Maximal Physical Performance Research Articles

Maximal handgrip strength can predict maximal physical performance in patients with chronic fatigue

BackgroundMaximal handgrip strength is used to predict exercise performance in healthy older subjects and in patients with chronic obstructive pulmonary disease, breast cancer or cirrhosis. Our objective was to evaluate the ability of maximal handgrip strength to predict maximal exercise performance in patients with chronic fatigue. MethodsSixty-six patients with myalgic encephalomyelitis/chronic fatigue syndrome and 32 patients with chronic fatigue but no diagnosis of myalgic encephalomyelitis/chronic fatigue syndrome were included. The maximal physical performance was measured on a cycle ergometer to measure the peak oxygen uptake and the maximal work rate. We searched for linear regressions between maximal handgrip strength and maximal performances. FindingsNo significant differences in slopes and ordinates of regression lines were noted between patients with or without a diagnosis of myalgic encephalomyelitis/chronic fatigue syndrome, allowing to pool the data. Maximal handgrip strength was significantly and positively correlated with peak oxygen uptake and maximal work rate in all patients with chronic fatigue. InterpretationWe conclude that handgrip strength can predict maximal exercise performance in patients with chronic fatigue.

Increasing Iron Status through Dietary Supplementation in Iron-Depleted, Sedentary Women Increases Endurance Performance at Both Near-Maximal and Submaximal Exercise Intensities

Iron deficiency persists as the most common micronutrient deficiency globally, despite having known detrimental effects on physical performance. Although iron supplementation and aerobic exercise have been examined individually and are known to improve physical performance, the impact of simultaneous iron supplementation and aerobic training remains unclear. The aim of this study was to examine the individual and combined effects of iron supplementation and aerobic training on improving maximal and submaximal physical performance in iron-depleted, nonanemic (IDNA) women. We hypothesized that women receiving iron would improve their endurance performance but not their estimated maximal oxygen consumption (eVO2max). Seventy-three sedentary, previously untrained IDNA (serum ferritin <25 µg/L and hemoglobin >110 g/L) women aged 18-26 y with a body mass index (kg/m2) of 17-25 participated in a double-blind, 8-wk, randomized controlled trial with a 2×2 factorial design including iron supplementation (42 mg elemental Fe/d) or placebo and aerobic exercise training (5 d/wk for 25 min at 75-85% of age-predicted maximum heart rate) or no training. Linear models were used to examine relations between training, supplement, and changes in the primary outcomes of observed maximal oxygen consumption (VO2peak) and eVO2max and ventilatory threshold (absolute oxygen consumption and percentage of maximum). Re-evaluation of a published meta-analysis was used to compare effects of iron supplementation on maximal oxygen consumption (VO2max) and VO2peak. There were significant training-by-supplement interactions for VO2peak, volume of oxygen consumption at the ventilatory threshold, and the percentage of eVO2max where the threshold occurred, with the iron-untrained group performing better than the placebo-untrained group. There was no beneficial effect of iron supplementation for VO2max (mean difference: 0.53; 95% CI: -0.75, 1.81; P=0.42), but a significant benefit was observed for VO2peak (mean difference: 1.87; 95% CI: 0.15, 3.60; P=0.03). Iron supplementation increases endurance performance at submaximal and maximal (VO2peak) exercise intensities in IDNA women. However, increasing iron status does not increase eVO2max. This trial was registered at clinicaltrials.gov as NCT03002090.

Performance measurement of sailors with custom hiking bench and motion tracking system

In the research, a static hiking bench, built after our custom design, with load sensors was used as a boat simulator. The feasibility of the developed instrument and measurement method was tested on a professional Finn dinghy sailor. The body posture in 3D and the exerted forces were recorded during different simulated wind strengths (light, moderate and strong wind), then the maximal physical performance was assessed by a Bucket-test and the measurement of the maximal arm forces.The results of the hiking sessions were compared to past measurements carried out on water. The profiles of the forces on the hiking strap were similar, but the profiles of the forces on the schott rope (simulated wind strength) were not comparable. Depending on the schott load, the CoM coordinates did not change significantly, while the hiking posture (the joint angles) did vary significantly. This means that the hiking technique depends on the wind speed and this can be described by numerical data.The analysis of the results concluded that the new measuring system is suitable for measuring and analyzing the performance of sailors’ hiking technique, which can lead to better instructions regarding the hiking of the sailor from the coaches and better results.

