Individualized Exercise Prescription Research Articles

Online-delivered resistance exercise intervention among racially diverse breast cancer survivors: Feasibility, acceptability, and exploratory outcomes of B-REP.

The aims are to determine the feasibility of an online-delivered resistance exercise program among racially diverse breast cancer survivors and to conduct an exploratory analysis of the intervention on muscular strength, physical activity levels, health-related quality of life, and self-efficacy. A 2-arm randomized controlled trial study design with assessments at pre- and post-intervention was used. Participants (n = 52) were recruited from clinics at the host institution and randomized to either intervention (n = 28) or minimal contact control (MCC) conditions (n = 24). All participants received a 12-week individualized resistance exercise prescription based on their baseline functional strength assessment. Intervention participants exercised one-on-one once per week over Zoom with an exercise trainer. MCC participants received no supervision. Descriptive statistics were used to determine feasibility and acceptability (primary outcomes). Repeated measures ANOVAs were used to examine exploratory outcomes. The intervention demonstrated high rates for feasibility outcomes of enrollment (80.0%) and post-intervention assessment completion (92.9%). Acceptability outcomes were high for session attendance (98.0%) and satisfaction (Mscore = 4.87 out of 5, SD = .18). The intervention group increased upper- (p < .01) and lower- (p < .02) body strength compared to MCC condition. The intervention was feasible, acceptable, and demonstrated increases in muscular strength. Limitations include a small sample recruited from one cancer center. Future research is needed to determine longitudinal impacts of resistance exercise on survivorship outcomes. Online-delivered resistance exercise shows promising efficacy among racially diverse breast cancer survivors. gov registration: NCT04562233 on September 18, 2020.

The ASSIST trial: Acute effects of manipulating strength exercise volume on insulin sensitivity in obese adults: A protocol for a randomized controlled, crossover, clinical trial.

Type 2 diabetes mellitus is a disease in which insulin action is impaired, and an acute bout of strength exercise can improve insulin sensitivity. Current guidelines for strength exercise prescription suggest that 8 to 30 sets could be performed, although it is not known how variations in exercise volume impact insulin sensitivity. Additionally, this means an almost 4-fold difference in time commitment, which might directly impact an individual's motivation and perceived capacity to exercise. This study will assess the acute effects of high- and low-volume strength exercise sessions on insulin sensitivity. After being thoroughly familiarized, 14 obese individuals of both sexes (>40 year old) will undergo 3 random experimental sessions, with a minimum 4-day washout period between them: a high-volume session (7 exercises, 3 sets per exercise, 21 total sets); a low-volume session (7 exercises, 1 set per exercise, 7 total sets); and a control session, where no exercise will be performed. Psychological assessments (feeling, enjoyment, and self-efficacy) will be performed after the sessions. All sessions will be held at night, and the next morning, an oral glucose tolerance test will be performed in a local laboratory, from which indexes of insulin sensitivity will be derived. We believe this study will aid in strength exercise prescription for individuals who claim not to have time to exercise or who perceive high-volume strength exercise intimidating to adhere to. This trial was prospectively registered (ReBEC #RBR-3vj5dc5 https://ensaiosclinicos.gov.br/rg/RBR-3vj5dc5).

Safety and efficacy evaluation of personalized exercise prescription during chemotherapy for lung cancer patients.

To explore the safety and effectiveness of personalized exercise intervention during chemotherapy for lung cancer patients who were relatively weak and with compromised cardiopulmonary function. Thirty-eight lung cancer patients treated with chemotherapy at Peking University Third Hospital were enrolled in this prospective study. The exercise group (N = 21) received individualized exercise guidance based on personal test results and exercised regularly, while the control group (N = 17) only received exercise education and planed exercise methods according to their own preferences. Both groups underwent three fitness tests and clinical indicator assessments at 0, 6, and 12 weeks after starting the exercise, and the differences in trends of various indicators between the two groups were compared. No exercise-related adverse events occurred during the 12-week exercise period. After 12 weeks of exercise training, in terms of fitness, the exercise group showed significant improvements in 6-min walk test (6MWT) (p < 0.001), peak oxygen consumption (VO2peak) (p = 0.005), muscle content (p < 0.001), muscle percentage (p < 0.001), and grip strength (p = 0.008) compared to the control group. In terms of clinical indicators, the exercise group showed significant improvements in vital capacity (p = 0.018), D-dimer (p = 0.031), and C-reactive protein (CRP) (p = 0.01), uric acid (p = 0.003), triglycerides (p < 0.001), functional average score (p < 0.001), and main symptom average score (p = 0.004) compared to the control group in trends over time. Rehabilitation exercises using individualized exercise prescriptions tailored by exercise prescription specialists during chemotherapy are safe for lung cancer patients. Adhering to exercise can achieve comprehensive improvements in physical fitness and quality of life at 12 weeks.

