Exercise Intervention Studies Research Articles

A Longitudinal Study of a Multicomponent Exercise Intervention with Remote Guidance among Breast Cancer Patients.

Purpose: Breast cancer patients in treatment suffer from long-term side effects that seriously influence their physical and mental health. The aim of this study was to examine effectiveness of a 12-week multicomponent exercise (ME) with remote guidance intervention on health-related outcomes after one year among breast cancer patients. Methods: In phases I–III, 60 patients (51.2 ± 7.9 years) with breast cancer (BC) who completed chemotherapy/postoperative radiotherapy within the previous four months to two years were randomly assigned to (1) multicomponent exercise with remote guidance (ME) and (2) usual care (UC). Eligible participants were approached to assess cancer-related quality of life (QOL), muscle strength, cardiorespiratory endurance, and physical activity (PA) barriers after one year. Results: The results demonstrated that, after one year, the ME group reported higher vitality-related QOL (5.776, 95% confidence interval [CI] 0.987, 10.565, effect size [ES] = 0.360), mental health-related QOL (9.938, 95% CI 4.146, 15.729, ES = 0.512), leg strength and endurance (2.880, CI 1.337, 4.423, ES = 0.557), and strength and endurance of upper extremities (2.745, 95% CI 1.076, 4.415, ES = 0.491) and lower physical activity (PA) hindrance (5.120, 95% CI 1.976, 8.264, ES = 0.486) than the UC group. Conclusions: The ME group observed significant differences from the UC group in QOL, muscle strength, cardiopulmonary endurance, and PA participation. These findings suggested that the multicomponent exercise intervention with remote guidance produced long-term health benefits for breast cancer patients.

Physical activity among individuals with spinal cord injury who ambulate: a systematic scoping review.

Systematic scoping review. The purpose of this project was to conduct a scoping review to understand the amounts, types, correlates, and outcomes of physical activity (PA) participation for ambulators with SCI. A systematic search was employed among five large databases and two theses/dissertation databases, yielding 3257 articles. Following a two-phase screening process by independent coders, 17 articles were included in the review. Data were charted and summarized, and correlates were coded using the COM-B model. 11 studies were cross-sectional, 5 studies involved an exercise intervention, and 1 study used mixed methods. Overall, ambulators with SCI participated in low levels of PA. The type of PA investigated across all studies was leisure-time PA (e.g., sports, exercise). Psychological and physical capability (e.g., perceived behavioral control, fatigue), social and environmental opportunity (e.g., perceptions of disability, cost), and automatic and reflective motivation (e.g., boredom, intentions) were correlates of PA measured within studies. Exercise intervention studies measured physical (e.g., strength, fitness) and one psychological outcome (i.e., depression). No studies examined the quality of PA experiences. Only leisure-time PA has been investigated among ambulators with SCI, and low levels of leisure-time PA have been reported. Correlates of leisure-time PA can be mapped onto all COM-B model constructs and are potential targets for PA-enhancing interventions. Further investigation is warranted into the physical and psychosocial outcomes across all types of LTPA in addition to understanding the quality of LTPA experiences.

Daily School Physical Activity from Before to After Puberty Improves Bone Mass and a Musculoskeletal Composite Risk Score for Fracture.

This 7.5-year prospective controlled exercise intervention study assessed if daily school physical activity (PA), from before to after puberty, improved musculoskeletal traits. There were 63 boys and 34 girls in the intervention group (40 min PA/day), and 26 boys and 17 girls in the control group (60 min PA/week). We measured musculoskeletal traits at the start and end of the study. The overall musculoskeletal effect of PA was also estimated by a composite score (mean Z-score of the lumbar spine bone mineral content (BMC), bone area (BA), total body lean mass (TBLM), calcaneal ultrasound (speed of sound (SOS)), and muscle strength (knee flexion peak torque)). We used analyses of covariance (ANCOVA) for group comparisons. Compared to the gender-matched control group, intervention boys reached higher gains in BMC, BA, muscle strength, as well as in the composite score, and intervention girls higher gains in BMC, BA, SOS, as well as in the composite score (all p < 0.05, respectively). Our small sample study indicates that a daily school-based PA intervention program from Tanner stage 1 to 5 in both sexes is associated with greater bone mineral accrual, greater gain in bone size, and a greater gain in a musculoskeletal composite score for fractures.

Vascular Structure and Function in Children and Adolescents: What Impact Do Physical Activity, Health-Related Physical Fitness, and Exercise Have?

