Independent Exercise Research Articles

12.10 Neuronal function in chronic spinal cord injury: Divergent course of locomotor and reflex activity in humans

Bizzarini E, Saccavini M, Lipanje F, Magrin P, Malisan C, Zampa A. Exercise prescription in subjects with spinal cord injuries. Arch Phys Med Rehabil 2005;86:1170–5.To evaluate the effect of training with ergometers on subjects with spinal cord injury (SCI) in the postacute phase.Cohort study.A spinal unit at a physical medicine and rehabilitation institute.Twenty-one subjects with SCI in the postacute phase as a consecutive sample were chosen on a strict first-come, first-chosen basis. All patients completed the study.A 6-week (5d/wk, 90min/d) program consisting of exercises with the ergometers formulated (as intensity and duration) for each patient on the basis of the results obtained in specific cardiovascular tests.Parameters of workload levels, as well as hematologic and hormonal parameters, recorded during the first 6 weeks of training.The workload performed during the training showed an initial increase, but it reached a plateau in week 4. No statistically meaningful variations in the workload emerged between the fourth and the sixth weeks of monitoring. There were no hematologic or hormonal signs of overtraining.Strengthening and aerobic rehabilitation programs for patients with subacute SCI should be limited to 4 weeks, followed by an independent maintenance exercise program. The strengthening program is safe for these patients.

Exercise Prescription in Subjects With Spinal Cord Injuries

Bizzarini E, Saccavini M, Lipanje F, Magrin P, Malisan C, Zampa A. Exercise prescription in subjects with spinal cord injuries. Arch Phys Med Rehabil 2005;86:1170–5. Objective To evaluate the effect of training with ergometers on subjects with spinal cord injury (SCI) in the postacute phase. Design Cohort study. Setting A spinal unit at a physical medicine and rehabilitation institute. Participants Twenty-one subjects with SCI in the postacute phase as a consecutive sample were chosen on a strict first-come, first-chosen basis. All patients completed the study. Interventions A 6-week (5d/wk, 90min/d) program consisting of exercises with the ergometers formulated (as intensity and duration) for each patient on the basis of the results obtained in specific cardiovascular tests. Main Outcome Measures Parameters of workload levels, as well as hematologic and hormonal parameters, recorded during the first 6 weeks of training. Results The workload performed during the training showed an initial increase, but it reached a plateau in week 4. No statistically meaningful variations in the workload emerged between the fourth and the sixth weeks of monitoring. There were no hematologic or hormonal signs of overtraining. Conclusions Strengthening and aerobic rehabilitation programs for patients with subacute SCI should be limited to 4 weeks, followed by an independent maintenance exercise program. The strengthening program is safe for these patients.

Body Mass Index Correlation Of Adherence To A 12-week Employee Based Walk/run Physical Activity Program

Corporate health promotion programs have been shown to contribute to decreased health care expenditures. While it is well established that those who exercise in groups show higher adherence rates than solitary exercisers, it is unclear what other factors influence adherence to physical activity programs. PURPOSE To examine the Body Mass Index as a determinant of adherence in an employee based training program. METHODS 130 employees actively participated in a 12-week walk/run program and also recorded their height and weight. Employees were self-selected into 1 of 5 training groups: Walkers, Run/Walk Beginners, Run/Walk Intermediate, Run/Walk Advanced, or Runners and received a training schedule designed for their group. Employees trained with their group once per week and were given a training log to record both group and independent exercise. RESULTS There was a 59% adherence rate for all participants. Significant (p < 0.05) differences in adherence rates were found between participants based on BMI. Participants with a BMI under 25 (normal) had a 66% adherence rate, participants with a BMI between 26–30 (overweight) recorded a 58% adherence rate, and participants with a BMI above 30 (obese) recorded a 54% adherence rate. CONCLUSION Employees with an elevated BMI are less likely to adhere to a prescribed exercise program. This suggests that special programming should be developed to increase adherence in overweight and/or obese individuals.