Association Between the 25-Hydroxyvitamin D Status and Physical Performance in Healthy Recreational Athletes.

Molecular and clinical studies have linked vitamin D (vitD) deficiency to several aspects of muscle performance. For this retrospective cross-sectional study data from 297 male (M) and 284 female (F) healthy recreational athletes were used to evaluate the prevalence of vitD deficiency in athletes living in Austria and to determine whether serum 25-hydroxyvitamin D (25(OH)D) correlates with maximal (Pmax) and submaximal physical performance (Psubmax) measured on a treadmill ergometer. The data were controlled for age, season, weekly training hours (WTH), body mass index (BMI) and smoking status. 96 M and 75 F had 25(OH)D levels ≤ 20 ng/mL. 25(OH)D levels showed seasonal variations, but no seasonal differences in Pmax and Psubmax were detected. M with 25(OH)D levels ≤ 20 ng/mL had significantly lower Psubmax (p = 0.045) than those with normal levels. In F no significant differences in Pmax or Psubmax were detected. Stepwise multiple regression analysis including all covariates revealed significant correlations between 25(OH)D levels and Pmax (β = 0.138, p = 0.003) and Psubmax (β = 0.152, p = 0.002) in M. Interestingly, for F significant correlations between 25(OH)D and both Pmax and Psubmax disappeared after adding WTH to the model. In conclusion, our data suggest that 25(OH)D status is associated with physical performance especially in M, while in F, WTH and BMI seem to affect the correlation.

Myocardial remodelling and tissue characterisation by cardiovascular magnetic resonance (CMR) in endurance athletes

There is still some controversy about the benignity of structural changes observed in athlete’s heart, especially regarding the observation of increased biomarkers and the presence of myocardial fibrosis (MF).AimOur purpose...

Predictive Value of the Fear-Avoidance Model on Functional Capacity Evaluation

Purpose Measuring the predictive value of the Fear-Avoidance Model (FAM) on lifting tasks in Functional Capacity Evaluation (FCE), and on reasons for stopping the evaluation (safe maximal effort, versus self-limited). Methods A monocentric prospective study was conducted on 298 consecutive inpatients. Components of the FAM were analyzed using the Cumulative Psychosocial Factor Index (CPFI: kinesiophobia, catastrophizing, depressive mood) and perceived disability (Hand/Spinal Function Sort: HFS/SFS). Floor-to-waist, waist-to-overhead and dominant-hand lifting tests were measured according to the FCE guidelines. Maximal safe performance was judged by certified FCE assessors. Analyses were conducted with linear multiple regression models. Results The CPFI was significantly associated with the 3 FCE lifting tests: floor-to-waist (ß = − 1.12; p = 0.039), waist-to-overhead (ß = − 0.88; p = 0.011), and dominant-handed lifting (ß = − 1.21; p = 0.027). Higher perceived disability was also related to lower performances: floor-to-waist (ß = 0.09; p < 0.001), waist-to-overhead (ß = 0.04; p < 0.001), and dominant-handed lifting (ß = 0.06; p < 0.001). The CPFI was not related to performances of patients with self-limited effort despite higher psychological scores, while a relationship was found for patients who achieved a safe maximal performance. Higher perceived disability was related to performances in both situations. Conclusions FAM components should be taken into account when interpreting maximal physical performance in FCE. This study also suggests that factors other than pain-related fears may influence patients with self-limited effort.

Prime Time Light Exposures Do Not Seem to Improve Maximal Physical Performance in Male Elite Athletes, but Enhance End-Spurt Performance.

