Personalized Exercise Program Research Articles

Cancer survivorship: understanding the patients’ journey and perspectives on post-treatment needs

Background Cancer treatments have many adverse effects on patient’s health leading to poor cardiorespiratory capacity, muscular- degeneration, fatigue, loss of strength and physical function, altered body-composition, compromised immune-function, peripheral neuropathy, and reduced quality of life (QOL). Exercise programs can significantly increase functional capacity when tailored to individual needs, thus improving health. Exercise interventions in cancer rehabilitation, when supported by appropriate nutrition can be effective in attaining a healthy weight and body-composition. The successful rehabilitation program should also include psycho-social education aimed to reduce anxiety and improve motivation.Methods The current study aimed to collect information on the post-treatment needs of cancer patients including barriers and expectations facing them, their caregivers and their families through consultation in focus group interviews. Cancer survivors living in the Republic of Ireland were recruited from the University Hospital Galway, community-based cancer centres, cancer support groups and social media platforms to participate in the study and attend a focus group interview. The focus group discussions were designed to obtain information on the collective views of cancer survivors on relevant topics selected. The topics were developed in consultation with a patient and public involvement (PPI) group supporting the study. The topics list was circulated to all participants prior to the focus group. The interviews were audio recorded and transcribed verbatim. Focus group transcripts were analysed subjected to a thematic framework analysis using NVivo.ResultsThirty-six participants took part in 9 focus groups. Our analysis uncovered two main themes. The first theme ‘cast adrift with no direction’ was grouped into three sub-themes: everything revolves around treatment; panic and fear; and what exercise should I be doing? The second theme ‘everybody is different’ was clustered into two sub-themes: side effects get in the way; and personalised exercise program.ConclusionThe study highlighted the lack of information and support needed by patients living with and beyond cancer. The study also highlighted the need for a personalised exercise programme designed to target the individual patient symptoms that would be ideal for the mitigation of long term symptoms and in improving QOL.

Pulmonary Rehabilitation: A Look Back, a Look Forward.

Pulmonary rehabilitation (PR) is a comprehensive approach to the management of patients with chronic lung disease that encompasses exercise, education, and psychosocial support. The development of PR programs began in the mid-20th century with the appreciation that exercise provided real benefit in chronic lung disease and that effective disease management involved patient education focused on medications, lifestyle changes, and lifelong regular exercise. Initially PR was primarily facility-based, but today PR is extending into the home with telemedicine, and this is encouraging a real partnership of patients and professionals supporting self-management. The evidence base supporting PR as a safe and effective modality has grown exponentially over the last 4 decades, and PR is strongly endorsed by virtually all the major professional societies. Importantly, PR has also clearly been shown to be cost-effective. Challenges remain, however. Access is still very limited for a variety of reason (logistics, financial, patient motivation) that need to be addressed. More focused and personalized exercise programs and monitoring strategies that encourage a patient's lifetime commitment to the principles of PR need to be developed and refined. The opportunity to really impact important clinical outcomes exists with PR, and this needs to be exploited.

Preact to lower the risk of falling by customized rehabilitation across Europe: the feasibility study protocol of the PRECISE project in Italy.

Falls are a major worldwide health problem in older people. Several physical rehabilitation programs with home-based technologies, such as the online DigiRehab platform, have been successfully delivered. The PRECISE project combines personalized training delivered through the application with an artificial intelligence-based predictive model (AI-DSS platform) for fall risk assessment. This new system, called DigiRehab, will enable early identification of significant risk factors for falling and propose an individualized physical training plan to attend to these critical areas. The study will test the usability of the DigiRehab platform in generating personalized physical rehabilitation programs at home. Fifty older adults participants will be involved, 20 of them testing the beta version prototype, and 30 participants testing the updated version afterwards. The inclusion criteria will be age ≥65, independent ambulation, fall risk (Tinetti test), Mini Mental State Examination ≥24, home residents, familiarity with web applications, ability and willingness to sign informed consent. Exclusion criteria will be unstable clinical condition, severe visual and/or hearing impairment, severe impairment in Activities of Daily Living and absence of primary caregiver. The first part of the screening consists in a structured questionnaire of 10 questions regarding the user's limitations, including the risk of falling, while the second consists in 10 physical tests to assess the functional status. Based on the results, the program will help define the user's individual profile upon which the DSS platform will rate the risk of falling and design the personalized exercise program to be carried out at home. All measures from the initial screening will be repeated and the results will be used to optimize the predictive algorithms in order to prepare the tool in its final version. For the usability assessment, the System Usability Scale will be administered. The follow-up will take place after the 12-week intervention at home. A semi-structured satisfaction questionnaire will also be administered to verify whether the project will meet the needs of older adults and their family caregiver. We expect that personalized training prescribed by DigiRehab platform could help to reduce the need for care in older adults subjects and the care burden.Clinical trial registration: [https://clinicaltrials.gov/], identifier [NCT05846776].

Maximal Exercise Tolerance, Objective Trunk Strength, and Mobility Measurements in Axial Spondyloarthritis.

