High-intensity Exercise Program Research Articles

Effect of a High-Intensity Tandem Bicycle Exercise Program on Clinical Severity, Functional Magnetic Resonance Imaging, and Plasma Biomarkers in Parkinson's Disease.

Rationale: The optimal modality, intensity, duration, frequency, and dose–response of exercise as a therapy for Parkinson's Disease (PD) are insufficiently understood.Objective: To assess the impact of a high-intensity tandem bicycle program on clinical severity, biomarkers, and functional MRI (fMRI) in PD.Methods: A single-center, parallel-group clinical trial was conducted. Thirteen PD patients aged 65 or younger were divided in two groups: a control group and an intervention group that incorporated a cycling program at 80% of each individual's maximum heart rate (HR) (≥80 rpm), three times a week, for 16 weeks. Both groups continued their conventional medications for PD. At baseline and at the end of follow-up, we determined in all participants the Unified Parkinson's Disease Rating Scale, anthropometry, VO2max, PD biomarkers, and fMRI.Results: VO2max improved in the intervention group (IG) (+5.7 ml/kg/min), while it slightly deteriorated in the control group (CG) (−1.6 ml/kg/min) (p = 0.041). Mean Unified Parkinson's Disease Rating Scale (UPDRS) went down by 5.7 points in the IG and showed a small 0.9-point increase in the CG (p = 0.11). fMRI showed activation of the right fusiform gyrus during the motor task and functional connectivity between the cingulum and areas of the frontal cortex, and between the cerebellar vermis and the thalamus and posterior temporal gyrus. Plasma brain-derived neurotrophic factor (BDNF) levels increased more than 10-fold in the IG and decreased in the CG (p = 0.028). Larger increases in plasma BDNF correlated with greater decreases in UPDRS (r = −0.58, p = 0.04).Conclusions: Our findings suggest that high-intensity tandem bicycle improves motor function and biochemical and functional neuroimaging variables in PD patients.Trial registration number: ISRCTN 13047118, Registered on February 8, 2018.

Heart Rate Variability Mediates Fatigue And Motivation Throughout A High-intensity Exercise Program.

PURPOSE: High-intensity exercise programs are often promoted as a time-efficient public health intervention to combat chronic disease. Increased physical effort, and subsequent fatigue, can be barriers to long-term maintenance of these exercise programs. The purpose of the present study was to determine if heart rate variability (HRV) mediates state traits related to exercise program adherence. We hypothesized that exercise-induced, temporary shifts in resting HRV would significantly affect daily fatigue and motivation. METHODS: Fifty-five healthy men and women (ages 19-35 years) used a commercially-available smartphone application to monitor daily HRV status throughout a six-week high-intensity exercise intervention. Participants were randomly assigned to either control (CON) (n = 29, 24.1 ± 4.1 years, 41.4% male) or treatment (TREAT) (n = 26, 23.7 ± 4.5 years, 53.8% male) groups. Within CON, exercise intensity was completed as prescribed while intensity within TREAT was modulated in response to observed shifts in daily HRV. Participants reported state motivation to exercise and global physical fatigue immediately prior to each exercise session. RESULTS: Prevalence of temporary shifts in resting HRV were 37.6 and 38.7% for the CON and TREAT conditions, respectively. Within CON, shifts in HRV resulted in less motivation (mean diff. = -4.00%; 95%CI = -7.56, -0.44; F = 4.86, p = 0.028) and more physical fatigue (mean diff. = 4.79%; 95%CI = 1.85, 7.74; F = 10.24, p < .001). Spectral domain metrics (i.e., LF:HR ratio) were significantly lower (mean diff. = -0.14 au; 95%CI = -0.27, -0.01; F = 4.715, p = .030) during HRV shifts. Within TREAT, shifts in HRV resulted in no change in motivation (mean diff. = 2.58%; 95%CI = -6.54, 1.38; F = 1.63, p = .202) with reduced physical fatigue (mean diff. = -5.94%; 95%CI = -9.56, -2.32; F = 10.40, p = .001). Within TREAT, LF:HF ratio was higher (mean diff. = 0.13 au; 95%CI = 0.23, 0.24; F = 5.59, p = .018) during HRV shifts. CONCLUSIONS: These data establish a link between expected shifts in heart rate variability throughout high-intensity exercise programs with motivation to participate and physical fatigue. Additionally, modulation of training volume, in response to these shifts, can optimize adherence-related behavioral responses during high-exercise programs.