Many sports competitions take place during television prime time, a time of the day when many athletes have already exceeded their time of peak performance. We assessed the effect of different light exposure modalities on physical performance and melatonin levels in athletes during prime time. Seventy-two young, male elite athletes with a median (interquartile range) age of 23 (21; 29) years and maximum oxygen uptake (VO2max) of 63 (58; 66) ml/kg/min were randomly assigned to three different light exposure groups: bright light (BRIGHT), blue monochromatic light (BLUE), and control light (CONTROL). Each light exposure lasted 60 min and was scheduled to start 17 h after each individual's midpoint of sleep (median time: 9:17 pm). Immediately after light exposure, a 12-min time trial was performed on a bicycle ergometer. The test supervisor and participants were blinded to the light condition each participant was exposed to. The median received light intensities and peak wavelengths (photopic lx/nm) measured at eye level were 1319/545 in BRIGHT, 203/469 in BLUE, and 115/545 in CONTROL. In a multivariate analysis adjusted for individual VO2max, total work performed in 12 min did not significantly differ between the three groups. The amount of exposure to non-image forming light was positively associated with the performance gain during the time trial, defined as the ratio of the work performed in the first and last minute of the time trial, and with stronger melatonin suppression. Specifically, a tenfold increase in the exposure to melanopic light was associated with a performance gain of 8.0% (95% confidence interval: 2.6, 13.3; P = 0.004) and a melatonin decrease of −0.9 pg/ml (95% confidence interval: −1.5, −0.3; P = 0.006). Exposure to bright or blue light did not significantly improve maximum cycling performance in a 12-min all-out time trial. However, it is noteworthy that the estimated difference of 4.1 kJ between BRIGHT and CONTROL might represent an important performance advantage justifying further studies. In conclusion, we report novel evidence that evening light exposure, which strongly impacts the human circadian timing system, enables elite athletes to better maintain performance across a 12-min cycling time trial.

Impact of Vitamin D in Sports: Does Vitamin D Insufficiency Compromise Athletic Performance?

Introduction Vitamin D is essential for calcium homeostasis and regulates the expression of over 900 genes. It thereby influences musculoskeletal health and function. Additionally, multiple other effects were observed through the detection of vitamin D receptors (VDR) in numerous tissues of the human body. Material and Methods We reviewed the literature regarding evidence of the impact of vitamin D on musculoskeletal health and peak athletic performance. Results and Discussion It is well known that there is a high prevalence of vitamin D deficiency in the average European population. This article confirmed the same for athletes in different disciplines. Therefore, vitamin D deficiency and its effects are relevant for competitive sports. The surprisingly high prevalence of inadequate vitamin D levels depends on the geographic location, the time of day and year, local climate conditions, and sports disciplines (indoor vs. outdoor). Based on the analysed literature, we found several correlations between 25-OH-D3 serum levels and different aspects of competitive sports. A serum level ≥ 30 ng/ml provides sufficient mineralisation of non-mineralised bone matrix and is therefore crucial for skeletal health. Furthermore, this concentration was positively correlated with an accelerated regeneration of muscular force. Levels above 40 ng/ml provided a protective effect on the development of stress fractures. Researchers suspect that levels above 50 ng/ml are required for athletes to achieve maximal physical performance. While there is an ongoing discussion amongst researchers regarding beneficial effects of such high levels, it is well known that blood levels lower than 30 ng/ml lead to mineralisation defects in bone (rickets, osteomalacia) and muscular function (reversible myopathy). Conclusion This review suggests that athletes should have an evaluation of vitamin D-dependent calcium homeostasis based on laboratory tests of 25-OH-D3, calcium, creatinine, and parathyroid hormone. In case of vitamin D insufficiency, normal blood levels of ≥ 30 ng/ml may be restored by optimising the athlete's lifestyle and, if appropriate, oral substitution of cholecalciferol. This concentration is associated with a protective effect and enhancement of physical performance. Consequently, it is a requirement for restoring and maintaining musculoskeletal health and athletic performance.

Improvement in functional performance with high-speed power training in older adults is optimized in those with the highest training velocity.