A physically active lifestyle can prevent cardiovascular disease. Exercise intervention studies in children and adolescents that aim to increase physical activity have resulted in reduced vascular wall thickening and improve cardiovascular function. Here we review the literature that explores the correlations between physical activity, health-related physical fitness, and exercise interventions with various measures of vascular structure and function in children and adolescents. While several of these studies identified improvements in vascular structure in response to physical activity, these associations were limited to studies that relied on questionnaires. Of concern, these findings were not replicated in studies featuring quantitative assessment of physical activity with accelerometers. Half of the studies reviewed reported improved vascular function with increased physical activity, with the type of vascular measurement and the way physical activity was assessed having an influence on the reported relationships. Similary, most of the studies identified in the literature report a beneficial association of health-related physical fitness with vascular structure and function. Overall, it was difficult to compare the results of these studies to one another as different methodologies were used to measure both, health-related physical fitness and vascular function. Likewise, exercise interventions may reduce both arterial wall thickness and increased vascular stiffness in pediatric populations at risk, but the impact clearly depends on the duration of the intervention and varies depending on the target groups. We identified only one study that examined vascular structure and function in young athletes, a group of particular interest with respect to understanding of cardiovascular adaptation to exercise. In conclusion, future studies will be needed that address the use of wall:diameter or wall:lumen-ratio as part of the evaluation of arterial wall thickness. Furthermore, it will be critical to introduce specific and quantitative measurements of physical activity, as intensity and duration of participation likely influence the effectiveness of exercise interventions.

Non-ambulatory children with cerebral palsy: effects of four months of static and dynamic standing exercise on passive range of motion and spasticity in the hip.

PurposeThe aim of this study was to compare the effects of four months of two types of structured training regimes, static standing (StS) versus dynamic standing (DyS), on passive range of motion (PROM) and spasticity in the hip among non-ambulatory children with cerebral palsy.MethodTwenty non-ambulatory children with cerebral palsy participated in an exercise intervention study with a crossover design. During StS, the Non-ambulatory children with cerebral palsy were encouraged to exercise according to standard care recommendations, including daily supported StS for 30–90 min. During DyS, daily exercise for at least 30 min at a speed between 30 and 50 rpm in an Innowalk (Made for movement, Norway) was recommended. We assessed adaptive effects from the exercise programs through PROM in the hip assessed with a handheld goniometer, and spasticity in the hip assessed with the Modified Ashworth Scale before and after 30 min of StS or DyS. A trained physiotherapist performed the assessments. The exercise test and exercise training were performed in the children’s habitual environment. Non-parametric statistics were used and each leg was used as its own control.ResultPROM increased in all directions after 30 min (p < 0.001), and after four months of exercise training (p < 0.001) of DyS. Thirty minutes of DyS lowered the spasticity in the muscles around the hip (p < 0.001) more than 30 min of StS (p < 0.001).ConclusionThirty minutes of DyS increased PROM and decreased spasticity among non-ambulatory children with CP. Four months of DyS increased PROM but did not decrease spasticity. These results can help inform individualised standing recommendations.

Physical function in patients newly diagnosed with multiple myeloma; a Danish cohort study

BackgroundMultiple myeloma is a cancer in the bone marrow causing bone destruction. Patients experience various symptoms related to the disease and/or treatment, such as pain and fatigue, leading to poorer quality of life. The symptom burden might affect physical function and physical activity levels, posing a risk of physical deterioration. The aim was to investigate whether physical function in newly diagnosed patients with multiple myeloma differs from the reference values of the normal population and other cancer patients.MethodsThe study is a cross sectional descriptive analysis of a prospective cohort of 100 patients newly diagnosed with multiple myeloma. Four physical function tests were carried out; Six-Minute-Walk-Test, Sit-to-Stand-Test, grip strength and knee extension strength. Age and gender specific results of physical function from the multiple myeloma population were compared to normative data and to data from other cancer populations.ResultsOf the 100 patients included, 73% had bone disease and 55% received pain relieving medicine. Mean age was 67.7 years (SD 10.3). Patients with multiple myeloma had significantly poorer physical function compared to normative data, both regarding aerobic capacity and muscle strength, although not grip strength. No differences in physical function were found between patients with multiple myeloma and other cancer populations.ConclusionsPhysical function in newly diagnosed Danish patients with multiple myeloma is lower than in the normal population. Exercise intervention studies are warranted to explore the value of physical exercise on physical function.Trial registrationClinicalTrials.gov, ID NCT02439112, registered 8 May 2015.