Examination Of Low Energy Availability And Sleep In High-intensity Functional Exercise Program Athletes

Low energy availability (LEA) affects the body’s physiological systems, which can negatively affect an athlete’s performance and recovery. Athletes that participate in high-intensity functional exercise may not have adequate dietary intake to match energy needs or obtain optimal amount of sleep to recover fully. PURPOSE: To examine the low energy availability (LEA) and sleep among male and female recreational athletes who engage in high-intensity functional exercise programs. METHODS: Thirty adults (age: 31.2 ± 8.1; males: n = 12, 176.9 ± 6.2 cm, 89.5 ± 15.1 kg; females: 164.7 ± 7.1 cm, 69.9 ± 11.1 kg) participated in a larger cross-sectional study. Participants completed a demographic survey, Pittsburgh Sleep Quality Scale, a 7-day online dietary and exercise log. Participants were measured for height, weight, DXA scan (BMD), and RMR through indirect calorimetry (MedGem). ANOVAs examined differences between gender and energy needs, and Chi-squared analysis examined differences between gender and risk for LEA and Poor Sleep. RESULTS: Significant differences were found between gender and RMR (males: 2296.7±400.3 kg; females: 1761.7±341.6 kg; P=0.001), EI (males: 2027.5±694.5 kg; females: 1568.9±461.1 kg; P=0.038) and EEE (males: 357.8±60.3 kg; females: 279.3±44.4 kg; P≤0.01). No significant differences were found between gender and LEA (males: 24.8.7±12.2 kg; females: 25.0±8.9 kg). Overall risk for LEA was 66.7% (n = 20); however independently LEA was 50% (n=6) for males and 77.8% (n=14) for females. Overall, 63.3% (n=19) recreational athletes report poor sleep. No significant differences were found across gender and poor sleep, independently poor sleep for males was 50% (n=6) and females 72.2% (n=13). No significant differences were found between gender, poor sleep, and LEA. Of those at risk for LEA (n=20), 60% (n=12) also had reported poor sleep. CONCLUSIONS: Recreational athletes were at risk for both LEA and poor sleep, with a majority at risk for both. A combination of LEA and poor sleep can lead to poor performance and recovery from high-intensity exercises. Therefore, education to recreational athletes on the importance of dietary intake to match energy needs and encouragement for positive sleeping habits is imperative to optimize physiological recovery.

Moderators of Cognitive Outcomes from an Exercise Program in People with Mild to Moderate Dementia.

Our aim was to estimate whether baseline participant variables were able to moderate the effect of an exercise intervention on cognition in patients with mild to moderate dementia. Subgroup analysis of a multicenter pragmatic randomized controlled trial. Community-based gym/rehabilitation centers. A total of 494 community-dwelling participants with mild to moderate dementia. Participants were randomized to a moderate- to high-intensity aerobic and strength exercise program or a usual care control group. Experimental group participants attended twice weekly 60- to 90-minute gym sessions for 4 months. Participants were prescribed home exercises for an additional hour per week during the supervised period and 150 minutes each week after the supervised period. Multilevel regression model analyses were undertaken to identify individual moderators of cognitive function measured through the Alzheimer Disease Assessment Scale-Cognitive Subscale score at 12 months. When tested for a formal interaction effect, only cognitive function assessed by the baseline number cancellation test demonstrated a statistically significant interaction effect (-2.7 points; 95% confidence interval = -5.14 to -0.21). People with worse number cancellation test scores may experience greater progression of cognitive decline in response to a moderate- to high-intensity exercise program. Further analyses to examine whether these findings can be replicated in planned sufficiently powered analyses are indicated.

Influence of Chair Based Exercises on Quality of Life among Frail Elderly

Frailty, a progressive physiologic decline in multiple body systems, marked by loss of function, loss ofphysiologic reserve and increased vulnerability to disease and death. The overall prevalence of frailty is22.7%. Frailty is more common in women (25.3%) than in men (18.6%).1 Exercise has a wide range ofhealth benefits in older people.[2,3] Mostly for community-dwelling population there is a clear evidenceto support exercise in improving health and quality of life with well evidenced exercise programs. Theseprograms have shown to reduce the risk of falls with associated benefits on mortality, morbidity and coststo health and social care.[5,6]Frail elderly people are often unable to undertake high intensity exerciseprogrammes.7 Therefore chair based exercises are been used as an alternative. Many research studies havereported the benefits of chair based exercises as a physical activity for older adults and individuals withlimited movement.4Method: The subjects in the KIMSDU campus were screened and 42 subjects fulfilling the criteria wereinvolved. Prior consent was taken. Treatment protocol consists of chair based exercises for 4 days perweek for 6 weeks The interpretation of the study was done on the basis of comparing pre-test and post-testassessment of QOL and 6MWT.Result: Intra group comparison results showed that chair based exercises are effective and QOL and 6MWTwere statistically significant (p<0.0001) and (0.0431) respectively.Conclusion: Chair based exercises were significantly effective in improving the mobility and function andpreventing the risk of falls among frail elderly population.

