Exercise Intervention Studies Research Articles

Interventions to prevent adverse fetal programming due to maternal obesity during pregnancy

Maternal obesity is a global epidemic affecting both developed and developing countries. Human and animal studies indicate that maternal obesity adversely programs the development of offspring, predisposing them to chronic diseases later in life. Several mechanisms act together to produce these adverse health effects. There is a consequent need for effective interventions that can be used in the management of human pregnancy to prevent these outcomes. The present review analyzes the dietary and exercise intervention studies performed to date in both altricial and precocial animals, rats and sheep, with the aim of preventing adverse offspring outcomes. The results of these interventions present exciting opportunities to prevent, at least in part, adverse metabolic and other outcomes in obese mothers and their offspring.

Recruitment of Chronically Ill and Mobility-Restricted Older Adults for an Exercise Intervention Study Supported by the General Practitioner's Practice

Recruitment of Chronically Ill and Mobility-Restricted Older Adults for an Exercise Intervention Study Supported by the General Practitioner's Practice

Design of the SHAPE-2 study: the effect of physical activity, in addition to weight loss, on biomarkers of postmenopausal breast cancer risk

BackgroundPhysical inactivity and overweight are two known risk factors for postmenopausal breast cancer. Former exercise intervention studies showed that physical activity influences sex hormone levels, known to be related to postmenopausal breast cancer, mainly when concordant loss of body weight was achieved. The question remains whether there is an additional beneficial effect of physical activity when weight loss is reached.The aim of this study is to investigate the effect attributable to exercise on postmenopausal breast cancer risk biomarkers, when equivalent weight loss is achieved compared with diet-induced weight loss.DesignThe SHAPE-2 study is a three-armed, multicentre trial. 243 sedentary, postmenopausal women who are overweight or obese (BMI 25–35 kg/m2) are enrolled. After a 4-6 week run-in period, wherein a baseline diet is prescribed, women are randomly allocated to (1) a diet group, (2) an exercise group or (3) a control group. The aim of both intervention groups is to lose an amount of 5–6 kg body weight in 10–14 weeks. The diet group follows an energy restricted diet and maintains the habitual physical activity level. The exercise group participates in a 16-week endurance and strength training programme of 4 hours per week. Furthermore, they are prescribed a moderate caloric restriction. The control group is asked to maintain body weight and continue the run-in baseline diet.Measurements include blood sampling, questionnaires, anthropometrics (weight, height, waist and hip circumference), maximal cycle exercise test (VO2peak), DEXA-scan (body composition) and abdominal MRI (subcutaneous and visceral fat). Primary outcomes are serum levels of oestradiol, oestrone, testosterone and sex hormone binding globulin (SHBG).DiscussionThis study will give insight in the potential attributable effect of physical activity on breast cancer risk biomarkers and whether this effect is mediated by changes in body composition, in postmenopausal women. Eventually this may lead to the design of specific lifestyle guidelines for prevention of breast cancer.Trial registrationThe SHAPE-2 study is registered in the register of clinicaltrials.gov, Identifier: NCT01511276.

Study of static yoga, repetitive yoga versus exercise intervention in management of mechanical low BACK pain – A comparitive study

Study of static yoga, repetitive yoga versus exercise intervention in management of mechanical low BACK pain – A comparitive study

