Exercise Advice Research Articles

Mobile health biometrics to prescribe immediate remote physical activity for enhancing uptake to cardiac rehabilitation (MOTIVATE-CR+): protocol for a randomised controlled feasibility trial

IntroductionCardiac rehabilitation (CR) can reduce cardiovascular mortality and improve health-related quality of life. In the United Kingdom, patient uptake of CR remains low (52%), falling well short of the target...

Efficacy of Spinal Extension Exercise and Ergonomic Advice for Non-specific Low Back Pain Among University Population

Background: College students are required to sit for long periods of time in their classrooms. Prolonged sitting isdefined as sitting for more than 2 hours continuously, students usually sit in classrooms on an average of 6 to 8hours per day. Prolonged sitting has become a major risk factor causing low back pain especially among universitystudents. The recurrence of LBP at old age also increases if the person is found to have LBP at an early stage.Purpose: The objective of this research is to establish the gradual development from functional limitations innon-specific low back pain (NSLBP) among college students after spinal extension exercise and ergonomic advice.Materials and Methods: Based on inclusion and exclusion criteria, the subjects were identified. They wereprovided with an explanation of the study. A group of 60 subjects were recruited for this research and divided into3 groups, in which the first group was given spinal extension exercise (n=20), the second group (n=20) was givenergonomic advice and the third group (n=20) was given combination of both the interventions. The Roland-MorrisDisability Questionnaire is a 24-item self-report tool for assessing function. The entire process was performed fromNovember 2022 to April 2023.Result: From statistical analysis, the group that received spinal extension exercise combined with ergonomicadvice has better outcomes. (p=0.001)Conclusion: The spinal extension exercise given along with ergonomic advice is effective in the treatment ofNSLBP for university students.

Biopsychosocial rehabilitation in the working population with chronic low back pain: a concept analysis.

To identify the essential attributes of biopsychosocial rehabilitation for chronic low back pain in the working population. A concept analysis was conducted according to the 8-step method of Walker and Avant. This framework provides a clear concept and theoretical and operational definitions. Five databases were searched, followed by a systematic screening. Subsequently, attributes, illustrative cases, antecedents, consequences and empirical referents were formulated. Of the 3793 studies identified, 42 unique references were included. Eleven attributes were identified: therapeutic exercise, psychological support, education, personalization, self-management, participation, follow-up, practice standard, goal-setting, social support, and dietary advice. Subsequently, illustrative cases were described. Antecedents, such as motivation, preparedness and a multidisciplinary team, were found, together with consequences such as decreased pain, less sick-leave and increased function and work status. Finally, examples of empirical referents were given. This study identified the attributes that are necessary to develop biopsychosocial rehabilitation intervention programmes for chronic low back pain. The defined concept of biopsychosocial rehabilitation for chronic low back pain may serve as a solid base to further develop and apply interventions. Future research should focus on the objectification of biopsychosocial rehabilitation and conceptualization regarding how personalization is done.

Home schooling during the COVID-19 pandemic: A randomized controlled trial of online exercise and ergonomics advice protocols on upper body symptoms.

