Participation In Exercise Program Research Articles

Effect of a 12-week remote exercising program (ExIOnc) on quality of life and symptoms of older patients with cancer in Brazil.

1623 Background: Leading organizations, including ASCO, recommend physical activity for patients with cancer. However, numerous barriers hinder patients from maintaining regular physical activity, particularly among older adults, who have lower participation in exercise programs. This study aims to evaluate the effects of a 12-week supervised remote exercise program on the health-related quality of life (HRQOL) of older patients with cancer (aged ≥65) undergoing treatment in Brazil. Methods: This was a single-arm pilot study evaluating a remote physical activity program which combined supervised and remote exercise. Eligible patients were contacted through WhatsApp for the initial assessment and received guidance on weekly exercises. The Vedius platform was employed to demonstrate proper home exercise techniques. The prescribed regimen consisted of 3-5 hours per week (4-6 days a week), encompassing both resistance and aerobic exercise. Outcome measures included overall HRQOL (FACT-G, scale 0-108) and symptom assessment (ESAS). Assessments were conducted at baseline and after 12 weeks. Descriptive statistics were calculated, and linear mixed models were employed to analyze changes from before to after the intervention. Results: Out of 46 approached patients, 41 patients were enrolled, with a median age of 70 years (range 65-88). Of the participants, 56.1% were female, 70.7% were white, and 58.2% were married, with 53.5% holding a college degree. The most common cancer types were breast (26.8%), genitourinary (22.0%), and lung (17.1%), all diagnosed at advanced stages. A significant improvement was observed in overall HRQOL (MT1=83.2 to MT2=94.4, P=0.001). Improvements were also seen in the severity of various symptoms, including pain (MT1=1.6 to MT2=0.7, P=0.001), fatigue (MT1=3.8 to MT2=1.3, P=0.001), nausea (MT1=0.8 to MT2=0.2, P=0.01), depression (MT1=2.6 to MT2=0.8, P=0.001), anxiety (MT1=3.2 to MT2=1.2, P=0.001), drowsiness (MT1=1.8 to MT2=0.4, P=0.001), and appetite (MT1=2.2 to MT2=0.6, P=0.001). Conclusions: This study demonstrates a positive impact of a 12-week remote physical activity program on HRQOL and symptom management for older patients with cancer, and set the stage for future randomized trials. Despite the challenges posed by cancer treatment, incorporating such programs into patient care could be an effective strategy to enhance overall well-being and mitigate treatment-related symptoms.

Evaluations of virtual exercise programmes for adults with mobility limitations: a scoping review protocol incorporating an equity lens to inform the development of strategies to optimise participation of under-represented groups

IntroductionFor individuals with mobility limitations, virtual exercise programmes can address the challenges of in-person participation in community exercise programmes. A synthesis of studies of virtual exercise programmes targeting mobility limitations...

Engagement of people diagnosed with schizophrenia in a five-month exercise program: CORTEX-SP study

Exercise programs represent useful non-pharmacological resources in preventing and treating mental disorders such as schizophrenia (SZ), but there are aforementioned reasons, (i.e., low rates of participation). The study aimed to explore the engagement of people diagnosed with SZ in a five-month exercise program. Therefore, purposive criterion sampling was utilized to recruit 35 participants who were diagnosed with SZ. Qualitative data was collected using semi-structured interviews; these were recorded and transcribed verbatim. The data was subsequently analyzed using thematic analysis. Three themes were identified from the analysis: intrapersonal factors (characteristics and clinical consequences of the SZ and pharmacotherapy), interpersonal factors (relationships with people that participate, health professionals, and family and friends), and environmental factors (exercise program organization and participants’ perception regarding the program). In conclusion, the symptoms and pharmacological treatments for the illness were perceived to be the primary barriers to engaging in exercise for the participants. Participants gave great importance to interpersonal factors, they perceived the group atmosphere and the program environment to be fundamental axes of the program. The presence of healthcare professionals, as well as the support, were also perceived to facilitate engagement in the exercise program. Keywords: schizophrenia, community exercise, qualitative methods, environmental health, mental health.

Invasiveness of previous treatment for peripheral arterial disease and risk of adverse cardiac events after coronary stenting

Patients with peripheral arterial disease (PADs), undergoing percutaneous coronary intervention (PCI), have higher adverse event risks. The effect of invasiveness of PADs treatment on PCI outcome is unknown. This study assessed the impact of the invasiveness of previous PADs treatment (invasive or non-invasive) on event risks after PCI with contemporary drug-eluting stents. This post-hoc analysis pooled 3-year patient-level data of PCI all-comer patients living in the eastern Netherlands, previously treated for PADs. PADs included symptomatic atherosclerotic lesion in the lower or upper extremities; carotid or vertebral arteries; mesenteric arteries or aorta. Invasive PADs treatment comprised endarterectomy, bypass surgery, percutaneous transluminal angioplasty, stenting or amputation; non-invasive treatment consisted of medication and participation in exercise programs. Primary endpoint was (coronary) target vessel failure: composite of cardiac mortality, target vessel-related myocardial infarction, or clinically indicated target vessel revascularization. Of 461 PCI patients with PADs, information on PADs treatment was available in 357 (77.4%) patients; 249 (69.7%) were treated invasively and 108 (30.3%) non-invasively. Baseline and PCI procedural characteristics showed no between-group difference. Invasiveness of PADs treatment was not associated with adverse event risks, including target vessel failure (20.5% vs. 16.0%; HR: 1.30, 95%-CI 0.75–2.26, p = 0.35), major adverse cardiac events (23.3% vs. 20.4%; HR: 1.16, 95%-CI 0.71–1.90, p = 0.55), and all-cause mortality (12.1% vs. 8.3%; HR: 1.48, 95%-CI 0.70–3.13, p = 0.30). In PADs patients participating in PCI trials, we found no significant relation between the invasiveness of previous PADs treatment and 3-year outcome after PCI. Consequently, high-risk PCI patients can be identified by consulting medical records, searching for PADs, irrespective of the invasiveness of PADs treatment.Graphical abstractComparison of patients with non-invasive and invasive PADs treatment. PADs peripheral arterial disease, PCI percutaneous coronary intervention.