Enhanced Conduit Artery Flow-Mediated Dilation in Elite Atheletes

Dear Editor-in-Chief Recently, Green et al. (1) reported structural enlargement and similar or even decreased flow-mediated dilation (FMD) in conduit arteries of elite athletes compared with sedentary counterparts. A previous handgrip exercise intervention study in active young males had provided evidence for the dependence of vascular adaptations on exercise-induced shear stress (7). In accordance with a theory first proposed by Laughlin (3), Green et al. suggested that lack of enhanced FMD in elite athletes might be a common feature of long-term training-induced vascular adaptations related to structural remodeling and normalization of exercise-induced shear stress. Given the relevance of that statement for the future interpretation of FMD data in both exercise science and clinical contexts, we would like to contribute to the discussion. Studies in elite endurance athletes performed by several research groups have shown conflicting FMD results (2,4–6,8). Indeed, there is a balance between studies reporting decreased (1) or normal (1,4,5), and enhanced FMD (2,6,8) in highly trained athletes compared with their sedentary counterparts. A previous study from our group demonstrated higher FMD in predominantly and nonpredominantly trained limbs of national and international class cyclists and swimmers (8). Moreover, we observed signs of structural remodeling such as larger baseline diameters in conduit arteries and also higher muscle perfusion and vascular conductance during isolated exercise in both groups of athletes (8). Interestingly, despite larger baseline artery diameters, peak exercise-induced shear stress was not normalized but increased in the cyclists and swimmers compared with their sedentary controls (8), contrasting with the rationale of the aforementioned statement (1). This finding is a key point to discuss arterial adaptations in highly trained athletes. To the best of our knowledge, no other study reported shear stress during exercise in highly trained athletes, and accordingly, the hypothesis that arterial remodeling necessarily causes normalization of shear stress during exercise training bouts remains to be explored, especially at the high exercise intensity levels reached by elite athletes. On the other hand, we do not discard that a partial normalization of shear stress may occur in highly trained athletes at some stages during their training program, thus decreasing the stimulus for FMD enhancement. Nonetheless, taking together, the literature does not support the existence of a steady arterial adaptation state characteristic of highly trained athletes as implied before (1). Although speculative, it is conceivable that arterial endothelial function adaptations could be strongly dynamic and related to variations in training intensity, volume, frequency, and modality of periodized training programs commonly followed by elite athletes to reach peak performance at particular time points during the competitive season. In conclusion, few research groups and thus few studies have investigated FMD in highly trained athletes. Therefore, until more evidence becomes available, we suggest to keep this interesting and consequential question open to further discussion. David Montero, Hons Philippe Obert, PhD Guillaume Walther University of Avignon Laboratoire de Pharm-Ecologie Cardiovasculaire Avignon, France

Web-Enabled Feedback Control Over Energy Balance Promotes an Increase in Physical Activity and a Reduction of Body Weight and Disease Risk in Overweight Sedentary Adults

This study aims to investigate whether a Web-based tool will facilitate the adoption of feedback control over calorie balance in overweight individuals, thereby promoting an increase of physical activity and a reduction of body weight and cardiovascular risk factors. This is a prospective exercise intervention study, commencing with a minimum weekly 3 × 20-min requirement of high-intensity interval training and requirement for Web-based self-monitoring and self-reporting of exercise and body weight. Subjects of this study include 83 overweight, sedentary, otherwise healthy adults aged 26-68 years. Anthropometric parameters, body fat, peak oxygen consumption, self-reported physical activity, frequency of use of the Web-based tool are among the characters measured in this study. This 24-week intervention substantially increased time spent for exercise (mean and median of 135 and 170 min/week, respectively) among the 72 % of participants who had adopted cognitive feedback control vs. no increase in the remaining participants of nonadopters. Adopters witnessed significantly improved peak oxygen consumption of >1 metabolic equivalent vs. no improvement among nonadopters. Adopters also reduced body mass index, body weight, and body fat by 1.6 kg/m(2), 4.8 kg, and 3.6 kg, respectively vs. 0.4 kg/m(2), 1.4 kg, and 1.1 kg in the control group. The increase in physical activity came at virtually no intervention effort of the investigators. This study demonstrates for the first time that adoption of cognitive feedback control over energy balance is possible with the help of a simple Web-based tool and that overweight adopters self-regulate exercise volume to significantly reduce body weight and improve biomarkers of fitness and cardiovascular risk.

An Increase in School-Based Physical Education Increases Muscle Strength in Children

Children and adolescents are encouraged to maintain a habitually active lifestyle because of the known health benefits associated with regular physical activity, but there are some reports that a high level of activity may be associated with increased fracture risk. This prospective controlled exercise intervention study in prepubertal children evaluated if a school-based exercise intervention could enhance growth-related gains in muscle strength and muscular function without affecting fracture risk. Fractures were registered in 417 girls and 500 boys age 7-9 yr in the intervention and in 836 age-matched girls and 872 boys. The intervention included 40 min·d of school physical education for 2 yr, whereas the controls achieved 60 min·wk. In a subsample consisting of 49 girls and 80 boys in the intervention and 50 girls and 53 boys in the control group, body composition was measured by dual-energy x-ray absorptiometry, muscle strength by isokinetic peak torque (PT) of the knee extensors, and flexors at 60 and 180°·s by a computerized dynamometer and neuromuscular performance by vertical jump height. The rate ratio (95% confidence interval) for children in the intervention group to sustain a fracture was 1.07 (0.66-1.68). The annual gain in knee extensor PT at 180°·s was significantly higher for both girls (P < 0.001) and boys (P < 0.01) in the intervention compared with the control group. Boys in the intervention group also had a greater annual gain in knee flexion PT at 180°·s (P < 0.001), and girls had a greater gain in vertical jump height (P < 0.05). An increase in school-based physical education from 60 to 200 min·wk enhanced muscle strength in prepubertal children without affecting fracture risk.