Although exercise therapy is safe, effective, and recommended as a nonpharmacological treatment for axial spondyloarthritis (axSpA), there is a lack of guidelines regarding type and dosage. Insufficient knowledge about physical and physiological variables makes designing effective exercise programs challenging. Therefore, the goal of this study was to simultaneously assess trunk strength, spinal mobility, and the cardiorespiratory fitness of patients with axSpA. In a cross-sectional study, 58 patients with axSpA (mean age 40.8 yrs, 50% male, mean symptom duration 10.3 yrs) performed maximal cervical and trunk mobility and isometric strength tests in all planes (using David Back Concept devices) and a maximal cardiopulmonary bicycle exercise test (n = 25). Mobility and strength data were compared to healthy reference data. Cut-off values for clinical cardiopulmonary exercise testing interpretation were used to judge normality. Patients were compared based on radiographic involvement and symptom duration. Both strength (P ≤ 0.02) and mobility (P ≤ 0.001) were significantly lower for the patients with axSpA compared to the reference. Strength deficits were comparable between the radiographic and nonradiographic groups (P > 0.05, except trunk extension [P = 0.03]), whereas mobility showed higher deficits in the radiographic group (cervical extension [P = 0.02] and rotation [P = 0.01], and trunk extension [P = 0.03] and rotation [P = 0.03]), regardless of symptom duration. Similarly, symptom duration positively affected oxygen pulse (P = 0.03), relative anaerobic threshold (P = 0.02), and aerobic capacity (P = 0.02). In patients with axSpA, strength is more affected than mobility when compared to healthy controls. Likewise, mainly the metabolic component of aerobic capacity is impaired, affecting cardiopulmonary fitness. These findings indicate that future personalized exercise programs in patients with axSpA should incorporate exercises for cardiopulmonary fitness next to strength and mobility training.

Exploring College Students’ Subjective Health Perceptions According to Physical Activity Level

PURPOSE: This study provides fundamental data required to promote the physical and mental health of college students by exploring their subjective health perception relative to physical activity level.METHODS: Individual, in-depth interviews were conducted in 2023 to assess the subjective health perception of eight collegiate students relative to their physical activity levels.RESULTS: The findings indicated that university students do not adhere to physical activity guidelines, with variations in preferences and motivations for engaging in different types of physical activities. Muscle-strengthening exercises were performed most often, reflecting a specific focus on building strength and muscle mass. Although most participants considered themselves healthy, contrasting perceptions existed regarding factors such as alcohol consumption and smoking. The participants actively engaged in diverse physical activities, thereby expressing a positive perception of the value of exercise. Furthermore, the participants demonstrated a proactive approach to health management by avoiding unhealthy foods and incorporating health supplements, exhibiting a deep understanding and commitment to maintaining their well-being. Almost all participants reported overall improvement in stamina from intense physical activities. However, perspectives on the health-enhancing effects of moderate physical activity varied, with some participants expressing uncertainty and others considering it to be the most suitable exercise for their health conditions. Approximately 50% of the participants emphasized the health benefits of strength training, citing its positive effects on muscle strength and increased self-confidence through an improved external image.CONCLUSIONS: This study explored the subjective health perceptions related to physical activity among eight university students, revealing a preference for strength training, generally positive health perceptions, and proactive health management strategies. These findings emphasize the need for personalized exercise programs based on individual health conditions.

Exploring the Health Behaviors of Young Adults Who Are Blind in South Korea

Introduction: Compared to sighted people, not only do people who are blind have multiple comorbidities and exhibit early mortality, but they also display high-risk health behaviors. To prevent problematic health behaviors affecting health-related quality of life and well-being, understanding the shared patterns of health behaviors among individuals with visual impairments, including blindness, is essential. Methods: This qualitative study explored the hidden constructs and patterns of health behaviors among employed young adults who are blind using a multiple case study analysis. Eight participants with self-reported total blindness were recruited via convenience sampling and recruitment postings. Results: The mean age was 27.43 ± 6.32 years with a range of 20–39 years. Seven males and one female completed the one-on-one telephone interviews. The study discovered eight patterns of health behaviors of young adults who are blind: (a) leading a sedentary lifestyle with physical inactivity, (b) eating irregularly and not cooking, (c) avoiding uncertainty and illness, (d) facing disability stigma in health care services, (e) seeking online information related to medical care, (f) sharing health-related information within the blind community, (g) receiving unreadable formats of health-related information, and (h) aiming for independence and autonomy in self-care. The following categorized health behavior constructs were extracted: perceived health problems, experiential attitude toward health care systems, health beliefs, perceived facilitators, and barriers. Discussion: The findings indicate that young adults who are blind prefer independent health-related activities. The identified problematic health behaviors were correlated to inaccessible healthcare resources. Implications for Practitioners: More accessible health resources enhancing the independence of young adults who are blind are needed to promote their health behaviors. For instance, more accessible fitness facilities and personalized exercise programs in workplaces and communities can motivate the physical activity of young adults who are blind.

A LEAP! FORWARD?: DOES PERSONALIZED EXERCISE HELP MAINTAIN COGNITIVE FUNCTION IN OLDER ADULTS?

Abstract Maintaining cognitive function is important to health in older adulthood. Physical activity can decrease the risk of cognitive decline in older individuals. We tested whether LEAP! Rx, a personalized exercise, and lifestyle education program would improve cognition in older adults. We randomized 220 participants (Mean age (SD) = 72 (4.83)), into the program or a control group. We used the NIH Toolbox Cognitive Battery to assess cognition. We analyzed change in cognitive performance from baseline to week 12 using repeated measures ANCOVA to compare the intervention and control groups, adjusting for age, gender, and education. Referral source (self- vs. physician-referred), treatment group (intervention vs. control), and measurement time (baseline vs. week 12) had a significant three-way interaction F(8, 212) = 4.57, p< 0.05. That is, clinician-referred participants in the intervention group improved more (vs. the clinician-referred control group), whereas self-referred control group participants improved more (vs. the self-referred intervention group). Older age, male gender, and lower education predicted poorer verbal learning F(1,218 = 18.79, p< 0.05; F(1, 218) = 28.67, p< 0.05; F(1, 219) = 4.13. Overall, cognitive scores improved more over 12 weeks in the intervention group compared to the control group. Thus, we conclude that personalized exercise programs may enhance or maintain cognitive function in older adults. The differences we observed in physician-referred versus self-referred participants has implications for implementation and scalability of health behavior change interventions, as well as implications for recruitment methods and representation in clinical trials research broadly.

Outcomes of a Remote Cardiac Rehabilitation Program for Patients Undergoing Atrial Fibrillation Ablation: Pilot Study.