Lessons learned from a pilot randomized clinical trial of home-based exercise prescription before allogeneic hematopoietic cell transplantation.

Allogeneic hematopoietic cell transplantation (alloHCT) is a life-saving technology that can cure otherwise incurable diseases, but imposes significant physiologic stress upon recipients. This stress leads to short-term toxicity and mid- to long-term physical function impairment in some recipients. Exercise interventions have demonstrated preliminary efficacy in preserving physical function in HCT recipients, but the role of these interventions prior to HCT (prehabilitative) is less known. We tested a 5- to 12-week, prehabilitative higher intensity home-based aerobic exercise intervention in a randomized study of alloHCT candidates. Of 113 patients screened, 34 were randomized to control or intervention groups, 16 underwent pre- and post-intervention peak oxygen consumption (VO2peak) testing, and 12 underwent pre- and post-intervention 6-min walk distance (6MWD) testing. No significant differences in VO2peak or 6MWD were seen pre- to post-intervention between intervention and control groups, but final numbers of evaluable participants in each group were too small to draw inferences regarding the efficacy of the intervention. We conclude that the design of our prehabilitative intervention was not feasible in this pilot randomized study, and make recommendations regarding the design of future exercise intervention studies in alloHCT.

Aerobic capacity attainment and reasons for cardiopulmonary exercise test termination in people with cancer: a descriptive, retrospective analysis from a single laboratory.

Aerobic exercise prescriptions in clinical populations commonly involve target intensities based on cardiopulmonary exercise tests (CPET). CPETs are often discontinued prior to a patient achieving true maximum oxygen consumption (VO2 max) which can adversely affect exercise dose and efficacy monitoring; however, reasons for early discontinuation are poorly reported. Accordingly, we explored the CPET termination reasons in persons with cancer participating in exercise intervention studies. This study comprised of an exploratory, descriptive analysis of retrospective CPET data (VO2 and anaerobic threshold) and termination reasons in a convenience sample of people with cancer participating in exercise intervention studies in a single laboratory. CPETs were standardized using the modified Bruce treadmill protocol with expired gas collection and analysis using a metabolic cart. VO2 max was considered "met" when participants demonstrated (a) oxygen consumption plateau or (b) two of the following criteria: rating of perceived exertion ≥ 9/10, respiratory exchange ratio ≥ 1.15, and/or heart rate of 95% of age-predicted maximum. The frequency and distribution of reasons for test termination relative to the number of CPET exposures for the participants were reported. Forty-four participants engaged in exercise studies between February 2016 and March 2018 provided data for the analysis. Participants completed up to three CPETs during this period (total of 78 CPETs in the current analysis). Eighty-six percent of all CPETs were terminated prior to achieving VO2 max verification criteria and no tests resulted in an oxygen consumption plateau. For those that did not demonstrate achievement of VO2 max verification criteria, reasons for discontinuation were distributed as follows: equipment discomfort-49%, volitional peak-36%, and physical discomfort-14.9%. For those who met VO2 max criteria, volitional peak was the most common reason for test termination (45.5%), followed by physical discomfort (36.4%), and equipment discomfort (18.2%). In our sample of cancer survivors, VO2 max criteria were infrequently met with equipment discomfort being a primary reason for participant-driven test termination. Protocol and equipment considerations are necessary for interpretation and application of CPET findings in clinical practice.

Exercise: A positive feature on functioning in daily life during cancer treatment - Experiences from the Phys-Can study.

Impaired functioning due to cancer treatment is a challenge for daily life. Exercise during treatment can improve functioning. However, research describing experiences of how exercise affects activities of daily life is limited. We aimed to explore how individuals with cancer receiving curative treatment and participating in an exercise intervention experienced their functioning in daily life. Twenty-one participants were recruited from Phys-Can, an exercise intervention study. Semi-structured interviews were conducted after the intervention had finished, and data was analysed using thematic analysis. Two main themes evolved: "Striving to maintain a normal life in a new context" and "Struggling with impairments from side effects of cancer treatment". The supervised group exercise proved popular, and participants reported positive effects on physical and psychological functioning, as well as social and informative support from other participants. Participants struggled with impaired cognitive and physical functioning and exhaustion. They strove to maintain a normal life by adjusting their activities. Perceived physical and psychological benefits from exercise during cancer treatment suggest that exercise should be a part of cancer rehabilitation to facilitate activities and participation in daily life. Striving to maintain a normal life during cancer treatment is vital, and adjustments are needed to maintain activities and participation in daily life. Cancer nurses should motivate patients to engage in physical activity and encourage the introduction of exercise as part of their rehabilitation. They could also support patients in making adjustments to maintain functioning in daily life.

