Efficacy Of Exercise Training Research Articles

Physical Activity in Long COVID: A Comparative Study of Exercise Rehabilitation Benefits in Patients with Long COVID, Coronary Artery Disease and Fibromyalgia.

Exercise in long COVID is poorly studied. Nevertheless, exerciserehabilitation could improve cardiorespiratory, muscular and autonomic functions. We aimed to investigate improvement in physical and autonomic performances of long COVID patients (n = 38) after a 4-week exercise rehabilitation program (3 sessions/week) compared to two control groups composed of coronary artery disease (n = 38) and fibromyalgia patients (n = 38), two populations for whom exercise benefits are well known. Efficacy of exercise training was assessed by a cardiopulmonary exercise test, a handgrip force test, and a supine heart rate variability recording at rest before and after the rehabilitation program. Cardiorespiratory and muscular parameters were enhanced after exercise rehabilitation in the three groups (p < 0.001). No significant difference was observed for the autonomic variables. Through this comparative study with control groups, we confirm and reinforce the interest of caring for long COVID patients without post-exertional symptom exacerbation by exercise rehabilitation of both strength and endurance training, by personalizing the program to the patient and symptoms.

Effects of exercise training on metabolic syndrome risk factors in post-menopausal women – A systematic review and meta-analysis of randomised controlled trials

Alterations in the hormonal profiles as women transition to the menopause predisposes individuals to the metabolic syndrome (MetS). In post-menopausal women, this can be exacerbated by sedentary behaviour and physical inactivity. Physical activity can convey many health benefits including improvement in MetS risk factors. However, it remains to be elucidated how differing exercise intensities and its mode of delivery can ameliorate MetS risk factors and resultant progression amongst post-menopausal women. The purpose of this systematic review and meta-analysis was to investigate the effects and efficacy of exercise training on MetS risk factors in post-menopausal women. Database searches using PubMed, Scopus, Web of Science and the Cochrane Central Register of Controlled Trials were conducted from inception to December 2021 for randomised controlled studies (RCTs) investigating exercise training (>8 weeks) in at least one of the MetS risk factors in post-menopausal women. Utilising the random-effects model, appropriate standardised mean differences (SMD) or mean differences (MD) with 95% confidence interval (CI) for each MetS risk factor were used to calculate the overall effect size between the exercise and control groups. Sub-group analyses were performed for exercise intensity, modality, and duration for each risk factor. Meta-regression was performed for categorical (health status) and continuous (body mass index) covariates. 39 RCTs (40 studies) involving 2132 participants were identified as eligible. Overall, the meta-analysis shows that exercise training significantly improved all MetS risk factors: waist circumference (WC) [MD:-2.61cm; 95% CI:-3.39 to-1.86cm; p<0.001; 21 studies]; triglycerides (TG) [SMD:-0.40mmol/L; 95% CI:-0.71 to-0.09mmol/L; p=0.01; 25 studies]; high-density lipoprotein (HDL) [SMD: 0.84mmol/L(95% CI: 0.41-1.27mmol/L; p<0.001; 26 studies]; fasting glucose (BG) [SMD:-0.38mmol/L (95% CI:-0.60 to-0.16mmol/L; p<0.001; 20 studies]; systolic blood pressure (SBP) [MD:-5.95mmHg (95% CI:-7.98 to-3.92mmHg; p<0.001; 23 studies]; and diastolic blood pressure (DBP) [MD:-4.14mmHg (95% CI:-6.19 to-2.08mmHg; p<0.001; 23 studies]. Furthermore, sub-group analyses identified that moderate intensity and combined exercise training significantly improved MetS risk factors (p<0.05) except for HDL, with combined exercise being the most effective. Long duration (≥12 weeks) training also significantly improved MetS risk factors except for TG. Meta-regression revealed no moderating effects on any MetS risk variables. This study reinforces the importance of regular physical activity as a non-pharmacological tool in the reduction of MetS risk in post-menopausal women, with significant metabolic improvements seen in interventions spanning 8-10 weeks. Moderate intensity and combined training significantly benefitted abdominal obesity, dyslipidaemia, dysglycaemia and hypertension in post-menopausal women. Improvements in at least one MetS risk were also seen with other exercise modalities and intensities.