Understanding of students' musculoskeletal health under home-schooling during the COVID-19 pandemic is limited. (1) To investigate the prevalence and severity of musculoskeletal symptoms in home-schooled adolescents during the COVID-19 pandemic. (2) To evaluate the effect of an online exercise + ergonomics advice protocol on symptoms, compared with ergonomics advice alone. Cross-sectional symptom survey identifying eligible participants, followed by a pragmatic randomized controlled trial. Online classes. Survey: 354 students (mean 16.6 years). 188 students with upper body musculoskeletal symptoms. Randomization to three groups (physical therapy exercises + ergonomics postural advice, ergonomics postural advice alone, nonintervention control) stratified by the site of symptoms (neck, shoulder, upper back). Interventions were orally delivered online (via WhatsApp) supplemented with written/illustrative material. Follow-up occurred at 8 weeks. Survey: prevalence of symptoms (Nordic Questionnaire). primary outcome = change in intensity of upper body symptoms (visual analogue scale); secondary outcome = number of participants reporting improvement in upper body symptoms. The 12-month prevalence of musculoskeletal disorders in the survey was 38% neck, 28% shoulder, and 35% upper back, with mean pain intensity of 3.6, 3.9, and 3.8, respectively, on 0-10 visual analogue scale: Two-thirds reported symptoms in multiple anatomical regions. In the trial, there was no statistically significant difference between the exercise + ergonomics group and ergonomics alone group on the primary outcome, yet both groups showed reduced symptom intensity compared with control (p < .001). More participants in the exercise + ergonomics group reported improvement than in the ergonomics advice alone group (p < .02). The prevalence of musculoskeletal symptoms was relatively high in home-schooled adolescents. Symptoms can be reduced by ergonomics advice with or without exercises, but the effect is enhanced by the addition of physical therapy exercises. The latter approach may be considered for improving schoolchildren's musculoskeletal health in the usual classroom setting.

Patients’ and staff’s experiences of Well-Track physical activity and sleep quality intervention in an Early Intervention in Psychosis (EIP) service

ABSTRACT Objective Individuals, who experience psychosis are found to have worse fitness levels, are less likely to be physically active, and experience greater sleep problems than the general population. The aim of this research was to examine the Well-Track psychical activity and sleep quality intervention which addresses these issues; it comprises using a Fitbit, motivational interviewing, goal identification and setting, exercise and sleep hygiene advice and feedback sessions with staff working in an Early Intervention in Psychosis (EIP) service. Method This qualitative study examined patients’ and staff’s experiences of Well-Track. Semi-structured interviews with thirteen patients and five staff were analysed using thematic analysis based on a structure-process-outcome framework. Results Key elements of the structure comprise supportive staff and the use of a wearable device (Fitbit). Process themes included the implementation of a multifaceted framework, setting realistic goals and a personal recovery process. Outcomes identified were knowledge (about exercise and sleep), implementation of action-orientated behaviours and improvements in well-being. Discussion Effective sleep and engagement with physical activity and exercise are important for the well-being and mental and physical health of EIP service patients and facilitating this can be achieved through Well-Track which comprises evidenced components to promote behaviour change. EIP services can implement Well-Track to meet service goals related to reducing weight gain, improving well-being, improving physical activity and enabling better self-management and healthier lifestyles.

Living with low muscle mass and its impact throughout curative treatment for lung cancer: A qualitative study.

To 1) explore the experience of patients with lung cancer with low muscle mass or muscle loss during treatment and the ability to cope with treatment, complete self-care, and 2) their receptiveness and preferences for nutrition and exercise interventions to halt or treat low muscle mass/muscle loss. This was a qualitative study using individual semi-structured interviews conducted using purposive sampling in adults with a diagnosis of non-small cell lung cancer (NSCLC) or small-cell lung cancer (SCLC), treated with curative intent chemo-radiotherapy or radiotherapy. Patients who presented with computed tomography-assessed low muscle mass at treatment commencement or experienced loss of muscle mass throughout treatment were included. Data were analysed using thematic analysis. Eighteen adults (mean age 73 ± SD years, 61% male) with NSCLC (76%) treated with chemo-radiotherapy (76%) were included. Three themes were identified: 1) the effect of cancer and its treatment; 2) engaging in self-management; and 3) impact and influence of extrinsic factors. Although experiences varied, substantial impact on day-to-day functioning, eating, and ability to be physically active was reported. Patients were aware of the overall importance of nutrition and exercise and engaged in self-initiated or health professional supported self-management strategies. Early provision of nutrition and exercise advice, guidance from health professionals, and support from family and friends were valued, albeit with a need for consideration of individual circumstances. Adults with NSCLC with or experiencing muscle loss described a diverse range of experiences regarding treatment. The types of support required were highly individual, highlighting the crucial role of personalised assessment of needs and subsequent intervention.

Maintaining the health of people with and without COVID-19 during isolation: a case study.