Body Mass Index Correlation Of Adherence To A 12-week Employee Based Walk/run Physical Activity Program

Corporate health promotion programs have been shown to contribute to decreased health care expenditures. While it is well established that those who exercise in groups show higher adherence rates than solitary exercisers, it is unclear what other factors influence adherence to physical activity programs. PURPOSE To examine the Body Mass Index as a determinant of adherence in an employee based training program. METHODS 130 employees actively participated in a 12-week walk/run program and also recorded their height and weight. Employees were self-selected into 1 of 5 training groups: Walkers, Run/Walk Beginners, Run/Walk Intermediate, Run/Walk Advanced, or Runners and received a training schedule designed for their group. Employees trained with their group once per week and were given a training log to record both group and independent exercise. RESULTS There was a 59% adherence rate for all participants. Significant (p < 0.05) differences in adherence rates were found between participants based on BMI. Participants with a BMI under 25 (normal) had a 66% adherence rate, participants with a BMI between 26–30 (overweight) recorded a 58% adherence rate, and participants with a BMI above 30 (obese) recorded a 54% adherence rate. CONCLUSION Employees with an elevated BMI are less likely to adhere to a prescribed exercise program. This suggests that special programming should be developed to increase adherence in overweight and/or obese individuals.

Project PASCALEA – public and stakeholder consultation in developing high‐profile corporate environmental strategy

AbstractThis paper looks at corporate social responsibility in the context of public and stakeholder dialogue and engagement. It demonstrates how this can contribute to the development of a long‐term environmental management strategy. It shows how government, stakeholder and economic pressure can encourage companies to positively engage their stakeholders.Using an example from the nuclear industry the paper describes how the importance of engaging in stakeholder dialogue and consultation has been recognized and how this can contribute to more positive stakeholder relationships.In 2002, AWE plc commissioned a major independent public and stakeholder consultation exercise (Project PASCALEA). Environmental Consultants from NNC Ltd. were commissioned to manage and execute the project, together with recognized consultation specialists from the IEPPP, Lancaster University. The case study gives an insight into the consultation methodology adopted and evaluates how the outcomes from the project contributed towards the successful delivery of AWE's corporate environmental management goals. Copyright © 2004 John Wiley &amp; Sons, Ltd and ERP Environment.

Using topographic lidar to map flood risk from storm-surge events for Charlottetown, Prince Edward Island, Canada

As part of a recent project to determine coastal impacts of climate change and sea-level rise on Prince Edward Island (PEI), airborne scanning laser altimetry (lidar) was employed to acquire high-resolution digital elevation models (DEMs) and other landscape information. The study area included both the Charlottetown urban area and an extensive portion of the rural North Shore of PEI. Problems with the lidar data included data gaps and incorrect classification of "ground" and "non-ground" laser hits along the waterfront. Accurate representation of wharves and other waterfront features in the DEM was achieved by combining "ground" and "non-ground" data. The importance of calibration and validation in lidar data acquisition and interpretation was demonstrated by three independent validation exercises that uncovered and adjusted for a vertical offset attributed to calibration problems. The ground DEM was adjusted to hydrographic chart datum and used to model flood extent at three storm-surge water levels, one observed in the record storm of 21 January 2000 and two higher levels representing flood scenarios under rising sea level. Flood modelling was executed in a geographic information system (GIS) on the gridded ground DEM. The resulting binary grids were vectorized along the flooding limit. Low-lying areas isolated from free exchange with the harbour were excluded from the flood area. Vectors depicting the storm-surge water lines for the three flood scenarios were implemented on the geographic information system (GIS) in the city planning department and overlain on property boundary and assessment layers. This study demonstrated that validated DEMs derived from airborne lidar data are efficient and adequate tools for mapping flood risk hazard zones in coastal communities.

