Controlled Trial Of Exercise Research Articles

Study protocol for a randomized controlled trial of neuromuscular exercise and pain neuroscience education in patients with chronic pain after total knee arthroplasty

Purpose: Total knee arthroplasty (TKA) is considered an effective treatment for pain relief and improved physical performance in end-stage knee osteoarthritis. However, several studies have reported less favorable outcomes after TKA with chronic pain rates of approximately 20%. Exercise might be an effective treatment strategy for chronic pain following TKA, but no randomized controlled trials have evaluated its effect. Therefore, we initiated the Neuromuscular Exercises and Pain Neuroscience Education for chronic Pain (the NEPNEP trial) with the purpose of investigating whether a 12-week neuromuscular exercise (NEMEX-TJR) program combined with pain neuroscience education (PNE) provides greater pain relief and improvement in physical performances than PNE alone in a population of patients with chronic pain after primary TKA.

Effects of recombinant human brain natriuretic peptide in patients with acute myocardial infarction undergoing percutaneous coronary intervention

Objective:To systematically review the effect of recombinant human brain natriuretic peptide (rhBNP) on the cardiac function in patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI).Methods:PubMed, Web of Science, the Cochrane Library, Chinese Biomedical Database (CBD), and China National Knowledge Infrastructure (CNKI) were electronically searched to collect randomized controlled trials (RCTs) of traditional exercise for patients with AMI undergoing PCI from the beginning of the database inception to January 2019. Two reviewers independently screened the literature, extracted data, and evaluated the quality of included studies. Then, meta-analysis was performed using the RevMan 5.3 software.Results:A total of 16 RCTs and 1551 patients were included. The results of the meta-analysis showed that, compared with the control-treated patients, rhBNP-treated patients with AMI had an increased left ventricular ejection fraction (LVEF) of 3.34% ([MD = 3.34, 95% CI (0.39,6.29), P = .03]) 1 week postoperatively, 6.22% ([MD = 6.22, 95% CI (4.15,8.28), P < .00001]) 4 weeks postoperatively, 7.34% ([mean difference (MD) = 7.34, 95% CI (4.52, 10.16), P < .00001]) 12 weeks postoperatively, and 5.32% ([MD = 5.32, 95% CI (3.05, 7.59), P < .00001]) 24 weeks postoperatively. Moreover, the heart failure (HF) recurrence of rhBNP-treated patients with AMI 12 weeks postoperatively was 0.24 times that of the control-treated patients ([risk ratio (RR) = 0.24, 95% CI (0.06, 0.92), P = .04]), and the difference was statistically significant. At the same time, rhBNP-treated patients had decreased N-terminal pro-brain natriuretic peptide (NT-proBNP) (24 hours, 48 hours, 72 hours) and aldosterone (Ald) (24 hours, 72 hours, 168 hours) levels in comparison with the control-treated patients.Conclusion:Current evidence shows that the application of rhBNP presents a greater clinical benefit to patients with AMI undergoing PCI. Due to the methodological bias in the included studies and small sample size, more high-quality studies are required to verify the study findings.Systematic Review Registration Number:PROSPERO (CRD42019126727)

Effects of Mind-Body Exercise in Cancer Survivors: A Systematic Review and Meta-Analysis.

Objective Mind-body exercise may have potential benefits for cancer survivors according to previous studies. We performed a systematic review and meta-analysis to summarize the published evidence and evaluate the safety and efficacy of mind-body exercise on general quality of life (QOL) and symptom management in cancer survivors. Methods Four English language databases were systematically searched for existing randomized controlled trials (RCTs) of mind-body exercise in cancer survivors from database inception through October 23, 2019. Methodological quality was appraised with the Cochrane Risk of Bias tool. A meta-analysis of comparative effects was performed using the Review Manager v.5.3 software. Results Fifteen studies encompassing 1461 patients were included. Analysis results showed that mind-body exercise could have a statistically significant effect on the outcomes of physical fitness, fatigue, sleep quality, depression, anxiety, and BMI, while effects on general QOL and stress were not statistically significant (all p > 0.05). No serious adverse events were reported. Conclusions The current evidence demonstrates that mind-body exercise is relatively safe and modestly effective for symptom management in cancer survivors. Furthermore, randomized trials with larger sample sizes and of higher methodological quality are needed to confirm these results.