Risk factor modification, in particular exercise and weight loss, has been shown to improve outcomes for patients with atrial fibrillation (AF). However, access to structured supporting programs is limited. Barriers include the distance from appropriate facilities, insurance coverage, work or home responsibilities, and transportation. Digital health technology offers an opportunity to address this gap and offer scalable interventions for risk factor modification. This study aims to assess the feasibility and effectiveness of a 12-week asynchronous remotely supervised exercise and patient education program, modeled on cardiac rehabilitation programs, in patients with AF. A total of 12 patients undergoing catheter ablation of AF were enrolled in this pilot study. Participants met with an exercise physiologist for a supervised exercise session to generate a personalized exercise plan to be implemented over the subsequent 12-week program. Disease-specific education was also provided as well as instruction in areas such as blood pressure and weight measurement. A digital health toolkit for self-tracking was provided to facilitate monitoring of exercise time, blood pressure, weight, and cardiac rhythm. The exercise physiologist remotely monitored participants and completed weekly check-ins to titrate exercise targets and provide further education. The primary end point was program completion. Secondary end points included change in self-tracking adherence, weight, 6-minute walk test (6MWT), waist circumference, AF symptom score, and program satisfaction. The median participant age was 67.5 years, with a mean BMI of 33.8 kg/m2 and CHADs2VASC (Congestive Heart Failure, Hypertension, Age [≥75 years], Diabetes, Stroke/Transient Ischemic Attack, Vascular Disease, Age [65-74 years], Sex [Female]) of 1.5. A total of 11/12 (92%) participants completed the program, with 94% of expected check-ins completed and 2.9 exercise sessions per week. Adherence to electrocardiogram and blood pressure tracking was fair at 81% and 47%, respectively. Significant reductions in weight, waist circumference, and BMI were observed with improvements in 6MWT and AF symptom scores (P<.05) at the completion of the program. For program management, a mean of 2 hours per week or 0.5 hours per patient per week was required, inclusive of time for follow-up and intake visits. Participants rated the program highly (>8 on a 10-point Likert scale) in terms of the impact on health and wellness, educational value, and sustainability of the personal exercise program. An asynchronous remotely supervised exercise program augmented with AF-specific educational components for patients with AF was feasible and well received in this pilot study. While improvements in patient metrics like BMI and 6MWT are encouraging, they should be viewed as hypothesis generating. Based on insights gained, future program iterations will include particular attention to improved technology for data aggregation, adjustment of self-monitoring targets based on observed adherence, and protocol-driven exercise titration. The study design will need to incorporate strategies to facilitate the recruitment of a diverse and representative participant cohort.

Personalized Exercise Program Design with Machine Learning in Sensor Networks

The use of wearable solutions and sensors has reached the point of modern machine learning (ML) techniques in recent years. It contains the different programs that help to develop personalized opportunities for the betterment of the individuals. The research shed light upon the functions of ML and distributed sensor networks (DSN) in promoting healthcare among users. It can be said that the functions of the ML help to develop good fitness among the users, which results in good health. This dissertation consists of different kinds of ML algorithms and the usage of DSNs for the development of physical exercise programs. It has been found that most individuals use the sensors for their benefit in developing good health. The use of machine learning techniques not only helps to record an individual's health data but also sends emergency information to the nearest medical center for the user's benefit. The use of ML helps to the identification of the location of an individual with the help of GPS measures of real-time distance and users' health activities.

OA05 Cycling: a tool for cardiovascular exercise in patients with established ankylosing spondyloarthritis

Abstract Introduction Ankylosing spondyloarthritis (AS) is a chronic inflammatory disease that can lead to irreversible changes in spine and sacroiliac joints, affecting spinal mobility adversely, leading to disability and severe functional impairment. Use of biological treatments in recent years has led to significant improvement in ability to control disease activity. Exercise remains an essential part of managing inflammatory arthritis such as AS. We present a case of long-standing AS which was in remission according to clinical calculators. However, it was the introduction of regular aerobic exercise that has greatly improved the patient's remaining musculoskeletal symptoms, sense of wellbeing, and energy levels. Case description A 64-year-old man was diagnosed with AS in the 1980s at age 27. He was managed with treatments available at the time such as nonsteroidal anti-inflammatory drugs and physiotherapy, including hydrotherapy, with relatively poor response, leading to gradual progression of disease and limitation in his spinal mobility and much stooped posture. He started adalimumab in 2008, leading to significant improvement in his disease activity. Despite achieving remission, he felt tired and although he was relatively pain free, it did not translate into an improved sense of wellbeing. He felt generally unfit and developed hypertension, requiring three antihypertensive medications and put on a few pounds. As part of his rheumatology consultation in 2012, it was suggested that cardiovascular exercise should help improve his fitness, hypertension, tiredness and sense of wellbeing. Due to spinal limitation, swimming and running were not suitable options. He therefore tried indoor rowing, which unfortunately led to worsening pain in his lower back within days. Instead of giving up, he decided to give cycling a trial. After initial discomfort, he was able to cycle regularly and started to feel the benefit within weeks. He then got involved a bit more and joined a local cycling club and was doing 10,000 km per year. He completed the Paris to London cycle ride for a charity. Within the first year of taking up regular cycling, he lost a couple of stone in weight, and now requires only one antihypertensive. Although his disease went into remission fairly soon after taking adalimumab and he became pain free, it was only with cardiovascular exercise he felt the real sense of wellbeing. He thinks that cycling has made a significant change in physical and psychological health. Discussion A recent meta-analysis of 14 randomised controlled studies, including 1,579 participants, demonstrated moderate-to-low quality evidence that exercise programmes slightly improve function, may reduce pain, and probably slightly reduce global patient assessment of disease activity when compared with no intervention. This study also showed that exercise programmes probably have minimal or no effect on function or pain when compared with usual care, and may have little or no effect on reducing patient assessment of disease activity. There is still no sufficient evidence to determine whether exercise programmes improve spinal mobility, reduce fatigue, or induce adverse effects. Nevertheless, exercise programmes are given a prominent role in treatment of AS. The evidence is primarily focused on mobility exercise rather than strengthening, balance or cardio-respiratory exercise. There is also an unmet need for information about exercise planning, frequency, intensity and duration or adherence to recommended programmes. Physical therapy with supervised exercises has been recommended and is thought to be better than home exercises. In one study, a supervised exercise program arm where exercise consisted of aerobic (treadmill), resistance and stretching exercises for 1 hour a day, five days a week for three weeks has shown to improve BASDAI and BASFAI. However, this result was not statistically significant when compared to the control group with home-based exercise. It also showed that secretion of the antioxidant responsible for inflammation decreases with intensive cardiovascular exercise. A systematic review of available evidence has suggested benefits of personalised exercise regimen in AS patients. Our case illustrates that regular cardiovascular exercise can improve the musculoskeletal, cardiovascular and psychological health in chronic inflammatory conditions like AS which are otherwise to be considered in remission as per available disease activity measuring tools. Key learning points There is evidence for the role of exercise in the management of AS which includes stretching, core work and posture advice, as well as cardiovascular work. The role of cardiovascular exercise in all forms of inflammatory arthritis is well established and is not only safe but also has been shown to have beneficial effects on cardiovascular risk, bone health, psychological health. This case highlights the importance of devising a personalised exercise programme for individual patients that takes into account any previous experience, physical limitations, lifestyle and any other barriers. We have been advising patients with established AS to try cycling or exercise bikes as one of the tools for achieving cardiovascular workout in a safe and effective manner and have seen several patients finding it useful. There is limited literature about use of cardiovascular exercise in AS, and no specific studies looking at cycling. There are, however, multiple individual patient stories online describing the benefits of cycling in AS. We feel the effectiveness of cycling can be further explored by setting up observational studies.