Effects of supervised high-intensity resistance and impact training or machine-based isometric training on regional bone geometry and strength in middle-aged and older men with low bone mass: The LIFTMOR-M semi-randomised controlled trial.

Few data exist on the effects of bone-targeted exercise on geometric and biomechanical indices of bone strength in men. The Lifting Intervention For Training Muscle and Osteoporosis Rehabilitation for Men (LIFTMOR-M) trial was designed to compare the efficacy and safety of two novel, supervised, twice-weekly, high-intensity exercise programs in middle-aged and older men with osteopenia and osteoporosis on musculoskeletal health and risk factors related to falls and fractures. The current report includes secondary outcomes of the LIFTMOR-M exercise intervention trial. Our goal was to determine the effects of two supervised, twice-weekly, high-intensity exercise programs on bone geometry and strength of the proximal femur, and distal and proximal sites of the tibia and radius in middle-aged and older men with osteopenia and osteoporosis. Generally-healthy men (≥45years), with low lumbar spine (LS) and/or proximal femur areal bone mineral density (aBMD), were recruited from the community. Eligible participants were randomised to either eight months of twice-weekly supervised high-intensity progressive resistance and impact training (HiRIT) or supervised machine-based isometric axial compression (IAC) exercise training. Intervention group outcomes were compared at baseline and eight months with a matched but non-randomised control group (CON) who self-selected to usual activities. DXA scans (Medix DR, Medilink, France) of the skeletally non-dominant proximal femur were analysed using 3D hip software (DMS Group, France) to derive femoral neck (FN) and total hip (TH) bone mineral content (BMC), volume, and volumetric bone mineral density (vBMD) for total, trabecular and cortical bone compartments. Total FN cortical thickness was determined as well as anterior, posterior, lateral and medial subregions. pQCT scans (XCT-3000, Stratec, Germany) of the 4 and 38% sites of the tibia, and 4 and 66% sites of the radius were conducted to determine a range of geometric and bone structural strength indices. Intervention effects were examined using univariate ANCOVA of percent change, and repeated measures ANCOVA of raw baseline and follow-up data, controlling for initial values, using intention-to-treat and per-protocol approaches. Ninety-three men (67.1±7.5yrs, 175.2±6.7cm, 82.1±11.6kg, 26.7±3.5kg/m2) with lower than average aBMD (LS T-score -0.06±1.04, FN T-score -1.58±0.58, TH T-score -1.00±0.58) were recruited, and designated CON (n=26) or randomised to HiRIT (n=34) or IAC (n=33). Compliance to the supervised exercise programs did not differ (HiRIT 77.8±16.6% versus IAC 78.5±14.8%, p=0.872). HiRIT improved medial FN cortical thickness compared with CON (5.6±1.7% versus -0.1±1.9%, p=0.028) and IAC (5.6±1.7% versus 0.7±1.7%, p=0.044). Distal tibia total BMC, vBMD, area and bone strength index, and trabecular BMC and bone strength index all declined for CON compared with maintenance for both HiRIT and IAC (all p<0.05). HiRIT maintained distal tibia trabecular area compared with a loss in CON (0.2±0.5% versus -1.6±0.5%, p=0.013). HiRIT and IAC maintained distal radius total BMC compared with loss in CON (-0.1±0.7% versus -3.7±0.8%, p=0.001; 1.3±0.7% versus -3.7±0.8%, p<0.001, respectively). HiRIT and IAC maintained distal radius total bone strength index compared with loss in CON (1.4±1.4% versus -6.0±1.6%, p=0.001; 0.2±1.3% versus -6.0±1.6%, p=0.004, respectively). HiRIT reduced proximal radius cortical area compared with CON (-3.1±1.0% versus 1.1±1.2%, p=0.011) and IAC (-3.1±1.0% versus -0.2±1.0%, p=0.042). No between-group differences were detected in any pQCT-derived bone outcome at the diaphyseal tibia 38% site. Findings indicate that supervised HiRIT provides a positive stimulus to cortical bone at the medial FN compared with supervised IAC exercise, and both HiRIT and IAC preserve bone strength at the distal tibia and distal radius. These effects may translate into a reduced risk of lower and upper extremity fracture in middle-aged and older men with low bone mass.

How Do Patients With Axial Spondyloarthritis Experience High-Intensity Exercise?