A pilot randomized controlled trial of exercise to improve cognitive performance in patients with stable glioma: a proof of concept.

BackgroundPatients with glioma often suffer from cognitive deficits. Physical exercise has been effective in ameliorating cognitive deficits in older adults and neurological patients. This pilot randomized controlled trial (RCT) explored the possible impact of an exercise intervention, designed to improve cognitive functioning in glioma patients, regarding cognitive test performance and patient-reported outcomes (PROs).MethodsThirty-four clinically stable patients with World Health Organization grades II/III glioma were randomized to a home-based remotely coached exercise group or an active control group. Patients exercised 3 times per week for 20–45 minutes, with moderate to vigorous intensity, during 6 months. At baseline and immediate follow-up, cognitive performance and PROs were assessed with neuropsychological tests and questionnaires, respectively. Linear regression analyses were used to estimate effect sizes of potential between-group differences in cognitive performance and PROs at 6 months.ResultsThe exercise group (n = 21) had small- to medium-sized better follow-up scores than the control group (n = 11) on several measures of attention and information processing speed, verbal memory, and executive function, whereas the control group showed a slightly better score on a measure of sustained selective attention. The exercise group also demonstrated small- to medium-sized better outcomes on measures of self-reported cognitive symptoms, fatigue, sleep, mood, and mental health–related quality of life.ConclusionsThis small exploratory RCT in glioma patients provides a proof of concept with respect to improvement of cognitive functioning and PROs after aerobic exercise, and warrants larger exercise trials in brain tumor patients.

Functional Electrical Stimulation Cycling Exercise in People with Multiple Sclerosis: Secondary Effects on Cognition, Symptoms, and Quality of Life.

Functional electrical stimulation (FES) cycling is an advanced rehabilitation modality that involves systematic mild electrical stimulation of focal muscle groups to produce leg cycling movement against an adjustable work rate. The present study reports on the efficacy of an assessor-blinded, pilot randomized controlled trial of supervised FES cycling exercise in people with multiple sclerosis (MS) on secondary trial outcomes, including cognition, fatigue, pain, and health-related quality of life. Eleven adult participants with MS were randomized to receive FES cycling exercise (n = 6) or passive leg cycling (n = 5) for 24 weeks. Cognitive processing speed was assessed using the Symbol Digit Modalities Test. Symptoms of fatigue and pain were assessed using the Fatigue Severity Scale, the Modified Fatigue Impact Scale, and the short-form McGill Pain Questionnaire. Physical and psychological health-related quality of life were assessed using the 29-item Multiple Sclerosis Impact Scale. Eight participants (four, FES; four, passive leg cycling) completed the intervention and outcome assessments. The FES cycling exercise resulted in moderate-to-large improvements in cognitive processing speed (d = 0.53), fatigue severity (d = -0.92), fatigue impact (d = -0.45 to -0.68), and pain symptoms (d = -0.67). The effect of the intervention on cognitive performance resulted in a clinically meaningful change, based on established criteria. We provide preliminary evidence for the benefits of FES cycling exercise on cognition and symptoms of fatigue and pain. Appropriately powered randomized controlled trials of FES cycling exercise are necessary to determine its efficacy for people with MS.

Retinal endothelial function in cardiovascular risk patients: A randomized controlled exercise trial.