To identify whether variability in limb movement velocity during high-speed power training (HSPT) may impact physical functioning in older adults. 42 older men and women (71.3±6.6 years) were randomized to lower extremity HSPT (n=28) or control (CON; n=14) (Analysis 1) for 12weeks. A second analysis (Analysis 2) allocated HSPT into high-velocity (n=14) or low-velocity (n=14) based on a limb movement speed above or below the median average velocity during the 12-week HSPT intervention. Habitual gait speed, maximal gait speed, timed up-and-go, and the short physical performance battery were measured at baseline and 12weeks. Change scores were compared between HSPT and CON (Analysis 1), and high-velocity, low-velocity, and CON (Analysis 2) using ANCOVA. Statistical significance was accepted at p<0.05. Analysis 1 There were no group differences in habitual gait speed, maximal gait speed, or timed up-and-go between HSPT and CON (all p>0.05). Short physical performance battery was greater in HSPT (0.96±0.19) compared to CON (0.10±0.26; p=0.01). Analysis 2 There were no group differences in the change in habitual GS (p=0.33) among high-velocity, low-velocity and CON. There were significant group differences in the change in maximal GS (p=0.007), timed up-and-go (p=0.03), and short physical performance battery (p=0.03). There is considerable variation in self-selected maximal limb velocity during HSPT in older adults. In the present cohort, an average limb velocity of 0.88m/s during HSPT was necessary to ensure optimal improvement in functional performance for older adults, but this threshold will need further investigation.

Along paths converging to Bengt Saltin's early contributions in exercise physiology.

A fascinating chain of events led in 1941 to the formation of the Department of Physiology at the Royal Gymnastic Central Institute (GCI) in Stockholm, Sweden. Erik Hohwü Christensen, from the scientifically advanced Lindhard School in Copenhagen became its first professor. A central research question for him concerned determining the limiting factors for maximal physical performance in man. This was the academic setting where the sports interested medical student Bengt Saltin was introduced to exercise physiology. In the summer of 1959, he became involved in a study on intermittent vs continuous running. A doctoral project, with Per-Olof Åstrand as his tutor, resulted in 1964 as the thesis “Aerobic work capacity and circulation at exercise in man. With special reference to the effect of prolonged exercise and/or heat exposure”. In the decade that followed, Saltin continued along that path. However, he also added a vital research line involving pioneering studies on skeletal muscles in the exercising man, a series of novel studies on the physiological demands in various sports, and studies of the effects of physical training within the general population.

Ageing and maximal physical performance

Abstract Elite master athletes with long-term devotion to physical training offer an economical means of investigating the effects of ageing and habitual exercise on maximal physical performance. Ideally, individuals with optimised living habits throughout their lives could serve as a human model of ‘primary’ or ‘inherent’ ageing, where age-related changes are not confounded by sedentary life-style and associated chronic diseases. A limitation of this approach is the selection bias as those with inherently high physical capacity and good health participate in competitive sports. The age-related decrements remain obvious, but the record performances of master athletes competing in running and jumping events are preserved at an extraordinary high level until old age. Similarly, underlying capacities such as muscle strength, power and endurance remain far above the age norms, thus providing superior functional reserves for activities of daily living. Nevertheless, even the best records may overestimate the age decrements. It is obvious that the older champions have never trained and performed as well as the current younger athletes, and that the performance of individual athletes retaining or increasing their training volume and intensity show smaller decrements over the years. The plasticity of individual development is preserved in later life thus making it possible, at least for some time, to modify the age-associated decline in the different aspects of maximal physical performance.

Bone rigidity to neuromuscular performance ratio in young and elderly men

Given the adaptation of bone to prevalent loading, bone loss should follow, but lag behind, the decline in physical performance during aging. Furthermore, bone responsiveness to load-induced strains is believed to decrease with aging. However, the relationship between bone and lean body (∼ muscle) mass appears to remain rather constant throughout adulthood. The purpose of this study was to examine the association between age and bone to neuromuscular performance ratio. Young ( N = 20, age 24 SD ± 2 years, body mass 77 ± 11 kg, height 178 ± 6 cm) and elderly ( N = 25, 72 ± 4 years, 75 ± 9 kg, 172 ± 5 cm) men served as subjects. Bone structural traits were measured at the right distal tibia and tibial mid-shaft with peripheral quantitative computed tomography (pQCT). Maximal section modulus ( Z max50), total area (ToA d), cortical area (CoA 50), total density (ToD d) and cortical density (CoD 50) were determined from the pQCT images. Neuromuscular performance was measured by recording vertical ground reaction force (GRF) in maximal bilateral hopping. Load-induced strains were estimated by calculating appropriate indices for compressive and tensile loading that took into account both the bone structure and apparent biomechanics of the given bone site. Young subjects had significantly higher maximal GRF compared to older men (4260 ± 800 N vs. 3080 ± 600 N, P < 0.001). They also had smaller ToA d (1100 ± 170 mm 2 vs. 1200 ± 100 mm 2, P = 0.028) while their ToD d was higher (370 ± 46 g/cm 3 vs. 330 ± 22 g/cm 3, P = 0.002). The Z max50 did not differ significantly between young (1660 ± 320 mm 3) and elderly men (1750 ± 320 mm 3) ( P = 0.224). Compressive (0.484 ± 0.102 vs. 0.399 ± 0.078, P = 0.016) and tensile (0.107 ± 0.016 vs. 0.071 ± 0.018, P < 0.001) strain indices were significantly higher in the younger group. In conclusion, the difference in bone to loading ratio at the tibial mid-shaft is bigger than expected from the delay in bone adaptation alone. Potential candidates to explain this phenomenon include a decrease in mechanosensitivity with aging, inability of maximal physical performance to adequately represent the bone loading environment, or the need to maintain constant safety factors to functional strains.