ObjectiveIn a few studies, high‐intensity exercise has displayed beneficial effects on cardiovascular health among patients with rheumatic diseases, yet the high‐intensity exercise mode is still not fully accepted among health care professionals. The aim of this study was to investigate experiences of high‐intensity exercise among patients with axial spondyloarthritis.MethodsFourteen respondents who had participated in a high‐intensity exercise program for 12 weeks were included in this qualitative study with individual semistructured, in‐depth interviews. The respondents’ median age was 53, ranging from 23 to 63 years old, and both men and women of different ethnicities were represented. Interviews were analyzed by qualitative content analysis, including both manifest content and interpretations of underlying latent meaning.ResultsThe analysis resulted in five categories describing the respondents’ experiences with high‐intensity exercise: 1) high‐intensity exercise as a challenge for both body and mind, 2) increased faith in one's own body, 3) changed attitude toward exercise, 4) taking charge of one's own health by challenging the disease, and 5) exercise in a social context.ConclusionSupervised high‐intensity interval exercise was perceived as challenging for both body and mind but was also described as a positive experience, with rapid bodily effects that strengthened respondents’ faith in their own bodies. The new experience seemed to have changed the respondents’ attitude and motivation for exercise and made them start taking charge of their health by challenging the disease. Exercise in a social context, under professional leadership, enhanced exercise self‐efficacy and helped the respondents to adhere to the exercise program.

Feasibility and Associated Physical Performance Outcomes of a High-Intensity Exercise Program for Children With Autism

ABSTRACT Purpose: Children with autism spectrum disorder (ASD) without intellectual disability (ID) exhibit social and motor impairments and circumscribed interests/behaviors that contribute to lower physical activity (PA) levels. Despite the need for exercise interventions for these children, there is a dearth of evidence-based treatments. This study tested the feasibility of a high-intensity exercise program for children with ASD without ID, and associated changes in physical performance. Method: Fifty-eight children, ages 7–12 with ASD without ID participated. The intervention (5 weeks, 19 sessions, 60 mins ea.) was conducted during the summer. Each session was manualized (operationalized instructional procedure and curriculum) and targeted components of fitness and motor performance using skill development exercises, workouts, and game-related activities. Feasibility was assessed via fidelity (implementation accuracy), satisfaction surveys, attrition, and injuries. Physical performance was tested at baseline and posttest using measures of work production (completed rounds of an exercise circuit) and within-session activity levels (time in moderate-to-vigorous PA), and six exercise tests (sit and reach, push-ups, sit-ups, air squats, long jump, and PACER). Results: Results indicated high levels of fidelity (93.7%) and child and staff satisfaction, and no attrition or injuries, supporting the feasibility, tolerability, and safety of the protocol. Significant increases were found in work production and activity levels (ds 0.83 and 1.05, respectively) and on three exercise tests (sit ups, air squats, and long jump; ds 0.29–0.37). Conclusion: The exercise program was feasible and safe, and completion was associated with significant improvements in multiple areas of performance; a randomized controlled trial appears warranted.

Effects of a High-Intensity Exercise Program on Weight Regain and Cardio-metabolic Profile after 3 Years of Bariatric Surgery: A Randomized Trial

Weight regain is one of the most common problems in the long-term after bariatric surgery. It is unknown if high-intensity exercise programs applied in late phases of post-surgical follow-up could counteract this trend. After a 3-year follow-up, 21 patients underwent sleeve gastrectomy were randomized into an exercise group (EG, n = 11), that performed a 5-month supervised exercise program, and a control group (CG, n = 10), that followed the usual care. Body composition, cardiorespiratory fitness, glycaemia and blood cholesterol were evaluated before and after the intervention. Finally, the EG repeated the evaluations 2 months after the end of the exercise program. Both groups reached their maximum weight loss at the first year after surgery and showed significant weight regain by the end of the follow-up. After the exercise program, the EG showed reductions in fat mass (−2.5 ± 2.6 kg, P < 0.05), glycaemia (−13.4 ± 8.7 mg·dL−1,P < 0.01) and blood cholesterol (−24.6 ± 29.1 mg·dL−1, P < 0.05), whereas the CG during the same period showed increases in weight (1.5 ± 1.3 kg, P < 0.05) and fat mass (1.8 ± 0.9, P < 0.01). Two months after the end of the program, EG had increases in weight (1.1 ± 1.2 kg, P < 0.05), fat mass (2.6 ± 2.2 kg, P < 0.01), glycaemia (8.2 ± 11.6 mg·dL−1, P < 0.05) and blood cholesterol (20.0 ± 22.1 mg·dL−1, P < 0.05), when compared with the values after the exercise program. Therefore, in the medium-term after sleeve gastrectomy exercise may contribute to prevent weight regain and to reduce fat mass, glycaemia, and blood cholesterol.

Is the Effect of a High-Intensity Functional Exercise Program on Functional Balance Influenced by Applicability and Motivation among Older People with Dementia in Nursing Homes?