The aim of this study was to investigate, for the first time, the effects of high-intensity interval training (HIIT) on retinal microvascular endothelial function in cardiovascular (CV) risk patients. In the randomized controlled trial, middle-aged and previously sedentary patients with increased CV risk (aged 58±6years) with ≥ two CV risk factors were randomized into a 12-week HIIT (n=33) or control group (CG, n=36) with standard physical activity recommendations. A blinded examiner measured retinal endothelial function by flicker light-induced maximal arteriolar (ADmax) and venular (VDmax) dilatation as well as the area under the arteriolar (AFarea) and venular (VFarea) flicker curve using a retinal vessel analyzer. Standardized assessments of CV risk factors, cardiorespiratory fitness, and retinal endothelial function were performed before and after HIIT. HIIT reduced body mass index, fat mass, and low-density lipoprotein and increased muscle mass and peak oxygen uptake (VO2peak). Both ADmax (pre: 2.7±2.1%, post: 3.0±2.2%, P=.018) and AFarea (pre: 32.6±28.4%*s, post: 37.7±30.6%*s, P=.016) increased after HIIT compared with CG (ADmax, pre: 3.2±1.8%, post: 2.9±1.8%, P=.254; AFarea, pre: 41.6±28.5%*s, post: 37.8±27.0%*s, P=.186). Venular function remained unchanged after HIIT. There was a significant association between ∆-change VO2peak and ∆-changes ADmax and AFarea (P=.026, R2 =0.073; P=.019, R2 =0.081, respectively). 12-weeks of HIIT improved retinal endothelial function in middle-aged patients with increased CV risk independent of the reduction in classical CV risk factors. Exercise has the potential to reverse or at least postpone progression of small vessel disease in older adults with increased CV risk under standard medication. Dynamic retinal vessel analysis seems to be a sensitive tool to detect treatment effects of exercise interventions on retinal microvascular endothelial function in middle-aged individuals with increased CV risk.

Exceptional reported effects and data anomalies merit explanation from “A randomized controlled trial of coordination exercise on cognitive function in obese adolescents” by Liu et al. (2018)

We read the article in Psychology of Sport and Exercise by Liu et al. (“A randomized controlled trial of coordination exercise on cognitive function in obese adolescents”) with great interest. Our interest in the article stemmed from the extraordinary differences in obesity-related outcomes reported in response to a rope-jumping intervention. We requested the raw data from the authors to confirm the results and, after the journal editors reinforced our request, the authors graciously provided us with their data. We share our evaluation of the original data herein, which includes concerns that weight and BMI loss by the intervention appears extraordinary in both magnitude and aspects of the distributions. We request that the authors address our findings by providing explanations of the extraordinary data or correcting any errors that may have occurred in the original report, as appropriate.

Randomized controlled trial of aquatic exercise for treatment of knee osteoarthritis in elderly people.

AimThe aim of this study is to assess the efficacy of aquatic exercise on pain, gait, and balance among elderly patients with knee osteoarthritis.MethodsWe performed a randomized controlled trial at a university hospital. Overall, 32 men with knee osteoarthritis, aged ≥ 60 years, were included. Pain, balance, and gait were evaluated before and 2 months after interventions. The group control used acetaminophen and followed lifestyle recommendations. The intervention group performed the aquatic exercise three sessions per week for 8 weeks.ResultsAt the end of the study, mean pain scores were significantly different between the groups (p = 0.010). Within-group analyses showed that group intervention experienced significant pain relief (p = 0.019), whereas group control did not show the significant change (p = 0.493). There was significant improvement in favor of aquatic exercise with regard to static (p = 0.001) and dynamic (p = 0.001) balance, step length (p = 0.038), stride length (p < 0.001), and cadence (p < 0.001). However, we did not find a significant difference in step time and width between the two groups.ConclusionsAquatic exercise would be beneficial in decreasing subjective pain of osteoarthritis. There are some recognizable improvements in patients’ gait and balance as well.

Exercise as Medicine for Mental and Substance Use Disorders: A Meta-review of the Benefits for Neuropsychiatric and Cognitive Outcomes.