Spiroergometrische Leistungsdiagnostik vor und nach Blutspende

The link between haemoglobin and physical performance was established a long time ago and is the underlying principle of blood doping. Blood loss on the other hand decreases physical capacity. The aim of this study is to evaluate physical performance loss and underlying mechanisms following voluntary blood donation. Eleven voluntary subjects (four female) completed a symptom-limiting cardio-pulmonary exercise test before and after blood donation (500 mL blood). The haemoglobin value decreased by 1.2 mg/dL (9%, p < 0.001), maximal oxygen uptake by 9% (p = 0.006), maximal work rate by 13% (p = 0.001) and duration of exercise fell from 663 down to 607 seconds (p = 0.005). Anaerobic transition occurred at 81.2% and 71.5% of maximal oxygen uptake before and after blood donation, respectively (p = 0.001). Subjects who practise recreational endurance sports appear to be more effected by endurance loss. The haemoglobin value was the only significant predictor of maximal oxygen uptake in regression analysis (p < 0.001). Maximal physical performance is impaired after blood donation. Haemoglobin decline accounts for the decreased oxygen uptake. As a consequence thereof the anaerobic transition occurs earlier. Subjects not engaged in regular sports activity did not experience a decline in their capacity. Inclusion of the haemoglobin value into equations predicting maximal oxygen uptake could improve prediction precision.

New East–Westfalian Postoperative Therapy Concept: A Telemedicine Guide for the Study of Ambulatory Rehabilitation of Patients after Cardiac Surgery

In-hospital rehabilitation can improve recovery of patients after surgery, but also contributes to the high costs of the German health system. A telemedicine-based rehabilitation used in the home as an alternative to in-hospital rehabilitation was evaluated in a pilot study. In an open trial, 170 patients performed a 3-month ambulatory rehabilitation after cardiac surgery. There were two groups (group 1 [n = 70] and group 2 [n = 100]). Group 1 participated in conventional in-hospital rehabilitation. Group 2 received ambulant rehabilitation using telemedicine. Physical performance, quality of life, (measured with a questionnaire), complications and costs were assessed and compared between the two groups. Maximal physical performance (MPP) was assessed at 6 and at 12 months after cardiac surgery. It was significantly increased by 46-54 watts in both study groups compared to their baseline value. Moreover, physical and psychological quality of life had increased in both study groups compared to baseline values. However, group 2 was the only group to show statistical significance in all categories. Fewer incidents of angina pectoris were reported within the study interval in group 2 compared to group 1 (p < 0.01). The total cost of rehabilitation was 58% lower in group 2 compared to group 1. Ambulatory rehabilitation using telemedicine improves physical performance, quality of life, is safe, and is inexpensive. Our data indicate that home-based rehabilitation is more effective than in-hospital rehabilitation for patients after cardiac surgery.

Blood boosting and sport.