74 - Comparative Success of Recruitment Strategies for an Exercise Intervention Study in Women With Polycystic Ovary Syndrome

We are conducting a prospective, randomized trial examining the effects of exercise training in inactive women with polycystic ovary syndrome (PCOS) aged 18-40. We report here on the comparative success of the recruitment strategies we used.

Higher baseline fat oxidation promotes gynoid fat mobilization in response to a 12-week exercise intervention in sedentary, obese black South African women.

This 12-week exercise intervention study assessed changes in cardiorespiratory fitness (CRF), energy expenditure (EE), and substrate utilisation at rest and during exercise in obese, black South African (SA) women and explored associations with changes in body composition. Black SA women (body mass index: 30-40 kg·m-2, age: 20-35 years) were randomised into control (CTL; n = 15, maintaining usual activity) or exercise (EXE; n = 20; 12 weeks, 4 days·week-1, 40-60 min·day-1 at >70% peak heart rate) groups. Pre- and post-intervention testing included peak oxygen consumption, resting and steady state (50% peak oxygen consumption) EE, respiratory exchange, and body composition (dual-energy X-ray absorptiometry). Dietary intake (4-day) and daily step-count (ActivPAL, activPAL3c; PAL Technologies Ltd, Glasgow, UK) was collected at pre-testing and at 4, 8, and 12 weeks. EXE increased peak oxygen consumption (24.9 ± 2.4 to 27.6 ± 3.4 mL·min-1·kg-1; p < 0.001) and steady state fat oxidation rates (7.5 ± 2.5 to 9.0 ± 2.7 mg·min-1·kg-1 fat-free soft tissue mass; p = 0.003) (same relative exercise intensity). CTL remained unchanged (p > 0.05). EXE reduced proportional gynoid fat mass (percentage total fat mass, p = 0.002). Baseline resting carbohydrate oxidation rates (p = 0.036) and steady state fat oxidation rates (p = 0.021) explained 60.6% of the variability in Δgynoid fat mass (p < 0.001) in EXE. This 12-week exercise intervention improved CRF and steady state fat oxidation rates. Greater reliance on fat oxidation at baseline promoted proportional reductions in gynoid, not visceral, fat mass in response to exercise training. Novelty Combined exercise training in obese black South African women increased cardiorespiratory fitness and rates of fat oxidation during steady state exercise. Exercise training reduced proportional gynoid, not visceral, fat, potentially representing an ethnic/sex-specific response. Baseline substrate utilisation (resting and steady state exercise (50% peak oxygen uptake)) predicted changes in gynoid fat mass.

The effect of cognitive function on mobility improvement among community-living older adults: A 12-week resistance exercise intervention study

ABSTRACT The purpose of the study was to investigate the association between baseline cognitive function and improvement in mobility after 12 weeks of resistance training (3 times/week; 3 sets, 6-8 repetitions at 75-80% of the 1-repetition maximum) among community-dwelling older adults in Iceland (N=205, 73.5±5.7 years, 57.0% female). Body composition, physical activity status, cardiovascular risk factors, 6-minute walk test (6MWT), and Mini-Mental State Examination (MMSE) were measured. The linear regression model was used to examine the association between baseline MMSE and mobility improvement. Mean distance of 6MWT was 462.8±71.6 meter at baseline and mean change after the exercise intervention was 33.7±34.9 meter. The mean MMSE score at baseline was 27.6±1.9. After adjusting for baseline covariates, we found that baseline MMSE score was significantly associated with improvement in mobility among older adults after the exercise intervention. Cognitive function strongly influences the effect of exercise intervention on mobility among older adults.