Exercise may improve neuropsychiatric and cognitive symptoms in people with mental disorders, but the totality of the evidence is unclear. We conducted a meta-review of exercise in (1) serious mental illness (schizophrenia spectrum, bipolar disorder and major depression (MDD)); (2) anxiety and stress disorders; (3) alcohol and substance use disorders; (4) eating disorders (anorexia nervosa bulimia nervosa, binge eating disorders, and (5) other mental disorders (including ADHD, pre/post-natal depression). Systematic searches of major databases from inception until 1/10/2018 were undertaken to identify meta-analyses of randomised controlled trials (RCTs) of exercise in people with clinically diagnosed mental disorders. In the absence of available meta-analyses for a mental disorder, we identified systematic reviews of exercise interventions in people with elevated mental health symptoms that included non-RCTs. Meta-analysis quality was assessed with the AMSTAR/+. Overall, we identified 27 systematic reviews (including 16 meta-analyses representing 152 RCTs). Among those with MDD, we found consistent evidence (meta-analyses = 8) that exercise reduced depression in children, adults and older adults. Evidence also indicates that exercise was more effective than control conditions in reducing anxiety symptoms (meta-analyses = 3), and as an adjunctive treatment for reducing positive and negative symptoms of schizophrenia (meta-analyses = 2). Regarding neurocognitive effects, exercise improved global cognition in schizophrenia (meta-analyses = 1), children with ADHD (meta-analyses = 1), but not in MDD (meta-analyses = 1). Among those with elevated symptoms, positive mental health benefits were observed for exercise in people with pre/post-natal depression, anorexia nervosa/bulimia nervosa, binge eating disorder, post-traumatic stress disorder and alcohol use disorders/substance use disorders. Adverse events were sparsely reported. Our panoramic meta-overview suggests that exercise can be an effective adjunctive treatment for improving symptoms across a broad range of mental disorders.

A randomised controlled trial of movement quality-focused exercise versus traditional resistance exercise for improving movement quality and physical performance in trained adults

ABSTRACTThe aim of this trial was to compare an eight-week individual movement quality versus traditional resistance training intervention on movement quality and physical performance. Forty-six trained adults were randomised to a movement quality-focused training (MQ) or a traditional resistance training (TRAD) group, and performed two individualised training sessions per week, for 8 weeks. Session-RPE (sRPE) was obtained from each session. Measures of movement quality (MovementSCREEN and Functional Movement Screen (FMS)) and physical performance were performed pre- and post-intervention. All measures improved significantly in both groups (3–14.5%, p = <0.005). The between-group difference in MovementSCREEN composite score was not statistically significant (0.3, 95% CI −3.4, 4.1, p = 0.852). However, change in FMS composite was significantly greater in MQ (1.3, 95% CI 0.8, 1.8, p < 0.001). There were no significant between-group differences in physical performance (p = 0.060–0.960). The mean sRPE was significantly lower in MQ (5.25, SD 1.2) compared to TRAD (6.6 SD 1.0, p = <0.001). Thus, although movement quality scores were not distinctly greater in the MQ group, a movement quality specific intervention caused comparable improvements in physical performance compared to traditional resistance training but at lower perceived training intensity.

Effects of Exercise on Chemotherapy Completion and Hospitalization Rates: The OptiTrain Breast Cancer Trial.

BackgroundExercise during chemotherapy is suggested to provide clinical benefits, including improved chemotherapy completion. Despite this, few randomized controlled exercise trials have reported on such clinical endpoints. From the OptiTrain trial we previously showed positive effects on physiological and health‐related outcomes after 16 weeks of supervised exercise in patients with breast cancer undergoing chemotherapy. Here, we examined the effects of exercise on rates of chemotherapy completion and hospitalization, as well as on blood cell concentrations during chemotherapy.Patients and MethodsTwo hundred forty women scheduled for chemotherapy were randomized to 16 weeks of resistance and high‐intensity interval training (RT‐HIIT), moderate‐intensity aerobic and high‐intensity interval training (AT‐HIIT), or usual care (UC). Outcomes included chemotherapy completion, hospitalization, hemoglobin, lymphocyte, thrombocyte, and neutrophil concentrations during chemotherapy.ResultsNo significant between‐groups differences were found in the proportion of participants who required dose reductions (RT‐HIIT vs. UC: odds ratio [OR], 1.08; AT‐HIIT vs. UC: OR, 1.39), or average relative dose intensity of chemotherapy between groups (RT‐HIIT vs. UC: effect size [ES], 0.08; AT‐HIIT vs. UC: ES, −0.07). A significantly lower proportion of participants in the RT‐HIIT group (3%) were hospitalized during chemotherapy compared with UC (15%; OR, 0.20). A significantly lower incidence of thrombocytopenia was found for both RT‐HIIT (11%) and AT‐HIIT (10%) versus UC (30%; OR, 0.27; OR, 0.27).ConclusionNo beneficial effects of either RT‐HIIT or AT‐HIIT on chemotherapy completion rates were found. However, combined resistance training and high‐intensity interval training were effective to reduce hospitalization rates, and both exercise groups had a positive effect on thrombocytopenia. These are important findings with potential positive implications for the health of women with breast cancer and costs associated with treatment‐related complications.Implications for PracticeCompleting the prescribed chemotherapy regimen is strongly associated with a good prognosis for patients with primary breast cancer. Despite this, treatment‐induced side effects make it necessary to reduce or alter the treatment regimen and can also lead to hospitalization. Exercise during chemotherapy is suggested to provide clinical benefits, including improved chemotherapy completion. This study showed that combined resistance and high‐intensity interval training during chemotherapy resulted in lower hospitalization rates and a lower incidence of thrombocytopenia in women with breast cancer undergoing chemotherapy. However, no beneficial effects of either exercise program on chemotherapy completion rates were found, which is in contrast to previous findings in this population. The findings reported in the current article have positive implications for the health of women with breast cancer and costs associated with treatment‐related complications.