Using Machine Learning Algorithms to Design Personalized Exercise Programs for Health and Wellness

The research paper showcases an elaborate study of machine learning, which is used in healthcare or medical platforms and can be used by healthcare professionals to adopt better diagnostic instruments and tools for examining medical issues or images. The paper highlights that a machine learning algorithm can be utilized in X-rays or MRI scans to examine disease and health issues. This paper will also discuss how this algorithm can help healthcare professionals, doctors, and nurses make accurate diagnoses for better services and patient outcomes. One of the major advantages of using the secondary research method in the following research is the abundance of the literature. All the data being used here are previously collected and evaluated with the result, and using these will increase the impact of the study overall. This method saves resources, including money, time, and manpower. This research method allows the researcher to build new knowledge and draw new conclusions based on existing expertise and knowledge. The chosen research philosophy is the Interpretivism research philosophy. The chosen research approach here is the inductive research approach. The chosen research design for this study is exploratory. All these help the research to achieve its objectives and reach the proposed goal of this research.

Gut microbiota and inflammation patterns for specialized athletes: a multi-cohort study across different types of sports.

Regular high-intensity exercise can cause changes in athletes' gut microbiota, and the extent and nature of these changes may be affected by the athletes' exercise patterns. However, it is still unclear to what extent different types of athletes have distinct gut microbiome profiles and whether we can effectively monitor an athlete's inflammatory risk based on their microbiota. To address these questions, we conducted a multi-cohort study of 543 fecal samples from athletes in three different sports: aerobics (n = 316), wrestling (n = 53), and rowing (n = 174). We sought to investigate how athletes' gut microbiota was specialized for different types of sports, and its associations with inflammation, diet, anthropometrics, and anaerobic measurements. We established a microbiota catalog of multi-cohort athletes and found that athletes have specialized gut microbiota specific to the type of sport they engaged in. Using latent Dirichlet allocation, we identified 10 microbial subgroups of athletes' gut microbiota, each of which had specific correlations with inflammation, diet, and anaerobic performance in different types of athletes. Notably, most inflammation indicators were associated with Prevotella-driven subgroup 7. Finally, we found that the effects of sport types and exercise intensity on the gut microbiota were sex-dependent. These findings shed light on the complex associations between physical factors, gut microbiota, and inflammation in athletes of different sports types and could have significant implications for monitoring potential inflammation risk and developing personalized exercise programs. IMPORTANCE This study is the first multi-cohort investigation of athletes across a range of sports, including aerobics, wrestling, and rowing, with the goal of establishing a multi-sport microbiota catalog. Our findings highlight that athletes' gut microbiota is sport-specific, indicating that exercise patterns may play a significant role in shaping the microbiome. Additionally, we observed distinct associations between gut microbiota and markers of inflammation, diet, and anaerobic performance in athletes of different sports. Moreover, we expanded our analysis to include a non-athlete cohort and found that exercise intensity had varying effects on the gut microbiota of participants, depending on sex.

Evaluation of the MOVE online exercise programme for young people aged 13–30

PurposeTo evaluate the MOVE exercise programme in supporting the recovery of young people affected by cancer.MethodsParticipants in an 8-week exercise rehabilitation programme delivered online by cancer rehabilitation specialists completed self-reported questionnaires at baseline and after programme completion. Assessments included cancer-related fatigue (FACIT fatigue scale) and health-related quality of life (EORTC-QLC-30). Qualitative data were provided through written accounts of participant experiences and underwent content analysis.ResultsSeventy-one participants commenced the exercise rehabilitation programme and 57 completed the programme and provided data for analysis (63% female; median age 22 years). Statistically significant improvements were observed in post-programme scores for all measured outcomes (cancer-related fatigue, quality of life, physical functioning, role functioning, emotional functioning). Content analysis of written experiences generated ten unique codes. The highest frequency codes were enjoyment (n = 34), motivation (n = 14) and fitness (n = 13).ConclusionsThese findings indicate feasibility of delivery, acceptability to patients and physical and psychological benefits of a personalised online exercise rehabilitation programme for young people living with and beyond cancer. Further research involving a control arm and long-term follow-up would be beneficial.Implications for cancer survivorsThese results support the inclusion of a personalised exercise programme as part of cancer rehabilitation for young people living with and beyond cancer.