Cardioprotective effects of exercise training on doxorubicin-induced cardiomyopathy: a systematic review with meta-analysis of preclinical studies

Doxorubicin (DOX)-induced cardiotoxicity in chemotherapy is a major treatment drawback. Clinical trials on the cardioprotective effects of exercise in cancer patients have not yet been published. Thus, we conducted a systematic review and meta-analysis of preclinical studies for to assess the efficacy of exercise training on DOX-induced cardiomyopathy. We included studies with animal models of DOX-induced cardiomyopathy and exercise training from PubMed, Web of Sciences and Scopus databases. The outcome was the mean difference (MD) in fractional shortening (FS, %) assessed by echocardiography between sedentary and trained DOX-treated animals. Trained DOX-treated animals improved 7.40% (95% CI 5.75–9.05, p < 0.001) in FS vs. sedentary animals. Subgroup analyses revealed a superior effect of exercise training execution prior to DOX exposure (MD = 8.20, 95% CI 6.27–10.13, p = 0.010). The assessment of cardiac function up to 10 days after DOX exposure and completion of exercise protocol was also associated with superior effect size in FS (MD = 7.89, 95% CI 6.11–9.67, p = 0.020) vs. an echocardiography after over 4 weeks. Modality and duration of exercise, gender and cumulative DOX dose did were not individually associated with changes on FS. Exercise training is a cardioprotective approach in rodent models of DOX-induced cardiomyopathy. Exercise prior to DOX exposure exerts greater effect sizes on FS preservation.

Standardized exercise training is feasible, safe, and effective in pulmonary arterial and chronic thromboembolic pulmonary hypertension: results from a large European multicentre randomized controlled trial.

This prospective, randomized, controlled, multicentre study aimed to evaluate efficacy and safety of exercise training in patients with pulmonary arterial (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH). For the first time a specialized PAH/CTEPH rehabilitation programme was implemented in 11 centres across 10 European countries. Out of 129 enrolled patients, 116 patients (58 vs. 58 randomized into a training or usual care control group) on disease-targeted medication completed the study [85 female; mean age 53.6 ± 12.5 years; mean pulmonary arterial pressure 46.6 ± 15.1 mmHg; World Health Organization (WHO) functional class II 53%, III 46%; PAH n = 98; CTEPH n = 18]. Patients of the training group performed a standardized in-hospital rehabilitation with mean duration of 25 days [95% confidence interval (CI) 17-33 days], which was continued at home. The primary endpoint, change of 6-min walking distance, significantly improved by 34.1 ± 8.3 m in the training compared with the control group (95% CI, 18-51 m; P < 0.0001). Exercise training was feasible, safe, and well-tolerated. Secondary endpoints showed improvements in quality of life (short-form health survey 36 mental health 7.3 ± 2.5, P = 0.004), WHO-functional class (training vs. control: improvement 9:1, worsening 4:3; χ2P = 0.027) and peak oxygen consumption (0.9 ± 0.5 mL/min/kg, P = 0.048) compared with the control group. This is the first multicentre and so far the largest randomized, controlled study on feasibility, safety, and efficacy of exercise training as add-on to medical therapy in PAH and CTEPH. Within this study, a standardized specialized training programme with in-hospital start was successfully established in 10 European countries.