A pragmatic randomised controlled trial of preferred intensity exercise in depressed adult women in the United Kingdom: secondary analysis of individual variability of depression

BackgroundThis study is a secondary analysis of the trial by Callaghan et al. (2011), which reported higher antidepressant effects for preferred intensity (n = 19) vs. prescribed intensity (n = 19) exercise of three sessions/week over four weeks in depressed women. In particular, the present study sought to examine whether greater clinically significant individual change/recovery was observed in the preferred compared to the prescribed exercise group.MethodsThe reliable change index and the Ccutoff score criteria described by Jacobson and Truax (1991) were employed to determine clinical significance. These criteria examined if individual change in depression scores from pre- to post-intervention in the preferred intensity group were statistically significant beyond the standard error of difference derived from the active comparator prescribed group, and subsequently within a normal population range. Patients fulfilling the first or both criteria were classified as improved or recovered, respectively.ResultsPost-intervention depression scores of six patients in the preferred intensity exercise group (32%) demonstrated statistically reliable improvement (p < 0.05) and recovery. Half of this subgroup started as moderately depressed. No patient demonstrated a reliable deterioration in depression. Due to a small sample size, it was impossible to determine whether patients on psychiatric medication or medication-free patients were equally benefited from preferred intensity exercise. Thirteen patients in the preferred intensity group (68%) displayed non-statistically significant change in post-intervention depression scores (p > 0.05), although eight of them showed a non-significant improvement in post-intervention depression scores and three could not technically show an improvement in depression due to floor effects (baseline depression within normal range).ConclusionsPreferred intensity exercise of three sessions/week over four weeks led almost a third of the patients to record scores consistent with recovery from depression. Health professionals may consider that short-term preferred intensity exercise provides clinically significant antidepressant effects comparing favourably to exercise on prescription.

Insights Following Implementation of an Exercise Intervention in Older Veterans with PTSD.

Individuals with post-traumatic stress disorder (PTSD) face numerous barriers to exercise. Little is known about behavioral strategies to promote participation in this population. This is a secondary analysis of individual barriers and goals, exercise prescription characteristics, and patient perceptions of a 12-week, community-based, randomized controlled exercise trial targeting older adults with PTSD, (N = 45; mean age = 68; male = 91%). The most common cited goals for participating included weight loss (65%) and increasing strength (65%). Exercise mode varied among those who completed the program (n = 37), with 14 (38%) using exclusively treadmill; eight (22%) using only bike, and 15 (41%) utilizing a combination. Patient-reported exercise duration and intensity progressively increased over the 12 weeks, and duration differed by mode of exercise. We observed high rates of attendance (84%) and completion (88%) to the program. Patient-reported barriers to attendance most often included health problems (62%) and medical appointments (55%). Participant responses to a program evaluation revealed high levels of satisfaction, preferences for group-based programs, and insights about the acceptability of the exercise environment (physical and social). This study is the first to report on goals, barriers, exercise prescription needs, and individual responses to supervised exercise training in a unique population, that is, older veterans with PTSD. Results of this study can inform future health promotion programs targeting older veterans with PTSD.