Background and ObjectivesExercise can be an important way of maintaining balance function in people with dementia, but further investigation is needed to determine the optimal way of exercising. The objective was to evaluate whether exercise applicability (i.e., attendance, exercise intensity, and adverse events) and motivation were associated with the effect on functional balance of a high-intensity functional exercise program for older people with dementia in nursing homes.Design, Setting and ParticipantsExercise intervention participants (n = 81; 60 women, 21 men) from a randomized controlled trial (UMDEX) were included. Their mean age was 84 and mean Mini-Mental State Examination score was 15.InterventionGroups of 3–8 participants participated in the High-Intensity Functional Exercise (HIFE) Program, with 5 sessions per 2-week period, for 4 months (total, 40 sessions).MeasurementsOutcome was the Berg Balance Scale (BBS), assessed at baseline and follow up, and the score difference, dichotomized to classify participants into two groups: responders (≥5-point increase) and non-responders (<5-point increase). Target variables were measures of applicability and motivation. Associations between each target variable and the outcome were analyzed using multivariable logistic regression. Baseline characteristics and new medical conditions developing during the intervention period were compared between responders and non-responders and included in the analyses when p < 0.10.ResultsThe BBS score was 28.6 ± 14.3 at baseline and 31.2 ± 15.3 at follow up, with the difference between follow-up and baseline scores ranging from −35 to 24. Twenty-nine (35.8%) participants were responders. The multivariable models showed no significant association between responders vs. non-responders and any target variable.ConclusionParticipation in a 4-month high-intensity functional exercise program can improve balance in many individuals with dementia in nursing homes, despite the progressiveness of dementia disorders and several co-existing medical conditions. Predicting balance exercise response based on applicability and motivation seem not to be possible, which lends no support for excluding this group from functional exercise, even when exercise intensity or motivation is not high.

Low-Intensity Running and High-Intensity Swimming Exercises Differentially Improve Energy Metabolism in Mice With Mild Spinal Muscular Atrophy

Spinal Muscular Atrophy (SMA), an autosomal recessive neurodegenerative disease characterized by the loss of spinal-cord motor-neurons, is caused by mutations on Survival-of-Motor Neuron (SMN)-1 gene. The expression of SMN2, a SMN1 gene copy, partially compensates for SMN1 disruption due to exon-7 excision in 90% of transcripts subsequently explaining the strong clinical heterogeneity. Several alterations in energy metabolism, like glucose intolerance and hyperlipidemia, have been reported in SMA at both systemic and cellular level, prompting questions about the potential role of energy homeostasis and/or production involvement in disease progression. In this context, we have recently reported the tolerance of mild SMA-like mice (SmnΔ7/Δ7; huSMN2+/+) to 10 months of low-intensity running or high-intensity swimming exercise programs, respectively involving aerobic and a mix aerobic/anaerobic muscular metabolic pathways. Here, we investigated whether those exercise-induced benefits were associated with an improvement in metabolic status in mild SMA-like mice. We showed that untrained SMA-like mice exhibited a dysregulation of lipid metabolism with an enhancement of lipogenesis and adipocyte deposits when compared to control mice. Moreover, they displayed a high oxygen consumption and energy expenditure through β-oxidation increase yet for the same levels of spontaneous activity. Interestingly, both exercises significantly improved lipid metabolism and glucose homeostasis in SMA-like mice, and enhanced oxygen consumption efficiency with the maintenance of a high oxygen consumption for higher levels of spontaneous activity. Surprisingly, more significant effects were obtained with the high-intensity swimming protocol with the maintenance of high lipid oxidation. Finally, when combining electron microscopy, respiratory chain complexes expression and enzymatic activity measurements in muscle mitochondria, we found that (1) a muscle-specific decreased in enzymatic activity of respiratory chain I, II, and IV complexes for equal amount of mitochondria and complexes expression and (2) a significant decline in mitochondrial maximal oxygen consumption, were reduced by both exercise programs. Most of the beneficial effects were obtained with the high-intensity swimming protocol. Taking together, our data support the hypothesis that active physical exercise, including high-intensity protocols, induces metabolic adaptations at both systemic and cellular levels, providing further evidence for its use in association with SMN-overexpressing therapies, in the long-term care of SMA patients.