Improved femoral neck BMD in older Finnish women between 2002 and 2010

PurposeThe number of hip fractures among Finns over 50-years of age rose constantly between 1970 and 1997, but since then, there has been a nationwide decline in incidence of hip fractures. One possible explanation, although not the only one, for the declining fracture rates, could be improved bone mineral density (BMD). The aim of this study was to evaluate differences in femoral neck BMD between older Finnish women born about a decade apart. MethodsWe compared the baseline data of two population-based samples of home-dwelling 70–80-year-old women who were initially recruited in exercise intervention studies (N=216 in Cohort1, and N=389 in Cohort 2). Femoral neck BMD was measured with DXA. Between-cohort differences were evaluated with analysis of covariance using age, height, weight, and use of hormone therapy as covariates. ResultsThe later-born Cohort 2 was somewhat older and taller than Cohort 1. Adjusted mean difference (95% CI) in femoral neck BMD between the cohorts was 0.043g/cm2 (0.023–0.064) corresponding the mean difference of 0.36 (0.19–0.53) in T-score in favor of Cohort 2. ConclusionsDespite several factors that basically could have indicated lower mean BMD in Cohort 2, the finding was the opposite. This suggests that the mean femoral neck BMD has increased substantially among older Finnish women within a decade, but primary reason for this improvement remains unclear, but improved social and economic resources may have at least partly accounted for this favorable phenomenon.

Abstract TMP88: Slipping, Tripping, and Rapid Ambulation are Key Fall Triggers for Stroke Survivors

Background: Stroke survivors fall up to seven times more annually than healthy adults of a similar age. The inability to recover balance from slipping, tripping, or rapid ambulation accounts for the majority of falls, while balance control can prevent falls. An examination of the triggers for falls and balance recovery strategies for near falls is crucial for fall prevention in stroke survivors. Purpose: To examine the self-reported triggers for falls and balance recovery strategies for near falls among community-dwelling stroke survivors. Methods: Descriptive study examining fall-related data from stroke survivors (n=89) aged ≥ 50 years, at ≥ 3 months post-stroke, participating in a 12-week exercise intervention study. All subjects were interviewed weekly to ascertain fall/near fall data over the 12 weeks. Falls were defined as: “events in which subjects end up on the floor or ground when they did not expect to.” Near falls were defined as: “events in which subjects recovered their balance without falling.” Results: Subjects (46% women) were on average 70±10 years old. The majority reported an ischemic stroke (80%), were White/European-American (79%), married/partnered (60%), college-educated (79%), and retired/unemployed (93%). Over the 12-week trial, there were a total of 124 fall-related events (n=34 falls, n=90 near falls); all events happened at home. Most falls happened due to slipping or tripping (21%) or rapid ambulation (18%). Other reported fall triggers included: legs or knees giving way (12%), bathroom related incidents such as incontinence (12%), reaching or leaning (6%), and vertigo or syncope (3%). Subjects most commonly recovered their balance without falling by grabbing onto or leaning against something (62%). A total of 29 (23%) fall-related events resulted in an injury, though only 8% of those events were evaluated by a healthcare provider. Conclusion: Our data suggests that stroke survivors fall most frequently as a result of slipping, tripping or rapid ambulation. Future studies investigating the effects of fall prevention strategies on these fall triggers are recommended. Since balance recovery was aided by grabbing onto or leaning against something, post-stroke home safety evaluation is essential in preventing falls.

A 5-Year Exercise Program in Pre- and Peripubertal Children Improves Bone Mass and Bone Size Without Affecting Fracture Risk