Moderate Intensity-interval-training With Blood Flow Restriction And Body Cooling For People With Post-concussion Syndrome

PURPOSE: To examine the effects of a 12-session aerobic exercise program with blood flow restriction (BFR) and body cooling (BC) on people diagnosed with post-concussion syndrome (PCS) less than a year. METHODS: A single blind randomized controlled trial of aerobic exercise with BFR and BC was conducted. Twenty-five adults with PCS were assigned to the experimental group (n=14, 8 females and 6 males, 38±11 yrs) or the control group (n=11, 9 females and 2 males, 33±10 yrs). Both groups rode a recumbent elliptical machine for 21 minutes at moderate intensity (60% of predicted maximum heart rate) twice a week for six weeks, but only the experiment group received BFR and BC while riding. PCS Symptom Checklist (26 items with a total score of 156) was used daily to track the number and severity of PCS symptoms during the 6-week intervention and the 6-week follow-up period. To examine the fluctuations of symptom number and severity, the variance of overall checklist scores and sub-domain scores for each individual during the 6-week intervention and the 6-week follow-up period was calculated. Mann-Whitney U test was used to test the group differences. RESULTS: The fluctuation of overall symptom severity during the 6-week intervention was significantly less in the experimental group (p=0.03). Less variations of severity in cognition and mood domains were observed in the experimental group (p=0.02 respectively). During the 6-week follow-up period, the number of PCS symptoms remained more stable in the experimental group (p=0.02). There is a trend that after the intervention ended, less symptom severity fluctuation was observed in the experimental group (p=0.05). The number of PCS symptoms in the cognition and sleep domains reduced after the 6-week intervention ended and remained stable during the 6-week follow-up period (p=0.007 and p=0.02). Furthermore, the severity of mood and sleep symptoms remained more stable in the experimental group (p=0.04 for both domains). CONCLUSIONS: Aerobic exercise with BFR and BC alleviated the post-concussive symptoms of people who suffered PCS less than a year. More stable recovery was found in individuals who exercised at 60% of predicted maximum heart rate under BFR and body cooling as compared to those who underwent the exercise without BFR and BC. Supported by Oak Foundation Grant OCAY-16-310.

Examining the Inter-relations of Depression, Physical Function, and Cognition with Subjective Sleep Parameters among Stroke Survivors: A Cross-sectional Analysis

Goal: Stroke survivors commonly experience depression as well as deficits in physical and cognition function. Emerging evidence also suggests sleep quality is compromised poststroke. Our primary objective was to examine the association of subjective sleep parameters (ie, total PSQI score) with depression, health related quality of life, physical function, and cognition among stroke survivors. Materials and Methods: Cross-sectional analysis of 72 older adults with chronic stroke (≥6 months postischemic stroke) enrolled in a randomized controlled trial of exercise or cognitive enrichment. Subjective sleep parameters were assessed using the Pittsburgh Sleep Quality Index (PSQI). We report total PSQI score and specific PSQI parameter scores (ie, PSQI-subjective sleep quality, PSQI-sleep latency, PSQI-sleep duration, PSQI-habitual sleep efficiency, PSQI-sleep disturbances, PSQI-use of sleep medication, and PSQI-daytime dysfunction). Bivariate correlations and multivariate linear regression assessed associations between subjective sleep parameters and depression/health related quality of life, physical function, and cognition. Findings: For bivariate correlations, depression was significantly associated with global PSQI, PSQI-subjective sleep quality, PSQI-habitual sleep efficiency, and PSQI-daytime dysfunction. Health related quality of life was significantly associated with PSQI-sleep medication. Physical function and health was significantly associated with PSQI-subjective sleep quality, PSQI-sleep latency, PSQI-sleep duration, and PSQI-daytime dysfunction. Multivariate linear regression demonstrated that PSQI-daytime dysfunction predicted depression and physical function; PSQI-subjective sleep quality predicted depression. No significant associations between global PSQI subjective sleep parameters with cognition were observed. Conclusion: Poor subjective sleep parameters and PSQI-subjective sleep quality among stroke survivors were associated with depression; PSQI-daytime dysfunction was associated with physical function. Thus, sleep should be considered in the management of those who have suffered a stroke to optimize poststroke rehabilitation outcomes.

