Exercise-based Training Research Articles

Dosing Balance Training for Older Adults

The physical processes that contribute to balance may decline as humans age. In exercise-based balance training, the most effective intervention for improving balance and falls-reduction among older adults, the type of exercise is set first, then intensity, then time. Clinical decision making about type of exercise program is based on examination and assessment of the person, including their goals and contributing impairments. Intensity is poorly reported, but 2 tools to measure and modulate intensity have been developed. Time component recommendations vary: most common are 2 to 3 times per week for 30-45 min for 12 weeks.

Combined therapeutic acute intermittent hypercapnic hypoxia and exercise-based respiratory training improve breathing after chronic cervical spinal cord injury

Therapeutic acute intermittent hypoxia (tAIH) is simple, safe, and effective means of inducing respiratory motor plasticity and improving breathing in rodent models of acute cervical spinal cord injury (SCI). Unfortunately, tAIH effects on breathing function are less effective with chronic injury. On the other hand, tAIH restores non-respiratory (limb) motor function with chronic SCI, but only when combined with task specific training (TST). The effcacy of combined tAIH and respiratory TST on breathing ability in rodent models (or humans) with chronic SCI has not been investigated. Here, we explore the potential for tAIH and respiratory TST to increase breathing ability; we further differentiate automatic vs. volitional TST, since the ability to sustain independent breathing is dependent on automatic (and not volitional) breathing function, which relies on distinct neural pathways. Physical exercise increases breathing automatically in direct proportion to metabolic rate, regulating arterial blood gases by a mechanism independent of chemoreceptor feedback (i.e. “exercise hyperpnea”). Thus, in ongoing studies, we are exploring treadmill training as a form of task-specific respiratory training in rats with chronic cervical SCI. We focus on a refined tAIH protocol that combines hypoxia with hypercapnia during each episode (therapeutic acute intermittent hypercapnic hypoxia; or tAIHH), since preliminary data suggests that tAIHH is a more potent stimulus to respiratory motor plasticity vs. tAIH alone. Adult Sprague-Dawley rats with chronic C2 spinal cord hemisection were treated with either 4 weeks of either tAIHH (10, 5-min episodes of 10.5% O2, 4% inspired CO2) combined with treadmill exercise (30 min total run time, 30 cm/sec) or tAIHH alone. Breathing function was assessed in awake, freely moving rats using whole-body plethysmography. In preliminary analyses, breathing capacity (i.e., minute ventilation in response to maximal chemoreflex activation) was increased in chronically injured rats treated with daily tAIHH paired with treadmill training relative to rats treated with tAIHH alone (120.7mL/min/100g vs. 98.7mL/min/100g; p=0.0018). Similar improvements in breathing function were not observed with tAIHH alone. These are the first studies to investigate the therapeutic effcacy of combined tAIH and exercise-based respiratory training targeting automatic breathing. These initial results indicate that, similar to non-respiratory motor systems, pairing tAIHH with respiratory TST improves breathing function in rodents with chronic cervical SCI. Supported by: Craig H. Neilsen Foundation (SCIRP891379), and the McKnight Brain Institute. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Exercise-based training programs for patients with chronic Chagas cardiomyopathy: A systematic review and meta-analysis.

We assessed the effects of exercise-based training programs (EBTP) in patients with chronic Chagas cardiomyopathy (CCC) through a systematic review and meta-analysis. We conducted a search in Pubmed/Medline, Embase, Scopus, Web of Science, Cochrane Library, Virtual Health Library, and SciELO until January 2023. Randomized controlled trials (RCTs) and non-randomized intervention studies (NRIS) investigating the effects of EBTP in CCC patients were included. The primary outcomes were all-cause mortality, cardiovascular mortality, and health-related quality of life (HRQoL), and the secondary outcomes were exercise capacity by peak VO2, heart failure-related hospital admissions (HFRHA), and left ventricular ejection fraction (LVEF). The search strategy yielded 3617 studies. After removing duplicates and screening, eight studies (3 RCTs and 5 NRIS) involving 222 patients were included. Seven studies were conducted in Brazil. The age range was from 30 to 71years, and 47.1% were male. Data on mortality, HRQoL, LVEF, and HFRHA were scarcely reported. The meta-analysis pooling four studies showed that the peak VO2 was significantly higher (mean difference 4.45, 95% confidence interval 3.50 to 5.39mL/kg/min, I2=0%) in the EBTP group compared to the control group. The evidence available was limited and heterogeneous. While EBTP has shown to improve HRQoL and exercise capacity, there is no conclusive information about the other proposed outcomes. These positive effects present an opportunity to provide treatment to CCC patients in low- and middle-income countries. Further studies are needed to ascertain the effects of EBTP on hard outcomes in this population.Registration number: CRD42022334060.

