women. Further, it was noted that fitness experts may implement such cost-effective CBMCEP to ensure the healthy aging of a nation.

Developing innovative digitalized community-based senior exercise program to improve older adults' cognitive and physical functions

Developing innovative digitalized community-based senior exercise program to improve older adults' cognitive and physical functions

The impact of an exercise intervention using low-cost equipment on functional fitness in the community-dwelling older adults: A pilot study.

Exercise interventions have shown significant improvements in the older adult population regarding functional and cognitive capacity. However, much research has applied exercise protocols that are expensive both for research and participation. Thus, high investments that are made are currently not ecologically efficient. The aim of the study was to determine whether the impact of a 20-week multicomponent exercise intervention using low-cost material could improve physical fitness in community-dwelling older adults. We tested the feasibility of this three times per week exercise protocol using an inclusive approach. Eligibility criteria included age ≥65years, the ability to stand and walk with or without assistive devices, being physically inactive; medical clearance, and living in the community. Outcomes were muscle resistance measured using the chair-stand test for lower limbs, cardiorespiratory capacity measured using the 6-min walk test, and agility and balance using the Timed-up and Go test. Flexibility was measured using the chair sit and reach for lower limbs and the back scratch for upper limbs using the dominant leg and arm, respectively. Hand grip strength was measured using a dynamometer. Thirty participants (n = 30) were recruited and included in the intention-to-treat analysis. The mean age of participants was 70years (±3.62years), 100% were Caucasians, and 50% were female. There was a significant trend toward a clinically important improvement in the chair-stand (t = -5.23; p < 0.001; d = 0.36), arm curl (t = -5.21; p < 0.001; d = 0.74), 6-min walk test (t = -4.69; p = <0.001; d = 0.77), timed-up and go test (t = 8.788; p < 0.001; d = 1.18), and hand grip strength (t = 2.846; p = 0.009; d = 0.23). There were also differences in the back scratch (t = 2.243; p = 0.035; d = 0.29) and chair sit and reach test (t = -3.380; p < 0.001; d = 0.15). This pilot study has provided preliminary evidence that a 20-week community-based low-cost exercise program may be effective in improving overall functional fitness in older people. The pilot trial has provided the necessary data to design future randomized-controlled trials that can be implemented in the community in an ecological feasible manner.

Perceptions and experiences of young Black South African women with obesity from a low socioeconomic community after following a 12-week structured exercise intervention.

BackgroundPrevious research has shown that Black South African (SA) women perceive a bigger body size to be acceptable and desirable, but nonetheless have shown interest in participating in community-based exercise programmes. This study aimed to investigate perceptions and experiences of participating in a 12-week exercise intervention designed to study the mechanisms of insulin sensitivity and secretion in young Black SA women with obesity.MethodsQualitative data was collected from young (23 ± 2.9 years) Black SA women (n = 17) residing in a low-income setting in Cape Town, who took part in a 12-week structured exercise intervention. Focus group discussions (FGDs) and in-depth interviews (IDIs) were conducted 1–4 months after the completion of the intervention. These were all audio recorded and took between 45 and 60 min. The recordings were transcribed, translated and qualitative content analysis, entailing a systematic process of coding and identification of salient themes, was conducted using the ATLAS.ti software.ResultsSix broad themes were identified from participants' experiences and perceptions: motivational factors, acceptability of the programme, barriers, sustainability and influencing others, benefits of being physically active, definitions and perceptions of exercise. Anticipated weight loss and financial remuneration were identified as motivational factors for enrolment and retention in the exercise programme. Aspects of the training environment and feelings of wellness appeared in the acceptability, sustainability and benefits themes, whereas time scheduling and travel constraints were regarded as barriers. Exercise was perceived as the maintenance of a healthy body, and in some cases, only relevant for specific groups.ConclusionFinancial considerations played an important role in participants enrolling and staying in the 12-week exercise intervention. Participants liked many aspects of the intervention and identified physical and mental benefits that seemingly outweighed the barriers and disliked aspects of the programme. Optimizing the acceptability of exercise programmes and maximizing the opportunity for participants to experience improved mental well-being may contribute to attracting and retaining young Black SA women in exercise programmes.

Exploring the Relationship Between Quality and Quantity of Physical Activity Participation in Community-Based Exercise Programs for Persons With Physical Disabilities.