Reinfusion of whole blood or packed red blood cells (RBCs) increasing the haemoglobin concentration ([Hb]) above the individual's normal values increases VO2max and enhances physical performance. During submaximal exercise heart rate and blood lactate concentration ([Hla]) are reduced, while arterial blood pressure remains unchanged despite increased haematocrit (Hct). There is no method available for detecting this type of blood 'doping'. Seven weeks of injection with recombinant human erythropoietin (rhEPO) (20-40 IU per kg body weight) increased [Hb] and Hct, maximal oxygen uptake (VO2max) and physical performance were increased. The change in VO2max per gram change in [Hb] is the same after reinfusion of blood and after rhEPO injections. During submaximal exercise arterial blood pressure is increased, which despite a reduced heart rate, puts greater stress on the circulation even in trained athletes. An electrophoretic method is available to detect the use of rhEPO but it is costly and slow and therefore it can not be used in sport. Indirect markers of increased erythopoiesis may be used. However, further research in this field is necessary.

Effect of sonic driving on maximal aerobic performance.

The study purpose was to evaluate antecedent binaural stimulation (ABS) on maximal aerobic physical performance. Twenty-two healthy, physically active subjects, 21-34 years, randomly received one of two preparations for each session: 15 min of quiet (BLANK) or percussive sonic driving at 200+ beats per minute (bpm) using a recorded compact disc (FSS, Mill Valley, CA) with headphones (ABS). Baseline HR, blood pressure (BP), and breathing frequency (f(br)) were obtained. During each condition, HR and f(br) were recorded at 3-min intervals. The graded maximal treadmill testing was administered immediately postpreparation session on separate days, with at least 48 h rest between sessions. There were significant differences in the antecedent period means between the two conditions, ABS (HR: 70.2 +/- 10.7 bpm; f(br): 18.5 +/- 3.3 br min(-1); BP: 134.5/87.9 +/- 13.6/9.2 mm Hg) and BLANK (HR: 64.6 +/- 7.9; f(br): 14.3 +/- 2.9; BP: 126.7/80.3 +/- 12.1/8.6). Differences were noted for each 3-min interval and pre- postantecedent period. The maximal graded exercise test (GXT) results showed that there was a small but significant (P < 0.05), increase in maximal VO(2) in the ABS (49.8 +/- 6.8 ml. kg(-1). min(-1)) vs. BLANK (46.7 +/- 8.7) conditions. Related to that finding was a slight increase (0.5 min) in time to exhaustion (P < 0.05). There were no significant differences in HR or RPE (P > 0.05). There may be a latency to ABS related to entrainment or imagery-enhanced warm-up. Am. J. Hum. Biol. 12:558-565, 2000. Copyright 2000 Wiley-Liss, Inc.

Aerobic exercise as therapy for cancer fatigue.

Fatigue and impairment of physical performance are common and severe problems of cancer patients. We describe the effect of an aerobic exercise program designed for cancer patients suffering from these symptoms. Five cancer patients (4 female, 1 male, age 18 to 55), participated in the training program. Fatigue had been present for a time ranging between 5 wk and 18 months and hindered the patients from carrying out normal daily activities. The training program consisted of walking daily on a treadmill with an intensity corresponding to a lactate concentration of 3 +/- 0.5 mmol.L-1 and was carried out for 6 wk. By the end of the exercise program we observed an improvement in maximal physical performance (from 6.4 +/- 0.4 km.h-1 to 7.5 +/- 0.9 km.h-1, P < 0.05) and maximal walked distance (from 1640 +/- 724 m to 3300 +/- 953 m, P < 0.05). Heart rate and lactate concentration by an equivalent submaximal workload (5 km.h-1) were significant reduced (from 138 +/- 21 beats.min-1 to 113 +/- 20 beats.min-1, P < 0.05, and from 2.6 +/- 1.4 mmol.L-1 to 1.3 +/- 0.6 mmol.L-1, P < 0.05); all patients experienced a clear reduction of fatigue and could carry out normal daily activities again without substantial limitations. We conclude that an aerobic exercise program of precisely defined intensity, duration, and frequency can be prescribed as therapy for primary fatigue in cancer patients.