A randomized controlled trial of exercise to prevent muscle mass and functional loss in elderly hemodialysis patients: Rationale, study design, and baseline sample.

BackgroundElderly maintenance hemodialysis (MHD) patients exhibit muscle wasting and impaired physical function. This trial determines whether MHD patients benefit from a 12-week home-based exercise program, protein supplementation, or both.Designand Methods: This is a randomized, blinded controlled trial involving 60 elderly MHD patients with impaired exercise capacity and function. Patients are randomized into either a homebased exercise program or normal care over a 12-week period. Measures at baseline include peak VO2, strength and body composition as well as cognitive and disease-specific questionnaires. Muscle biopsies are obtained and analyzed for protein signaling, expression of IGF-1, androgen receptors, and myostatin.ResultsAt baseline, patient characteristics in the exercise and normal care groups were similar by age, gender and anthropomorphic measures. Peak VO2 was impaired (14.7 ± 3.3 ml/kg/min), representing 55 ± 14% of the age-predicted value. Six-minute walk distance was 322 ± 71 m, and the mean 1-min sit to stand test was 18 ± 8 repetitions, representing 69 ± 16% and 55 ± 22% of the age-predicted values, respectively. Indices of muscle function, including upper and lower body and hand grip strength all indicate marked impairment. Quality of life (QoL) using the SF36, the Beeson cognitive test, and KDQOL all suggest marked impairments compared to age-expected reference values for non-MHD patients.ConclusionsPatients undergoing MHD exhibit markedly reduced physical function and QoL. Thus, there are potentially significant gains to be made through a program of aerobic and resistance exercise. We anticipate this trial will demonstrate that home-based exercise improves cardiopulmonary function, protein signaling and QoL, and increases muscle mass, strength, and body composition.

Two-year follow-up of the OptiTrain randomised controlled exercise trial

PurposeThe aim of this study was to determine if there were any differences in health-related outcomes and physical activity (PA) between the two OptiTrain exercise groups and usual care (UC), 2 years post-baseline.MethodsThe OptiTrain study was a three-arm randomised controlled trial comparing 16 weeks of concurrent aerobic high-intensity interval training (HIIT) and progressive resistance exercise (RT-HIIT) or concurrent HIIT and continuous moderate-intensity aerobic exercise (AT-HIIT) to UC in 206 patients with breast cancer undergoing chemotherapy. Eligible participants were approached 2 years following baseline to assess cancer-related fatigue, quality of life, symptoms, muscle strength, cardiorespiratory fitness, body mass, PA, sedentary behaviour, and sick leave.ResultsThe RT-HIIT group reported lower total cancer-related fatigue, (− 1.37, 95% CI − 2.70, − 0.04, ES = − 0.06) and cognitive cancer-related fatigue (− 1.47, 95% CI − 2.75, − 0.18, ES = − 0.28), and had higher lower limb muscle strength (12.09, 95% CI 3.77, 20.40, ES = 0.52) than UC at 2 years. The AT-HIIT group reported lower total symptoms (− 0.23, 95% CI − 0.42, − 0.03, ES = − 0.15), symptom burden (− 0.30, 95% CI − 0.60, − 0.01, ES = − 0.19), and body mass − 2.15 (− 3.71, − 0.60, ES = − 0.28) than UC at 2 years.ConclusionAt 2 years, the exercise groups were generally experiencing positive differences in cancer-related fatigue (RT-HIIT), symptoms (AT-HIIT), and muscle strength (RT-HIIT) to UC. The findings provide novel evidence that being involved in an exercise program during chemotherapy can have long-term benefits for women with breast cancer, but that strategies are needed to create better pathways to support patients to maintain physical activity levels.Trial registrationClinicaltrials.gov registration number: NCT02522260. Trial registered on 9 June 2015. https://clinicaltrials.gov/ct2/show/NCT02522260. Retrospectively registered.

Effects of Exercise During or Postchemotherapy in Cancer Patients: A Systematic Review and Meta-Analysis.