Safety and feasibility of a randomized controlled trial testing a personalized exercise program in patients with cancer: The CHOiCE trial.

e24045 Background: Growing evidence suggests that physical exercise (EX) may reduce mortality and recurrence risk in patients (pts) with cancer, as well as help in managing cancer treatment side effects and improve quality of life (QoL). Despite these well-recognized benefits, most pts are insufficiently active, and compliance with the EX intervention is often challenging. This pilot study aimed to evaluate the safety, feasibility, and preliminary efficacy of a 3-month EX-intervention in pts with cancer. Methods: A pilot, two-center randomized controlled trial was conducted on pts with different cancers at early stages. Pts allocated in the 3-month EX intervention participated in bi-weekly aerobic and resistance training tailored to the patient's baseline condition and preferences. The duration of aerobic training progressively increased over weeks, whereas the resistance component consisted of body weight or elastic-bands exercises performed in 2-3 sets of 8-12 repetitions. EX intensity was moderate and monitored using the 10-point Borg Rating of the Perceived Exertion Scale. Pts randomized to control received usual care. Primary study endpoints were safety, monitored through the Common Terminology Criteria for Adverse Events (AEs), and feasibility, evaluated through recruitment rate, adherence, and withdrawals. Secondary endpoints included functional capacity, using the Six minutes walking test, and muscle strength, with the handgrip and leg press test. European Organization for Research and Treatment of Cancer Quality of Life and Core Questionnaire (EORTC- QLQ-C30) was used to assess the QoL. Descriptive statistics was applied, and repeated-measures analysis of variance was used to evaluate within- and between-group differences. Results: With a 38% recruitment rate, 57 pts were randomized (56 years; 68% breast, 14% colorectal) to the EX-intervention (n = 37) and controls (n = 20). Five dropouts occurred, n = 3 in the EX-group (leukemia onset n = 1, psychiatric disorder n = 1, gonarthrosis n = 1), and n = 2 in the controls (lack of interest n = 2). Adherence to EX-sessions was high, 93%. Concerning safety, three AEs were reported: worsening in the lymphedema, Grade 1 (n = 2), and elbow inflammation, Grade 1. Compared to the controls, EX-group reported a significant increase in functional capacity (within group, p &lt; 0.01), and lower limb strength (within and between group, p &lt; 0.01). Regarding QoL, EX produced enhancements in social function (within group, p &lt; 0.05), fatigue (within group, p &lt; 0.05), nausea and vomiting (within group p &lt; 0.01), dyspnea (within group, p &lt; 0.05), insomnia (within group, p &lt; 0.05), and loss of appetite (within group, p &lt; 0.01). Conclusions: Preliminary findings support the feasibility of a combined aerobic and resistance EX in pts with cancer with minimal AEs. Moreover, improvements in physical parameters and some domains of QoL were detected. Clinical trial information: NCT04226508 .

How is personalisation used in exercise for people with dementia, in what circumstances and why? A rapid realist review

AbstractBackgroundRealist reviews are a type of systematic theory‐driven approach for making sense and evaluating the literature with the intention to identify plausible theories or models. This review will determine what literature and theoretical knowledge is available on “personalisation” in the context of exercise for people living with dementia (PwD). The aim of the review is to develop an initial programme theory that can be used to inform the development and testing of resources to support exercise interventions for PwD.MethodElectronic databases and gg terms: personalisation, tailoring, adaptations, person‐centred, etc. Inclusion criteria were:• PwD (any type, severity, or location)• Exercise intervention (all forms)• Explicit discussion of theoretical concepts or rationale to PersonalisationArticles were not excluded based on study design. A preliminary search to scope the evidence, refine search terms and criteria was undertaken before the start of this review.Data were collected from the included articles and managed through data analysis software that accommodates both qualitative and quantitative data (Excel). The review was registered on PROSPERO and followed RAMESES guidance and publication standards.ResultOf the 2036 articles initially found, data extraction was completed from 64, following sorting for relevance and rigour (Figure 1). An initial programme theory involving 11 context‐mechanism‐outcome configurations (CMOc) is presented (Table 1) at different socio‐ecological levels of interaction needed to underpin a personalised exercise programme for PwD.Consideration of the individual’s identity, preference, preserved/embodied abilities, vulnerabilities, motivations (behaviour change), and their care‐giver should be acknowledged at an inter/intra‐personal level. Staff implementing the exercise programmes should have a person‐centered care approach, acknowledging concepts of personhood and using shared decision‐making. Finally, the cultural norms and expectations of the society within which the exercise programme is being conducted, and the PwD is situated within, should be considered to promote social connections rather than stigmatisation.ConclusionThe initial programme theory explains personalisation and illustrates a novel foundation upon which to develop and refine a programme of exercise adapted specifically for PwD. Results from this review will inform data collection in the subsequent realist evaluation (e.g., interview questions).

Systemic Lupus, Metabolic Syndrome, Cardiac Disease, and Peripheral Artery Disease