Community-based exercise programs for persons with disabilities promote greater quantity of leisure-time physical activity (LTPA) participation among their members, perhaps because of the quality experiences fostered by the program. This study aimed to explore the relationship between quality and quantity of physical activity participation in the context of community-based exercise programming and the role that gender plays in this relationship. Adults with physical disabilities (N = 91; Mage = 55, 49 men) from three community-based exercise programs across Canada completed a survey asking about quality participation (Measure of Experiential Aspects of Participation [MeEAP]) and LTPA. Structural equation modeling was used to examine the relationship between MeEAP scores and LTPA. Quality participation was not related to LTPA, even with gender included as a moderator. Men reported higher levels of LTPA and quality participation than women, highlighting gender differences that should be considered when researching and designing exercise programs for individuals with disabilities.

A Web-Delivered, Clinician-Led Group Exercise Intervention for Older Adults With Type 2 Diabetes: Single-Arm Pre-Post Intervention.

BackgroundThe COVID-19 pandemic created unprecedented shifts in the way health programs and services are delivered. A national lockdown to prevent the spread of COVID-19 in Australia was introduced in March 2020. This lockdown included the closure of exercise clinics, fitness centers, and other community spaces, which, before the pandemic, were used to deliver Beat It. Beat It is an 8-week in-person, community-based, and clinician-led group exercise and education program for adults self-managing diabetes. To continue offering Beat It, it was adapted from an in-person program to a fully web-based supervised group exercise program for adults with type 2 diabetes (T2DM).ObjectiveThis study aims to assess whether the Beat It Online program produced comparable health outcomes to the Beat It in-person program in terms of improving physical fitness (muscular strength and power, aerobic endurance, balance, and flexibility) and waist circumference in older adults with T2DM.MethodsAustralians with T2DM who were aged ≥60 years were included. They were enrolled in Beat It Online, a twice-weekly supervised group exercise and education program conducted via videoconference over 8 weeks. Anthropometric measurements and physical fitness parameters were assessed at baseline and completion. The adaptations to Beat It are reported using the Model for Adaptation, Design, and Impact, including the type of changes (what, where, when, and for whom), the criteria for making those changes (why and how), and the intended and unintended outcomes. The intended outcomes were comparable functional fitness as well as physical and mental health improvements across demographics and socioeconomic status.ResultsA total of 171 adults (mean 71, SD 5.6 years; n=54, 31.6% male) with T2DM were included in the study, with 40.4% (n=69) residing in lower socioeconomic areas. On the completion of the 8-week program, significant improvements in waist circumference, aerobic capacity, muscular strength, flexibility, and balance were observed in both male and female participants (all P<.001). The Model for Adaptation, Design, and Impact reports on 9 clinical, practical, and technical aspects of Beat It that were adapted for web-based delivery.ConclusionsThis study found that Beat It Online was just as effective as the in-person program. This adapted program produced comparable health benefits across demographics and socioeconomic status. This study offers important findings for practitioners and policy makers seeking to maintain independence of older people with T2DM, reversing frailty and maximizing functional and physical fitness, while improving overall quality of life. Beat It Online offers a flexible and inclusive solution with significant physical and mental health benefits to individuals. Further evaluation of Beat It (both in-person and Online) adapted for culturally and linguistically diverse communities will provide greater insights into the efficacy of this promising program.

The challenges and gains of delivering a home-exercise intervention: a qualitative study of physiotherapists and physiotherapy assistants

ObjectivesThe paper presents insights from the Community based Rehabilitation after Knee Arthroplasty (CORKA) trial. We aimed to explore physiotherapists and physiotherapy assistants’ experiences of delivering a home-base exercise intervention following knee replacement surgery. We were particularly interested in the feasibility, potential benefits and barriers of a community-based exercise programme from the perspective of physiotherapists and physiotherapy assistants and to understand any constraints or training needs that arose. DesignQualitative thematic analysis of semi-structured interviews. SettingThe Community based Rehabilitation after Knee Arthroplasty (CORKA) trial.ParticipantsFive physiotherapists and six physiotherapy assistants with a range of clinical experience.MethodsInterviews were digitally recorded and transcribed verbatim. We used the stages of reflexive thematic analysis suggested by Braun and Clarke. One researcher conducted the interviewers whilst three researchers with experience in qualitative research methods contributed to the coding and analysis of data.ResultsWe developed seven themes that help to understand the benefits and challenges of delivering treatment interventions in a person’s home: seeing the person in their own world; thinking outside the cubicle;developing people skills; enjoying the above and beyond; treading a fine line between patient and friend; feeling outside my comfort zone; needing a support network.ConclusionsTreating people in their own homes facilitates a holistic approach. Our findings highlight areas for clinical education: (1) how do we help clinicians to tread the fine line between friend and professional (2) how do we balance the need to provide support and structure with the freedom to work creatively and independently?