Differences in Exercise Effects from Static versus Dynamic Standing in Non-Ambulatory Children with Cerebral Palsy

PURPOSE: To compare the metabolic adaptive effects to four months of two types of structured training regimes, static standing (StS) versus dynamic standing (DyS), on cardiopulmonary and metabolic parameters among non-ambulatory children with cerebral palsy (Na-CP). METHODS: Eighteen Na-CP participated in an exercise intervention study with a crossover design, comparing four months of StS to four months of DyS. During StS, the Na-CP were encouraged to exercise according to standard care recommendations in Sweden including daily supported StS for 30-90 minutes. During DyS, daily exercise for at least 30 minutes at a speed between 30 to 50 rpm in an Innowalk (Made for movement, Norway) was recommended. We assessed adaptive effects from the exercise programs through indirect calorimetry during 30 minutes of StS and DyS. Exercise test to evaluate StS was performed in a standing frame and to evaluate DyS using an Innowalk (Made for movement, Norway). An airtight mask covering the mouth and nose was worn in order to measure breath-by-breath VO2, VCO2 and VE (Oxycon Mobile, Jaeger, Germany). Heart rate was recorded continuously throughout the test (Polar T1, Polar, Finland). As many of the variables were linearly correlated, we used robust Principal Component Analysis (rPCA) to determine the components carrying most information. A multidimensional Shapiro-Wilk test indicates that the data can be well described as being multivariate normal distributed, allowing the use of a Hotelling T2 test. RESULTS: In a multidimensional statistical analysis of metabolic exercise effects, oxygen consumption, carbon dioxide production, and ventilation were concluded to carry most information and additionally, seen to be statistical different between StS and DyS reviling a p-value for the two groups having different means of 4.6 *10-5. CONCLUSIONS: A highly statically significant difference was found in the metabolic adaptation, described as VO2, VCO2 and VE, to StS versus DyS.Figure.: Shows the two most relevant components (rpc1 and rpc2), computed using Robust PCA (RPCA). The dark points are the differences of the second and first measurement for StS, the lighter points, are the same difference for DyS. A multidimensional Shapiro-Wilk test was used to define the 95% confidence level ellipses to be drawn.

Personal Training vs. Group-based Exercise Prescription Compliance In Breast Cancer Survivors

PURPOSE: Exercise interventions can improve fitness and quality of life among breast cancer survivors. The magnitude of these effects may be dependent on compliance to the intended exercise prescription (ExRx), but few studies in cancer survivors have reported this information. This study examined breast cancer survivors’ ExRx compliance during a personal training (PT) or group-based exercise (GBE) intervention. METHODS: Women (N=26) with stage I-II breast cancer who had completed chemotherapy and/or radiation treatment within the previous year were randomly assigned to PT or GBE for 8 weeks. All participants received supervised exercise twice per week for 60 minutes a session. Participants were compliant to aerobic ExRx if they completed 20-30 minutes at 50-80% of heart rate reserve. Participants were compliant to upper and lower body resistance ExRx if they completed 2-3 sets of 8 repetitions within 50-80% of 1RM for chest and leg press. Compliance to aerobic, upper, and lower resistance ExRx was coded dichotomously (yes/no) for each session, then summed and divided by the number of sessions attended to calculate percent compliance. Independent t-tests examined differences in ExRx compliance between PT and GBE. Results are reported as mean±SD. RESULTS: Participants were aged 52±8.5 years, and 13.4±5.1 months post diagnosis. Of the N=24 who completed the intervention, exercise session attendance was 15.8±0.5 (99%) in PT, and 13.4±1.0 (82%) in GBE out of 16 possible sessions (p=.000). Compliance for aerobic ExRx was 77.2±0.17% in PT, and 70.1±0.17% in GBE (p=.41). Compliance for upper body resistance ExRx was 76.0±0.37% in PT and 82.4±0.20% in GBE (p=.597). Compliance for lower body resistance exercise was 80.2±0.23% in PT and 87.9±0.21% in GBE (p=.40). CONCLUSION: Exercise session attendance was higher in PT. Overall ExRx compliance was >70% for aerobic, >80% for resistance, and similar in PT and GBE. With growing support for establishing exercise programs for cancer survivors, it is important to determine sustainable and scalable delivery modalities. GBE may be more resource conscientious than PT, and this study suggests GBE can achieve comparable ExRx compliance to PT. Future exercise intervention studies in breast cancer survivors should examine how ExRx compliance affects health and/or fitness outcomes.