Blaess J, Goepfert T, Geneton S, Irenee E, Gerard H, Taesch F, Sordet C, Arnaud L. Benefits & risks of physical activity in patients with systemic lupus erythematosus: a systematic review of the literature. Semin Arthritis Rheum. 2023 Feb;58:152128. Epub 2022 Nov 19. doi:10.1016/j.semarthrit.2022.152128. PMID: 36436314There has been little clinical exercise physiology research performed on individuals with systemic lupus erythematosus (SLE). Significant and severe fatigue is the primary symptom reported. Those with SLE are at increased risk of cardiovascular disease and metabolic syndrome because of progression of the disease and glucocorticoid treatment. Compared to healthy individuals, those with SLE exhibit higher brachial and carotid systolic blood pressure. Inactivity results in higher levels of inflammatory markers such as CRP, IL-2, and TNF-α. Due to the nature of SLE, inactivity is common, which further promotes a decline in health. Recent trials have evaluated the impact of physical activity (PA) on patients with SLE. This systematic review examined PA's benefits and potential risks in those with SLE.Methods: This systematic review was performed in using MEDLINE (via PubMed). Only studies from 1989 through March of 2022 were used. The search strategy used terms “Exercise” and “Lupus Erythematosus, Systemic” as well as additional and relevant free text combinations such as “physical activity.” Studies were included in the analysis if they investigated the relationship between PA and SLE (randomized, case-control, or cohort studies) and contained original data.Results: The authors used 40 studies with varying design, published between 1989 and 2022 for the analysis with a total of 229 patients included.PA Levels and Adherence to WHO Recommendations: Those with SLE had lower levels of PA compared to the general population. Only 11% to 30% met current WHO recommendations. The reasons reported for not performing PA were poor fitness, pain, and fatigue.Impaired Aerobic Capacities and Cardiorespiratory Fitness: The Vo2max of physically active SLE patients was 35.5 ± 1.9 mL·kg−1·min−1, significantly higher than sedentary patients with SLE.Benefits of PA: Mixed training programs increase aerobic capacity and Vo2max. Resistance training programs tend to provide less significant improvement in aerobic capacity. However, resistance training improves symptoms and muscle function. Considering the risk of cardiovascular disease due to inactivity, when patients with SLE reallocated 10 minutes per day of sedentary behavior into moderate-vigorous PA, the decrease of the estimated 10-year cardiovascular risk was ~20%.Safety of PA in SLE: No adverse events were reported across the included studies, and there was no increase in disease activity. This suggests exercise is generally safe in those with SLE.Discussion: Patients with SLE have low levels of PA and spend the majority of their day in sedentary behavior resulting in impaired aerobic capacities, which increases the risk of SLE. The preferred solution is to replace a minimum of 10 minutes of sedentary behavior with moderate-vigorous PA to reduce their risk of cardiovascular disease.Aerobic training programs provide benefits such as improved Vo2max and reduced estimated cardiovascular risk, whereas resistance training programs improve strength and function. Combining both aerobic and resistance training may prove the most useful for individuals with SLE, and both appear to be safe to implement. Additionally, PA has demonstrated improvements in fatigue and depression, which are prevalent with SLE.Reljic D, Dieterich W, Herrmann HJ, Neurath MF, Zopf Y. “HIIT the inflammation”: comparative effects of low-volume interval training and resistance exercises on inflammatory indices in obese metabolic syndrome patients undergoing caloric restriction. Nutrients. 2022 May 10;14(10):1996. doi:10.3390/nu14101996. PMID: 35631137As the prevalence of obesity continues to rise, it is important to identify and understand the possible comorbidities that exist in this population. Metabolic syndrome (MetS), a risk related to obesity, is also associated with inflammation, which may contribute to the development of various secondary diseases. The primary mechanism of inflammation is the oversecretion of proinflammatory adipokines and cytokines from adipose tissue. Reducing this inflammation may reduce risk. The purpose of this study was to compare the effects of 12 weeks of low-volume high-intensity interval training (LOW-HIIT), single and 3 set resistance training (1-RT and 3-RT), and whole-body electromyostimulation (WB-EMS) on inflammatory and cardiometabolic measures in a cohort of obese patients with MetS.Methods: Patients were randomly assigned to different exercise regimens (including LOW-HIIT, 1-RT, WB-EMS, and 3-RT) performed for a duration of 12 weeks combined with nutritional counseling. This analysis focused on the impact of the different low-volume exercise programs on inflammation outcomes in a sample of patients. The primary outcome of this study was serum concentration of C-reactive protein (CRP), and secondary outcomes were further inflammatory markers, cardiometabolic indices, Vo2max, and anthropometric variables as specified below. Additionally, the cardiometabolic risk status was quantified using the metabolic syndrome severity score (MetS z-score) for all subgroups. The MetS z-score represents a risk score that was developed to assess severity of MetS.Results:Body Composition. All groups reduced body weight primarily from a decrease in fat mass (FM). The relative amount of weight loss did not differ significantly between groups. Skeletal muscle mass decreased significantly in the WB-EMS and control (CON) groups.Inflammatory Markers. Significant reductions in serum concentrations of CRP, hsCRP, IL-6, and LBP in the LOW-HIIT group compared to the 1-RT, 3-RT, and WB-EMS group.Cardiometabolic Markers. MetS z-scores were found to be reduced in the LOW-HIIT, 1-RT, and 3-RT group.Discussion: There were 4 primary findings of this study: (a) all groups exhibited similar weight loss during the period of calorie restriction (3.6%); (b) serum concentrations of inflammatory markers decreased only in the LOW-HIIT group; (c) among the RT groups, only 3-RT was related to a reduction in inflammatory markers (hsCRP and LBP); and (d) MetS severity score improved in the LOW-HIIT, 1-RT, and 3-RT groups.Rinaldo L, Caligari M, Acquati C, Nicolazzi S, Paracchini G, Sardano D, Giordano A, Marcassa C, Corrà U. Functional capacity assessment and minimal clinically important difference in post-acute cardiac patients: the role of Short Physical Performance Battery. Eur J Prev Cardiol. 2022 May 25;29(7):1008–14. doi:10.1093/eurjpc/zwab044. PMID: 33846721Developed by the National Institute on Aging, the Short Physical Performance Battery (SPPB) consists of a series of assessments aimed to evaluate lower extremity physical function in older adults. Physical function is associated with various biomarkers including functional decline, chronic disease, falls, hospitalization, and mortality. Exercise programs, such as cardiac rehabilitation, aim to improve physical function and reduce risk factors associated with chronic disease. This study had 2 objectives: to examine the relationship between SPPB and short-term outcomes in elderly patients admitted to cardiac rehabilitation, and to determine the minimal clinically important difference (MCID) in SPPB scores for this population.Methods: Data obtained from cardiac patients (≥75 years) admitted to cardiac rehabilitation in the postacute phase following a cardiac event were retrospectively examined. Patients completed a personalized exercise program which included a 6-day rehabilitation phase consisting of activities such as calisthenics, stair climbing, cycling, and assisted walking twice a day for 6 days. The SPPB was administered upon admission and again prior to discharge to assess standing balance, gait speed, and chair rise tests. Short-term outcomes included rate of in-hospital cardiac and noncardiac complications, resources used, changes in SPPB, and duration of hospitalization. The Patient Global Impression of Change (PGIC), which asks patients to rate their health status and physical function since admission, was used as the anchor to determine the MCID in SPPB.Results: Patients (N = 385) 80.1 ± 3.7 years of age (58% males) and were admitted to cardiac rehabilitation following cardiac surgery (70.9%), acute coronary syndrome (17.7%), or congestive heart failure (10.4%). Short-term outcome data revealed a longer average length of stay (31.1 ± 16.1, 20.2 ± 6.1, 24.9 ± 10.2, 17.1 ± 5.9 days) and greater major complications rate (63%, 47%, 34%, 27%) based on SPPB scoring categorization of severe, moderate, mild, minimal/no limitations, respectively. SPPB scores from admission to discharge improved significantly (P < 0.001) for the entire study cohort. An increase of >1 on SPPB was determined to be the MCID for the SPPB. Clinically significant improvements were observed in 74.2% of patients completing cardiac rehabilitation, however the degree of improvement based on changes in SPPB scores was inversely related to level of functional impairment upon admission.Discussion: Physical function assessments such as the SPPB can offer clinicians an objective measure to evaluate a patient's risk for various negative health outcomes. In the current study, older adults with lower SPPB scores following a cardiac event experienced more complications and were hospitalized longer. While research tends to focus on statistical significance, establishing criteria for MCID may be more useful in an applied setting such as cardiac rehabilitation. To aid in determining a meaningful change in SPPB scores following cardiac rehabilitation in the postacute phase, the current study determined an increase greater than 1 in SPPB score was meaningful in terms of patients' health status and physical function. Additionally, cardiac rehabilitation was successful at eliciting a clinically significant improvement in 83% of patients classified as severe or moderate limitations. Research should be expanded to include later phases of cardiac rehabilitation and include a wider population for greater application of MCID for SPPB.Lanzi S, Belch J, Brodmann M, Madaric J, Bura-Riviere A, Visonà A, Mazzolai L. Supervised exercise training in patients with lower extremity peripheral artery disease. Vasa. 2022 Sep;51(5):267–74. doi:10.1024/0301-1526/a001024. PMID: 36059219Reduced blood flow as the result of atherosclerotic narrowing of arteries supplying the lower limbs, known as peripheral arterial disease (PAD), often leads to exertional leg pain or intermittent claudication (IC). Consequently, PAD negatively impacts lower limb function including altered gait patterns, and reduces strength, balance, and walking performance. Supervised exercise therapy (SET) should be considered as a tool for initial management of PAD, as it is successful at improving ambulatory parameters and quality of life. This study sought to determine perceptions of SET as well as its availability and use in European countries.Methods: A link to an anonymous web-based 21-question survey, developed by specialists (clinical exercise physiologist and vascular physicians) in vascular rehabilitation, was published in the European Society for Vascular Medicine (ESVM) and distributed to vascular medicine national societies via ESVM board members. The questionnaire focused on awareness, referral, insurance coverage, and programmatic topics.Results: The study team received 131 responses from 17 European countries, with highest responses from France (52%), Switzerland (13%), and Italy (11%). The majority of responders were angiologists (80%; 105/131). Awareness of SET as a first-line treatment option, and its ability to improve function and walking parameters was reported by 95% and 96% of responders, respectively. Additionally, 95% indicated they would refer those with PAD to SET if available. The majority of SET program coordinators were either vascular physicians (48%) or cardiologists (26%). Responders from 6 countries reported that SET is reimbursed by health insurance, while responders from 10 countries indicated SET is not reimbursed. One country reported SET is funded by a national insurance program. Of the 131 responders, 22 were unaware of SET insurance coverage. SET was available in 10 countries. In 7 countries, SET availability in their country was unknown by 7% of responders. Characteristics of the SET programs included: 34% are stand-alone programs specific for PAD patients, 26% were a form of individual practice, 23% were a part of cardiac rehabilitation, and 17% did not offer (or were unaware of) a SET program; 65% enrolled only symptomatic patients, 9% enrolled both symptomatic and asymptomatic patients, 8% only enrolled patients following revascularization, and 1% only enrolled asymptomatic patients. Some responders (17%) were unaware of which patients were eligible. Length and frequency of SET programs were 12 weeks or less (67%), most commonly offered 2–3 times per week (37%), and predominantly utilized walking only (26%), or combined walking and resistance training (47%).Discussion: Although very strong evidence exists for the benefits of SET for PAD, and most clinicians recognize it as a valuable component of initial disease management, this paper highlighted large variability in availability and reimbursement for SET in European countries. While 59% reportedly have SET for PAD, reimbursement is only available in 41% of countries. This is paradoxical considering SET is a Class 1A recommendation for chronic PAD patients. Interestingly, the inconsistent availability and utilization of SET for PAD may not be unique to Europe, as data from a recent study in the United States revealed SET was not available according to 54% of responders surveyed. This study demonstrates the need for improvements in SET for those with PAD in terms of clinician awareness of program availability and reimbursement, eligibility criteria, and consistency in programming.