Virtual Implementation And Feasibility Of EXCEL: Exercise For Underserved Individuals Living With Cancer

Exercise is safe and effective for individuals living with and beyond cancer. However, disparities in access to exercise services remain, including for those in underserved areas. To address this inequity, the EXercise for Cancer to Enhance Living Well (EXCEL) implementation-effectiveness study was designed to better reach these individuals through virtual exercise delivery. PURPOSE: Describe the virtual implementation and feasibility of the EXCEL program after one year. To support sustainable implementation, EXCEL is building networks of healthcare providers (HCP), qualified exercise professionals (QEP) supported with training, and individuals living with cancer. METHODS: Participants, up to 3 years post treatment, may self-refer or HCP may refer. QEPs, aided by a moderator, lead fitness assessments (FxAx) and group-based exercise sessions for the 12-week, 2 time/week exercise intervention, via Zoom. QEPs demonstrate exercises, providing modifications to tailor to participant needs. Training for QEPs and moderators includes online cancer exercise education, a live-virtual EXCEL training day, and online moderating hours within the program. Program feasibility (FxAx completion rates, program adherence) and adverse events are tracked. RESULTS: In year one, 3 program waves enrolled 155 participants, and 17 HCPs partnered with EXCEL to refer participants across 6 provinces. Twelve QEPs were fully trained (education + moderating hours), and 9 have actively delivered online exercise classes. Over the first year, adherence to the exercise program was >83% and only one adverse event (minor) was reported. FxAx pre and post completion rates were > 98% and 89%, respectively. CONCLUSIONS: Virtual implementation of EXCEL has been both feasible and safe in year one. Network building includes educational outreach to HCPs, supporting referrals from clinic to community-based exercise programs. EXCEL provides sustainable cancer and exercise educational training for QEPs, and the online exercise oncology program assessment and delivery is feasible for participants. As in-person programs resume post-pandemic, practical virtual exercise options will remain vital for improving access to exercise oncology services, further supporting exercise as part of standard care. Supported by the CIHR-CCS and ACF.

P02-12 The implementation cost of a walking football exercise program for patients with type 2 diabetes: a case study of SWEET-Football (Portugal)

BackgroundEconomic analysis of health interventions is essential to the development and implementation of sustainable health policies, especially in noncommunicable diseases area. Type 2 diabetes (T2D) is one of the most relevant noncommunicable diseases globally. Regular physical activity is an established cornerstone of T2D control, with benefits in glycemic control, cardiovascular risk factors and quality of life. Thus, the current study aimed to assess the cost of a community-based physical activity intervention for patients with T2D.MethodsWe assessed the SWETT-Football program - a community-based walking football exercise program for middle-aged and older male patients with T2D. The program was tested in Portugal through a scientific project (NCT03810846) funded by FIFA (FIFA Research Scholarship 2018). One season of this program consists of three sessions per week (60 minutes per session) during nine months (October to June). For the calculations, we considered a total of 40 patients (two groups of 20). We calculated the direct costs of one season for the host institution: 216 hours of renting a sports hall and hiring human resources (a football coach and a nurse); cardiac stress tests and sports insurance for the participants; sports equipment (balls, cones, vests); vital signs monitoring equipment (blood pressure, heart rate and capillary blood glucose); logistical equipment (disposable and non-disposable); and technical training. In addition, we considered an economic depreciation of five years for sports and electronic materials. Cost analysis dated January 2022.ResultsOne season of this program for 40 patients with T2D was estimated to have a total implementation cost of 11,026.51€: 1,225.17€/month; 275.66€/patient; 51.05€/session; 30.63€/patient/month; and 2.55€/patient/session.ConclusionsA community-based walking football program for patients with T2D has an affordable cost and is feasible for large-scale implementation by local communities with the involvement of football clubs, municipalities and primary health care units, promoting physical activity and contributing to T2D control.

Effect of home-based exercise on falls in community-dwelling older adults: an umbrella review.