PATIENT-SPECIFIC ADAPTIVE DYNAMIC CYCLING IS ASSOCIATED WITH IMPROVED PD SYMPTOMS

https://youtu.be/b2S2VPwRthE BACKGROUND High-cadence dynamic cycling is an effective therapy for improving motor symptoms in individuals with Parkinson’s Disease (PD), as measured by the Unified Disease Parkinson’s Rating Scale-Motor III (UPDRS-III). However, there is significant variability in individual responses to this therapy. Our lab developed a patient-specific adaptive dynamic cycling (PSADC) paradigm that manipulates entropy of cadence to optimize exercise prescriptions for individuals at various stages of disease progression. The purpose of this study is to evaluate the effectiveness of 12 sessions of PSADC on motor symptom improvement (UPDRS-III score) in individuals with PD. METHODS Twenty-three individuals with idiopathic PD (were randomized into two groups: PSADC (n=13) or active control (n=10). All individuals completed 12 sessions (3 sessions per week for 4 weeks) of dynamic cycling on a SMART (Speed Manipulated Adaptive Rehabilitation Therapy) bicycle. Each session consisted of a 5-minute warm-up at 60 revolutions per minute (rpm), 30-minute exercise session (80 rpm), and 5-minute cool-down (60 rpm). Individuals in the PSADC group followed an adaptive exercise prescription in which resistance level was optimized on a weekly basis, based on the individual’s entropy of cadence, and cycling effort. Individuals in the active control group remained at a constant resistance level for the entirety of the intervention. UPDRS-III was assessed in all participants prior to and following the 12-session intervention. Two-way analysis of variance (ANOVA) and paired samples t-tests were performed to detect statistical differences in UPDRS-III score between the groups. RESULTS There was a significant group by time interaction (F= 18.746, p &amp;lt;0.001). The PSADC group showed a significant reduction (improvement) in UPDRS-III score (Pre: 32.8, Post: 27.5; p&amp;lt;0.001), while the active control group showed no significant change in UPDRS-III score (Pre: 28.2, Post: 32.4, p=0.08). CONCLUSIONS 12 sessions of PSADC significantly improved UPDRS-III score, compared to non-adaptive high-cadence dynamic cycling. These results suggest that optimizing entropy of cadence is valuable for motor symptom improvement. Future studies will develop machine learning algorithms designed to predict appropriate clinical exercise prescriptions for individuals with PD.

Contexts, behavioural mechanisms and outcomes to optimise therapeutic exercise prescription for persistent low back pain: a realist review

ObjectiveTherapeutic exercises are a core treatment for low back pain (LBP), but it is uncertain how rehabilitative exercise facilitates change in outcomes. Realist reviews explore how the context (C) of...

Cancer exercise app design

Background: Exercise is important for the health of people living with and beyond cancer. Yet most cancer survivors do not receive advice or referral to exercise oncology rehabilitation programs. A smartphone delivered exercise oncology app could minimize many of the barriers to exercise that these individuals face. Objective: To develop an exercise oncology application that provides a tailored exercise program (based on exercise history, current physical function, etc.) and adapts to user’s fatigue levels to minimize many of the barriers faced by clinicians, patients and people in underserved areas. Methods: The algorithms in the app were developed based on previous research. The individualized exercise prescription is based on the user’s daily level of fatigue, and if the user is on treatment, type and duration of treatment, and current fitness level. Results: Developed an easy to navigate, read and use app with reminders to exercise and positive feedback for reaching one’s goals. Conclusion: Cancer Exercise is a unique app that provides a tailored exercise oncology program for cancer survivors. Additional research is needed to see how the app may benefit people living in rural and underserved communities.

Using artificial intelligence for exercise prescription in personalised health promotion: A critical evaluation of OpenAI's GPT-4 model.