‘On-the ground’ strategy matrix for fostering quality participation experiences among persons with disabilities in community-based exercise programs

ObjectiveThe purposes of this paper are to (1) document the generation and refinement of a quality participation strategy list to ensure resonance and applicability within community-based exercise programs (CBEPs) for persons with physical and intellectual disabilities, and (2) identify theoretical links between strategies and the quality participation constructs. MethodsTo address purpose one, a list of strategies to foster quality participation among members was extracted from qualitative interviews with providers from nine CBEPs serving persons with physical disabilities. Next, providers from CBEPs serving persons with physical (n = 9) and intellectual disabilities (n = 6) were asked to identify the strategies used, and examples of their implementation, within their programs. Additional strategies noted by providers and in recent published syntheses were added to the preliminary list. A re-categorization and revision process was conducted. To address purpose two, 22 researchers with expertise in physical and/or intellectual disability, physical activity, participation and/or health behaviour change theory completed a closed-sort task to theoretically link each strategy to the constructs of quality participation. ResultsThe final list of 85 strategies is presented in a matrix. Each strategy has explicit examples and proposed theoretical links to the constructs of quality participation. ConclusionsThe strategy matrix offers a theoretically-meaningful representation of how quality participation-enhancing strategies can be practically implemented “on-the-ground” in CBEPs for persons with disabilities.