Exercise Based Cancer Rehabilitation Program Improves Phase Angle In Breast Cancer Survivors

Phase angle (PhA) is an index of cell membrane integrity and is a prognostic indicator of survival and quality of life in cancer survivors. The efficacy of exercise-based cancer rehabilitation programs (ExCR) on PhA is unknown. PURPOSE: To assess the effect of ExCR on PhA in breast cancer survivors. METHODS: Seventy female breast cancer survivors (61 ± 9 years, PhA 4.57 ± 0.51) were referred to the ExCR by their oncologist and participated in one-on-one exercise-based training for 90 minutes, 3 times a week, for 12 weeks. Training sessions included 30 minutes of cardiorespiratory training at intensities between 40-85% of heart rate reserve with a rate of perceived exertion (RPE) between 3-8, 45 minutes of resistance training (including both muscular strength and endurance) at intensities between 40-85% of 1 repetition maximum with an RPE between 3 and 8, and 15 minutes of flexibility training including both dynamic and static stretching. Participants completed pre and post assessments for muscular strength, muscular endurance, cardiorespiratory endurance, flexibility, body composition and PhA (Inbody 770). The results of the initial assessment were used to develop individualized exercise prescriptions. RESULTS: PhA significantly increased (p<0.05) after ExCR (PhApre = 4.56; PhApost = 4.63; Δ = 1.9%). Improvements in PhA show a positive correlation with improvements in muscular strength (incline bench press, r=0.45, p<0.0001; seated cable row, r=0.51, p<0.0001, latissimus dorsi pulldown, r=0.55, p<0.0001; leg press, r=0.39, p=0.0007; leg curl, r=0.43, p=0.0002; leg extension, r=0.38, p=0.0014; and grip strength, r=0.57, p<0.0001), cardiorespiratory endurance (VO2 peak, r=0.41, p=0.0008),and flexibility (sit and reach, r=0.35, p=0.0009). CONCLUSION: A 12-week ExCR significantly improves PhA in breast cancer survivors. Improvements in PhA are significantly positively correlated with improvements in muscular strength, cardiorespiratory endurance, and flexibility. The improvements in fitness are likely due to enhanced neuromuscular function, which may represent restoration of damaged cell membranes from cancer and cancer related treatments.

Exercise-based cardiac rehabilitation for one or three montsh after surgical aortic valve replacement, a feasibility study of a randomized controlled trial

Abstract Funding Acknowledgements Type of funding sources: None. Background Aortic stenosis (AS) is a common disease. Many patients on the waiting list for surgery cut down on their physical activity resulting in anxiety and reduced physical function. It is important to offer this group exercise-based training in the shape of cardiac rehabilitation (CR) after surgery. Aim The primary aim was to study the feasibility of a randomized controlled trial studying if there was any differences in change of level of physical activity and functional exercise capacity after one month of training compared to three months of training. Method A feasibility study of a randomized controlled trial (RCT) with one group receiving one month of CR (group A) versus one group receiving three months of CR (group B). Feasibility was measured in terms of recruitment rate, adherence rate, retention rate, adverse events and the ability to collect primary and secondary outcome measurements. Primary outcome measure was 6-minute walk test (6MWT) and secondary outcome measures were heel-lift, 30-second chair stand test (CST), self-perceived physical activity, level of physical activity, factors limiting functional exercise capacity in daily life and current state of self-perceived health. Thirty patients were included in the result. Result Regarding feasibility in this study the recruitment rate was low, but the adherence and retention rates were good. The ability to collect outcome assessment was good and there was only one adverse event. Significant differences were found regarding physical activity and self-perceived health in favor of the three-months training group (group B). There were no differences in 6MWT, heel-lift, CST or physical capacity between the two groups. Conclusion This feasibility study showed that recruitment rate was low but other measures of feasibility was satisfactory. Results indicate that a shorter supervised program may be sufficient and may facilitate effective use of resouces.