AimsThe aim of this review study was to examine the effectiveness of home-based and community-based exercise programmes in the rate of falls and improving physical functioning in community-dwelling older adults.MethodsAll types of home-based and community-based exercise interventions were searched. From 1186 studies identified, 14 studies were selected for the umbrella review. Most studies had high methodological quality. The types of interventions were multi-functional programmes (n = 11 studies) and Otago Exercise Programme (OEP) (n = 3 studies).ResultsThe results showed that home-based and community-based exercise interventions can reduce falls by 22–32%. Studies that included meta-analysis showed that the clinical significance of home-based interventions in fall prevention and improving physical function was moderate to high.ConclusionsIn conclusion, home-based and community-based exercise interventions are a safe, effective, and feasible method of fall prevention that could be implemented with minimum supervision by allied health professionals to maximise autonomy, self-efficacy, and adherence in community-dwelling older adults.

Components of a successful community-based exercise program for individuals with Parkinson’s disease: Results from a participant survey

ObjectivesThe aim of the project was to examine the personal beliefs, motivators, and barriers in people with Parkinson’s disease (PwPD) relating to their participation in a year-round community-based cycling program, Pedaling for Parkinson’s (PFP). DesignCross-sectional survey from a 12-month pragmatic study. SettingFive community-based PFP sites. Main outcome measuresA survey was designed to capture the attitudes and beliefs of those participating in a PFP program. Survey responses were rated on a 5-point Likert scale (1–5; higher number representing a more positive response) assessing the subdomains of Personal Beliefs and Knowledge, Health and Disability, Program, and Fitness Environment following a 12-month exercise observational period. ResultsA total of 40 PwPD completed the survey. Mean subdomain scores were as follows: 4.37 (0.41) for Personal Beliefs and Knowledge, 4.25 (0.65) for Health and Disability, 4.11 (0.53) for Program, and 4.35 (0.44) for Fitness Environment. There were no significant correlations between survey subdomains and demographic variables (age, years of education, years since diagnosis, years attending the PFP program, and disease severity) or subdomains and exercise behavior (cadence, attendance, and heart rate). ConclusionsRegardless of demographic variables and disease severity, PwPD who attended a PFP program enjoyed the class, felt that their PD symptoms benefited from exercise, and were motivated to exercise by their PD diagnosis. Factors such as location of the gym, cost, and transportation were important. With the growing body of PD literature supporting the role of exercise in potentially altering the disease trajectory, it is critical that communities adopt and implement exercise programs that meet the needs of PwPD and facilitate compliance.

How Community-Based Teams Use the Stroke Recovery in Motion Implementation Planner: Longitudinal Qualitative Field Test Study.

BackgroundThe Stroke Recovery in Motion Implementation Planner guides teams through the process of planning for the implementation of community-based exercise programs for people with stroke, in alignment with implementation science frameworks.ObjectiveThe purpose of this study was to conduct a field test with end users to describe how teams used the Planner in real-world conditions; describe the effects of Planner use on participants’ implementation-planning knowledge, attitudes, and activities; and identify factors influencing the use of the Planner.MethodsThis field test study used a longitudinal qualitative design. We recruited teams across Canada who intended to implement a community-based exercise program for people with stroke in the next 6 to 12 months and were willing to use the Planner to guide their work. We completed semistructured interviews at the time of enrollment, monitoring calls every 1 to 2 months, and at the end of the study to learn about implementation-planning work completed and Planner use. The interviews were analyzed using conventional content analysis. Completed Planner steps were plotted onto a timeline for comparison across teams.ResultsWe enrolled 12 participants (program managers and coordinators, rehabilitation professionals, and fitness professionals) from 5 planning teams. The teams were enrolled in the study between 4 and 14 months, and we conducted 25 interviews. We observed that the teams worked through the planning process in diverse and nonlinear ways, adapted to their context. All teams provided examples of how using the Planner changed their implementation-planning knowledge (eg, knowing the steps), attitudes (eg, valuing community engagement), and activities (eg, hosting stakeholder meetings). We identified team, organizational, and broader contextual factors that hindered and facilitated uptake of the Planner. Participants shared valuable tips from the field to help future teams optimize use of the Planner.ConclusionsThe Stroke Recovery in Motion Implementation Planner is an adaptable resource that may be used in diverse settings to plan community-based exercise programs for people with stroke. These findings may be informative to others who are developing resources to build the capacity of those working in community-based settings to implement new programs and practices. Future work is needed to monitor the use and understand the effect of using the Planner on exercise program implementation and sustainability.