The impact of different intensities of exercise on body weight reduction and overactive bladder symptoms- randomised trial

Objectivesto investigate the effect of a 3-month exercise programme with two different intensities on the reduction of body weight and body fat percentage in overweight women with overactive bladder symptoms (OAB). Study Designrandomised controlled study. The sample consisted of 77 overweight women with OAB symptoms, with an average age of 26.2 years. Body mass index (BMI) measurements confirmed if women were overweight. Participants were split into two groups, as follows: Group 1 (programme with high intensity) (n = 39) and group 2 (programme with low intensity) (n = 38). For evaluation of body composition, we used Bioelectric impedance analysis with assessment of body fat percentage (BFP) and visceral fat area (VFA). OAB symptoms were evaluated using a voiding diary, an overactive bladder questionnaire (OAB-q) and the Patient Perception of Intensity of Urgency Scale (PPIUS). The intervention was a Programme for Reduction of Abdominal Fat, aimed at reducing abdominal fat with elements of aerobic training, strengthening of the surface and deep abdominal muscles and stretching. ResultsGroup 1 lost body weight and showed a reduction in Body Fat Percentage (BFP) of more than 5%, whereas group 2 did not. Significant differences in OAB symptoms (p < 0.01) were recorded after training in favour of group 1 (number of voiding per 24 h changed from 8.92 ± 1.7 to 6.87 ± 0.40, OAB-q SS from 11.36 ± 8.57 to 1.46 ± 3.4). In the body composition assessment, significant differences (p < 0.001) were recorded after training in favour of group 1, in terms of BMI, BFP, WFA and body weight reduction. ConclusionThe high intensity exercise programme for reducing abdominal fat (PRAF) significantly reduces overweight and mild symptoms of OAB after 12 weeks.

Mechanisms to Reduce the Burden on Dementia Caregivers

Background: Caregiving for people with dementia is highly demanding. It is unclear which patient factors should be targeted to relieve caregiver burden. We aimed to identify potential mechanisms that could alleviate caregiver burden. Methods: We conducted a causal mediation analysis of the Dementia And Physical Activity (DAPA) randomised controlled trial. DAPA was a pragmatic, investigator masked, randomised controlled trial conducted in 15 regions across England. DAPA recruited a sample of 494 people with mild to moderate dementia (DSM-IV) and their caregivers and compared a moderate to high intensity exercise programme (n=329) versus usual care (n=165). We estimated mediating effects of the intervention on caregiver burden at 12 months through the following mediators measured at six months, participants' social quality of life (Quality of Life in Alzheimer's Disease scale), physical function (Bristol Activities of Daily Living scale), behavioural symptoms (Neuropsychiatric Inventory), and cognitive function (Alzheimer disease assessment scale cognitive subscale). Findings: The exercise programme had no effect on behavioural, cognitive, physical and social mediators. All mediators were significantly associated with less caregiver burden. Physical function had the strongest association with carer burden (0.20, 95%CI = 0.11 to 0.30), followed by behavioural symptoms (0.19, CI = 0.08 to 0.30). Interpretation: Interventions that can improve physical function and reduce behavioural symptoms of people with dementia can reduce caregiver burden. Funding Statement: National Institute of Health Research (NIHR) Health Technology Assessment Programme, NIHR Collaboration for Leadership in Applied Health Research and Care Oxford at Oxford Health NHS Foundation Trust, and the NIHR Oxford Musculoskeletal Biomedical Research Unit. Declaration of Interests: All authors declare no conflicts of interests. Ethics Approval Statement: The national ethics review committees (REC No 11/SW/0232) and research governance departments in each organisation approved the original DAPA trial.

Heart rate variability mediates motivation and fatigue throughout a high-intensity exercise program.

High-intensity exercise interventions are often promoted as a time-efficient public health intervention to combat chronic disease. However, increased physical effort and subsequent fatigue can be barriers to long-term maintenance of high-intensity exercise programs. The purpose of the present study was to determine if heart rate variability (HRV) mediated state traits related to exercise program adherence. Fifty-five healthy men and women (ages 19-35 years) used a commercially available smartphone application to monitor daily HRV status throughout a 6-week high-intensity exercise intervention. Participants reported state motivation to exercise and global physical fatigue immediately prior to each exercise session. Temporary shifts toward increased parasympathetic reactivation (p = 0.030) resulted in significant increases in daily fatigue (p < 0.001) and decreases in motivation to exercise (p = 0.028). Through modulation of exercise volume, in response to these temporary shifts in HRV, these effects were reversed (p < 0.001) via increased parasympathetic withdrawal (p = 0.018). For the first time, these data demonstrate a mediating effect of HRV on adherence-related trait states throughout a high-intensity exercise program. Applied strategies, such as appropriately timed exercise volume moderation, may be able to leverage this effect and help facilitate long-term exercise program maintenance. Novelty These data establish a link between expected shifts in HRV throughout high-intensity exercise programs with motivation to participate and physical fatigue. Modulation of training volume, in response to these shifts, can optimize adherence-related behavioral responses during high-exercise programs.