Brain-Computer Interface Priming for Cervical Transcutaneous Spinal Cord Stimulation Therapy: An Exploratory Case Study.

Loss of arm and hand function is one of the most devastating consequences of cervical spinal cord injury (SCI). Although some residual functional neurons often pass the site of injury, recovery after SCI is extremely limited. Recent efforts have aimed to augment traditional rehabilitation by combining exercise-based training with techniques such as transcutaneous spinal cord stimulation (tSCS), and movement priming. Such methods have been linked with elevated corticospinal excitability, and enhanced neuroplastic effects following activity-based therapy. In the present study, we investigated the potential for facilitating tSCS-based exercise-training with brain-computer interface (BCI) motor priming. An individual with chronic AIS A cervical SCI with both sensory and motor complete tetraplegia participated in a two-phase cross-over intervention whereby they engaged in 15 sessions of intensive tSCS-mediated hand training for 1 h, 3 times/week, followed by a two week washout period, and a further 15 sessions of tSCS training with bimanual BCI motor priming preceding each session. We found using the Graded Redefined Assessment for Strength, Sensibility, and Prehension that the participant's arm and hand function improved considerably across each phase of the study: from 96/232 points at baseline, to 117/232 after tSCS training alone, and to 131/232 points after BCI priming with tSCS training, reflecting improved strength, sensation, and gross and fine motor skills. Improved motor scores and heightened perception to sharp sensations improved the neurological level of injury from C4 to C5 following training and improvements were generally maintained four weeks after the final training session. Although functional improvements were similar regardless of the presence of BCI priming, there was a moderate improvement of bilateral strength only when priming preceded tSCS training, perhaps suggesting a benefit of motor priming for tSCS training.

Exercise-Based Training Strategies to Reduce the Incidence or Mitigate the Risk Factors of Anterior Cruciate Ligament Injury in Adult Football (Soccer) Players: A Systematic Review.

Anterior cruciate ligament (ACL) is one of the most concerning injuries for football players. The aim of this review is to investigate the effects of exercise-based interventions targeting at reducing ACL injury rate or mitigating risk factors of ACL injury in adult football players. Following PRISMA guidelines, a systematic search was conducted in CINAHL, Cochrane Library, PubMed, Scopus, SPORTDiscus and Web of Science. Studies assessing the effect of exercise-based interventions in ACL injury incidence or modifiable risk factors in adult football players were included. 29 studies evaluating 4502 male and 1589 female players were included (15 RCT, 8 NRCT, 6 single-arm): 14 included warm-up, 7 resistance training, 4 mixed training, 3 balance, 1 core stability and 1 technique modification interventions. 6 out of 29 studies investigated the effect of interventions on ACL injury incidence, while the remaining 23 investigated their effect on risk factors. Only 21% and 13% studies evaluating risk of injury variables reported reliability measures and/or smallest worthwhile change data. Warm-up, core stability, balance and technique modification appear effective and feasible interventions to be included in football teams. However, the use of more ecologically valid tests and individually tailored interventions targeting specific ACL injury mechanisms are required.