This case study evaluated the effects of a health package (HP) of a light intensity individualised exercise program and advice on anxiety management and nutrition, on the physical and mental health of people with or without COVID-19, who were quarantined in hotels used as Special Health Accommodation and admitted to the Royal Prince Alfred Virtual Hospital, Sydney during the COVID-19 pandemic. After initial screening and consenting, participants completed three surveys: Depression, Anxiety, Stress Scale; Brief Fatigue Inventory; and the European Quality of Life 5-Dimensions 5-Levels, and were provided with the HP for the duration of their quarantine. The three surveys and a participant reported experience measure were completed prior to discharge. The HP for people in quarantine demonstrated stability of health outcomes and reduction in fatigue. Most participants reported that the HP helped them cope with isolation. Provision of a HP during quarantine could be useful to support physical and mental health.

Qualitative study on the key elements of obesity counseling in Korean Medicine

Objectives: Weight counseling is an inevitable process for patients with obesity who intend to lose weight; however, the contents of real-world counseling practices remain uncertain in Korean medicine (KM) practice. This study aimed to explore the structure and constituents of obesity counseling in KM.Methods: Qualitative methods were used to explore the structure of weight counseling and clinicians' approaches to weight counseling, particularly the advice and main constituents of weight counseling in KM. Nine KM clinicians (4 women, 5 men) from nine clinics completed face-to-face, individual and semi-structured interviews from September 2019 to February 2020 in Seoul, Daejeon, Cheonan, Seongnam, Asan, and Hwaseoug. The interviews were digitally recorded, transcribed verbatim, and categorized based on their constituents.Results: During weight loss counseling, the six principal constituents of KM identified were: planning with patients, motivation, correcting misinformation on weight loss, dietary and exercise advice, medication guidance, and customized guides for each type.Conclusion: Clinicians with in-depth knowledge about obesity prescribed personalized guidance for exercise, diet, and medication through an integrative approach. The study results provide an in-depth understanding of weight counseling in KM. These six constituents could guide the counseling provided by clinicians in obesity care.

Menopausal symptoms, exercise practices, and advice received in active women: a multi-country survey of strava app users

ABSTRACT The study aimed to identify the prevalence of symptoms, changes in exercise levels, and exercise advice received during the menopausal transition in a large multi-country sample. Using total population sampling, 2.5 percent of female Strava app users (n = 970) from 7 countries completed an online survey between 14 February 2019 and 11 March 2019. The survey discussed menopause status (perimenopausal or postmenopausal), menopausal symptoms, changes to exercise behaviors, and advice received concerning exercise during menopause. Frequencies, chi-square statistics, and linear regressions were used to analyze data. The most commonly reported menopausal symptoms were sexual (18–83 percent) and cognitive/psychological (77–78 percent). 41 percent of women reported no change in exercise behavior since menopause began (46 percent increased and 11 percent decreased behaviors). The majority (88 percent) of women did not receive advice regarding exercise during menopause. Women who received advice were more likely to report an increase in their exercise than those not receiving advice (60 percent vs 46 percent; X2 (df 2, n = 927) = 7.1, p = .03). Exercise behaviors increased the longer it had been since the menopausal onset (X2 (df 8, n = 937) = 77.42, p < .001). The results suggested high menopausal symptom prevalence in active women and a general lack of exercise advice. More women reported higher symptom prevalence and an increase in exercise participation, the longer it had been since menopause onset. Future research should determine whether these increased exercise behaviors are being used as a coping mechanism.