The Stroke Recovery in Motion Implementation Planner: Mixed Methods User Evaluation

BackgroundAs more people are surviving stroke, there is a growing need for services and programs that support the long-term needs of people living with the effects of stroke. Exercise has many benefits; however, most people with stroke do not have access to specialized exercise programs that meet their needs in their communities. To catalyze the implementation of these programs, our team developed the Stroke Recovery in Motion Implementation Planner, an evidence-informed implementation guide for teams planning a community-based exercise program for people with stroke.ObjectiveThis study aimed to conduct a user evaluation to elicit user perceptions of the usefulness and acceptability of the Planner to inform revisions.MethodsThis mixed methods study used a concurrent triangulation design. We used purposive sampling to enroll a diverse sample of end users (program managers and coordinators, rehabilitation health partners, and fitness professionals) from three main groups: those who are currently planning a program, those who intend to plan a program in the future, and those who had previously planned a program. Participants reviewed the Planner and completed a questionnaire and interviews to identify positive features, areas of improvement, value, and feasibility. We used descriptive statistics for quantitative data and content analysis for qualitative data. We triangulated the data sources to identify Planner modifications.ResultsA total of 39 people participated in this study. Overall, the feedback was positive, highlighting the value of the Planner’s comprehensiveness, tools and templates, and real-world examples. The identified areas for improvement included clarifying the need for specific steps, refining navigation, and creating more action-oriented content. Most participants reported an increase in knowledge and confidence after reading the Planner and reported that using the resource would improve their planning approach.ConclusionsWe used a rigorous and user-centered process to develop and evaluate the Planner. End users indicated that it is a valuable resource and identified specific changes for improvement. The Planner was subsequently updated and is now publicly available for community planning teams to use in the planning and delivery of evidence-informed, sustainable, community-based exercise programs for people with stroke.

A preliminary study on the feasibility of community game-based respiratory muscle training for individuals with high cervical spinal cord injury levels: a novel approach

BackgroundRespiratory disorders result in rehospitalization and premature death of patients with cervical spinal cord injuries (CSCI). Community game-based respiratory muscle training (RMT) programs could reduce secondary complications.MethodsWe examined the feasibility and preliminary efficacy of RMT as a community-based exercise program. Among the 10 included participants (eight male and two female), four, one, one, and four reported C3, C4, C5, and C6 complete injuries, respectively (eight graded by American Spinal Injury Association impairment scale [ASIA] A and two by ASIA B). Their mean age was 43 ± 12.3 y. The time since injury was 10 ± 6.7 y. The participants completed an RMT program for 60 min/day, twice weekly, for 8 weeks. The participants were trained in the use of a newly developed game-based RMT device. The device provides consistent pressure for respiratory muscle strength and endurance training. Seven RMT devices were modified to allow 10 game-based RMT programs. Forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), peak expiratory flow (PEF), vital capacity (VC), inspiratory capacity (IC), inspiratory reserve volume (IRV), expiratory reserve volume (ERV), maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), and peak cough flow (PCF) were measured.ResultsThere were improvements after RMT compared to pre-RMT in FVC (p = 0.027, 10.62%, 0.22 effect size [ES]), PEF (p = 0.006, 23.21%, 0.45 ES), VC (p = 0.002, 35.52%, 0.60 ES), IC (p = 0.001, 46.94%, 0.81 ES), IRV (p = 0.001, 90.53%, 1.22 ES), MIP (p = 0.002, 97.25%, 1.32 ES), MEP (p = 0.005, 141.12%, 1.07 ES), and PCF (p = 0.001, 35.60%, 0.74 ES). The participants reported a positive impact of the program.ConclusionsCommunity game-based RMT for individuals with CSCI appears to be safe and feasible. Community exercise with RMT use may have a positive impact on the respiratory measures for patients with CSCI who are vulnerable to respiratory compromise.Trial registrationKCT0005980.

A community-based adapted exercise program to increase quality of life and self-efficacy among adults with physical disabilities: A mixed-method study.