The rise of artificial intelligence (AI) applications in healthcare provides new possibilities for personalized health management. AI-based fitness applications are becoming more common, facilitating the opportunity for individualised exercise prescription. However, the use of AI carries the risk of inadequate expert supervision, and the efficacy and validity of such applications have not been thoroughly investigated, particularly in the context of diverse health conditions. The aim of the study was to critically assess the efficacy of exercise prescriptions generated by OpenAI's Generative Pre-Trained Transformer 4 (GPT-4) model for five example patient profiles with diverse health conditions and fitness goals. Our focus was to assess the model's ability to generate exercise prescriptions based on a singular, initial interaction, akin to a typical user experience. The evaluation was conducted by leading experts in the field of exercise prescription. Five distinct scenarios were formulated, each representing a hypothetical individual with a specific health condition and fitness objective. Upon receiving details of each individual, the GPT-4 model was tasked with generating a 30-day exercise program. These AI-derived exercise programs were subsequently subjected to a thorough evaluation by experts in exercise prescription. The evaluation encompassed adherence to established principles of frequency, intensity, time, and exercise type; integration of perceived exertion levels; consideration for medication intake and the respective medical condition; and the extent of program individualization tailored to each hypothetical profile. The AI model could create general safety-conscious exercise programs for various scenarios. However, the AI-generated exercise prescriptions lacked precision in addressing individual health conditions and goals, often prioritizing excessive safety over the effectiveness of training. The AI-based approach aimed to ensure patient improvement through gradual increases in training load and intensity, but the model's potential to fine-tune its recommendations through ongoing interaction was not fully satisfying. AI technologies, in their current state, can serve as supplemental tools in exercise prescription, particularly in enhancing accessibility for individuals unable to access, often costly, professional advice. However, AI technologies are not yet recommended as a substitute for personalized, progressive, and health condition-specific prescriptions provided by healthcare and fitness professionals. Further research is needed to explore more interactive use of AI models and integration of real-time physiological feedback.

Metabolic Myopathies: Experience of a Reference Center of Inherited Metabolic Diseases.

Metabolic myopathies (MM) are a heterogeneous group of genetic disorders affecting metabolic pathways involved in energy production during rest, exercise and physiologic stress (fever, fasting, …). Impairments in the pathways of glycolysis/ glycogenolysis, fatty acid transport/oxidation or in the mitochondrial respiratory chain present primarily with exercise intolerance, myalgias, weakness, cramps, or rhabdomyolysis. Depending on aetiology, the diagnosis can be made through neonatal screening, pre-symptomatic or in the set of clinical manifestations for which a high level of suspicion is important. Retrospective descriptive study of the clinical, biochemical, and molecular features of patients with a confirmed diagnosis of MM followed by the multidisciplinary team of the Reference Center of Inherited Metabolic Diseases of Centro Hospitalar Universitário de Lisboa Central from 2009 to 2022. Twenty-three patients with MM were included: 9 (39%) glycogen storage diseases (7 McArdle and 2 Pompe), 7 (30%) fatty acid oxidation disorders (3 CPT2, 3 LCHAD and 1 MAD deficiencies), 6 (26%) mitochondrial disease with significant muscle involvement (2 Pearson, 1 Kearns Sayre, 1 VARS2, 1 SUCLA2 and 1 MT-TL1 deficiencies), and 1 myoadenylate deaminase deficiency. Ages varied from 15 months to 35 years. Eighteen (78%) patients were diagnosed by clinical symptoms, 3 by newborn screening (LCHAD) and 2 were asymptomatic (1 Pompe and 1 McArdle). Frequent symptoms were rhabdomyolysis triggered by illness or exercise 12 (52%), fatigue 11 (48%), exercise intolerance 10 (43%), and myalgia 9 (43%). Eight (35%) patients (LCHAD and mitochondrial) had multisystemic involvement. In 20 (87%) patients, the diagnosis was confirmed by biochemical and/or genetic analysis and 3 (McArdle) by muscle biopsy. MM are a heterogeneous set of disorders, but a careful history may guide the differential diagnosis among biochemical pathways and other etiologies. Nowadays, molecular testing has become a powerful tool for diagnosis confirmation, surpassing muscular biopsy in most cases. Accurate diagnosis is important to identify who may benefit from specific therapeutic options, such as enzyme replacement therapy, restricted diets, emergency regime and cofactors. All patients benefit from adequate lifestyle modifications, individualized exercise prescription, nutritional intervention, and genetic counselling.