Long-term effectiveness and cost-effectiveness of an 18-week supervised exercise program in patients treated with autologous stem cell transplantation: results from the EXIST study

PurposeTo evaluate the long-term effectiveness and cost-effectiveness of a supervised 18-week high-intensity exercise program compared with usual care in patients treated with autologous stem cell transplantation.MethodsOne hundred nine patients were randomly assigned to the exercise intervention (n = 54) or the usual care control group (n = 55). Data on cardiorespiratory fitness (VO2peak), handgrip strength, general fatigue, and health-related quality of life (quality-adjusted life years [QALYs]) were collected at baseline (T0), after completion of the exercise intervention or at a similar time point in the control group (T1) and 12 months later (T2). Cost questionnaires were used to assess societal costs. Long-term effectiveness (at T2) was evaluated using linear mixed model analyses. For the economic evaluation, missing data were imputed using multiple imputation, and data were analyzed using linear mixed models.ResultsAt T2, no statistically significant differences were found between the intervention and control group for VO2peak (0.12; 95%CI − 1.89; 2.14 ml/min/kg), handgrip strength (− 1.08; 95%CI− 2.47; 2.31), and general fatigue (− 0.69; 95%CI − 2.52; 1.14). During 12-months follow-up, no significant between-group differences in QALYs and societal costs were found (QALYs − 0.07; 95%CI − 0.17; 0.04; costs 529; 95%CI − 3205;4452). Intervention costs were €1340 per patient. For all outcomes, the probability of the intervention being cost-effective was low at reasonable values of willingness-to-pay.ConclusionWe found no evidence for the exercise intervention being effective on physical fitness and fatigue, nor cost-effective from a societal perspective.Trial registrationThe study was prospectively registered on 27 May 2010 at the Netherlands Trial Register (NTR2341).Implications for Cancer SurvivorsThe current exercise intervention should not be recommended to patients recently treated with autologous stem cell transplantation.

Predictors of outcomes in exercisers with Parkinson disease: A two-year longitudinal cohort study.

Exercise may modify disease progression in persons with Parkinson disease (PD). The purpose of this longitudinal cohort study was to determine factors that predict motor, activity, and participation-based outcomes over two years in exercisers with PD. A convenience sample with idiopathic PD was included in the analysis [n = 74; mean age 66.7(8.4) years; male 54%; median months post diagnosis 69.0(76.0), median Hoehn and Yahr score 1.0(2.0)]. Exercise behaviors (minutes of exercise/week, peak rate of perceived exertion (RPE) and mode of exercise) and outcomes of impairment [grip strength], activity [10-meter walk test, functional reach test, activity specific balance confidence scale] and participation [Parkinson Disease Questionnaire-39] were assessed at baseline, 6, 12, 18 and 24 months. Using generalized estimating equations at least one exercise behavior was a significant predictor across most of the models (p≤0.026), with higher RPE predicting better outcomes in all activity and participation domains. Younger age, male gender and lower disease severity also significantly predicted better outcomes over time (p≤0.041). Exercise behaviors contributed to activity and participation-based outcomes over two years in exercisers with PD. Participation in high-intensity exercise programs may enhance maintenance of health and function over time in individuals with PD.

Effect of high-flow nasal therapy during exercise training in COPD patients with chronic respiratory failure: study protocol for a randomised controlled trial

BackgroundThe benefit of pulmonary rehabilitation (PR) in symptomatic chronic obstructive pulmonary disease (COPD) is well known. However, advanced patients with chronic respiratory failure (CRF), a category excluded from most studies, are frequently unable to sustain a work-load sufficiently high to obtain the full benefit of PR on exercise tolerance. Recent studies involving heated and humidified high flow oxygen therapy (HFOT) showed positive effects on breathing pattern and ventilatory efficiency during effort. We thus plan to compare, in COPD patients with CRF undergoing a high-intensity exercise programme, the effect of using HFOT versus standard oxygen delivery via Venturi Mask (V-mask), at the same inspiratory oxygen fraction, on improving exercise endurance.Methods/DesignThis is a multicentre randomised controlled trial that will involve 156 COPD inpatients with CRF recruited from seven PR hospitals. Patients will be randomised to one of two groups – V-mask versus HFOT. All patients will undergo the same high-intensity exercise programme using either of the oxygen delivery devices as per their group allocation. Training will consist of 20 sessions, over 1 month (5 sessions per week) within the hospitalisation period. Anthropometric and clinical data, including body mass index, diagnosis, spirometry and comorbidities (Cumulative Rating Scale) will be collected at baseline. At baseline and at the end of the exercise programme (primary assessment time) evaluation will include exercise tolerance (Constant Work Rate Exercise Test) (primary outcome), functional capacity (6-min walk test), maximal inspiratory pressure/maximal expiratory pressure, peripheral muscle strength (biceps and quadriceps) by manual dynamometer, respiratory exchanges (blood gases analysis), disability (Barthel Index and Barthel Dyspnoea Index), impact of disease (COPD Assessment test), and quality of life (Maugeri Respiratory Failure Scale-26). At the end of the training period, patient satisfaction will be evaluated.DiscussionThis study will add knowledge about the exercise response in advanced COPD with CRF and verify if an alternative tool, namely HFOT, can increase the benefit obtained from PR.Trial registrationClinicalTrials.gov ID NET03322787Registered: 6 November 2017