CORRELATES OF ADHERENCE TO A 10-WEEK EMPLOYEE BASED 5K WALK/RUN TRAINING PROGRAM

Corporate health promotion programs have been shown to decrease health care dollars spent by employers. Compared to independent exercisers, those who exercise in groups show higher adherence rates. It is unclear what correlates increase adherence to corporate health promotion group exercise programs. PURPOSE To examine the correlates that led to increased adherence in an employee based 5K training program. METHODS 66 employees (mean age 41 years) participated in a 10-week 5K training program and completed a fitness evaluation for cardiovascular endurance, muscular strength and endurance, flexibility, and body composition. Employees self-selected into 1 of 5 training groups: Walkers, Run/Walk Beginners, Run/Walk Intermediate, Run/Walk Advanced, or Runners and received a training schedule designed for their group. Employees trained with their group once per week and were given a training log to record both group and independent exercise. At the end of the 10-week program, employees completed the same fitness evaluations as pre-testing. RESULTS There was a 66% adherence rate for all participants. No significant differences in adherence rates were found between training groups. Pre-screening estimated VO2 (r=0.400, p = 0.002), curl ups (r=0.323, p = 0.012), and push-ups (r=0.283, p = 0.030) were positively correlated with adherence while age (r=−0.466, p ≤ 0.01) was negatively correlated with adherence. Body composition and flexibility did not correlate with adherence (p ≥ 0.05). CONCLUSION Higher fit employees are more likely to adhere to a group exercise program; therefore, special considerations should be taken to cater to low fit individuals to increase their adherence rates.

PHYSICAL ACTIVITY AND ENDOTHELIAL FUNCTION IN CARDIOVASCULAR DISEASE

Exercise training has well-established beneficial effects on symptoms and myocardial perfusion in patients with coronary artery disease (CAD). Regression of coronary artery stenosis and improvement of collateralization have been suggested as potential mechanisms. However, angiographic techniques have so far failed to document any significant increase in coronary collaterals at rest. Although net regression of stenotic lesions may be achieved in high intensity exercise training it is unlikely that in causes the significant improvement in myocardial perfusion which is seen much earlier than plaque regression. Myocardial perfusion and angina levels improve within weeks after the initiation of training programs – much more rapidly than explained by morphologic changes. Within the last decade endothelial dysfunction has been identified as a trigger of myocardial ischemia. The impaired production of endothelium-derived nitric oxide (NO) in response to acetylcholine and flow leads to paradoxic vasoconstriction and exercise-induced ischemia. The novel tools to examine coronary endothelial function in vivo and in vitro have now made it clear, that exercise training enhances myocardial perfusion by increasing both eNOS and ecSOD expression, which attenuates the premature breakdown of NO by ROS. These increases in both local NO production and half-life improve endothelium-dependent vasodilation in response to flow or acetylcholine. It is reasonable to suppose that these functional changes occur rather rapidly after the initiation of an exercise training program – although no studies are available on their precise time course. Anatomic changes like augmentation of the capillary bed and slowing of the progression of coronary atherosclerosis will require more extended periods of training. Recently, first reports about a possible association between endothelial dysfunction and the frequency of clinical events have been published. If it turns out to be an independent prognostic marker exercise training may be promoted from a symptomatic intervention to a preventive strategy with long-term prognostic benefits.