An intensive exercise-based training program reduces prefrontal activity during usual walking in patients with Parkinson’s disease

IntroductionParkinson’s disease (PD) leads to a progressive loss of locomotor automaticity. Consequently, PD patients rely more on executive resources for the control of gait, resulting in increased prefrontal activity while walking. Exercise-based training programs may improve automaticity of walking and reduce prefrontal activity in this population. This study aimed to assess the effect of an intensive multidisciplinary exercise-based training program on prefrontal activity and gait performance during usual walking in PD patients. MethodFourteen patients (mean age: 67 ± 9; disease duration: 6 ± 5 years; Hoehn and Yahr score: 1.9 ± 0.6) were included in this study. They were assessed in ON stage at three different times at 5-week intervals: two times before the training program (T0 and T1) and once after the training program (T2). Gait performance (stride time, speed, stride length, cadence, and their respective coefficient of variation) and cortical activity in the dorsolateral prefrontal cortex (DLPFC) using functional near infrared spectroscopy (fNIRS) were measured during usual walking. ResultsPatients had reduced cortical activity of the DLPFC at T2 compared to T1 (p = 0.003). Patients had shorter stride time at T2 compared to T1 (p = 0.025) and tended to have longer stride length at T2 than at T1 (p = 0.056). ConclusionThe training program led to positive effects on prefrontal activity and gait performance. Reduced prefrontal activity during usual walking after training program suggests that patients may have a greater reserve capacity to face more challenging walking conditions. Further studies will investigate the effect of this training on cortical activity during dual-task walking..

Training needs assessment: identification of competence fields for the dismantling of nuclear power plants

Abstract. The dismantling of nuclear facilities is a continuous process of change encompassing the complete site. Thereby, the focus changes from a stable and standardized operational phase to a situation characterized by constant changes in the facility as well as in the facility organization. Thus, employees and managers are confronted with a markedly changed working environment: processes and methods must be continuously re-evaluated and adapted, qualification requirements change or shift and new interfaces emerge. Furthermore, compared to the operational phase, the regulatory depth is reduced, decisions must be made faster and more flexible and the mode of operation changes from hierarchically organized routine standard operational procedures to an efficiency-orientated project-based mode of operation with limited resources at the same time. To make dismantling efficient and safe, this change should be actively managed by a change project in terms of the human technology organization approach (MTO approach, Strohm and Ulich, 1999). Against this background, our BMBF-funded collaboration project (“Die Kompetenzen von Führungskräften und MitarbeiterInnen für den Rückbau stärken – Rückbaukompetenzen”; funding number 15S9426A) aims to identify the dismantling-related requirement changes and the associated competence shifts as well as to develop and support the changed roles of managers and employees by scientifically based training (Goldstein and Ford, 2002; IAEA, 1998). Thereby, seminar-based training (knowledge-based and demonstration-based, e.g., Sitzmann and Weinhardt, 2019) will be complemented by exercise-based and experience-based training (Cannon-Bowers and Bowers, 2010) with multimodal mixed reality applications, which allow experience-based learning with the help of virtual reality-based representations (via data glasses, tablet or PC) and can be adapted to the individual usage and learning style preferences of the trainees. The training will be developed and implemented in cooperation with our project partner GfS (Gesellschaft für Simulatorschulung mbH). After project completion, the GfS will provide the training to nuclear power plant operators and, if necessary, develop them so that a sustainable contribution to the preservation of the specialized knowledge in the nuclear energy sector is achieved. To identify the needs for dismantling-relevant training objectives and competencies in the first step, a document analysis (safety alerts and monthly reports from our project partner PreussenElektra GmbH and over 500 reportable incidents from 28 nuclear power plants from 2012–2020), as well as 10 expert interviews, were conducted. The document analysis was used to investigate the incidents for (1) differences between operational phase and decommission, (2) differences in events between in-house and contractor personnel and to identify the incidents with the highest frequencies. The objective of the expert interviews was the qualitative context analysis as well as the identification of dismantling-relevant competence fields. The analysis allowed us to identify nine dismantling-related competence fields for employees and managers and a further three specifically for managers. These 12 competence fields will be discussed and defined in more detail in further interviews with approximately 20 managers and 30 employees. Based on these findings, training objectives will be formulated and training content designed. The presentation outlines the analysis described above as well as the identified fields of competence and sketches the further procedure of the collaborative project.

The benefit of exercise-based rehabilitation programs in patients with pulmonary hypertension: a systematic review and meta-analysis of randomized controlled trials.