We studied the effect in children of an exercise intervention program on fracture rates and skeletal traits. Fractures were registered for 5 years in a population-based prospective controlled exercise intervention study that included children aged 6-9 years at study start, 446 boys and 362 girls in the intervention group and 807 boys and 780 girls in the control group. Intervention subjects received 40 min/school day of physical education and controls, 60 min/week. In 73 boys and 48 girls in the intervention group and 52 boys and 48 girls in the control group, bone mineral density (BMD, g/cm(2)) and bone area (mm(2)) were followed annually by dual-energy X-ray absorptiometry, after which annual changes were calculated. At follow-up we also assessed trabecular and cortical volumetric BMD (g/cm(3)) and bone structure by peripheral computed tomography in the tibia and radius. There were 20.0 fractures/1,000 person-years in the intervention group and 18.5 fractures/1,000 person-years in the control group, resulting in a rate ratio of 1.08 (0.79-1.47) (mean and 95 % CI). The gain in spine BMD was higher in both girls (difference 0.01 g/cm(2), 0.005-0.019) and boys (difference 0.01 g/cm(2), 0.001-0.008) in the intervention group. Intervention girls also had higher gain in femoral neck area (difference 0.04 mm(2), 0.005-0.083) and at follow-up larger tibial bone mineral content (difference 0.18 g, 0.015-0.35), larger tibial cortical area (difference 17 mm(2), 2.4-31.3), and larger radial cross-sectional area (difference 11.0 mm(2), 0.63-21.40). As increased exercise improves bone mass and in girls bone size without affecting fracture risk, society ought to encourage exercise during growth.

Impact of lifestyle modification on glycemic control in patients with type 2 diabetes mellitus

Background:Current treatment guidelines support the role of lifestyle modification, in terms of increasing the quantity and quality of physical activity to achieve target glycemia in patients with type 2 diabetes mellitus.Objective:To assess the effect of structured exercise training and unstructured physical activity interventions on glycemic control.Materials and Methods:This was a randomized six-month exercise intervention study conducted with previously inactive 279 patients of type 2 diabetes mellitus. Before randomization, all enrolled T2DM participants (n: 300; 30 to 60 year old, having diabetes for more than a year with HbA1c levels of 6.5% or higher) entered a one-month run-in phase to reduce dropout and maintain adherence.Results:A recommendation to increase physical activity was beneficial (0.14% HbA1c reduction; P = 0.12), but was not bringing significantly declines in HbA1c, whereas, structured exercise training is associated with a significant HbA1c decline of 0.59%. (P = 0.030). In a subgroup analysis limited to participants with a baseline HbA1c value > 7%, both the unstructured (0. 48%; P = 0.04) and structured exercise training (0.77%; P < 0.01) groups experienced significant decline in HbA1c Vs the control, whereas among participants with baseline hemoglobin A1c values less than 7%, significant reduction occurred only in the structured exercise training group. Changes in blood pressure; total cholesterol, HDL-cholesterol (high-density lipoprotein), LDL-cholesterol (low-density lipoprotein) and the atherogenic index factors did not statistically significantly differ within (baseline to follow-up) and among groups.Conclusion:Supervised structured training was more efficacious than unstructured activity in achieving declines in HbA1c. Although both structured and unstructured training provide benefits, only the former was associated with significant reductions in HbA1c levels. Therefore, T2DM patients should be stimulated to participate in specifically designed exercise intervention programs.

Oxidative Stress and Cardiovascular Risk in Overweight Children in an Exercise Intervention Program

This study aimed to determine whether oxidative stress was related to cardiovascular risk indices in children, and whether an exercise intervention would reduce oxidative stress. A randomized trial of two different doses of exercise and a no-exercise control group included 112 overweight and obese children, 7-11 years old. Plasma isoprostane levels were obtained at baseline and after the intervention. Cross-sectional analysis of oxidative stress and metabolic markers at baseline was performed. The effect of the exercise training on oxidative stress was tested. Lower isoprostane levels were observed in blacks. At baseline, isoprostane was positively related to measures of fatness (BMI, waist circumference, percent body fat), insulin resistance and β-cell function (fasting insulin, insulin area under the curve, Matsuda index, disposition index, oral disposition index), and several lipid markers (low-density lipoprotein, triglycerides, total cholesterol), and inversely with fitness [peak oxygen consumption (VO(2))], independent of race, sex, and cohort. No relation was found with visceral fat, blood pressure, or glycemia. Independent of percent body fat, isoprostane predicted triglycerides, β=0.23, total cholesterol-to-high-density lipoprotein (TC/HDL) ratio, β=0.23, and insulin resistance (insulin area under the curve, β=0.24, Matsuda index, β=-0.21, oral disposition index, β=0.33). Exercise did not reduce oxidative stress levels, despite reduced fatness and improved fitness in these children. Isoprostane levels were related to several markers of cardiovascular risk at baseline; however, despite reduced fatness and improved fitness, no effect of exercise was observed on isoprostane levels. To our knowledge, this is the first report in children to demonstrate a correlation of oxidative stress with disposition index, fitness, and TC/HDL ratio, the first to test the effect on oxidative stress of an exercise intervention that reduced body fat, and the first such exercise intervention study to include a substantial proportion of black children.