Exercise prescription for persons with spinal cord injury: a review of physiological considerations and evidence-based guidelines.

Persons with spinal cord injury (SCI) experience gains in fitness, physical and mental health from regular participation in exercise and physical activity. Due to changes in physiological function of the cardiovascular, nervous, and muscular systems, general population physical activity guidelines and traditional exercise prescription methods are not appropriate for the SCI population. Exercise guidelines specific to persons with SCI recommend progressive training beginning at 20min of moderate to vigorous intensity aerobic exercise twice per week transitioning to 30min three times per week, with strength training of the major muscle groups two times per week. These population-specific guidelines were designed considering the substantial barriers to physical activity for persons with SCI and can be used to frame an individual exercise prescription. Rating of perceived exertion (i.e., perceptually regulated exercise) is a practical way to indicate moderate to vigorous intensity exercise in community settings. Adapted exercise modes include arm cycle ergometry, hybrid arm-leg cycling, and recumbent elliptical equipment. Body weight-supported treadmill training and other rehabilitation modalities may improve some aspects of health and fitness for people with SCI if completed at sufficient intensity. Disability-specific community programs offer beneficial opportunities for persons with SCI to experience quality exercise opportunities but are not universally available.

What I see and what I feel: the influence of deceptive visual cues and interoceptive accuracy on affective valence and sense of effort during virtual reality cycling.

How we feel during exercise is influenced by exteroceptive (e.g., vision) and interoceptive (i.e., internal body signals) sensory information, and by our prior experiences and expectations. Deceptive visual cues about one's performance during exercise can increase work rate, without negatively impacting affective valence (good/bad responses) or perceived exertion. However, what is less understood is whether the perception of the exercise experience itself can be shifted, if work rate is held constant. Here we aimed to investigate whether deceptive vision-via illusory hills in a virtual reality (VR) cycling experience-alters affective valence and perceived exertion when physical effort is controlled. We also evaluated whether the accuracy with which one detects interoceptive cues influences the extent to which deceptive visual information can shift exercise experiences. A total of 20 participants (10 female; 30.2 ±11.2yrs) completed three VR cycling conditions each of 10-min duration, in a randomised, counterbalanced order. Pedal resistance/cadence were individualised (to exercise intensity around ventilatory threshold) and held constant across conditions; only visual cues varied. Two conditions provided deceptive visual cues about the terrain (illusory uphill, illusory downhill; resistance did not change); one condition provided accurate visual cues (flat terrain). Ratings of affective valence (Feeling Scale) and of perceived exertion (Borg's RPE) were obtained at standardised timepoints in each VR condition. Interoceptive accuracy was measured via a heartbeat detection test. Linear mixed effects models revealed that deceptive visual cues altered affective valence (f2 = 0.0198). Relative to flat terrain, illusory downhill reduced affective valence (Est = -0.21, p=0.003), but illusory uphill did not significantly improve affective valence (Est = 0.107, p=0.14). Deceptive visual cues altered perceived exertion, and this was moderated by the level of interoceptive accuracy (Condition-Interoception interaction, p=0.00000024, f2 = 0.0307). Higher levels of interoceptive accuracy resulted in higher perceived exertion in the illusory downhill condition (vs flat), while lower interoceptive accuracy resulted in lower perceived exertion in both illusory hill conditions (vs flat) and shifts of greater magnitude. Deceptive visual cues influence perceptual responses during exercise when physical effort does not vary, and for perceived exertion, the weighting given to visual exteroceptive cues is determined by accuracy with which interoceptive cues are detected. Contrary to our hypotheses, deceptive visual cues did not improve affective valence. Our findings suggest that those with lower levels of interoceptive accuracy experience most benefit from deceptive visual cues, providing preliminary insight into individualised exercise prescription to promote positive (and avoid negative) exercise experiences.

Development of a complex exercise rehabilitation intervention for people with pulmonary hypertension: the supervised pulmonary hypertension exercise rehabilitation (SPHERe) trial

BackgroundPeople with pulmonary hypertension (PH) are not routinely referred for exercise rehabilitation despite the potential for reducing breathlessness and improving quality of life. We describe the development of a supervised...