Abstract 16553: Effects of Digital Yoga on Physical and Psychological Outcomes in Patients With Heart Failure: A Randomised Controlled Trial

Objectives: To determine effects of digitally delivered yoga on exercise capacity and patient-reported outcome measures. Methods: Two-arm randomised controlled study including participants with heart failure or conditions in need of intensive care from four hospitals in Sweden. Participants were randomised to a control group receiving individual exercise advice or to the intervention group (tele-yoga). The intervention lasted for 3 months and included live-streamed group-yoga via Zoom for 60 minutes twice/week and individual yoga for a minimum of 10 minutes/day using an app. The primary endpoint of the study was a combined endpoint consisting of change in functional capacity measured by 6 minute walk test (6MWT), health-related quality of life (EQ-5D index/VAS) and symptoms of anxiety and depression (hospital anxiety and depression scale - HADS). The primary end-point analysis after 3 months follow-up compared the change in the combined endpoint between the participants in the tele-yoga and control group. Secondary endpoints included separate analysis of functional capacity, health-related quality of life and symptoms of anxiety/depression. Results: 311 participants were randomized to tele-yoga (n=156) and control (n=155), mean age 66 years, 30% women, 80% diagnosed with heart failure. There was a significant improvement in favor of the tele-yoga group in the combined primary endpoint consisting of physical function, quality of life and anxiety and depression (p=.006). When analysing them separately, there was a significant improvement in 6MWT (p=.008) and quality of life in EQ-5D VAS (p=.014), but not in EQ-5D index (p=.12), and a significant difference between the groups in symptoms of anxiety and depression (p=.03). Median attendance to yoga-sessions was 20 sessions (maximum 24) and 69% of the study participants were adherent to &gt;18 tele-yoga sessions. There were no adverse events reported during yoga sessions or app usage. Conclusion: Digitally delivered mind-body training such as tele-yoga showed a significant improvement in the combined end-point consisting of physical function, health-related quality of life and mental health. Tele-yoga may be a promising new form of rehabilitation for patients with heart failure.

Perceptions about smartphone-based interventions to promote physical activity in inactive adults with knee pain – A qualitative study

Purpose Smartphone-based interventions offer a promising approach to address inactivity in people with knee osteoarthritis (OA). We explored perceptions towards smartphone-based interventions to improve physical activity, pain, and depressed mood in inactive people with knee pain. Methods This qualitative study included six focus groups at Boston University with inactive people with knee pain (n = 35). A smartphone app, developed by our team, using constructs of Social Cognitive Theory, was used to obtain participant feedback. Results Participants discussed wanting to use smartphone-based interventions for personalized exercise advice, for motivation (e.g., customized voice messages, virtual incentives), and to make exercise “less boring” (e.g., music, virtual gaming). Preferred app features included video tutorials on how to use the app, the ability to select information that can be viewed on the home screen, and the ability to interact with clinicians. Features that received mixed responses included daily pain tracking, daily exercise reminders, peer-interaction for accountability, and peer-competition for motivation. All participants discussed privacy and health data security concerns while using the app. Conclusions Using a co-design approach, we report preferences and concerns related to using smartphone-based physical activity interventions in inactive people with knee pain. This information may help improve acceptability of such interventions in this population.

Moderators of a Diet and Physical Activity Intervention: who Responds Best to Sequential vs. Simultaneous Approaches.

Given that low physical activity levels and poor dietary intake are co-occurring risk factors for chronic disease, there is a need for interventions that target both health behaviors, either sequentially or simultaneously. Little is known about participant characteristics that are associated with better or worse response to sequential and simultaneous interventions. The 12-month Counseling Advice for Lifestyle Management (CALM) randomized trial (N = 150; Mage = 55.3years) targeted these two behaviors either via a sequential approach - dietary advice first then exercise advice added ("Diet-First") or exercise advice first then dietary advice added ("Exercise-First") - or via a simultaneous approach. The objective was to examine demographic, clinical, and psychosocial moderators of intervention effects on 12-month change in (1) moderate-to-vigorous physical activity (MVPA), (2) fruit/vegetable intake, (3) caloric intake from saturated fat, and (4) weight. Hierarchical regressions first compared Diet-First to Exercise-First, followed by comparisons of these arms combined ("sequential") to the simultaneous arm. Older age, higher baseline BMI, and lower social support were associated with higher MVPA in Exercise-First vs. Diet-First, while lower tangible support was associated with higher fruit/vegetable intake in Exercise-First but not in Diet-First. Poor sleep was associated with higher levels of MVPA in the sequential arm than in the simultaneous arm. Lower vitality was associated with greater weight loss in the sequential arm than in the simultaneous arm, while the opposite was true for those who were not married. Identifying moderators of treatment response can allow the behavioral medicine field to enhance intervention efficacy by matching participant subgroups to their best-fitting interventions. NCT00131105.