Several studies have suggested that exercise capacity and quality of life are reduced in patients with pulmonary hypertension, and exercise-based rehabilitation can improve exercise capacity and quality of life in patients with pulmonary hypertension. The aim of this study is to assess the efficacy and safety of exercise-based rehabilitation in patients with pulmonary hypertension through a meta-analysis of randomized controlled trials. We searched PubMed, Embase, Medline, and the Cochrane Central Register of Controlled Trials up to November 2018. All randomized controlled trials comparing exercise capacity and quality of life between patients undergoing exercise-based rehabilitation and those undergoing non-exercise training were included. Data were extracted separately and independently by two investigators, and discrepancies were arbitrated by the third investigator. We used the random-effects model to analyze the results, the GRADE to assess the risk of bias in the included studies, and I2 statistic to estimate the degree of heterogeneity. Nine randomized controlled trials are included; however, only seven randomized controlled trials were able to extract data. Including inpatients and outpatients, the total number of participants was 234, most of whom were diagnosed as pulmonary artery hypertension. The study duration ranged from 3 to 15 weeks. The mean six-minute walking distance after exercise training was 51.94 m higher than control (27.65–76.23 m, n = 234, 7 randomized controlled trials, low quality evidence), the mean peak oxygen uptake was 2.96 ml/kg/min higher (2.49–3.43 ml/kg/min, n = 179, 4 randomized controlled trials, low-quality evidence) than in the control group. In conclusion, our finding suggests that an exercise-based training program positively influences exercise capacity in patients with pulmonary hypertension.

Role of early short-term cardiac rehabilitation in patients undergoing pacemaker implantation.

Exercise-based cardiac rehabilitation (CR) improves the clinical outcomes in patients with cardiovascular diseases. However, few data exist regarding the role of early short-term CR in patients undergoing pacemaker (PM) implantation. We assessed whether short-term CR following PM implantation was sufficient to improve both physical function and quality of life (QOL). A total of 27 patients with a 6-minute walking distance (6MWD) of less than 85% of the predicted value on the day following PM implantation were randomly assigned to either the CR group (n = 12, 44.4%) or the non-CR group (n = 15, 55.6%). The CR group involved individualized exercise-based training with moderate intensity for 4 weeks after PM implantation. Cardiopulmonary exercise test (CPET), 6MWD, muscle strength, and Short Form (SF)-36 were assessed at baseline and at the 4-week follow-up. After a mean follow-up period of 38.3 days, both groups showed significantly improved 6MWD. Peak oxygen uptake improved in both groups on CPET, but the difference was not statistically significant. Knee extension power and handgrip strength were similar in both groups. Regarding QOL, only the CR group showed improved SF-36 scores in the items of vitality and mental health. There was no difference in any subscale in the non-CR group. Neither lead dislodgement nor significant changes in PM parameters were observed in any patient. Early short-term CR following PM implantation was associated with improved psychological subscales and can be safely performed without increasing the risk of procedure-related complications.

Does Exercise-Based Conventional Training Improve Reactive Balance Control among People with Chronic Stroke?

Background: Exercise-based conventional training has predominantly benefited fall-associated volitional balance control domain; however, the effect on reactive balance control is under-examined. Therefore, the purpose of this study was to examine the effect of exercise-based conventional training on reactive balance control. Methods: Eleven people with chronic stroke (PwCS) underwent multi-component training for six weeks (20 sessions) in a tapering manner. Training focused on four constructs-stretching, functional strengthening, balance, and endurance. Volitional balance was measured via movement velocity on the Limits of Stability (LOS) test and reactive balance via center of mass (COM) state stability on the Stance Perturbation Test (SPT). Additionally, behavioral outcomes (fall incidence and/or number of steps taken) were recorded. Results: Movement velocity significantly increased on the LOS test (p < 0.05) post-intervention with a significant decrease in fall incidence (p < 0.05). However, no significant changes were observed in the COM state stability, fall incidence and number of recovery steps on the SPT post-intervention. Conclusion: Although volitional and reactive balance control may share some neurophysiological and biomechanical components, training based on volitional movements might not significantly improve reactive balance control for recovery from large-magnitude perturbations due to its task-specificity.