Correlation between physical performance and fatigue in cancer patients

Fatigue and a reduction in physical ability are common and often severe problems of cancer patients regardless of disease stage and modality of treatment. However, while physical performance can be assessed objectively with laboratory tests, fatigue is a subjective phenomenon whose perception is influenced by past experience and expectations for the future. To evaluate the correlation between fatigue and physical impairment, we assessed maximal physical performance with a treadmill test, and mental state with two questionnaires, the Profile of Mood States (POMS) and the Symptom Check List (SCL-90-R), in a successive series of 78 cancer patients with solid tumors or hematological malignancies. A weak association between fatigue and maximal physical performance was found (r = -0.30; P < 0.01). However, intensity of fatigue showed a strong correlation with several indicators of psychological distress such as depression (r = 0.68), somatization (r = 0.64) and anxiety (r = 0.63; P for all < 0.001). Furthermore, patients with lower levels of physical performance had significantly higher scores for depression (P = 0.005), somatization (P = 0.03) and anxiety (P = 0.08), and significantly lower scores for vigor (P = 0.05) than their counterparts whose physical performance was higher. We conclude that fatigue in cancer patients may be related to mood disturbance but appears to be independent of physical performance. Moreover, low physical performance can be viewed as an independent predictor of mental distress in cancer patients.

Effects of Aerobic Exercise on the Physical Performance and Incidence of Treatment-Related Complications After High-Dose Chemotherapy

AbstractLoss of physical performance is a universal problem of cancer patients undergoing chemotherapy. We postulated that this impairment can be partially prevented by aerobic exercise. In a randomized study, 33 cancer patients receiving high-dose chemotherapy followed by autologous peripheral blood stem cell transplantation (training group, T) performed an exercise program consisting of biking on an ergometer in the supine position after an interval-training pattern for 30 minutes daily during hospitalization. Patients in the control group (C, n = 37) did not train. Maximal physical performance was assessed with a treadmill test by admission and discharge. Physical performance of the two groups was not different on admission. The decrement in performance during hospitalization was 27% greater in the control group than in the training group (P = .05); this resulted in a significantly higher maximal physical performance at discharge in the trained patients (P = .04). Duration of neutropenia (P = .01) and thrombopenia (P = .06), severity of diarrhea (P = .04), severity of pain (P = .01), and duration of hospitalization (P = .03) were reduced in the training group. We conclude that aerobic exercise can be safely carried out immediately after high-dose chemotherapy and can partially prevent loss of physical performance. Based on the potential significance of the observed outcomes, further studies are warranted to confirm our results.

AEROBIC EXERCISE IN THE REHABILITATION OF CANCER PATIENTS 1578

Fatigue and loss of physical performance are common and severe problems of cancer patients. In two studies, we investigated the effects of aerobic training on the physical performance of cancer patients in different stages of disease and treatment. Study 1 included 32 patients with solid tumors and lymphomas undergoing high-dose chemotherapy (HDC). Patients in the training group (T, n=16; age 42±9 years; sex 6 male, 10 female; BMI 25±5) participated in a training program consisting of walking of a treadmill, 30 minutes daily following an interval-training pattern. Training intensity corresponded to a heart rate of 80±5% of calculated maximum(220-age). Training program began immediately after discharge (16±2 days after HDC) and was carried out for 6 weeks. Patients in the control group(C, n=16; age 39±11 years; 5 male 11 female; BMI 24±3) did not train. After 6 weeks, improvement of maximal physical performance (maximal speed by treadmill stress test) was significantly higher (p<0.05) for patients in the training group than for controls (Pre: T=6,2±1,1 km/h; C=6,2±1,3 km/h, NS; post: T=8,3±1,6 km/h, C=7,5±1,3 km/h). Study 2 included 70 cancer patients with solid tumors undergoing HDC. The training group (T, n=33, age 39±10 years, 10 male, 23 female, BMI 25±6) trained with a bed cycle ergometer 30 minutes daily following an interval-training pattern by a heart rate corresponding to 70% of the maximum (220-age); training began the day after concluding chemotherapy and was carried out during hospitalization (approximately 2 weeks). Control patients (C, n=37; age 40±11 years, 10 male, 27 female, BMI 24±4) did not train. Prior to hospital admission and by discharge, maximal physical performance was evaluated with a treadmill stress-test. Loss of physical performance in the training group (T pre: 7,9±1,2 km/h; post:6,8±1,1 km/h) was 27% lower than in the control group (C pre:7,5±1,3 km/h, post:6,0±1,3 km/h). This resulted in a significantly higher physical performance in the training group than in the control group by discharge (p<0.05). Conclusion: Aerobic training is an effective method to reduce loss of physical performance of cancer patients during hospitalization following chemotherapy and to accelerate recovery after discharge.