Exploring the practicality and acceptability of a brief exercise communication and clinician referral pathway in cancer care: a feasibility study

BackgroundThe majority of cancer patients and cancer care clinicians-CCCs (e.g., oncologists) believe that exercise is an important adjunct therapy that should be embedded in standard practice. Yet, CCCs do not routinely discuss exercise with their patients, nor do they regularly refer them to exercise professionals (e.g., exercise physiologists-EPs). This study evaluated the feasibility and acceptability of an evidence-based approach to improving exercise communication between CCCs and their patients, including an exercise referral pathway.MethodsImplementation and testing of the Exercise Communication and Referral Pathway (ECRP) occurred in Sydney, Australia. The ECRP included a brief oncology-initiated communication exchange with patients, CCC exercise referral to an EP, followed by EP-initiated telephone consultation with patients concerning tailored exercise advice. Participant perceptions concerning the feasibility and applicability of the ECPR were evaluated. Semi-structured interviews were conducted with CCCs (n = 3), cancer patients (n = 21), and an EP (n = 1). Inductive thematic analysis was undertaken.ResultsAnalysis generated three themes: (1) Navigating the role of CCCs in the ECRP, suggesting that oncology-initiated communication is a cue to action, however there was a lack of role clarity regarding exercise referral; (2) Implementing Patient-Orientated Care within a Standardised Pathway, highlighting the need for tailored information and advice for patients that reflects individual disease, socio-cultural, and environmental factors, and; (3) Taking Steps Towards Action, revealing the need for structural (e.g., EP initiated contact with patients) and policy changes (i.e., changes to Medicare, direct oncologist referral) to engage patients and better integrate exercise as part of standard care.ConclusionsFindings provide important insights into improving oncology-patient exercise communication and developing an exercise referral pathway to increase engagement and patient reach. However, individual (e.g., experience, knowledge) and contextual factors (e.g., time, resources) need consideration when implementing an ECRP.Trial registrationThis trial was prospectively registered with the Australian New Zealand Clinical (#ACTRN12620000358943) on March 13, 2020.

National study of NAFLD management identifies variation in delivery of care in the UK between 2019 to 2022

Non-alcoholic fatty liver disease (NAFLD) is associated with liver and cardiovascular morbidity and mortality. Recently published NAFLD Quality Standards include 11 key performance indicators (KPIs) of good clinical care. This national study, endorsed by British Association for the Study of the Liver (BASL) and British Society of Gastroenterology (BSG), aimed to benchmark NAFLD care in UK hospitals against these KPIs. This study included all new patients with NAFLD reviewed in the outpatient clinic in the months of March 2019 and March 2022. Participating UK hospitals self-registered for the study through BASL/BSG. KPI outcomes were compared using Fisher's exact or Chi-square tests. Data from 776 patients with NAFLD attending 34 hospitals (England [25], Scotland [four], Wales [three], Northern Ireland [two]) were collected. A total of 85.3% of hospitals reported established local liver disease assessment pathways, yet only 27.9% of patients with suspected NAFLD had non-invasive fibrosis assessment documented at the point of referral to secondary care. In secondary care, 79.1% of patients had fibrosis assessment. Assessment of cardiometabolic risk factors including obesity, type 2 diabetes, hypertension, and smoking were conducted in 73.2%, 33.0%, 19.3%, and 54.9% of all patients, respectively. There was limited documentation of diet (35.7%) and exercise advice (55.1%). Excluding those on statins, only 9.1% of patients with NAFLD at increased cardiovascular risk (T2DM and/or QRISK-3 >10%) had documented discussion of statin treatment. Significant KPI improvements from 2019 to 2022 were evident in use of non-invasive fibrosis assessment before secondary care referral, statin recommendations, and diet and exercise recommendations. This national study identified substantial variation in NAFLD management in the UK with clear areas for improvement, particularly fibrosis risk assessment before secondary care referral and management of associated cardiometabolic risk factors. This study identified significant variation in the management of NAFLD in the UK. Only 27.9% of patients with suspected NAFLD had non-invasive fibrosis assessment performed to identify those at greater risk of advanced liver disease before specialist referral. Greater emphasis is needed on the management of associated cardiometabolic risk factors in individuals with NAFLD. Hospitals with multidisciplinary NAFLD service provision had higher rates of fibrosis evaluation and assessment and management of cardiometabolic risk than hospitals without multidisciplinary services. Further work is needed to align guideline recommendations and real-world practice in NAFLD care.