An analysis of new social fitness activities: loyalty in female and male CrossFit users

CrossFit is a type of high-intensity functional exercise programme in which a type of philosophy of life and competitive sport take place together. This product is created for all kinds of people and interrelates with a diversity of social practices. This work aims to analyze the relationships between customer engagement, perceived value, satisfaction, and future intentions in CrossFit users as well as the significance of this activity for the person. The study engaged 520 participants with an online questionnaire. A confirmatory factor analysis and multi-group analysis was performed to test the difference between two invariance models. The findings show positive relationships between customer engagement and perceived value in women, and between perceived value, satisfaction and fidelity in men. Therefore, this work has shown that the participation of customers has positive consequences for the CrossFit customer loyalty chain.

Feasibility of a 6-week Handcycling High Intensity Interval Training Program for Spinal Cord Injury

PURPOSE: Spinal cord injury (SCI) can be debilitating to one’s health, functional capacity, and quality of life. Specifically, SCI contributes to an elevated risk of preventable cardiometabolic and hypokinetic diseases. Many individuals with SCI have low levels of fitness due to barriers including lack of time, accessible equipment and awareness of exercises that are safe and effective. Using an indoor stationary handcycle to perform a high-intensity exercise program (HIIT) could be a time-efficient and accessible means of improving fitness. The primary aim of this study was to determine adherence, acceptance and fitness outcomes of a 6-week HIIT program for non-ambulatory persons with SCI. METHODS: Three men with SCI have completed the study to date (Table). At baseline, S2 did not participate in regular physical activity (PA). S1 and S3 participated in 1-3 hours of PA 2 times/week. Participants completed a baseline and post graded exercise test. The HIIT program consisted of 2, 25 min supervised at-home sessions (2-3 min warm-up, 10, 1:1 min work/recovery phases at 90% peak power output (PPO) and 0-20% PPO and 2-3 min cool-down). Real-time power, heart rate (HR), cadence and velocities were recorded via sensors and an app (Garmin Connect). RESULTS: Subjects completed all 12 sessions and 10 bouts with the exception of S2 (7/10 and 8/10 bouts for sessions 1 and 4). S2 performed 3 unsupervised sessions verified via the app. Fitness outcomes were not apparent for S2 and S3 while S1 showed increases in VO2 (16.0 to 17.1 ml/kg), minute ventilation (37.9 to 42.0 ml/kg), and tidal volume (1.2 to 1.5 L) peaks after training.Table:: Baseline and training data averaged over the 12 sessions (work phases)CONCLUSION: Feasibility was demonstrated by excellent adherence and remote monitoring of compliance with HIIT intensities. A greater number of weekly sessions and/or a longer training period are likely to lead to improvements in fitness parameters.

Diverse Exercises Similarly Reduce Older Adults' Mobility Limitations.

Little is known about the comparative effectiveness of exercise programs, especially when delivered at a high intensity, in mobility-limited older adults. We compared the effects of 25 sessions of high-intensity agility exergaming (EXE) and stationary cycling (CYC) at the same cardiovascular load on measured and perceived mobility limitations, balance, and health-related quality of life in mobility-limited older adults. Randomized to EXE (n = 28) and CYC (n = 27), mobility-impaired older adults (age 70 yr) exercised five times per week for 5 wk at 80% of age-predicted maximal heart rate. Waitlisted controls did not exercise (n = 28). Groups did not differ at baseline in any outcomes (P > 0.05). The primary outcomes (The Short Form-36-Health Survey: EXE, 6.9%; effect size, 2.2; CYC, 5.5%, 1.94; Western Ontario and McMaster Universities Osteoarthritis Index: EXE, -27.2%, -3.83; CYC, -17.2, -2.90) improved similarly (P > 0.05). Secondary outcomes, including body mass (-3.7%), depression (-18%), and walking capacity (13.5%) also improved (P < 0.05) similarly after the two interventions. Activities of daily living, Berg Balance Score, BestTest scores, and Dynamic Gait Index improved more (P < 0.05) after EXE than CYC. Center of pressure of standing sway path improved in one of six tests only after EXE (P < 0.05). Postexercise cardiovascular response improved in EXE (P = 0.019). CON did not change in any outcomes (P > 0.05). When matched for cardiovascular and perceived effort, two diverse high-intensity exercise programs improved health-related quality of life, perceived mobility limitation, and walking capacity similarly and balance outcomes more in mobility-limited older adults, expanding these older adults' evidence-based exercise options to reduce mobility limitations.