Factors Influencing Learners’ Participation in Physical Education in The New Normal: An Input to Curriculum Development Program

&#x0D; This study focused on determining the factors that influence the learners’ participation in Physical Education (PE) under the New Normal; it also investigated perceptions about teaching quality, level of readiness in distance learning, and the mean level of participation in PE in accordance to MELCS.  It further looked into the significant relationships between factors of teaching quality; learners’ level of readiness to distance learning as against learners’ participation; and learners’ demography. This study offers a lot of learning opportunities about simplified and essential teaching modalities, which are focused and easy for learners, under the New Normal environment and under the threat of being infected with Covid-19. Frequencies, percentage, means, standard deviation, Pearson product moment of correlation, multiple linear regression, and hierarchical linear regression were the statistical tools applied in the analysis of data collected from selected Junior High School learners from 25 districts in the Division of Laguna. Major findings from the study are that (i) learners have a high level of perception of teaching quality in terms of cognitive activation, supportive climate, and classroom management; (ii) learners have a high level of readiness on distance learning in terms of availability of technology, use of technology, self-confidence, acceptance, and time management skills; and (iii) a high mean level on learner’s participation in PE according to their respective MELCS in terms of personalized exercise programs, physical activity participation, physical activity/fitness assessment, and skills demonstration. This study recommended that physical education teachers may provide students with more enhanced and localized activities that are tailored to their interests and appropriate for this new normal setting. &#x0D;

Efficacy of personalized exercise program on physical function in elderly patients with rheumatoid arthritis at high risk for sarcopenia: study protocol for a randomized controlled trial

BackgroundPatients with rheumatoid arthritis (RA) are prone to muscle atrophy due to inflammatory cytokines and corticosteroid use and immobility due to joint pain and deformity. Although resistance training is effective and safe in reversing muscle atrophy in RA, some patients are unable to perform a conventional high-load exercise program due to disease-related limitations. This study aims to examine the efficacy of individualized exercise therapy on physical function in elderly patients with RA who are at a high risk for sarcopenia.MethodsThis study is a single-center, parallel-group, two-arm, healthcare provider- and outcome assessor-blinded, superiority randomized controlled trial with a 1:1 allocation ratio. A total of 160 participants with RA between 60 and 85 years of age with a positive screening test for sarcopenia will be included. The intervention group will receive nutritional guidance and a four-month individualized exercise program in addition to the usual treatment. The control group will receive nutritional guidance in addition to the usual care. The primary endpoint will be physical function assessed using the Short Physical Performance Battery (SPPB) at 4 months. The data on outcome measures will be collected at baseline and at the two- and four-month follow-ups. Linear mixed-effects models for repeated measures will be conducted using the modified intention-to-treat analysis population.DiscussionThis study will provide evidence on whether a personalized exercise program can improve physical function and quality of life in elderly patients with RA. Some limitations include limited generalizability due to the single-center study and lack of blinding of the patients to the intervention assignment because of the nature of the exercise. Physical therapists may use this knowledge in their daily practice to improve RA treatment. Tailored exercise may enhance the health outcomes of the RA population and contribute to a reduction in healthcare costs.Trial registrationThe study protocol was retrospectively registered at the University hospital Medical Information Network-Clinical Trial Repository (UMIN-CTR) (registration number: UMIN000044930, https://www.umin.ac.jp/ctr/index-j.htm) on January 4, 2022.

Effect of Scapular Stabilizer Muscles Strength on Scapular Position.

Maintaining scapular mechanics is important for upper extremity functionality and posture. Determining the extent to which the scapular stabilizer muscles affect the scapular position may guide the creation of an exercise program for people with scapular dyskinesis. The serratus anterior (SA), upper trapezius (UT), middle trapezius (MT), and lower trapezius (LT) muscles play different roles on scapular position when humeral elevation increase. Cross-sectional study. Level 4. A total of 70 women aged 40 to 65 years (mean age, 49 ± 7 years) who met the inclusion criteria were included in the study. Isometric muscle strength of the SA, UT, MT, and LT was evaluated with a handheld dynamometer. For assessment of scapular position, the lateral scapular slide test (LSST) was used. Multiple stepwise regression analysis was used to evaluate scapular parameters. There were positive and statistically significant correlations between the isometric muscle strength of the SA, UT, MT, and LT muscles and the values at different humerus positions in the LSST (P < 0.05). The UT and SA muscles greatly affected the changes in the position of the inferior region of the scapula (R2 > 24.5%). The LT (11.3%) in neutral position, MT (25.4%) with arm abducted at 45°, and SA (34.5%) with arm abducted 90° had a major effect on the changes in the mediolateral position of the scapula. While the LT muscle affects the mediolateral position of the scapula to a large extent, the strength of the MT and SA muscles becomes effective as the shoulder elevation increases. SA and UT muscle strength have a greater effect on the position of the inferior region of the scapula. Dyskinesis can be observed at different levels of the scapula; therefore, it is important to determine at which level the dyskinesis is more prominent for each individual and consequently to form a personalized exercise program to increase function and control dyskinesis.