Prevention and treatment of noncognitive complications.

Patients aged 65 and older are the fastest growing segment in the population of many countries. Based on evolving demographics showing increasing life expectancies, it is expected that there will be a concurrent rise in the demand for a large variety of surgical and anesthesia services. Surgery offers definitive management of many age-related diseases and provides symptom-relieving (morbidity) and life-extending (mortality) benefits. However, elderly adult surgical patients, especially the frail ones, often require a different level of care than younger patients during the perioperative period. As many have chronic illnesses and acquired deconditioning and functional decline, older patients are prone to develop untoward outcomes such as postoperative complications and loss of independence. This manuscript focuses on the holistic quality person-centered care, supported by a wide stakeholder team of health-care workers, ensuring fidelity to comprehensive geriatric assessment and optimization services where possible, offering a systematic approach to early health risk assessment and risk modification in the perioperative period, with the ultimate goal of reducing postoperative complications and health-care costs. The "comprehensive geriatric assessment and optimization" cost-effective approach builds on robust evidence with older people more likely to be alive, a shorter length of hospital stay due to fewer postoperative medical complications, and improved rates of return to usual residence. Prehabilitation programs are delivered focusing on primary (through counseling) and secondary prevention (through screening) with an aim to improve fitness for surgery, by evaluating functional capacity, nutritional and psychological health, prompting interventions, targeting physical exercise, lifestyle and nutritional advice, and psychological support.

The Effects of an Educational Intervention on Exercise Advice Behaviors of Thai Oncology Nurses

ObjectiveTo evaluate an educational intervention based on the Theory of Planned Behavior to increase oncology nurses’ exercise advice behaviors. MethodsA single-group, quasi-experimental repeated measures design study was used with 124 oncology nurses in a Thai cancer institute. The educational intervention included preeducation self-directed activities for 1 hour, a 2-hour group education session, and posteducation outreach contact 1 week later. The outcome measures, including the Theory of Planned Behavior constructs, exercise knowledge, and self-reported exercise prescription behaviors, were collected at three time points: Time 1 (2 weeks preintervention), Time 2 (immediately preintervention), and Time 3 (2 weeks after the intervention). ConclusionResults indicated a statistically significant increase in scores after the intervention for all outcomes, including the Theory of Planned Behavior constructs (overall P value <.001), exercise knowledge (β = 2.99, P < .001), and exercise prescription behaviors: asking (odds ratio [OR] = 12.98, P < .001), assessing (OR = 6.20, P < .001), referring (OR = 4.10, P < .001), and writing exercise advice (OR = 11.52, P < .001). Additionally, verbal counseling behavior was performed by all participants, and therefore, the odds for verbal counseling were not reported. Structural equation modeling analysis demonstrated that attitudes and perceived behavioral control explained 41% of the variance in exercise advice intention. Perceived behavioral control and intention also explained 20% of the variance in self-reported exercise advice behaviors. Implications for Nursing PracticeAttitudinal and perceived behavioral control constructs should be a focus of attention to improve health care professionals’ exercise advice behaviors. More focused research is required to examine whether patients engage in and follow the exercise advice provided by oncology nurses.