Pilot Project: Heart Chargers-A Successful Model for a Home-Based Physical Activity Program Utilizing Telemedicine for Fontan Patients.

Fontan patients have decreased exercise capacity which further declines throughout adolescence. A positive exercise capacity trajectory in children predicts better adult Fontan outcomes. Hospital-based physical activity programs improve exercise capacity and attenuate the age-expected decline in Fontan patients. The purpose of this project was to investigate the feasibility and safety of a partially reimbursable 12-month, home-based, individualized physical activity program (Heart Chargers) for Fontan patients utilizing telemedicine. The Heart Chargers team included a cardiologist, nurse coordinator, and exercise physiologists. Eligible participants with a Fontan completed a baseline cardiopulmonary exercise test (CPET) and consented to participate in Heart Chargers, a 12-month home-based exercise prescription. The individualized exercise prescription focused on skeletal and respiratory muscle strength training and aerobic activities. Participants received a Garmin© device to monitor adherence. Telephone check-ins ranged from weekly to monthly as participants gained independence. Pre- and post-program CPET and informal surveys of physical activity self-efficacy were completed. Nine participants have completed the Heart Chargers program. There was no pre-postdifference in maximal or submaximal oxygen consumption (VO2), peak heart rate, or oxygen saturation. There was a significant pre-post increase in systolic blood pressure (p-value 0.004) and minute ventilation (p-value 0.012) at peak exercise. Per subjective report, exercise-related self-efficacy increased after program completion. There were no adverse events. At present, 7 participants remain actively enrolled in the program. Heart Chargers, a novel, home-based, partially reimbursable, 12-month individualized exercise program using telemedicine was successfully implemented in Fontan patients with no adverse events. The lack of decline in exercise capacity for participants is encouraging.

An at-home, virtually administered graded exertion protocol for use in concussion management: Preliminary evaluation of safety and feasibility in healthy youth and children with subacute concussion.

Graded exertion testing (GXT) is an important tool for concussion management, as it is used to personalize post-concussion exercise prescription and return athletes to sport. However, most GXT requires expensive equipment and in-person supervision. Our objective was to assess the safety and feasibility of the Montreal Virtual Exertion (MOVE) protocol, a no-equipment, virtually compatible GXT, in healthy children and children with subacute concussion. Cross-sectional. The MOVE protocol consists of seven stages of bodyweight and plyometric exercises performed for 60 seconds each. Twenty healthy (i.e., non-concussed) children completed the MOVE protocol virtually over Zoom Enterprise. Next, thirty children with subacute concussion (median: 31.5 days post-injury) were randomized to the MOVE protocol or Buffalo Concussion Treadmill Test (BCTT), which increases the incline or speed of the treadmill every minute until maximum exertion. Out of an abundance of caution, all concussed participants completed the MOVE protocol in an in-person clinical space. However, the test evaluator was stationed in a different room within the clinic and administered the MOVE protocol using Zoom Enterprise software to mimic telehealth conditions. Safety and feasibility outcomes were recorded throughout GXT, including heart rate, rate of perceived exertion (RPE), and symptom outcomes. No adverse events were recorded, and all feasibility criteria were successfully met in healthy youth and youth with concussion. Among concussed youth, increases in heart rate (MOVE: 82.4  17.9 bpm, BCTT: 72.1  23.0 bpm; t(28)=1.36, p=0.18), RPE (MOVE: 5.87  1.92, BCTT: 5.07  2.34, t(28)=1.02, p=0.32), and overall symptom presentation were similar between the MOVE and BCTT protocols. The MOVE protocol is a safe and feasible GXT that in healthy youth and youth with subacute concussion. Future studies should assess the fully virtual administration of the MOVE in children with concussion, MOVE protocol tolerability in children with acute concussion, and whether the MOVE protocol can be used to guide individualized exercise prescription.