Effect of Physical Activity (PA) Interventions On Health-Related Quality of Life (HRQoL) Post Hematopoietic Stem Cell Transplantation (HSCT): A Systematic Review and Meta-Analysis

AbstractAbstract 1968 Background:Recent advances in HSCT have resulted in improved overall and relapse-free survival and decreased incidence of serious complications. Improved survival has prompted an increased focus on enhancing HRQoL. There is an accumulating body of evidence emphasizing that physical activity (PA) may be one modifiable lifestyle factor associated with decreased negative side effects related to HSCT and improved HRQoL. We sought to summarize the available evidence related to the effects of PA participation and HRQoL in HSCT recipients. Methods:We searched electronic databases including Pubmed/MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and conference proceedings from American Society of Hematology and American Society of Clinical Oncology to April 1, 2012. No language or publication date limits were used. Studies were eligible for inclusion if they were randomized controlled trials (RCTs) or quasi-experimental trials with a control group comparing exercise interventions with placebo-control or standard of care in adult HSCT recipients. Exercise was defined as any form of PA that was performed on a repeated basis for a fixed time frame over a fixed time interval. Included studies were required to have a HRQoL measure as a primary (1o) or secondary (2o) outcome. Change in global HRQoL from pre to post-intervention for intervention and control groups were compared using a DerSimonian and Laird random effects model. Heterogeneity was assessed by calculating the Q- and I2 statistics. Meta-regression was performed for the following study characteristics: total number (no.) of study participants; mean age; % female; average body mass index (BMI); mean exercise duration in minutes per session; intervention length in weeks; % adherence; type of transplant (allo- or combination of allo- and auto-transplants); and whether HRQoL was a 1o or 2o outcome. Sensitivity analysis assessed the cumulative effect of studies by publication year and no. of participants. Influential analysis was conducted to determine change in pooled effect estimate by removing one study at a time. Publication bias was assessed the Begg's rank correlation and Egger's regression test and plot. Results:Of the 1606 studies originally identified, 7 studies involving 420 patients who underwent HSCT (of which 208 were assigned to exercise or PA intervention) met all inclusion criteria. One study was excluded from the final analysis as it was identified as an extreme outlier. All 6 remaining studies used the European Organization of Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) measurement tool thus weighted mean differences (WMD) were calculated for ease of interpretation. Participation in an exercise intervention resulted in an increase in global HRQoL with a WMD of 4.72 points (95% CI: −0.04, 9.47; P = 0.05). The proportion of variability in WMD attributed to intra-study heterogeneity was 65% (95% CI: 15%, 85%; P = 0.02) and was due primarily to variation in exercise intervention protocols and study quality. Meta-regression identified that whether HRQoL was a 1o or 2o outcome significantly affected the pooled effect estimate (P=0.02). Sensitivity analysis did not reveal any important trends. Influential analysis demonstrated that the study with the most influence when removed was Baumann A, where WMD decreased to 2.86 points (95% CI: −1.25, 8.57). There was no statistical evidence of publication bias by assessment with the Egger’s regression test (coefficient for bias 2.35, 95% CI −1.90 to, 6.59, P = 0.20) and Begg’s rank correlation test (Z-score 0.75 with continuity correction, P = 0.45). Conclusions:This analysis summarizes the best available evidence regarding effect of exercise participation on overall self-reported HRQoL in adult HSCT recipients. The pooled estimate, after excluding outliers, showed that exercise participation resulted in a 4.72 point increase in the global HRQoL score on the EORTC QLQ-C30 measure, which was borderline statistically significant (P =0.05). This effect estimate is similar in magnitude to pivotal meta-analyses of exercise interventions in breast cancer survivors. Substantial heterogeneity existed among included trials. Larger RCTs with a strong focus on study quality and long-term effects of exercise participation should be conducted. [Display omitted] Disclosures:No relevant conflicts of interest to declare.