Self-efficacy is one of the key constructs that directly influence physical activity, community participation, and mental health while acting as a strong influence on the quality of life (QOL) for adults with physical disabilities (AWPDs). There are relatively few studies focusing on a community-based exercise program in this population. This study aims to quantitatively examine a community-based adapted exercise program on the QOL and self-efficacy of AWPDs. In addition, we explored AWPD's perceived benefits of community-based exercise programming and any factors that may influence those perceived benefits. Adults with physical disabilities (N = 50) participated in a 9-week community-based adapted exercise program (90-minute session, twice per week). QOL (WHOQOL-BREF) and self-efficacy were measured at baseline and at the conclusion of the program. A follow-up focus group (n = 22) was conducted at the postprogram. Quantitative data were analyzed by paired t test (α = 0.05). Qualitative data were analyzed by thematic coding and content analysis. Significant improvement with moderate effect size was found across all variables. Two main themes emerged from the qualitative analysis: 1) perceived benefit of exercise program and 2) factors of an exercise program for AWPD. A community-based exercise program and self-efficacy play a large role in the exercise behaviors and QOL of AWPDs. The benefits of exercise and factors identified as promoting exercise may be carefully considered to improve QOL for this population. The finding of this study offers practical recommendations to community-based exercise specialists, which would assist in establishing an appropriate exercise program for AWPDs.

Health Fitness Professionals’ Perceptions to Offering a Cancer Exercise Program: A Qualitative Study

ABSTRACT Introduction/Purpose The purpose of this study is to qualitatively investigate fitness professionals’ perceptions of barriers and enablers to offering community-based exercise programs targeting cancer survivors at their fitness and/or community centers. Methods A qualitative case study approach incorporating Web-based survey and semistructured interview components was used to evaluate community-based fitness professionals’ programming perceptions. Results A total of seven subjects completed a semistructured interview. Data analysis using content analysis and the constant comparative method process revealed three primary domains with 11 underlying themes: 1) program barriers (education and awareness, physician referral, cost, and care along the cancer continuum); 2) program enablers (champion advocacy, sponsor/funding, personnel, and propositional solutions); and 3) program perceptions (social support, gym atmosphere, and cancer-specific modifications). Conclusions Findings from this qualitative study identified multiple domains and themes articulating health and fitness professionals’ perceptions of key barriers, enablers, and programmatic aspects in offering community-based exercise cancer programming. These results have important implications for guiding the design and delivery of community-based exercise programs for cancer survivors and represent an advance in the current literature surrounding implementation strategies in a clinic-to-community translational model of exercise-based supportive cancer care.

Feasibility and acceptability of a remotely delivered, home-based, pragmatic resistance ‘exercise snacking’ intervention in community-dwelling older adults: a pilot randomised controlled trial

BackgroundVery few older adults meet current muscle strengthening exercise guidelines, and several barriers exist to supervised, community-based resistance exercise programs. Older adults therefore require access to feasible resistance exercise modalities that may be performed remotely. This pilot study assessed the feasibility and acceptability of undertaking a four-week home-based resistance ‘exercise snacking’ intervention (performed either once, twice, or thrice daily) when delivered and monitored remotely in older adults. MethodsThirty-eight community-dwelling older adults [mean ± SD age 69.8 ± 3.8 y, 63% female] were randomised to complete resistance ‘exercise snacks’ (9-minute sessions) either once (n = 9), twice (n = 10), or thrice (n = 9) daily, or allocated to usual-activity control (n = 10). Exercise adherence and adverse events were assessed using an exercise diary, and acceptability of the intervention was explored using an online questionnaire. Physical function [balance, 5-times sit-to-stand (STS), and 30-second STS tests] was assessed remotely at baseline and follow-up using videoconferencing.ResultsThe intervention was feasible and safe, with 100% participant retention, high adherence (97, 82, and 81% for once, twice, and thrice daily, respectively), and only two adverse events from a total of 1317 ‘exercise snacking’ sessions. The exercise intervention was rated as enjoyable (75% reported their enjoyment as ≥4 on a 5-point Likert scale), easy to perform, and most (82%) planned to continue similar exercise at home. We also found it was feasible to assess measures of physical function via videoconferencing, although effect sizes for 4-week changes in both 5-STS (d range, 0.4–1.4) and 30-STS (d range, 0.7–0.9) following the exercise intervention were similar to controls (d = 1.1 and 1.0 for 5-STS and 30-STS, respectively).ConclusionsResistance ‘exercise snacking’ may be a feasible strategy for engaging older adults in home-based resistance exercise when delivered and monitored remotely. The findings of this pilot feasibility trial support the need for longer-term studies in larger cohorts to determine the effectiveness of resistance ‘exercise snacking’ approaches for improving physical function in older adults.Trial registrationThe trial was retrospectively registered on 10/11/2021 with the Australian New Zealand Clinical Trials Registry (ANZCTR) (ACTRN12621001538831).