Application of european society of cardiology guidelines 2020 on competitive sports eligibility in a large population of subjects with surgically corrected congenital heart disease

Abstract Funding Acknowledgements Type of funding sources: None. Background Congenital heart disease (CHD) affects approximately 0.5-1% of the general population. Thanks to the improvement of medical and surgical techniques, in developed countries 90% of individuals with CHD reach adulthood and, consequently, the demand for participation in sporting activities also increases. Recently, the European Society of Cardiology have given recommendations on participation in recreational and competitive sports (ESC 2020) based on a clinical and functional algorithm. Purpose To show the prevalence of the eligibility for competitive sports proposed by ESC 2020 in a real CHD population and the prevalence of real engagement in physical activity (both competitive and non-competitive). Also, to evaluate the difference in cardiorespiratory fitness (CRF) and the impact of training among different sport eligibility classes. Methods Retrospective study of 401 patients with surgically corrected CHD and followed up with cardiopulmonary exercise test (CPET) performed on treadmill or cycle ergometer until patients’ exhaustion. Subjects were divided in 4 classes according with ESC 2020 guidelines and corresponding to the eligibility for all competitive sport (A), all except endurance specialties (B), only for skill disciplines (C) or not eligible (D). Results Median (IQR) age was 18.0(13.0; 21.5) years; 266 patients (66.3%) were males. 34% were in class D, 13% in class B, 25% in class C and 28% in class A. Within the entire population, 179 subjects (44.6%) carried out structured exercise training, corresponding to 60.7% of subjects in class A, 45.1% of those in class B, 41.7% of those in class C and 41.1% of those in class D. VO2peak/Kg was similar between class A [39.2 (33.6-44.4) mL/Kg/min] and B [37.9 (30.6-42.6) mL/Kg/min], but significantly different between class A vs. class C [33.3 (28.3-41.4) mL/Kg/min p&amp;lt;.0001] and class D [32.2 (27.6-39.3) mL/Kg/min p&amp;lt;.0001]. Also, functional impairment, defined as &amp;lt;85% of the predicted for age and sex, resulted significantly higher in patients in the lower classes of sport eligibility (C and D) than in the higher ones, with a prevalence of impaired CRF of 22.5% in class A, 42.5% in class B, 55.1% in class C and 57.0% in class D (p &amp;lt;.0001). Paired comparison showed significant differences in CRF (VO2peak/Kg) between trained and untrained subjects both within and across ESC 2020 classes, while there was no significant difference between paired groups of different classes who presented the same level of physical activity (Figure 1). Conclusions Subjects in class A had better functional capacity than those in C and D classes, but exercise training (competitive or non-competitive) can have a significant impact on CRF level. Figure 1 shows that trained people in D class had higher CRF than untrained in A class, supporting that functional evaluation and an individualized exercise prescription may recruit functional "reserve" by improving the VO2peak as key prognostic component.

Exercise during CHemotherapy for Ovarian cancer (ECHO) trial: design and implementation of a randomised controlled trial

IntroductionEpidemiological evidence supports an association between higher levels of physical activity and improved cancer survival. Trial evidence is now needed to demonstrate the effect of exercise in a clinical setting....

The Key Role of Mitochondrial Function in Health and Disease.

The role of mitochondrial function in health and disease has become increasingly recognized, particularly in the last two decades. Mitochondrial dysfunction as well as disruptions of cellular bioenergetics have been shown to be ubiquitous in some of the most prevalent diseases in our society, such as type 2 diabetes, cardiovascular disease, metabolic syndrome, cancer, and Alzheimer's disease. However, the etiology and pathogenesis of mitochondrial dysfunction in multiple diseases have yet to be elucidated, making it one of the most significant medical challenges in our history. However, the rapid advances in our knowledge of cellular metabolism coupled with the novel understanding at the molecular and genetic levels show tremendous promise to one day elucidate the mysteries of this ancient organelle in order to treat it therapeutically when needed. Mitochondrial DNA mutations, infections, aging, and a lack of physical activity have been identified to be major players in mitochondrial dysfunction in multiple diseases. This review examines the complexities of mitochondrial function, whose ancient incorporation into eukaryotic cells for energy purposes was key for the survival and creation of new species. Among these complexities, the tightly intertwined bioenergetics derived from the combustion of alimentary substrates and oxygen are necessary for cellular homeostasis, including the production of reactive oxygen species. This review discusses different etiological mechanisms by which mitochondria could become dysregulated, determining the fate of multiple tissues and organs and being a protagonist in the pathogenesis of many non-communicable diseases. Finally, physical activity is a canonical evolutionary characteristic of humans that remains embedded in our genes. The normalization of a lack of physical activity in our modern society has led to the perception that exercise is an "intervention". However, physical activity remains the modus vivendi engrained in our genes and being sedentary has been the real intervention and collateral effect of modern societies. It is well known that a lack of physical activity leads to mitochondrial dysfunction and, hence, it probably becomes a major etiological factor of many non-communicable diseases affecting modern societies. Since physical activity remains the only stimulus we know that can improve and maintain mitochondrial function, a significant emphasis on exercise promotion should be imperative in order to prevent multiple diseases. Finally, in populations with chronic diseases where mitochondrial dysfunction is involved, an individualized exercise prescription should be crucial for the "metabolic rehabilitation" of many patients. From lessons learned from elite athletes (the perfect human machines), it is possible to translate and apply multiple concepts to the betterment of populations with chronic diseases.