Effects of Exercise Training on Vascular Markers of Disease Progression in Patients with Small Abdominal Aortic Aneurysms

BackgroundCurrently, no medical therapy is effective in limiting progression of small abdominal aortic aneurysms (AAA; ≤5.5 cm). Previously, we have demonstrated safety and efficacy of exercise training in patients with AAA. However, the impact of exercise training on vascular markers of AAA progression, such as lipid accumulation product and matrix metalloproteinase 9 (MMP-9, linked to destruction of aortic matrix), is unknown. The aim of this study was to assess the impact of exercise training on AAA diameter, lipid accumulation product, MMP-9, and other risk markers of vascular disease. MethodsIn this randomized trial, complete data of 96 patients (male: n = 87, female: n = 9; exercise training (exercise) n = 42, usual care n = 54) were studied. Changes in AAA diameter, exercise capacity, lipid accumulation product (men = [waist circumference 65] × fasting triglycerides; women = [waist circumference −58] × triglycerides) and MMP-9 were performed. ResultsThe exercise group demonstrated a significant increase in maximal exercise time and estimated metabolic equivalent of tasks. Lipid accumulation product decreased in exercise and increased in usual care (P < .001 between groups); MMP-9 remained statistically unchanged in exercise, but increased significantly in usual care (P = .005; between groups P = .094). In both groups, there was a significant increase in transverse diameter, but no difference between groups; neither group assignment nor level of fitness correlated with AAA enlargement. No adverse clinical events occurred. ConclusionsThis is the first study to demonstrate that in AAA, exercise beneficially modifies lipid accumulation product and MMP-9, both markers of vascular disease, without inducing aneurysmal growth beyond what is otherwise observed during usual care.

Abstract B49: Effects of exercise on ovarian cancer initiation and progression

Abstract Epidemiology studies support a strong association between physical activity and lower risk of cancer. Exercise is a promising nonpharmacologic strategy in preventing cancer and mitigating adverse effects of cancer and anticancer therapies. However, we have not been able to optimize the efficacy of exercise training as an anticancer intervention due to the lack of knowledge regarding the biologic mechanisms of action, the effective doses, and the biomarkers for predicting and monitoring responses of exercise-based intervention. Our objective is to utilize mouse models to determine the effects and underlying mechanisms of exercise on ovarian cancer initiation and progression. C57BL/6 mice ran on a treadmill for 45min daily to mimic human exercise activity. The control groups were placed on treadmill for 45min daily. After a month of this exercise regiment, both groups were injected with cancer cells derived from ovarian tumors of Dicer-/-; Pten-/-; Tp53R172H mice. Tumor progression was monitored through IVIS imaging system. Blood and peritoneal fluid samples were tested for cytokine levels. Tissue samples were collected and gene expression levels were quantified via qPCR. Peritoneal macrophages were isolated after acute exercise and were used in flow cytometry analysis or cocultured with cancer cells. Our model resembled the biologic changes of exercise in human. Eight-week treadmill-running exercise suppressed early tumor formation and tumor spreading. Exercise altered visceral fat tissue gene expression profile, which may inhibit cancer-induced cachexia and metabolic imbalance. In addition, one-hour exercise induced the acute proinflammatory activation of peritoneal macrophages. Coculture of peritoneal macrophages and PBMC (peripheral blood mononuclear cells) or NK (natural killer) cells from the exercise group and cancer cells reduced survival of cancer cells. Chronic and acute exercise can both suppress ovarian cancer tumorigenesis in mouse models. The underlying mechanisms involve enhancing anticancer immune system responses and adjusting metabolic balance. More research is needed to determine the specific mechanisms by which chronic and acute exercise affects ovarian cancer. Citation Format: Fangfang Bi, Madeline Morrisson, Sarah Cady, Alexandra Cerchia, Kevin Yang, Ivy Ling, Yang Yang-Hartwich. Effects of exercise on ovarian cancer initiation and progression [abstract]. In: Proceedings of the AACR Special Conference on Advances in Ovarian Cancer Research; 2019 Sep 13-16, 2019; Atlanta, GA. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(13_Suppl):Abstract nr B49.