EXERCISE HABITS SIX MONTHS FOLLOWING SUPERVISED EXERCISE PROGRAMS DIFFERING IN AMOUNT AND INTENSITY

It is unknown how an initial exercise prescription in a structured setting may influence subsequent independent exercise habits. PURPOSE To investigate exercise habits 6 months following supervised exercise programs differing in amount and intensity. METHODS 79 sedentary, overweight (BMI 25–35 kg/m2) men and women aged 40–65 completed one of three 8 mo. exercise programs: 1) low [⁁188 min/week at 40–55% VO2max], 2) moderate [⁁123 min/wk at 65–80% VO2max] or 3) high [⁁169 min/wk at 65–80% VO2max]. Each person was contacted via phone 6 months following their initial program to answer questions in regards to exercise frequency, intensity, duration and mode. RESULTS The percent of people that continued to exercise in the low, moderate and high groups were 69%, 72% and 56% respectively. The average min/wk that each group exercised are as follows: low (156), moderate (129) and high (129). It is interesting that the moderate and high groups exercised at the same intensity during the supervised programs but over half of the high group chose to decrease the intensity when exercising independently. Conversely, more than 2/3 of the low group increased intensity. Walking was clearly the preferred mode of exercise among all three groups. Of all individuals contacted, 34% did not continue exercising despite the fact that half of them were members at exercise facilities. The most common reason among all 3 groups for not continuing to exercise was time constraints, with travel and motivation being second and third. CONCLUSION These data show that individuals completing a supervised program in the high group are less likely to continue exercising compared to the low or moderate group. Furthermore, it is shown that individuals in the high group chose to modify their exercise by decreasing both amount and intensity while the low group decreased amount and increased intensity. These data suggest that beginning a program involving a low amount of moderate intensity exercise may lead to an increase in future adherence. Supported by NIH Grant HL-57354.

The case for perspicuous programming

Traditional approaches to coding interactive programs, even literate programming, suffer from the problem of focusing on what the computer will do, not what the user wants it to do. The algorithmic code is primary and any documentation secondary, especially user documentation. Help facilities appear to be added as an almost independent exercise. We can solve this problem by focusing on the user documentation and regarding the algorithmic code as a mere adjunct. The production of an interactive program should start with the user documentation, with the majority of effort spent on developing and refining that documentation and its structure. Developers should add algorithmic code for any program module only after its documentation is complete and all parties have tested and agreed to it. This perspicuous programming approach seeks to produce programs for the user that are as unenigmatic as possible. With a touch of blithely false etymology, we could call this igmatic programming instead. Take your pick.

Functional Electrical Stimulation For Walking In Paraplegia: 17-Year Follow-Up Of 2 Cases

Objective: To assess the safety and effectiveness of long-term use of functional electrical stimulation (FES) for exercise, standing, and walking in individuals with paraplegia, using percutaneous intramuscular wire electrodes.Design: Case study with more than 1 7 years of follow-up.Setting: Institutional rehabilitation practice.Study Participants: Two long-term (17 years) volunteer participants with paraplegia who were able to stand and walk using FES.Intervention: Chronically indwelling percutaneous intramuscular wire electrodes connected to a portable microprocessor-controlled stimulator were used to exercise muscles while controlling trunk, hips, knees, and ankles and develop activation patterns to produce standing and walking.Main Outcome Measures: Clinical complications, electrode performance and survival probability, and functional performance.Results: The most noted clinical complications included localized inflammation at the electrode site and superficial infection that responded well to topical and oral antibiotic treatment. The change from coil-wire electrodes, with a survival of 35% after 1 year, to double-helix electrodes improved electrode survival to 80% at 1 year and 48% at 5 years. Maintenance of the multichannel percutaneous FES walking system required replacement of an average of 2 electrodes every 6 months. Participants were able to use their system for independent exercise and standing and for walking with standby assistance.Conclusion: Although the FES system was devised as a temporary means of achieving functional activation until permanent means could be achieved, it was found to be effective and relatively safe for more than 17 years. Two long-time users of the system had no adverse effects to their skeletal system. The most common problems were daily care of electrodes at exit sites, frequent irritation of the skin around electrodes, and replacement of failed electrodes. The percutaneous system has the potential for short-term rehabilitation in individuals with incomplete paraplegia or stroke.Spinal Cord Med. 2003;26:86-91

Partial Normalization of the Heart Rate Response to Exercise After Cardiac Transplantation: Frequency and Relationship to Exercise Capacity