The Mediating Effects of Coping Style on the Effects of Breath Count Mindfulness Training on Depressive Symptoms among International Students in China.

Mindfulness training has gained popularity in the scientific field and has been proposed as an efficient way for emotional regulation. Mindfulness-based cognitive therapy (MBCT) is designed especially for depressive people in reducing risk of depression relapse and is recommended in national guidelines as a treatment choice for relapse prevention in recurrent depression. The aim of the current study was to investigate the effects of mindfulness training on depressive symptoms of international students and probe into the mediating role of mindfulness in stressful events and depression. In addition, we introduced a new kind of mindfulness training, the breathing exercise-based mindfulness training, which is based on the integration of Buddhism and Daoism. Self-report questionnaires assessing the coping style, abnormal depressive behavior, and stressful live events were completed in 260 international students in China (mean age = 21.4 years). The results showed that (1) many international students showed depression symptoms, (2) stressful life events play a completely mediating role in the initiation of depression and anxiety, and (3) mindfulness training for 8 weeks significantly reduced the depressive symptoms, and it was also related to a positive coping style. This study has certain theoretical significance in exploring the mechanism of the occurrence and development of depression among international students and provides useful tools for this special group of international students. In addition, the international students can also learn Chinese culture through the training. These findings indicate that mindfulness training and positive coping style are interrelated with treating depressive symptoms for international students.

Enhancing functional improvement in reablement – a qualitative study

Background and purpose Reablement is aimed to enable people to remain independent in their lives and is based on users’ own goals. Interventions are described to involve both physical exercises and guidance in everyday activities. However, descriptions of the content of reablement practices are sparse. This study aims to investigate and discuss how physiotherapists (PTs) on reablement teams plan and adapt training interventions to enhance users’ functional abilities. Methods We conducted fieldwork with seven Norwegian reablement teams, including video observations of interventions and interviews with PTs and home trainers. The results were analysed through thematic content analyses in which we used motor learning theory to interpret the results. Results The analyses revealed that reablement practices typically involved either (i) exercise-based training, (ii) activity-based training, or (iii) a combination of both exercise- and activity-based training. Discussion Reablement interventions are described as individually tailored and goal oriented. However, in practice, it is challenging to implement training that emphasises both physical function- and goal-oriented activities. Motor learning and relearning depend on several principles and require both exercise-based and activity-based training. Standardised approaches emphasising physical exercises may neglect a particular activity that is important to the user. On the other hand, exclusively activity-based approaches may omit individual, specific aspects of bodily movement and physical constraints. The use of only one aspect of training may limit the potential for functional improvement, while a combination of the two is more likely to meet the principles of motor learning theories.

Surface Perturbation Training to Prevent Falls in Older Adults: A Highly Pragmatic, Randomized Controlled Trial.

Falls are the leading cause of injuries among older adults, and trips and slips are major contributors to falls. The authors sought to compare the effectiveness of adding a component of surface perturbation training to usual gait/balance training for reducing falls and fall-related injury in high-risk older adults referred to physical therapy. This was a multi-center, pragmatic, randomized, comparative effectiveness trial. Treatment took place within 8 outpatient physical therapy clinics. This study included 506 patients 65+ years of age at high fall risk referred for gait/balance training. This trial evaluated surface perturbation treadmill training integrated into usual multimodal exercise-based balance training at the therapist's discretion versus usual multimodal exercise-based balance training alone. Falls and injurious falls were assessed with a prospective daily fall diary, which was reviewed via telephone interview every 3months for 1year.A total of 211/253 (83%) patients randomized to perturbation training and 210/253 (83%) randomized to usual treatment provided data at 3-month follow-up. At 3months, the perturbation training group had a significantly reduced chance of fall-related injury (5.7% versus 13.3%; relative risk 0.43) but no significant reduction in the risk of any fall (28% versus 37%, relative risk 0.78) compared with usual treatment. Time to first injurious fall showed reduced hazard in the first 3months but no significant reduction when viewed over the entire first year. The limitations of this trial included lack of blinding and variable application of interventions across patients based on pragmatic study design. The addition of some surface perturbation training to usual physical therapy significantly reduced injurious falls up to 3months posttreatment. Further study is warranted to determine the optimal frequency, dose, progression, and duration of surface perturbation aimed at training postural responses for this population.