Effects of exercise training combined with psychological intervention compared to exercise training alone in prediabetes subjects

Prior research has confirmed the efficacy of exercise training (ET) in patients with prediabetes. However, whether the effectiveness of a combination of exercise and psychological intervention (EP) is better than ET alone in prediabetes in terms of physiological function, psychological status and glycometabolism has rarely been investigated. Forty newly diagnosed prediabetes patients (65.3±8.1years) took part in the study. Subjects were divided into a pure ET group and a combined EP group. Interventions were conducted in 40-50-min sessions twice weekly for 32weeks. Physiological, psychological and biochemical indicator measurements were taken after pre-, mid- and post-interventions, respectively. The main finding confirmed a significant improvement in systolic blood pressure, diastolic blood pressure (DBP) and heart rate, high-density lipoprotein, fasting plasma glucose (FPG) and glycosylated hemoglobin (HbA1c) from pre- to mid- and post-test differentially in both groups (P<0.05) by post hoc analyses. The EP group has a greater magnitude of improvement of DBP than the ET group. Significant differences were observed in FPG at mid-intervention and total cholesterol at post-intervention between the ET and EP groups. Self-Rating Anxiety Scale (SAS) scores of EP group were significantly less than ET group after post-intervention. Our results suggest that EP might be a promising method lead to more apparent long-term effects on glycometabolism and psychological status for prediabetes patients. Other domains were improved by both interventions, but no typical pattern could be identified. Its underlying mechanisms need further study, and directions for future research are suggested.

Addressing myths about exercise in hemodialysis patients

Despite decades of research, there are few published guidelines related to the safety and efficacy of exercise training in hemodialysis patients. This has led to disparate recommendations regarding the type, intensity, and timing for exercise, especially for patients with multiple comorbidities. Many common recommendations are not supported by research data, so their justification is uncertain. These recommendations include exercising in the first hour of dialysis; not exercising if hypertensive, cramping, or volume overloaded; avoiding heavy weights on vascular access limb; clinicians managing an exercise program; intradialytic exercise or interdialytic exercise is better; and strength training during dialysis is impractical. The purpose of this review is to describe the evidence that supports or refutes these beliefs. In summary, these beliefs or myths have generally led to an overly conservative approach to exercise that serves as a barrier to increasing physical activity levels in an overly sedentary population that could benefit from moving more.

Effects of Structured Exercise Training in Children and Adolescents With Juvenile Idiopathic Arthritis.

To examine safety and efficacy of exercise training (ET) for juvenile idiopathic arthritis (JIA) to improve physical fitness, pain, functional capability, and quality of life. Ovid Medline, PubMed, CINAHL, PEDro, and Web of Science were searched from 1995 to April 2018 to find English-language articles examining effects of ET in JIA, ages 4 to 21 years. Quality of evidence/strength of clinical recommendations were assessed using the Cochrane GRADE (Grading of Recommendations, Assessment, Development and Evaluation) system. Results were reported using the 2009 Preferred Reporting Items for Systematic Reviews and meta-Analyses (PRISMA) checklist for health care interventions. Nine papers met inclusion criteria. A total of 457 individuals with JIA, ages 4 to 19.9 years, received ET or alternate activity, wait-list, or no intervention. Moderate-quality evidence supports Stott Pilates and underwater knee-resistance exercise. No adverse effects of ET were reported. Moderate-quality evidence exists for ET (30-50 minutes, 2-3 times/week, 12-24 weeks) to decrease pain, improve range of motion, knee strength, functional capability, and quality of life in JIA.

1747P - EXTEND: Safety and efficacy of exercise training in men receiving enzalutamide (ENZ) in combination with conventional androgen deprivation therapy (ADT) for hormone naïve prostate cancer (HSPC)