Effects of core-stabilization and trunk balance exercises on clinical parameters in patients with non-specific chronic low back pain – a randomized pilot study

Introduction and aim. This study compared the efficacy of core stabilization (CSE) and trunk balance exercises (TBE) with flexibility training on pain-related disability (PRD), psychological status (PS) and fear avoidance belief (FAB) in patients with non-specific chronic low back pain (NSCLBP). Material and methods. Twenty-eight (28) participants diagnosed of NSCLBP were randomly assigned into CSE, TBE, and control groups (CG). Participants in CSE (n=10); TBE (n=8) and CG groups (n=10) received core stabilization exercise, trunk balance exercise and back care advice respectively. All participants received flexibility training in addition to treatment in their respective groups. Assessment of outcomes were done at baseline, end of 4 th and 8 th week. Results. There was significant improvement in all outcomes in the CSE, TBE and CG at 8 weeks; PRD (p=0.005, p=0.008, p=0.005), PS: depression (p=0.005, p=0.008, p=0.007); anxiety (p=0.005, p=0.007) and FAB about work (p=0.005, p=0.007, p=0.005); about physical activity (p=0.005, p=0.018, p=0.006). Comparison of outcomes between CSE and TBE groups showed no significant difference (p&gt;0.05) Conclusion. Both CSE and TBE with flexibility training are effective in improving PRD, PS and FAB of patients with NSCLBP.

Efficacy of physical exercise advice to ischemic heart disease patients in the maintenance of physical exercise during phase III cardiac rehabilitation program. A cluster randomised controlled trial

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Col·legi de Fisioterapeutes de Catalunya [R02/2018] Health Department of Generalitat de Catalunya. Instrumental action of intensification of nursing professionals (SLT017/20/000098). Introduction Benefits of cardiac rehabilitation (CR) in the prognosis of patients with ischemic heart disease have been demonstrated with a class I level A recommendation. Despite this, its implementation is still very scarce in any of its three phases. Purpose To assess the efficacy of a phase III CR program (CRP), based on counselling in the maintenance of physical exercise, in the time of physical exercise per week in patients with ischemic heart disease who have completed a phase II of the CRP supervised physical exercise program. Methods We conducted an open, controlled, cluster randomised trial. Eligible patients were diagnosed with acute or chronic coronary syndrome, had completed the phase II of CRP supervised physical exercise program, without cognitive deficit, Barthel index &amp;gt;60 and had provided signed informed consent. Patients allocated to control group (CG) received standard visits at their primary healthcare center. Patients allocated to intervention group (IG), carried out phase III of CRP with the CR reference team (a doctor and a nurse from primary healthcare center trained in CR by a hospital CRP team) by visits at 1, 3, 6 and 12 months. During these visits, physical exercise advices were given and the information on the practice of physical exercise was reinforced. The patient's interests and the available resources for the practice of exercise were considered. Patients were provided with information on the health assets available in their area. Likewise, adherence to treatment and control of cardiovascular risk factors were reinforced. The follow-up period was 12 months. The main outcome was the minutes of physical exercise per week. Results Fourteen primary healthcare centers were randomized, 7 in the CG and 7 in the IG. Fifty-four patients from the CG [85% men; 59 years (SD 3)] and 45 from the IG [87% men; 60 years (SD 10)] were analyzed. Fifty percent of the CG and 35.6% of the IG were at moderate-high risk(p=0.149). At the end of phase II, 72.2% and 88.9% (p=0.04) of CG and IG patients respectively practiced ≥150 minutes of moderate activity and/or ≥75 minutes of vigorous activity. At 12 months of follow-up, 58.5% of CG patients and 80.0% of IG patients (p=0.02) reached the recommended levels of physical activity. Related to strengthening activities, CG practiced 9.1 minutes/week (SD 25.6) versus 27.8 (SD 43.2) in the IG (p= 0.001). Related to flexibility activities, CG practiced 15.4 minutes/week (SD 26.3) versus 24.5 (SD 29.2) in the IG (p= 0.049). Conclusions Despite observing an expected decrease in the practice of physical exercise over time, at 12 months of follow-up, a higher percentage of patients in the IG performed the recommended levels of physical exercise. Similarly, the IG spent more minutes performing strengthening and flexibility activities compared to the control group.