The Independent Walking for Brain Health Intervention for Older Adults: Protocol for a Pilot Randomized Controlled Trial.

Extensive research suggests that physical activity (PA) is important for brain and cognitive health and may help to delay or prevent Alzheimer's disease and related dementias. Most PA interventions designed to improve brain health in older adults have been conducted in laboratory, gym, or group settings that require extensive resources and travel to the study site or group sessions. Research is needed to develop novel interventions that leverage mobile health (mHealth) technologies to help older adults increase their engagement in PA in free-living environments, reducing participant burden and increasing generalizability of research findings. Moreover, promoting engagement in moderate-to-vigorous PA (MVPA) may be most beneficial to brain health; thus, using mHealth to help older adults increase time spent in MVPA in free-living environments may help to offset the burden of Alzheimer's disease and related dementias and improve quality of life in older age. We developed a novel PA intervention that leverages mHealth to help older adults achieve more minutes of MVPA independently. This pilot study was a 12-week randomized controlled trial to investigate the feasibility of providing just-in-time (JIT) feedback about PA intensity during free-living exercise sessions to help older adults meet current PA recommendations (150 minutes per week of MVPA). Participants were eligible if they were cognitively healthy English speakers aged between 65 and 80 years without major cardiovascular, neurologic, or mental health conditions; could ambulate independently; and undergo magnetic resonance imaging. Enrollment occurred from October 2017 to March 2020. Participants randomized to the PA condition received an individualized exercise prescription and an mHealth device that provided heart rate-based JIT feedback on PA intensity, allowing them to adjust their behavior in real time to maintain MVPA during exercise sessions. Participants assigned to the healthy aging education condition received a reading prescription consisting of healthy aging topics and completed weekly quizzes based on the materials. In total, 44 participants were randomized to the intervention. A follow-up manuscript will describe the results of the intervention as well as discuss screening, recruitment, adverse events, and participants' opinions regarding their participation in the intervention. The long-term goal of this intervention is to better understand how MVPA affects brain and cognitive health in the real world and extend laboratory findings to everyday life. This pilot randomized controlled trial was conducted to determine the feasibility of using JIT heart rate zone feedback to help older adults independently increase time spent in MVPA while collecting data on the plausible mechanisms of change (frontal and medial temporal cerebral blood flow and cardiorespiratory fitness) that may affect cognition (memory and executive function) to help refine a planned stage 2 behavioral trial. ClinicalTrials.gov NCT03058146; https://clinicaltrials.gov/ct2/show/NCT03058146. DERR1-10.2196/42980.

Cardiopulmonary exercise testing for exercise prescription in cardiac rehabilitation

Aerobic endurance training is acore component of exercise training (ET) during cardiac rehabilitation (CR). Improvements of cardiopulmonary performance and symptom-free exercise capacity that can be achieved by ET during CR are essential for patient's prognosis and quality of life. Before initiating exercise training in CR, adetailed risk stratification including incremental exercise testing is required in order to ensure safe and effective exercise training conditions. Cardiopulmonary exercise testing (CPX) with measurement of respiratory gases is considered the gold standard of cardiopulmonary performance diagnostics. The oxygen uptake measured at the highest exercise intensity achieved (peakVO2) has strong prognostic implications in primary and secondary prevention of cardiovascular diseases, respectively. The use of CPX with measurement of peakVO2 and determination of ventilatory thresholds (VT) enables areliable determination of the individual cardiopulmonary performance (peakVO2) and also the aerobic exercise capacity. In addition, CPX is avaluable tool to detect increments in exercise capacity that were achieved by ET during CR. The measurement of peakVO2 and the determination of ventilatory thresholds are basic parameters for an individually tailored exercise prescription. In addition, the targeted control of aerobic endurance training on the basis of CPX parameters increases the effectiveness and safety of the exercise program during CR. In this article, recommendations for an individual exercise prescription, based on the results of CPX, are given for patients with coronary heart disease (CHD), heart failure, as well as for patients with CHD and concomitant type2 diabetes mellitus.