Background: ADT is associated with physical side effects and a decline in cardiorespiratory fitness that can be mitigated with exercise (EX). Addition of a more potent androgen receptor inhibitor such as ENZ might worsen these effects. In this pilot study, we investigated whether an EX program could mitigate adverse changes from ADT + ENZ treatment. Methods: Men starting ADT for M0 HSPC were treated with ADT + ENZ for 8 months and randomized to usual care (UC) or EX for 16 weeks. EX began 4 weeks prior to starting ADT + ENZ and consisted of 48 supervised exercise sessions delivered 3x/week between 55-80% of exercise capacity (VO2peak) for aerobic training and 60-85% of one repetition maximum (1-RM) for resistance training. The primary endpoint was change in VO2peak from baseline to 16 weeks. Secondary endpoints included 6 minute walk distance (6MWD), upper and lower body strength (1-RM), body composition (DXA), and patient reported outcomes (FACT-P, FACIT-Fatigue). The study was originally designed to recruit 56 subjects (N = 28/arm) but was halted early due to funding issues. Results: 26 men (UC, N = 13; EX, N = 13) completed the protocol. Baseline age and BMI (mean ± standard deviation [SD]) were 65.0 ± 8.1 yr and 28.5 ± 4.6 kg/m2. Intention to treat analyses for mean 16-week change from baseline with a 95% confidence interval (CI) for each assessment by arm are presented in the table.Table: 1747PEndpointUC + ADT + ENZ (mean change [95% CI])EX + ADT + ENZ (mean change [95% CI])VO2peak (ml kg-1 min-1)-3.2 (-6.3, -0.2)-0.9 (-2.4, 0.5)6MWD (ft)-32.0 (-71.2, 7.3)+42.0 (5.6, 78.4)1-RM Leg Press (lbs)+6.7 (-46.7, 60.0)+107.1 (43.2, 171.0)1-RM Chest Press (lbs)+4.9 (-11.0, 20.9)+24.3 (9.2, 39.4)1-RM Row (lbs)+3.0 (-10.5, 16.5)+14.9 (0.7, 29.0)Fat Mass (g)+2949 (565, 5333)-122 (-1593, 1350)Lean Mass (g)-3088 (-5384, -792)-2094 (-3549, -640)FACT-P TOI-11.6 (-20.3, -2.9)-5.4 (-10.8, 0.1)FACIT-F Score-9.2 (-16.0, -2.4)-5.0 (-8.0, -2.1) Open table in a new tab Conclusions: Supervised aerobic and resistance EX resulted in less decline in VO2peak, as well as improved function and strength in men treated with ADT + ENZ for M0 HSPC. EX was associated with less fat gain and muscle mass loss, less decline in QOL, and less increase in fatigue. Larger trials of EX in this setting are warranted. Clinical trial identification: NCT02256111. Legal entity responsible for the study: Duke University Health System. Funding: Pfizer (Medivation), Astellas. Disclosure: All authors have declared no conflicts of interest.

The efficacy of exercise training in kidney transplant recipients: a meta-analysis and systematic review.

The effectiveness of exercise in kidney transplant recipients is not well established. We, therefore, performed a systematic review of the effects of exercise training in kidney transplantation recipients. We searched two electronic databases for articles up to April 2017. Inclusion criteria were as follows: randomized controlled trial and kidney transplant recipients aged 18years or older. The main outcomes were allograft function (estimated glomerular filtration rate, eGFR), exercise tolerance (VO2 peak), and quality of life (QOL). After screening of 1303 references in PubMed and Ichushi, six randomized control trials were analyzed. For kidney transplant recipients, supervised exercise training was shown to significantly improve VO2 peak [mean difference 2.42; 95% confidence interval (95%CI) 0.22-4.63] and QOL (mean difference 7.23; 95%CI 0.94-13.52). However, exercise training did not improve allograft kidney function (mean difference 6.22; 95%CI - 13.00 to 25.44). No reporting bias was observed in any of the outcomes. There were no reports including patient survival rates and the harm associated with exercise training. Exercise training for kidney transplant recipients significantly improved exercise tolerability and QOL, but a significant improvement was not obtained with respect to allograft kidney function. Evaluation of patient survival rates and the harm associated with exercise training has not been reported, therefore, future studies are needed to resolve these issues.