O038 Positive impact of an ERAS programme on living and deceased donor renal transplant recipients’ recovery during COVID pandemic

Abstract Introduction An ERAS (Enhanced Recovery After Surgery) programme was created to reduce length of stay (LoS) and improve outcomes following renal transplant surgery. This aimed to reduce post-operative hospital-acquired infection, especially COVID-19. Methods The ERAS protocol was finalised following a literature review and MDT discussion. ERAS information, with post-operative exercise advice, was distributed to patients on the renal transplant waitlist. LOS was evaluated, comparing ERAS with pre-ERAS recipients and, to remove pandemic bias, pre-pandemic (December 2019) recipients. Secondary outcomes were opiate use, mobilisation, bowel function and patient-reported outcomes. ERAS protocol compliance was monitored. Data analysis was with student t-test and Chi-2 test in GraphPad Prism. Results Some 35 consecutive recipients completed ERAS protocol (March 2021). Baseline characteristics were comparable between live-donor recipients 9/35 vs 13/35 pre-ERAS and 12/35 pre-COVID. BMI&amp;gt;30 was higher in ERAS group (19vs. 11vs. 8). Median LoS was significantly reduced: ERAS - 5 days, pre-ERAS - 7 days, pre-COVID - 8 days (p=0.01). 51% of ERAS discharges were within 5 days vs. 17% pre-ERAS vs. none pre-COVID (X2 12.59, p&amp;lt;0.001). For overstayers (&amp;gt;5 days), potential preventable reasons were identified. 79.2% of ERAS recipients mobilised on day 1 post-op. ERAS indicated no significant reduced opiate use. Two ERAS recipients were readmitted within 30 days (vs.9/70 pre-ERAS) and one returned to theatre (vs.5/70 pre-ERAS). Conclusion This ERAS programme successfully reduced the LoS by 2 days in comparative population with minimal adverse events. Patient and staff feedback was positive. It's hypothesised that assigning a specialist ERAS nurse will improve compliance.

Longitudinal Changes in Body Composition and Resting Metabolic Rate in Male Professional Flat Jockeys: Preliminary Outcomes and Implications for Future Research Directions

Jockeys are unique given that they make weight daily and, therefore, often resort to fasting and dehydration. Through increasing daily food frequency (during energy deficit), we have reported short-term improvements in jockey's body composition. While these changes were observed over 6-12weeks with food provided, it is unclear whether such improvements can be maintained over an extended period during free-living conditions. We, therefore, assessed jockeys over 5years using dual X-ray absorptiometry, resting metabolic rate, and hydration measurements. Following dietary and exercise advice, jockeys reduced fat mass from baseline of 7.1 ± 1.4kg to 6.1 ± 0.7kg and 6.1 ± 0.6kg (p < .001) at Years 1 and 5, respectively. In addition, fat-free mass was maintained with resting metabolic rate increasing significantly from 1,500 ± 51kcal/day at baseline to 1,612 ± 95kcal/day and 1,620 ± 92kcal/day (p < .001) at Years 1 and 5, respectively. Urine osmolality reduced from 816 ± 236mOsmol/L at baseline to 564 ± 175mOsmol/L and 524 ± 156mOsmol/L (p < .001) at Years 1 and 5, respectively. The percent of jockeys consuming a regular breakfast significantly increased from 48% at baseline to 83% (p = .009) and 87% (p = .003) at Years 1 and 5, alongside regular lunch from 35% to 92% (p < .001) and 96% (p < .001) from baseline to Years 1 and 5, respectively. In conclusion, we report that improved body composition can be maintained in free-living jockeys over a 5-year period when appropriate guidance has been provided.