To determine the frequency of partial normalization of the heart rate response to graded exercise and its relationship to exercise capacity in cardiac transplant recipients. The study subjects were 95 adults (77 men, 18 women) who were available to perform a cardiopulmonary exercise test 1 year after orthotopic cardiac transplantation, which occurred between June 1988 and September 1998. All subjects received standard immunosuppressant medications. At the time of the exercise tests, the mean +/- SD age of the subjects was 49+/-14 years. The mean +/- SD resting left ventricular ejection fraction was 62%+/-8%. All subjects participated in a 6- to 8-week supervised exercise program, starting no later than 1 month after surgery. Subjects were given an exercise prescription for independent exercise training after finishing the supervised program. Self-reported weekly exercise training had a median value of 90 minutes (interquartile range, 0-210 minutes). Symptom-limited graded exercise was performed on a treadmill, with breath-by-breath analysis of expired air. For the entire cohort, peak exercise oxygen uptake was 19.9+/-4.8 mL x kg(-1) x min(-1) (61%+/-15% of age and sex predicted). Thirty-two subjects (34%) had a partially normalized heart rate response to graded exercise. The frequency was similar for men (25/77 [33%]) and for women (7/18 [39%]) and was independent of recipient or donor age. Peak exercise heart rate (147+/-18 vs 134+/-21 beats/min; P=.008) and heart rate reserve (46+/-15 vs 33+/-15 beats/min; P<.001) were greater for subjects with a partial normalization of heart rate response. Peak exercise oxygen uptake was similar for subjects with or without partial normalization of the heart rate response (20.9+/-5.8 vs 19.4+/-4.2 mL x kg(-1) x min(-1); P=.22). Submaximal exercise oxygen uptake during the first few minutes of exercise was also not affected by normalization of the heart rate response. At 1 year after cardiac transplantation, approximately one third of subjects had partial normalization of the heart rate response to graded exercise. However, a higher peak exercise heart rate and a larger heart rate reserve did not result in better aerobic exercise capacity.

A dynamic e-Reporting system for contractor's performance appraisal

Contractor performance should be monitored and controlled on a regular basis, so that any undesirable shortfalls or failures could be identified and rectified without further losses or delays. However, contractor Performance Appraisal and Reporting (PAR) has been conducted in an ad hoc manner and is usually limited to independent project level exercises. The needs for a more structured approach to PAR and the potential benefits of reviewing contractor performance at an organizational level (i.e. by covering the overall project portfolio) lead to a proposal for an industry-wide dynamic PAR system. Advancements in World Wide Web techniques provide enhanced capacities to collect compile and disseminate performance-related information to various construction stakeholders in a timely and cost-effective manner. This paper describes the conceptual framework formulated for an e-Reporting system in the form of a web-based PAR. The system design and a brief overview of a prototype e-Reporting system are also provided. The potential applications of the e-Reporting system in dynamic decision support scenarios are also discussed.

Comparability and subjectivity of land cover maps produced with digital image classification techniques: some recent experiences from Denmark and northern Germany

In many countries, including those of northwest Europe, there have been several decades of development work and application of satellite digital image data for the mapping of land cover. Considerable numbers of environmental and ecological projects and programmes now either use such land cover data or undertake such mapping for themselves, and the possibility to do land cover mapping from image data is increasingly appearing as a standard 'turn-key' component of GIS software. Into this context, this paper discusses issues related to this operationalisation of land cover mapping from image data. Specifically, it presents the methods and experiences of two recent land cover mapping projects, covering Denmark and parts of the German state of Schleswig-Holstein in terms of their comparability and their handling of subjecitive aspects of the mapping. These two independent but linked mapping exercises each developed and adopted specific operational procedures customised to their mapping objectives and their geographical contexts. Their methods and results reflect upon the needs to handle within statistical image analysis techniques such as supervised maximum likelihood classification subjective 'real-world' elements in as objective a way as possible.

Predicting physical therapy visits needed to achieve minimal functional goals after arthroscopic knee surgery.