Exercise may effectively reduce side effects caused by chemotherapy. However, no meta-analyses of exercise during or postchemotherapy for cancer patients have been definitely performed to guide clinical practice. To evaluate and summarize available scientific evidence to provide recommendations of an exercise intervention for cancer patients undergo chemotherapy. A systematic review and meta-analysis were performed with databases searching of MEDLINE, Cochrane Library, and Embase from their inception to October 15, 2017. Literature was selected to identify randomized controlled trials of exercise during or postchemotherapy for cancer patients. Risk-of-bias assessment was performed by two reviewers independently. Data were analyzed using the Cochrane Collaboration's RevMan 5.3 (Review Man, Copenhagen, Denmark). A total of 10 trials with 838 participants were included in our study. Exercise could have a beneficial effect in cancer patients undergo chemotherapy in the outcome of physical fitness (MD: 0.16, 95% CI: 0.08-0.25, p<.01 and MD: 2.46, 95% CI: 1.44-3.47, p<.01) and depression (MD: -1.36, 95% CI: -2.68 to -0.04, p=.04), but not in FACT-G, FACT-B, anxiety, weight, and BMI (all p>.05). Exercise sequence (during or postchemotherapy) did not influence the effect of exercise for cancer patients undergo chemotherapy. In total, six studies were assessed as an overall low risk of bias. Subgroup analyses and sensitivity analyses reached results similar to those of the meta-analyses, which reflected our results were reliable and robust. Exercise seems to have a beneficial effect on physical fitness and depression, but not on quality of life, anxiety, weight, and BMI. More specific and detailed description of the implementation of exercise programs should be proposed in the future.

Assessing serum albumin concentration following exercise-induced fluid shifts in the context of the athlete biological passport.

The hydration status of an athlete at the time of a doping control sample collection is an important factor to consider when reviewing athlete biological passports (ABPs). Dehydration results in a reduction of the circulating plasma volume (PV), which may lead to artificially high values of some blood parameters. This study aimed to identify whether serum albumin could serve as a single marker of fluid shifts, which are not currently accounted for in the hematological passport. An additional marker could be used to assist experts when interpreting irregularities in the ABP. Twelve subjects underwent multiple controlled exercise trials designed to induce varying levels of PV shifts. Pre-exercise blood samples were collected to establish baseline values for individual passports. During exercise interventions, blood samples were collected before the start of exercise and at 10 minute, 1 hour, 2 hours, and 24 hours following exercise. Significant increases in hematological parameters - hemoglobin [Hb], hematocrit (HCT), albumin (ALB), and calculated OFF-score - were identified at varying time points following fluid shift-inducing exercise. Changes in ALB correlated strongly with changes in [Hb] (r=0.753) and with estimated PV shifts (r=-0.764). In analyzing ABPs, the resulting increases in Hb did not trigger any atypical findings at 99% specificity. Monitoring changes in ALB longitudinally may assist experts when reviewing PV shifts in the biological passport.

Breaking Barriers: Could Exercise Supervision Attenuate Kinesiophobia in an Older Cancer Patient?

Background: Kinesiophobia, the fear that movement and physical activity could worsen side effects such as fatigue and pain, is a barrier to exercise in cancer patients. Physical inactivity and deconditioning can lead to functional decline, higher mortality risk and lower quality of life, in older adults, and even more in oncogeriatrics because of a lower physical activity level during cancer treatments. The case: We present the case of an older breast cancer patient recruited in a controlled exercise trial and randomized to the control arm of the study (a 12-week supervised static stretching program). She expressed fear that physical activity might exacerbate some of her cancer-related symptoms during baseline physical capacity assessment (Senior Fitness Test, handgrip strength and maximal lower body strength). After completing the 12-week supervised static stretching program, she exhibited similar and/or larger improvements in many of the physical capacity tests than the mixed exercise intervention group, despite being in the control arm. Conclusions: These observations and physical capacity results have led us to emit the hypothesis that (1) this participant’s baseline physical capacity assessment might have been biased by kinesiophobia and (2) the supervision by exercise physiologist might have mitigated this fear over time. Hence, based on this case, we suggest that kinesiophobia should be measured in future exercise trials and clinical interventions targeting older cancer patients.