Association between Regional Body Muscle Mass and Non-Alcoholic Fatty Liver Disease: An Observational Study Using Data from the REACTION Study

Background and aims: Regional muscle distribution is associated with abdominal obesity and metabolic syndrome. However, the relationship between muscle distribution and nonalcoholic fatty liver disease (NAFLD) remains unclear. This study was to determine the relationship between regional muscle distribution and the risk and severity of NAFLD. Methods: This cross-sectional study ultimately included 3161 participants. NAFLD diagnosed by ultrasonography was classified into three groups (non, mild, and moderate/severe). We estimated the regional body muscle mass (lower limbs, upper limbs, extremities, and trunk) through multifrequency bioelectrical impedance analysis (BIA). The relative muscle mass was defined as the muscle mass adjusted for the body mass index (BMI). Results: NAFLD participants accounted for 29.9% (945) of the study's population. Individuals with a higher lower limb, extremity, and trunk muscle mass had a lower risk of NAFLD (p < 0.001). Patients with moderate/severe NAFLD had a lower muscle mass of the lower limbs and trunk than patients with mild NAFLD (p < 0.001), while the muscle mass of the upper limbs and extremities did not differ significantly between the two groups. Moreover, similar results were found for both sexes and among different age groups. Conclusions: A higher muscle mass of the lower limbs, extremities, and trunk was negatively associated with the risk of NAFLD. A lower muscle mass of the limbs and trunk was inversely associated with the severity of NAFLD. This study provides a new theoretical basis for the development of individualized exercise prescriptions for the prevention of NAFLD in non-NAFLD patients.

IMPROVEMENTS AFTER PATIENT-SPECIFIC ADAPTIVE DYNAMIC CYCLING IN PARKINSON'S DISEASE

https://youtu.be/k9T32ExGuPw BACKGROUND Parkinson's disease (PD) is a progressive neurological disorder characterized by symptoms of bradykinesia, tremor, and muscle rigidity. Previous studies have shown that high cadence dynamic cycling promotes significant improvement in PD motor symptoms. This improvement is attributed to a higher entropy (variability) of cadence during dynamic cycling. However, it is not clear how entropy of cadence and level of effort can be utilized to develop individualized exercise prescriptions for individuals with PD, as well as how patient specific adaptive dynamic cycling impacts motor function and mobility in individuals with PD. Therefore, the purpose of this study was to develop an individualized exercise paradigm by manipulating entropy of cadence and level of effort and also examine the effects on motor function and mobility in PD. METHODS/DESIGN 11 individuals diagnosed with idiopathic PD were randomized into either the patient-specific adaptive dynamic cycling (PSADC) or an active control (AC) group. The dynamic cycle resistance settings were optimized for each individual in the PSADC group, while settings remained constant in the AC group. Each group completed 12 sessions over the course of 4 weeks. Motor function and mobility were measured at baseline and after 12 exercise sessions using the clinical and Kinesia One Unified Parkinson's Disease Rating Scale Motor III (UPDRS Motor III) and the Timed Up and Go (TUG). The UPDRS Motor III is the gold standard measurement of PD symptom severity. TUG is a mobility assessment that is highly correlated to overall functional mobility. Outcome measures were compared using repeated measures ANOVA, as well as paired samples and independent samples t-tests. RESULTS Individuals in the PSADC group saw significant improvements UPDRS Motor III score (Pre: 43.33, Post: 36.67; p=0.040), Kinesia One UPDRS Motor III score (Pre: 25.142, Post 23.833; p = 0.017), and TUG completion time (Pre: 12.37s, Post: 9.99s; p=0.036) from baseline to follow up. Individuals in the AC group did not significantly improve motor function (Pre: 28.60, Post: 29.60) or mobility (Pre: 11.23s, Post: 10.85s). CONCLUSIONS PSADC is associated with significant improvements in motor function and mobility in individuals with PD. Future studies will consider developing machine learning or artificial intelligence algorithms to provide accurate and valid exercise prescriptions to be utilized in the clinical rehabilitation for individuals with PD.