Bradykinin type 2 receptor -9/-9 genotype is associated with triceps brachii muscle hypertrophy following strength training in young healthy men

BackgroundBradykinin type 2 receptor (B2BRK) genotype was reported to be associated with changes in the left-ventricular mass as a response to aerobic training, as well as in the regulation of the skeletal muscle performance in both athletes and non-athletes. However, there are no reports on the effect of B2BRK 9-bp polymorphism on the response of the skeletal muscle to strength training, and our aim was to determine the relationship between the B2BRK SNP and triceps brachii functional and morphological adaptation to programmed physical activity in young adults.MethodsIn this 6-week pretest-posttest exercise intervention study, twenty nine healthy young men (21.5 ± 2.7 y, BMI 24.2 ± 3.5 kg/m2) were put on a 6-week exercise protocol using an isoacceleration dynamometer (5 times a week, 5 daily sets with 10 maximal elbow extensions, 1 minute rest between sets). Triceps brachii muscle volumes were assessed by using magnetic resonance imaging before and after the strength training. Bradykinin type 2 receptor 9 base pair polymorphism was determined for all participants.ResultsFollowing the elbow extensors training, an average increase in the volume of both triceps brachii was 5.4 ± 3.4% (from 929.5 ± 146.8 cm3 pre-training to 977.6 ± 140.9 cm3 after training, p<0.001). Triceps brachii volume increase was significantly larger in individuals homozygous for −9 allele compared to individuals with one or two +9 alleles (−9/-9, 8.5 ± 3.8%; vs. -9/+9 and +9/+9 combined, 4.7 ± 4.5%, p < 0.05). Mean increases in endurance strength in response to training were 48.4 ± 20.2%, but the increases were not dependent on B2BRK genotype (−9/-9, 50.2 ± 19.2%; vs. -9/+9 and +9/+9 combined, 46.8 ± 20.7%, p > 0.05).ConclusionsWe found that muscle morphological response to targeted training – hypertrophy – is related to polymorphisms of B2BRK. However, no significant influence of different B2BRK genotypes on functional muscle properties after strength training in young healthy non athletes was found. This finding could be relevant, not only in predicting individual muscle adaptation capacity to training or sarcopenia related to aging and inactivity, but also in determining new therapeutic strategies targeting genetic control of muscle function, especially for neuromuscular disorders that are characterized by progressive adverse changes in muscle quality, mass, strength and force production (e.g., muscular dystrophy, multiple sclerosis, Parkinson’s disease).

Abstract B70: Design of the SHAPE-2 trial; Effects of equivalent weight loss, with and without exercise, on postmenopausal breast cancer risk

Abstract Background: Physical inactivity and overweight are two modifiable risk factors for breast cancer. These factors probably act through sex hormone-related pathways. The results of dietary intervention studies (mostly uncontrolled) suggest that diet-induced weight loss reduces postmenopausal sex hormone levels. The question remains if the beneficial effect of physical activity on breast cancer risk is fully explained by the accompanied weight loss. Three out of four exercise intervention studies showed that physical activity mainly influences hormone levels when concordant loss of body fat is achieved. One intervention study, however, suggests an effect of exercise on sex hormones independent of changes in adiposity. Therefore, we set out to study the effect of weight loss mainly driven by exercise compared to equivalent diet induced weight loss only on sex hormone levels. Methods/Design: We designed a three-armed, single blind, two-centre trial in 250 sedentary, postmenopausal women who are overweight/obese (BMI 25-35 kg/m2). Women are randomly allocated to a (1) Diet induced weight loss group, (2) Exercise induced weight loss group or (3) a stable weight Control group. The aim of both intervention groups is to loose an equivalent amount of 5-6 kg body weight in 10 to 14-week timeframe. The Diet-group will therefore follow an energy restricted diet. The Exercise-group will participate in a 16-week endurance and strength training programme (4 hours/week) combined with a slight caloric intake restriction. Measurements include blood sampling, questionnaires, anthropometrics, maximal exercise test, total body DEXA-scan (body (fat) composition) and MRI (abdominal fat). The main outcomes are endogenous serum levels of estradiol, estrone, testosterone and sex hormone binding globulin (SHBG). Discussion: This study will give insight in the possible attributable effect, and the underlying mechanisms, of physical activity on endogenous sex hormone levels, directly and/or mediated by changes in body(fat) composition, in postmenopausal women. Eventually this may lead to the design of more specific guidelines on lifestyle interventions and physical activity for prevention of breast cancer. Citation Format: Willemijn AM van Gemert, Petra HM Peeters, Jantine A. Schuit, Evelyn M. Monninkhof. Design of the SHAPE-2 trial: Effects of equivalent weight loss, with and without exercise, on postmenopausal breast cancer risk. [abstract]. In: Proceedings of the Eleventh Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2012 Oct 16-19; Anaheim, CA. Philadelphia (PA): AACR; Cancer Prev Res 2012;5(11 Suppl):Abstract nr B70.