Study protocol for a randomised controlled trial of exercise training in pulmonary hypertension (ExTra_PH)

BackgroundExercise training is an integral component of evidence-based management programs for many chronic cardiac and respiratory conditions. Despite this, there are limited high-quality studies available on the significance of exercise training in pulmonary hypertension (PH). The aim of this study is to evaluate the short and long-term effectiveness of exercise training in PH patients in terms of exercise capacity, quality of life, cardiac function and disease progression.MethodsThis randomized control trial will aim to recruit 50 medically stable PH patients categorised as New York Heart Association functional classification II-III. Participants will be randomly allocated to either the supervised exercise training group or usual care group for the 8-week study period. Exercise training will be conducted in an outpatient setting. Measurements at baseline and following the 8-week study period include exercise capacity (6 min walk distance and cardiopulmonary exercise test), cardiac function (exercise cardiac magnetic resonance imaging [CMRI] and echocardiography), health-related quality of life (Cambridge Pulmonary Hypertension Outcome Review), adverse responses to exercise training and time to clinical worsening. In addition, participants will be followed up for a minimum of 2 year period from commencement of the study so as to monitor long-term clinical outcomes i.e. time to clinical worsening.DiscussionThis study will determine whether an 8-week outpatient based supervised exercise training program is safe and beneficial for medically stable PH patients in the short and long term. This will be the first study to examine the impact of exercise training on right heart function using exercise CMRI. Results from the study will contribute new knowledge in relation to the impact of exercise training on cardiac function, long-term prognosis and inform clinical practice guidelines for this patient population. Moreover, the study will add to our understanding regarding the efficacy of exercise training in individuals with PH in an outpatient setting.Trial registrationAustralia and New Zealand Clinical Trials Registry: ACTRN12616001467426. Registered 21st October, 2016.

Exercise Training on Locomotion in Patients with Alzheimer's Disease: A Feasibility Study.

Although current literature has shown that patients with Alzheimer's disease (AD) have worse locomotion compared with healthy counterparts, no studies have focused on the efficacy of exercise training in improving gait abnormalities including biomechanics and metabolic aspects, in this population. To verify the effectiveness of exercise training (ET) on gait parameters (i.e., speed, step and stride length, single and double support, and energy cost of walking (Cw)) in patients with AD with respect to a standard cognitive treatment (CT). In this study, we included a small portion of data belonging to a larger study (ClinicalTrials.gov number, NCT03034746). Patients with AD (Mini-Mental State Examination 22±5) were included in the study. Gait parameters and Cw were assessed at baseline and after 6 months (72 treatment sessions) of treatment. ET included 90 min of aerobic and strength training. CT included 90 min of cognitive stimuli. The 16 patients assigned to ET exhibited significant improvement of Cw (-0.9±0.1 J/kg·m-1), while differences in gait parameters were negligible. The effect on gait parameters were undetectable in the 18 patients assigned to CT (-0.2±0.5 J/kg·m-1). Data from this study showed that ET program seems effective in improving Cw in patients with AD. Interestingly, the positive effect of ET on Cw was not coupled with ameliorations of patient's gait parameters, suggesting that the gain of metabolic aspects of locomotion were the main factors responsible for this positive result.

Effects of exercise training on patients with lung cancer who underwent lung resection: a meta-analysis

BackgroundThe efficacy of exercise training in patients with lung cancer after lung resection has not been well established yet. Therefore, we performed a meta-analysis to investigate the efficiency of exercise training in patients with lung cancer after lung resection.MethodsSeveral databases were searched for eligible randomised controlled trials (RCTs). The primary outcome was quality of life, and the secondary outcomes included 6-min walk distance (6MWD), forced expiratory volume in 1 s (FEV1) and postoperative complications (POCs). Weighted mean differences (WMDs) and relative risks (RRs) with 95% confidence intervals (CIs) were calculated by random-effects model.ResultsSix RCTs involving 438 patients were enrolled in this meta-analysis. The pooled WMDs of the scores were 2.41 (95% CI = −5.20 to 10.02; P = 0.54) and −0.46 (95% CI = −20.52 to 19.61; P = 0.96) for the physical and mental components of the 36-item short-form scale, respectively. The pooled WMDs were 23.50 m (95% CI = −22.04 to 69.03; P = 0.31) for 6MWD and 0.03 L (95% CI = −0.19 to 0.26; P = 0.76) for FEV1. Finally, the pooled RRs were 0.79 (95% CI = 0.41 to 1.53; P = 0.49) for POCs.ConclusionsInsufficient evidence is available to support the efficacy of exercise training in patients with lung cancer after lung resection. Further studies must confirm our findings and investigate the long-term effects of exercise training on patients with lung cancer following lung resection.