Retrospective, cross-sectional regression modeling. To predict physical therapy visits following arthroscopic knee surgery. The number of physical therapy visits required to achieve a set of specific minimal-level goals (full knee extension, straight leg raise, normalized gait pattern, bicycle pedaling, and independent home exercises) that are related to decreased complication rates has not previously been modeled. A multiple regression model to predict postoperative physical therapy visits was developed using subject demographics and 2 simple clinical measures, degree of straight leg raise lag and total range of motion. All data were collected from 148 patient charts. Model validity was examined by the predicted residual sum of squares technique and a second independent sample of 157 charts. Diagnosis group, surgery group, and range of motion were the significant variables predicting visits in the final model (R2 = 0.384). Results of model validation analyses using predicted residual sum of squares technique (R2 = 0.346) and the second set of data (R2 = 0.282) were satisfactory. Analysis of residuals (difference of observed and predicted visits) showed prediction of the number of physical therapy visits within 3 visits for approximately 75% of the cases in both sets of data. Using the model to predict physical therapy visits following arthroscopic knee surgery was more accurate than using diagnosis alone, except for lateral retinacular release. This study demonstrates how regression models could be used to explain variance in physical therapy visits for a given set of minimal functional goals.

Predictors of pregnancy-associated change in physical activity in a rural white population.

The objective of this study was to examine the relationship of sociodemographic and psychosocial characteristics and exercise prior to pregnancy to change in physical activity (PA) during pregnancy. This study was part of the Bassett Mothers' Health Project (BMHP), a prospective cohort study of women who enrolled for prenatal care in the Bassett Healthcare system between November 7, 1994, and November 15, 1996. Six hundred twenty-two women met the eligibility criteria and were enrolled in the study. Sociodemographic and psychosocial characteristics and exercise behavior were assessed prenatally using the medical record and an anonymous mailed questionnaire. Staged linear regression analysis was used to predict change in physical activity with the psychosocial and sociodemographic characteristics as the independent variables and prepregnancy exercise frequency as a control variable. Women who were older, more educated, and had higher household incomes were more likely to exercise prior to pregnancy (p < .05). Change in PA after becoming pregnant was associated with prepregnancy exercise frequency (p < .001). Women who exercised frequently moderated their activity, while sedentary women maintained or increased their PA after becoming pregnant. Exercise self-efficacy (the belief in one's ability to exercise regularly) and body mass index (BMI) were positive predictors of change in PA (p < .05), while prepregnancy exercise frequency remained significant as a control variable. Interventions that aim to help women maintain or increase their PA during the perinatal period should be designed to increase exercise self-efficacy.

A Physical Activity Intervention in a Community Alcohol Service

People recovering from alcohol-related or drug-related problems are often in poor physical condition and have an extremely sedentary lifestyle. This article describes a study in which an occupational therapist in a community alcohol service implemented a physical activity intervention. The aim of the intervention was for clients with substance misuse problems to increase independent physical activities, to engage more in community-based activities, to increase their awareness of the benefits of exercise and to perceive benefits in their health following the programme. Seven people attended a 6-week programme consisting of nine sessions. Each session included an exercise class and group-based physical activity counselling. Case studies for five of the participants are presented. It was shown that it is possible for an intervention combining physical activity counselling with supervised and independent exercise to have an impact on the lives of a few individuals with substance misuse problems. Four of the five participants made substantial gains in all the target areas relating to independence, integration, education and health. It was also shown that it is feasible for an occupational therapist to play a pivotal role in promoting fitness-oriented activities for those with substance misuse problems. Controlled studies are required with larger samples, longer follow-up periods and the comparison of different intervention elements.