The effects of a six-week supervised multimodal exercise intervention during chemotherapy on cancer-related fatigue

PurposeCancer related fatigue (CRF) is a common problem for cancer patients across diagnoses during chemotherapy and is associated with physical inactivity, lower functional level and lack of energy. Few RCT exercise intervention studies have included cancer patients undergoing chemotherapy. The objective of this study is to evaluate whether a six-week supervised multimodal exercise intervention, adjunct to chemotherapy and standard care, can reduce the patient's CRF level. MethodsData is based on analyses of a prospective randomised controlled trial ‘The Body & Cancer Trial’. 213 cancer patients with different diagnoses were randomised into an intervention group or wait-list control group. The primary outcome, Fatigue score (CRF), was evaluated by the Functional Assessment of Cancer Therapy-Anaemia Questionnaire (FACT-An-) (FACT-G score & FACT-An Anemia subscale). Intervention: Supervised exercise, comprising high-intensity cardiovascular and heavy resistance training, relaxation- and body awareness training and massage, 9 h weekly for 6 weeks. ResultsCRF was significantly reduced in the intervention group, corresponding to a Fatigue score reduction of 3.04 (effect size of 0.44, 95% CI 0.17–0.72) (P = .002), the FACT-An score by 5.40 (P = .015), the FACT-An Toi score by 5.22 (P = .009) and the Anaemia-ANS by 3.76 (P = .002). There was no statistically significant effect on the General Quality of Life score (FACT-G) or on any of the individual wellbeing scores; Physical (P = .13), Emotional (P = .87), Social (P = .83) and Functional (P = .26). ConclusionIn summary, this six-week supervised multimodal exercise intervention can lead to significant reduction in self-reported CRF in cancer patients undergoing chemotherapy.

Abstract B47: A home-based motivational exercise intervention for African American breast cancer survivors: A pilot study.

Abstract Background: Compared with White breast cancer survivors, African American (AA) survivors engage in less physical activity following diagnosis and treatment. Exercise intervention studies have shown that regular physical activity is associated with improvements in physical function, cardiopulmonary fitness, muscle strength, fatigue, mood, and overall quality of life (QOL) in breast cancer survivors. Researchers have found that AA breast cancer survivors who met recommended physical activity levels reported significantly better physical and psychological QOL than those not meeting recommendations. Research on the benefits of exercise in breast cancer survivor's outcomes continues to grow, but further research is needed on how best to deliver exercise programs to AA survivors. The objectives of this study were to determine whether AA participants of a 4-month home-based motivational exercise intervention increase their physical activity and explore whether exercise has a positive impact on health and fitness. Methods: Seventeen AA breast cancer survivors, stage 0-IIIa, who were within 2 years of completing primary cancer treatments were recruited for this 16 week home-based progressive aerobic and resistance training exercise pilot study. To date, complete data has been obtained on 9 participants. Participants completed self-administered physical activity questionnaires, as well as measures for fatigue and QOL at baseline and 4 months post intervention. Two visits, baseline and post intervention, were required for health and fitness testing. Testing included cardiopulmonary exercise testing, muscle strength, functional movement assessment, and DEXA scans for body composition. Motivational interviewing (MI) was utilized at baseline to determine goals, exercise self-efficacy and to explore facilitators and barriers to exercise. Participants completed weekly exercise logs and received a weekly phone call based on MI techniques. Wilcoxon Signed Rank tests were used to detect significant changes in physical activity, as well as changes in fitness parameters, fatigue and QOL. Results: The mean age of the 9 participants was 51 years. Body mass index at baseline ranged from 25.3-39.3 with a mean of 30.5. At baseline the mean minutes of total physical activity per week was 36.88 (SD = 46.59). There was a significant increase in minutes of total physical activity a week post intervention (M = 169, SD = 111.6; p = 0.008). Significant improvements were found in cardiopulmonary fitness as measured by VO2peak with a mean increase of 2.36 ml/kg/min (p = 0.004). Muscle strength increased, with significant findings for left arm extension (p = 0.004), right arm flexion (p = 0.03), left leg extension (p = 0.008), right leg extension (p = 0.004) and flexion (p = 0.03). There were no significant differences in percentage of body fat or lean muscle mass on DEXA scan. While both QOL and fatigue scores increased, indicating improvement, neither were significant. Conclusions: Most women increased their physical activity to at least 150 minutes/week, which is the minimum recommended level of weekly moderate physical activity for cancer survivors to help improve health and prevent other illnesses. Preliminary analyses indicate that the intervention was effective at increasing physical activity and as a result improvements were found on several physiologic health measures. Note: This abstract was withdrawn after the Program and Proceedings were printed and was not presented at the conference. Citation Format: Denise Spector, Allison M. Deal, Hojin Yang, Claudio Battaglini. A home-based motivational exercise intervention for African American breast cancer survivors: A pilot study. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr B47.