Older persons with signs of frailty in a home-based physical exercise intervention: baseline characteristics of an RCT

Increasing the level of physical activity among persons with signs of frailty improves physical functioning. There is a lack of long-term supervised physical exercise intervention studies including a validated definition of frailty. To present baseline characteristics of persons with signs of frailty participating in a randomized long-term home-based physical exercise trial (HIPFRA), and to study associations between the severity of frailty, functional independence and health-related quality-of-life (HRQoL). Three hundred persons, ≥ 65years old and with signs of frailty (assessed by Fried´s phenotype criteria) were recruited from South Karelia, Finland and randomized to a 12-month physiotherapist-supervised home-based physical exercise program (n = 150), and usual care (n = 150). Assessments at the participants' homes at baseline, and after 3, 6 and 12months included the Short Physical Performance Battery (SPPB), the Functional Independence Measure (FIM), HRQoL (15D) and the Mini-Mental State Examination (MMSE). Eligibility was screened among 520 persons; 300 met the inclusion criteria and were randomized. One person withdrew consent after randomization. A majority (75%) were women, 182 were pre-frail and 117 frail. The mean age was 82.5 (SD 6.3) years, SPPB 6.2 (2.6), FIM 108.8 (10.6) and MMSE 24.4 (3.1) points, with no significant differences between the study groups. Inverse associations between the severity of frailty vs. FIM scores and HRQoL (p < 0.001 for both) were found. Our participants showed marked physical frailty without major disabilities. The severity of frailty seems to be associated with impaired functional independence and HRQoL. ClinicalTrials.gov NCT02305433.

The Influence of Continuous Exercising on Chronotropic Incompetence in Multi-Episode Schizophrenia.

People with schizophrenia die on average 15–20 years earlier than age and gender matched controls in the general population. An essential part of this excess mortality in people with schizophrenia is caused by physical illnesses. Among the physical illnesses, cardiovascular disease (CVD) has been identified as the most common natural cause of death in up to 40–45% of the cases. Chronotropic incompetence (CI) is defined as the inability of the heart to increase its beating frequency in proportion to increased physical activity or higher metabolic demand. It is an established independent cardiovascular risk factor for major cardiac events and overall mortality and might explain adaptation intolerance of the cardiovascular system to even minor exercise courses. CI needs objective exercise testing for definitive diagnosis and therefore represents a biological marker indicating the integrity of the cardiovascular system. It was recently described in patients with schizophrenia and might help explain the reduced physical fitness in these patients and the inability of a subgroup of patients to benefit from exercise interventions. In this study, we tried to replicate the occurrence of CI in an independent sample of patients with schizophrenia and evaluated whether CI can be influenced by a continuous endurance training of 12 weeks. Therefore, we re-analyzed the fitness testing data of 43 patients with schizophrenia and 22 aged and gender matched healthy controls. Parameters of aerobic fitness and chronotropic response to exercise were calculated. Patients with schizophrenia were less physically fit than the healthy controls and displayed a significantly higher heart rate at rest. 10 of 43 patients with schizophrenia and no healthy control subject were classified as chronotropically incompetent. Chronotropic response to exercise did not change significantly after 12 weeks of continuous aerobic exercise training. No differences were observed for baseline heart rate and peak heart rate in both subgroups of schizophrenia patients. Aerobic fitness did not improve significantly in the patients with schizophrenia classified as chronotropically incompetent. Our results confirm the occurrence of CI in patients with multi-episode schizophrenia. This should be taken into account when planning an exercise or lifestyle intervention studies in this population. Schizophrenia patients with CI do not seem to benefit as well as schizophrenia patients without CI from aerobic exercise training interventions. Larger, prospective randomized controlled clinical trials with different training interventions are urgently needed to address the topic of schizophrenia patients not responding to exercise and the relationship to the illness itself.

Abstract P319: Salusin-α is a Novel Biomarker of Cardiovascular Disease Risk in Aging and Exercise Lifestyle: Cross-Sectional and Intervention Study