Low-functioning hemodialysis patients improve with exercise training

The Renal Exercise Demonstration Project provided two different approaches to exercise programming to a group of hemodialysis patients. Physical functioning and self-reported health-related quality of life were measured at baseline, after 2 months of independent exercise, and again after 2 months of in-center cycling. This study compares the responses to intervention of patients who initially scored low (<34) on the Physical Component Scale (PCS) on the Medical Outcomes Study Short-Form 36 questionnaire to those who initially scored higher (>34) on the same scale. The high-PCS group scored higher on all physical function tests (normal gait speed, fast gait speed, and sit-to-stand test) at each testing time than the low-PCS group. The high-PCS group improved only on the sit-to-stand test, whereas the low-PCS group improved in all three physical function tests. There were significant differences between the groups in change over time in all the physical scales and the PCS over time, with the low-PCS group showing improvements in response to the intervention and the high-PCS group showing no change over time. No differences in change over time were noted between the groups on the mental scales in either group. We conclude that low-functioning hemodialysis patients can benefit from exercise counseling in both objective measures of physical functioning and self-reported physical functioning. The impact of such interventions seems to be more profound in the lowest functioning patients.

Program participation, exercise adherence, cardiovascular outcomes, and program cost of traditional versus modified cardiac rehabilitation

Common concerns with the traditional protocol (TP) for cardiac rehabilitation include suboptimal program participation, poor facilitation of independent exercise, the use of costly continuous electrocardiographic (ECG) monitoring, and lack of insurance reimbursement. To address these concerns, a reduced cost-modified protocol (MP) was developed to promote independent exercise. Eighty low- to moderate-risk cardiac patients were randomized to a TP (n = 42) or a MP (n = 38) and were compared over 6 months on program participation, exercise adherence, cardiovascular outcomes, and program costs. During month 1, patients followed identical regimens, including 3 ECG-monitored exercise sessions/week, with encouragement to achieve ≥5 thirty-minute sessions/week. In week 5, the TP continued with a facility-based regimen including 3 exercise sessions/week for 6 months and used ECG monitoring the initial 3 months. The MP discontinued ECG monitoring in week 5 and were gradually weaned to an off-site exercise regimen that was complemented with educational support meetings and telephone follow-up. Compared with TP patients, MP patients had higher rates of off-site exercise over 6 months (p = 0.05), and total exercise (on site + off site) during the final 3 months (p = 0.03). Also, MP patients were less likely to drop out (p = 0.05). Both protocols promoted comparable improvements in maximal oxygen uptake (p <0.05), blood lipids (p <0.001), and hemodynamic measurements (p <0.002). The MP cost $738 less/patient than the TP and required 30% less staff (full-time equivalents). These results suggest that a reduced cost MP was as effective as an established TP in improving physiologic outcomes while demonstrating higher rates of exercise adherence and program participation. Thus, the MP or a similar protocol has applicability to hospitals with large capitated or managed care populations to provide cost-effective cardiovascular risk reduction to patients.

Physical functioning and health-related quality-of-life changes with exercise training in hemodialysis patients

The Renal Exercise Demonstration Project was designed to test the effects of two different approaches to exercise programming on the levels of physical activity, physical functioning, and self-reported health status in hemodialysis patients. Two hundred eighty-six patients were recruited for participation. Intervention patients were given individually prescribed exercise for 8 weeks of independent home exercise, followed by 8 weeks of incenter cycling during dialysis. Physical performance testing was performed at baseline and after each intervention using gait speed, sit-to-stand test, and 6-minute walk. The Medical Outcomes Study Short Form 36-item (SF-36) questionnaire was used to assess self-reported health status. The intervention group showed increased participation in physical activity. There were significant differences between the intervention and nonintervention groups in change over time in normal and fast gait speed, sit-to-stand test scores, and the physical scales on the SF-36, including the physical component scale. The intervention group improved in these test results, whereas the nonintervention group either did not change or declined over the duration of the study. It is clear that improvements in physical functioning result from exercise counseling and encouragement in hemodialysis patients. Because self-reported physical functioning is highly predictive of outcomes in hemodialysis patients, more attention to patients' levels of physical activity is warranted.