Systematic review of the methodological quality and outcome measures utilized in exercise interventions for adults with spinal cord injury

Systematic literature review. The primary aims of this study were to evaluate the methodological quality of exercise intervention studies in adults with spinal cord injuries (SCIs); and to classify the reported outcome measures according to the International Classification of Functioning, Disability and Health (ICF). Electronic searches of PubMed, CINAHL, SPORTDiscus, PsychINFO, Scopus and the Cochrane Center Register of Controlled Trials from 2001 to 2011 were performed. Selected studies were evaluated for methodological quality using the Downs and Black checklist. Outcome measures were extracted and linked to categories of the ICF using standardized linking rules. Two-hundred forty abstracts were retrieved, 57 studies met eligibility criteria. The mean methodological quality score was 14.7 ± 3.2 out of 28 on the Downs and Black checklist. Three-hundred seventy four outcome measures were extracted with 333 concepts linked to 35 second-level ICF categories across the four components. Studies of exercise interventions for adults with SCI included in this review are generally low in methodological quality, primarily reporting outcomes related to the Body Functions and Body Structures components of the ICF. It is recommended that studies employ more vigorous methodological designs to reduce bias and confounding, and include outcome measures targeting more categories in the Activities and Participation component so as to reflect the potential benefits of exercise on health and functioning in this population.

Are Older Adults Who Volunteer to Participate in an Exercise Study Fitter and Healthier Than Nonvolunteers? The Participation Bias of the Study Population

BACKGROUND: Participation bias in exercise studies is poorly understood among older adults. This study was aimed at looking into whether older persons who volunteer to participate in an exercise study differ from non-volunteers. METHODS: A self-reported questionnaire on physical activity and general health was mailed out to 1000 persons, aged 60 or over, who were covered by the medical insurance of the French National Education System. Among them, 535 answered it and sent it back. Two hundred and thirty-three persons (age 69.7 ±7.6, 65.7% women) said they would volunteer to participate in an exercise study and 270 (age 71.7 ±8.8, 62.2% women) did not. RESULTS: Volunteers were younger and more educated than non-volunteers, but they did not differ in sex. They had less physical function decline and higher volumes of physical activity than non-volunteers. Compared to volunteers, non-volunteers had a worse self-reported health and suffered more frequently from chronic pain. Multiple logistic regressions showed that good self-reported health, absence of chronic pain, and lower levels of physical function decline were associated with volunteering to participate in an exercise study. CONCLUSIONS: Volunteers were fitter and healthier than non-volunteers. Therefore, caution must be taken when generalizing the results of exercise intervention studies.

Heart Rate Variability Assessment of the Effect of Physical Training on Autonomic Cardiac Control

The effect of exercise interventions on autonomic nervous system (ANS) control of the heart by heart rate variability (HRV) is often investigated in just one position. It was hypothesized that results of exercise-induced changes on ANS are dependent on body position and that it is possible to distinguish between exercise induced changes in vagal and sympathetic influence by taking measurements in different body positions. One hundred eighty-three (male = 100, female = 83) healthy volunteers, between 18 and 22 years, participated in a prospective twelve week medium to high intensity exercise intervention study with a self-control design. The influence of the exercise intervention was investigated on supine, rising, and standing as well as on the orthostatic response. Time domain, frequency domain and nonlinear (Poincaré) HRV analysis were performed. The exercise intervention lead to a significant increase (P < 0.05) in vagal influence during supine, rising, and standing. Sympathetic control in the supine position was decreased and increased during rising and standing. In the initial orthostatic response to rising from the supine position, the exercise intervention lead to increased (P < 0.05) vagal withdrawal as well as increased sympathetic control. The orthostatic response measured as the difference between standing and supine indicated only an exercise induced increase in sympathetic control. Exercise-induced changes in sympathetic and parasympathetic ANS control differ, depending on posture and period of measurement. Exercise induced changes in parasympathetic and sympathetic outflow, respectively, can be extracted from measurements from supine, through the orthostatic response, to standing, thereby detecting changes in ANS that are otherwise obscured.