Introduction: A physically active lifestyle leads to reduced risks of cardiovascular disease events in the elderly. A level of circulating salusin-α is a novel biomarker of cardiovascular disease and is associated with increased arterial stiffness. Indeed, circulating levels of salusin-α are lower in patients with coronary arterial disease and hypertension compared to healthy subjects. However, it is unknown whether circulating salusin-α levels are decreased with advanced age and whether circulating salusin-α levels are associated with the reduced cardiovascular disease risks by exercise lifestyle. Hypothesis: We assessed the hypothesis that salusin-α is involved to the changes in cardiovascular disease risk by aging or exercise-promoting healthy lifestyle. Methods: In Experiment 1, 105 healthy subjects (20-80 years old) participated in a cross-sectional study. The subjects were divided into 2 groups: young (under 40 years, n=45) versus middle-age and older (over 40 years, n=60). In Experiment 2, 36 young subjects (young aerobic exercise training group; Young-AT: n=27 and control group; Young-Con: n=9) and 40 healthy middle-age and older subjects (middle-age and older aerobic exercise training group; Middle-age and older-AT: n=26 and control group; Middle-age and older-Con: n=14) volunteered to participate. Subjects in AT groups completed eight weeks of habitual aerobic exercise (60-70% peak oxygen uptake [VO2peak] for 45 min, 3 days/week). We measured serum salusin-α level, carotid-femoral pulse wave velocity (cfPWV), brachial artery systolic (SBP) and diastolic (DBP) blood pressures, common carotid intima-media thickness (ccIMT) and VO2peak. Results: In the cross-sectional study, cfPWV, SBP, DBP and ccIMT were significantly higher and serum salusin-α levels were significantly lower in the middle-age and older adults compared to young adults. Negative correlations were observed between serum salusin-α levels and age (r=–0.698, P&lt;0.01), SBP (r=–0.458, P&lt;0.01), DBP (r=–0.473, P&lt;0.01), cfPWV (r=–0.479, P&lt;0.01), and ccIMT (r=–0.577, P&lt;0.01). In the exercise intervention study, VO2peak and serum salusin-α levels were significantly increased, and cfPWV, SBP and DBP were significantly lowered in the Middle-age and older-AT group compared to the Con group (each P&lt;0.05). Additionally, significant negative correlations between exercise-induced changes in serum salusin-α levels and cfPWV (r=-0.597, P&lt;0.01), SBP (r=–0.591, P&lt;0.01), DBP (r=–0.442, P&lt;0.05) or ccIMT (r=–0.484, P&lt;0.05) were observed in the Middle-age and older-AT group. There were no significant differences for any of the parameters between Young-AT and Con groups. Conclusions: Changes in salusin-α levels may be a novel biomarker of the increase in cardiovascular disease risks with age and the decrease in cardiovascular disease risks with exercise lifestyle in healthy middle-age and older adults.

Abstract P1-12-17: Exercise and nutrition intervention on breast cancer survivors in Taiwan with BMI 25 or more to decrease BMI and maintain at an appropriate level -A preliminary report

Abstract It has been reported that lifestyle changes after completion of breast cancer treatment may decrease recurrence rate. Lifestyle was formed since childhood, and modified and sustained throughout lifetime. Usually, lifestyle changes are difficult without specific motivation. Materials and Methods Breast cancer survivors, aged from 20 to 80 years old with stage I, II, III, who have received surgery and completed courses of chemotherapy within 4 years, were candidates for the study. According to the American Athletic Association sports guidelines, aerobic, muscular and extension exercises are taught by a sports instructor to the participants, and the participants were asked to exercise at home, 150 minutes a week, 30 minutes each time. Participants were instructed to calculate the calories they needed (25 calories/kg/day). Food selection and diet plan must meet the calories they have calculated, and a diet log was recorded. The study of one-year diet and exercise intervention study was designed. Group meeting was started at the beginning and then held every 3 months. Measurements of body weight, height, body fat, BMI, waist circumference, muscle mass, and basal metabolic rate were performed; WHO quality of life and brief pain inventory (BPI) were also collected. Results A total of 32 breast cancer survivors were recruited, and 20 participants had completed one-year follow-up. Two of the participants withdrew from the study due to personal reasons, and the remaining 18 were included in the statistical analysis. Body weight, BMI, and body fat decreased after interventions in diet and exercise and reached a significant lower level (p-value = 0.001, 0.002 and 0.01, respectively). In the linear regression model, it could be seen that body weight has a negative correlation with time; the body weight and BMI gradually decreased during the one-year period (β= -0.327, p-value=0.005; β= - 0.362, p-value=0 .002, respectively). There was no statistically significant change in waist circumference, muscle mass and basal metabolic rate. BPI at baseline, 17 reported among 20 participants (80%) and decreased to 11% (2/18) at after one-year follow-up. In the quality of life questionnaire, after the score calculation, the single factor repeated measurement analysis (calculated under the statistical power α=0.05) was used. There was no significant difference and change between the scores after the interventional measures. In the bivariate regression analysis, it was also seen that QOL had not changed due to weight loss, and there was no correlation between the two. Discussion This study results demonstrated that lifestyle adjustment can be motivated, and lifestyle can be changed by exercise and diet intervention; however, statistically, quality of life did not change with weight loss. Citation Format: Hsieh C-M, Yang N-C, Yang A-K, Tseng C. Exercise and nutrition intervention on breast cancer survivors in Taiwan with BMI 25 or more to decrease BMI and maintain at an appropriate level -A preliminary report [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-12-17.