Safety, adherence and efficacy of exercise training in solid-organ transplant candidates: A systematic review.

Patients awaiting solid-organ transplantation may be encouraged to undertake exercise training to improve pre- and post-transplant outcomes. However, the safety, adherence and efficacy of exercise training in this population remain unclear. All randomized, non-randomized and non-controlled trials of exercise training interventions in solid-organ transplant candidates were included. The Cochrane risk of bias tool and a modified Newcastle-Ottawa scale were used to assess procedural quality. Safety was defined as the number of reported adverse events during exercise training. Adherence was evaluated from session attendance, and efficacy as changes in cardiorespiratory fitness (CRF), exercise capacity, muscular strength, health-related quality of life (HR-QoL) and lung function. Eleven studies involving 874 patients were included: four randomized controlled, one non-randomized controlled and six non-controlled trials. Six studies included heart transplant candidates and five involved patients awaiting lung transplantation. Three trials included aerobic-only training, one incorporated resistance-only exercise and seven combined modalities. Twelve adverse events were reported with four due to exercise, although methods to collect these data were often omitted. Exercise adherence ranged from 82.5% to 100%, but was poorly described. No significant between-group changes attributable to exercise training were demonstrated. However, significant within-group improvements in CRF, exercise capacity, muscular strength, lung function and HR-QoL were observed. Patients awaiting heart or lung transplant appear to tolerate exercise training despite the larger number of adverse events compared to other high-risk populations. Exercise training demonstrated within-group benefits for several outcomes, with no significant between-group differences. Randomized controlled trials with sufficient statistical power are required for all solid-organ transplant candidates.

Safety and efficacy of exercise training in adults with Pompe disease: evalution of endurance, muscle strength and core stability before and after a 12 week training program.

BackgroundPompe disease is a proximal myopathy. We investigated whether exercise training is a safe and useful adjuvant therapy for adult Pompe patients, receiving enzyme replacement therapy.MethodsTraining comprised 36 sessions of standardized aerobic, resistance and core stability exercises over 12 weeks. Before and after, the primary outcome measures safety, endurance (aerobic exercise capacity and distance walked on the 6 min walk test) and muscle strength, and secondary outcome measures core stability, muscle function and body composition, were evaluated.ResultsOf 25 patients enrolled, 23 successfully completed the training. Improvements in endurance were shown by increases in maximum workload capacity (110 W before to 122 W after training, [95 % CI of the difference 6 · 0 to 19 · 7]), maximal oxygen uptake capacity (69 · 4 % and 75 · 9 % of normal, [2 · 5 to 10 · 4]), and maximum walking distance (6 min walk test: 492 meters and 508, [−4 · 4 to 27 · 7] ). There were increases in muscle strength of the hip flexors (156 · 4 N to 180 · 7 N [1 · 6 to 13 · 6) and shoulder abductors (143 · 1 N to 150 · 7 N [13 · 2 to 35 · 2]). As an important finding in secondary outcome measures the number of patients who were able to perform the core stability exercises rose, as did the core stability balancing time (p < 0.05, for all four exercises). Functional tests showed small reductions in the time needed to climb four steps (2 · 4 sec to 2 · 1, [− 0 · 54 to −0 · 04 ]) and rise to standing position (5 · 8 sec to 4 · 8, [−2 · 0 to 0 · 0]), while time to run, the quick motor function test results and body composition remained unchanged.ConclusionsOur study shows that a combination of aerobic, strength and core stability exercises is feasible, safe and beneficial to adults with Pompe disease.