Characteristics of quadriceps fatigue induced by continuous maximal knee extension among young and elderly adult men with different levels of physical activity

BACKGROUND: Skeletal muscle strength can be impacted by various factors. However, the possible effects of different forms of exercises on the elderly’s muscle strength remain unknown. Furthermore, whether the level of physical activity influences the effects of an exercise-based training also remains unclear. OBJECTIVE: To investigate the characteristics of fatigued quadriceps by continuous maximum knee extension movements among different male groups under different physical conditions. METHODS: A total of 36 male participants (24 elderly and 12 youth) were divided into three groups, namely, young male group, and two groups of elderly participants: physically active and physically inactive. All groups underwent two sets of fatigue procedures. They initially finished 30 isokinetic maximum knee extension contractions at 60∘/s. Three days later, they completed 50 isokinetic maximum knee extension at 180∘/s. Then, their muscle strength characteristics were assessed. RESULTS: During the 60∘/s fatigue test the total work of the dominant and non-dominant quadriceps in the two elderly groups was significantly lower than that of the young male group (p&lt; 0.05). Moreover, the total work of dominant quadriceps in physically active elderly male group was significantly higher than physically inactive male group in the middle (71.1 ± 12.0 vs. 52.0 ± 18.5 J) and the last third (60.9 ± 8.6 vs. 44.4 ± 15.4 J, p&lt; 0.05). During the 180∘/s fatigue test the total work of dominant and non-dominant quadriceps in young male group was significantly higher than their elderly counterparts (p&lt; 0.05). Moreover, the total work of dominant quadriceps in physically active elderly male group was significantly higher than in the physically inactive male group in the first (48.9 ± 4.6 vs. 31.7 ± 6.3 J), the middle (41.2 ± 4.8 vs. 26.1 ± 3.5 J), and the last third (33.3 ± 7.0 vs. 20.3 ± 3.1 J, p&lt; 0.05). CONCLUSION: Exercise is associated with improved function and fatigue resistance of the quadriceps in elderly people. Moreover, the implications of the bilateral quadriceps’ imbalance in this group may be of functional importance and should thus be clinically considered.

Partnered, adapted argentine tango dance for cancer survivors: A feasibility study and pilot study of efficacy

BackgroundNeurotoxic cancer treatments can cause chemotherapy-induced peripheral neuropathy and postural control deficits that cancer survivors report as a concern. Exercise-based sensorimotor training has emerged as a promising treatment for symptoms including balance deficits, however, more study is needed to optimize engagement and participation. We evaluated feasibility, satisfaction, and preliminary efficacy of a novel balance training program for cancer survivors: partnered, Adapted Argentine Tango dance (Tango). MethodsTwenty-two individuals participated (n = 22). Tango classes (1 h) were offered twice/week. At baseline, midpoint (8 classes), and conclusion of the training (15 or 16 classes), we assessed postural control by measuring center-of-pressure (CoP) measures during quiet standing with eyes closed. We also documented attendance, barriers to attendance, and satisfaction (7 point scale; 1 high). At conclusion, we analyzed whether 1) attendance and satisfaction met feasibility criteria; 2) postural control improved among participants who were outside of normal range at baseline; and 3) co-enrolling with a companion increased attendance. FindingsFeasibility criteria were met: more than half of participants attended more than half the classes offered with a mean satisfaction rate of 1.2 (SD 0.4). Those who enrolled with a companion (n = 9) attended more sessions than those who did not (n = 13) (Mann-Whitney U value = 20; p = 0.012). Participants with demonstrated deficits (n = 9) improved in 3 CoP measures at midpoint (i.e., medial-lateral sway, ellipse area, medial-lateral velocity), retaining improvement in 2 CoP measures at endpoint (i.e., medial-lateral sway, ellipse area). InterpretationPartnered, Adapted Argentine Tango is feasible for cancer survivors and may improve postural control. Enrolling with a companion improved attendance.