Novel Approach to Characterize Heterogeneity in an Aerobic Exercise Intervention.

Exercise intervention studies for brain health can be difficult to interpret due to heterogeneity in exercise intensity, exercise duration, and in adherence to the exercise intervention. This study aimed to characterize heterogeneity in these components in a cohort of healthy middle-age and older adults who participated in a prescribed 6-month supervised aerobic exercise intervention as part of the Brain in Motion study. Group-based multitrajectory analysis (GBMTA) was used to characterize variation in the trajectory of exercise intensity and duration for male and female participants in the first 3 months of the exercise program. The GBMTA for males and females revealed two distinct trajectory subgroups, namely, "high-increasing" (HI) and "low-increasing" (LI). Logistic regression was used to assess the association between the identified latent subgroups and (i) demographic characteristics; (ii) physiological characteristics, including cardiovascular and cerebrovascular function; (iii) genetic characteristics; and (iv) adherence with American College of Sports Medicine guidelines on exercise for older adults. Of the 196 participants, 54.1% met the American College of Sports Medicine aerobic exercise targets for intensity and duration during the intervention. Aerobic fitness (maximal oxygen uptake; odds ratio, 1.27; P < 0.01) was significantly different between these trajectory subgroups in males, and cerebrovascular function (cerebrovascular resistance; odds ratio, 0.14; P < 0.01) was significantly different between these trajectory subgroups in females. This novel approach to tracking a prespecified exercise program highlights that there are individual and group-specific variations within a prescribed exercise intervention. Characterizing exercise adherence in this way holds promise in developing optimized exercise prescriptions tailored to individual baseline characteristics, and additionally highlighting those participants at greatest risk of not meeting minimum dosage requirements for physiological and/or cognitive health.

A Scoping Review of Physical Performance Outcome Measures Used in Exercise Interventions for Older Adults With Alzheimer Disease and Related Dementias.

There is growing evidence that exercise interventions can mitigate functional decline and reduce fall risk in older adults with Alzheimer disease and related dementias (ADRD). Although physical performance outcome measures have been successfully used in older adults without cognitive impairment, additional research is needed regarding their use with individuals who have ADRD, and who may have difficulty following instructions regarding performance of these measures. The purpose of this scoping review was to identify commonly used physical performance outcome measures, for exercise interventions, that are responsive and reliable in older adults with ADRD. Ultimately, we aimed to provide recommendations regarding the use of outcome measures for individuals with ADRD across several domains of physical performance. A scoping review was conducted to broadly assess physical performance outcome measures used in exercise interventions for older adults with ADRD. Exercise intervention studies that included at least 1 measure of physical performance were included. All physical performance outcome measures were abstracted, coded, and categorized into 5 domains of physical performance: fitness, functional mobility, gait, balance, and strength. Criteria for recommendations were based on (1) the frequency of use, (2) responsiveness, and (3) reliability. Frequency was determined by the number of studies that used the outcome measure per physical performance domain. Responsiveness was assessed via calculated effect size of the outcome measures across studies within physical performance domains. Reliability was evaluated via published studies of psychometric properties. A total of 20 physical performance outcome measures were extracted from 48 articles that met study inclusion criteria. The most frequently used outcome measures were the 6-minute walk test, Timed Up and Go, repeated chair stand tests, short-distance gait speed, the Berg Balance Scale, and isometric strength measures. These outcome measures demonstrated a small, medium, or large effect in at least 50% of the exercise intervention studies. Good to excellent reliability was reported in samples of older adults with mild to moderate dementia. Fitness, functional mobility, gait, balance, and strength represent important domains of physical performance for older adults. The 6-minute walk test, Timed Up and Go, repeated chair stand tests, short-distance gait speed, Berg Balance Scale, and isometric strength are recommended as commonly used and reliable physical performance outcome measures for exercise interventions in older adults with mild to moderate ADRD. Further research is needed on optimal measures for individuals with severe ADRD. The results of this review will aid clinicians and researchers in selecting reliable measures to evaluate physical performance outcomes in response to exercise interventions in older adults with ADRD.