The effect of exercise training on skin blood flow: a systematic review and meta‐analysis

Background Microvascular disease results in reduced skin blood flow (SkBF) and an increased risk of poor healing, ulceration and amputation, particularly in the lower extremity. Regular exercise is known to produce significant cardiovascular benefits and improved functional outcomes in people with chronic disease. However, it is unknown if these benefits also translate into improvements in SkBF. The purpose of this study was to evaluate the efficacy of exercise training on altering SkBF in adults by systematic review and meta-analysis.

Safety and efficacy of cardiac rehabilitation for patients with continuous flow left ventricular assist devices.

Despite the increasing use of left ventricular assist devices (LVADs) in terminal heart failure, cardiac rehabilitation protocols have not yet been documented in larger LVAD patient cohorts. The aim of this study was to investigate safety and efficacy of exercise training during a rehabilitation programme after post-operative discharge of LVAD patients. Rehabilitation data obtained between 2010-2012 from 41 LVAD patients (mean age 54.8 ± 11.6 years; 20% female) were retrospectively analysed. The exercise protocol consisted of strength exercises for lower limbs, bicycle ergometry, walking and gymnastics. The numbers of training sessions, their duration and intensity as well as adverse events were documented. Spiroergometry was performed at least once and twice in a subgroup of 15 patients (at the beginning and end of rehabilitation). Rehabilitation started 48 ± 38 days post LVAD implantation with an average duration of 32 ± 6 days. An increase in exercise capacity was observed. Duration (19 ± 4 vs 14 ± 2 min, p < 0.001) and intensity of bicycle ergometry increased (module number 6.2 ± 2.8 vs 2.0 ± 1.9, p < 0.001) as well as muscular strength all muscle groups trained (e.g. 33.6 ± 15.2 vs 26.6 ± 11.9 kg at the leg press, p = 0.002). Spiroergometry revealed an increase of maximal oxygen consumption (14.5 ± 5.2 vs 11.3 ± 4.1 ml/min/kg, p = 0.007) in the subgroup that underwent two examinations. In the whole population the average increase was lower (12.81 ± 4.35 ml/min/kg). One training-related adverse event (non-sustained ventricular tachycardia) was observed. Exercise training for LVAD patient as part of a multidisciplinary rehabilitation programme is effective and safe. This warrants the broad application of exercise training after LVAD implantation.

Exercise training for pulmonary hypertension: A systematic review and meta-analysis

Exercise training for pulmonary hypertension: A systematic review and meta-analysis

Pulmonary rehabilitation for COPD: are programs with minimal exercise equipment effective?

Pulmonary rehabilitation is an essential component of chronic obstructive pulmonary disease (COPD) management with strong evidence supporting the efficacy of pulmonary rehabilitation to improve exercise capacity and quality of life, as well as reduce hospital admissions. However, it is estimated that only 2-5% of people with COPD who could benefit from pulmonary rehabilitation have access to programs. Most research on the benefits of pulmonary rehabilitation has used equipment such as cycle ergometers and treadmills for endurance training and weight machines for resistance training. To enable greater availability of pulmonary rehabilitation, the efficacy of exercise training using minimal equipment needs to be evaluated. Randomised controlled trials that used minimal, low cost equipment for endurance (eight trials) and strength training (three trials) compared to no training in people with COPD were evaluated. Statistically and clinically significant differences in functional exercise capacity and quality of life, as well as improvements in strength were demonstrated when exercise training with minimal equipment was compared to no training [six-minute walk test: mean difference 40 (95% CI: 13 to 67) metres; St George's Respiratory Questionnaire: mean difference -7 (95% CI: -12 to -3) points]. While the number of studies is relatively small and of variable quality, there is growing evidence that exercise training using minimal, low cost equipment may be an alternative to equipment-intensive pulmonary rehabilitation programs.