Effectiveness of virtual and augmented reality-enhanced exercise on physical activity, psychological outcomes, and physical performance: A systematic review and meta-analysis of randomized controlled trials

Virtual reality (VR) and augmented reality (AR)-enhanced exercise training is a novel approach to promoting health. Previous systematic reviews have focused on the effectiveness of VR interventions in clinical settings. The present study was the first systematic review to investigate the effectiveness of exercise-based VR and AR training as preventive measures in improving physical activity, psychological outcomes, and physical performance of a healthy population when compared with traditional programs and no-exercise controls. This study included 22 research articles published between 1997 and 2017, involving 1,184 participants aged 18 to 79. The results showed a large effect on physical activity (Hedges' g = 0.83, SE = 0.18), a small to moderate effect on physical performance (Hedges’ g = 0.31, SE = 0.09), and no significant effect on psychological outcomes. VR training programs were particularly shown to be effective for enhancing frequency of physical activity and strength of physical performance. Only two studies examined the effectiveness of AR training programs on physical performance, and the findings concerning those effects were not separately reported. A list of plausible moderators was tested but that variable was not significantly associated with the effects of VR on the three outcomes. Limitations and future directions are discussed.

Frailty and Exercise Training: How to Provide Best Care after Cardiac Surgery or Intervention for Elder Patients with Valvular Heart Disease.

The aim of this literature review was to evaluate existing evidence on exercise-based cardiac rehabilitation (CR) as a treatment option for elderly frail patients with valvular heart disease (VHD). Pubmed database was searched for articles between 1980 and January 2018. From 2623 articles screened, 61 on frailty and VHD and 12 on exercise-based training for patients with VHD were included in the analysis. We studied and described frailty assessment in this patient population. Studies reporting results of exercise training in patients after surgical/interventional VHD treatment were analyzed regarding contents and outcomes. The tools for frailty assessment included fried phenotype frailty index and its modifications, multidimensional geriatric assessment, clinical frailty scale, 5-meter walking test, serum albumin levels, and Katz index of activities of daily living. Frailty assessment in CR settings should be based on functional, objective tests and should have similar components as tools for risk assessment (mobility, muscle mass and strength, independence in daily living, cognitive functions, nutrition, and anxiety and depression evaluation). Participating in comprehensive exercise-based CR could improve short- and long-term outcomes (better quality of life, physical and functional capacity) in frail VHD patients. Such CR program should be led by cardiologist, and its content should include (1) exercise training (endurance and strength training to improve muscle mass, strength, balance, and coordination), (2) nutrition counseling, (3) occupational therapy (to improve independency and cognitive function), (4) psychological counseling to ensure psychosocial health, and (5) social worker counseling (to improve independency). Comprehensive CR could help to prevent, restore, and reduce the severity of frailty as well as to improve outcomes for frail VHD patients after surgery or intervention.

Physical Training and Cardiac Rehabilitation in Heart Failure Patients.

Regardless of advances in medical and interventional treatment of cardiovascular disease (CVD), a limited number of patients attend a cardiac rehabilitation (CR) programme on a regular basis. Due to modern therapies more individuals will be surviving an acute cardiovascular event, but the expected burden of chronic heart failure will be increasing worldwide.However, both in high- and low-income countries, secondary prevention after an acute myocardial infarction or stroke has been implemented in less than a half of eligible patients.Combined interventions are still needed to reduce decompensations, hospitalizations and mortality in heart failure patients from any origin. In addition to medical treatments, regular exercise has been demonstrated to improve metabolic and hemodynamic conditions in both asymptomatic risk factor carriers and cardiac patients. Risk factor control and exercise should gather together for an effective management of patients.Exercise-based training is a core component of primary and secondary prevention. It should involve healthy carriers of cardiovascular risk factors, and patients with cardiomyopathy as well. The supposed attenuated effect of CR in the era of advanced revascularization and structural interventions is due to the heterogeneity of training models and physical training in the literature. Moreover, lifestyle modification, psycho-social challenges and patient's compliance are potential confounders.In this chapter the most recent evidences about training modalities and potential benefit of CR in heart failure patients are discussed.