Leveraging Emerging Technologies to Expand Accessibility and Improve Precision in Rehabilitation and Exercise for People with Disabilities.

Physical rehabilitation and exercise training have emerged as promising solutions for improving health, restoring function, and preserving quality of life in populations that face disparate health challenges related to disability. Despite the immense potential for rehabilitation and exercise to help people with disabilities live longer, healthier, and more independent lives, people with disabilities can experience physical, psychosocial, environmental, and economic barriers that limit their ability to participate in rehabilitation, exercise, and other physical activities. Together, these barriers contribute to health inequities in people with disabilities, by disproportionately limiting their ability to participate in health-promoting physical activities, relative to people without disabilities. Therefore, there is great need for research and innovation focusing on the development of strategies to expand accessibility and promote participation in rehabilitation and exercise programs for people with disabilities. Here, we discuss how cutting-edge technologies related to telecommunications, wearables, virtual and augmented reality, artificial intelligence, and cloud computing are providing new opportunities to improve accessibility in rehabilitation and exercise for people with disabilities. In addition, we highlight new frontiers in digital health technology and emerging lines of scientific research that will shape the future of precision care strategies for people with disabilities.

Perspectives of patients with metastatic breast cancer on physical exercise programs: results from a survey in five European countries

BackgroundTo successfully implement exercise programs for patients with metastatic breast cancer (MBC), services and patient education should consider patients’ knowledge, preferences, values, and goals. Hence, gaining insight into their perspectives on exercise and exercise programming is important.MethodIn this cross-sectional survey, we recruited patients with MBC from the Netherlands, Germany, Poland, Spain, and Sweden. We collected data on patients’ knowledge and skills about exercise and outcome expectations. We identified barriers to and facilitators of participation in exercise programs, and patients’ preferences for program content and modes of exercise delivery.ResultsA total of 420 patients participated in the survey. Respondents were, on average, 56.5 years old (SD 10.8) and 70% had bone metastases. Sixty-eight percent reported sufficient skills to engage in aerobic exercise, but only 35% did so for resistance exercise. Respondents expected exercise to have multiple physical benefits, but a few patients expected exercise to worsen their pain (5%). Not having access to an exercise program for cancer patients (27%), feeling too tired (23%), and/or weak (23%) were the most often reported barriers. Facilitators for exercising regularly were previous positive physical (72%) and emotional (68%) experiences with exercising, and receiving personalized advice from a physiotherapist or sport/fitness instructor (62%). Patients were most interested in walking and preferred exercising at a public gym, although there were differences by country. Fifty-seven percent did not know whether their insurance company reimburses exercise programs and only 9% would be willing to pay more than €50 per month to participate.ConclusionA large percentage of patients with MBC lack the skills to engage in regular exercise as recommended by exercise guidelines for people with cancer. Patients may benefit from personalized advice and appropriate training facilities to overcome barriers. When implementing exercise interventions, attention should be given to reimbursement and the relatively low willingness-to-pay.

Community Exercise Program Participation and Mental Well-Being in the U.S. Texas-Mexico Border Region.

Hispanics are disproportionately affected by low rates of physical activity and high rates of chronic diseases. Hispanics generally and Mexican Americans specifically are underrepresented in research on physical activity and its impact on mental well-being. Some community-based interventions have been effective in increasing physical activity among Hispanics. This study examined data from a sample of low-income Hispanic participants in free community exercise classes to characterize the association between self-reported frequency of exercise class attendance, intensity of physical activity, and participant well-being. As part of two cross-sectional samples recruited from a stratified random sample of community exercise classes, 302 participants completed a questionnaire consisting of a modified version of the Godin-Shephard Leisure-Time Exercise Questionnaire (LTEQ) and the Mental Health Continuum Short Form (MHC-SF). Adjusted logistic regression analyses indicated that those who achieve mild, moderate, and strenuous self-reported physical activity have 130% higher odds (p = 0.0422) of positive mental well-being after adjustment for age, frequency of attendance, and self-reported health. This study provides evidence that the intensity of physical activity is associated with flourishing mental well-being among Hispanic adults. The association between physical activity and mental well-being is more pronounced when considering participants engaged in mild levels of physical activity. The study further provides insight into the planning and development of community-based physical activity programming tailored to low-income populations.

Maternal Exercise during Pregnancy Impacts Motor Performance in 9-Year-Old Children: A Pilot Study.

The benefits of maternal physical activity during pregnancy are well documented, but long-term effects on the child have been less studied. Therefore, we conducted a pilot follow-up study of a lifestyle intervention during pregnancy that aimed to investigate whether exercise (endurance and strength training) during pregnancy affects motor performance and body composition of children up to 9 years of age, as well as possible influencing factors like brain-derived neurotrophic factor (BDNF) and lifestyle. Eleven mother-child pairs from the intervention and eight mother-child pairs from the control group were included. From birth up to 9 years of age, no differences in body mass index (BMI) or body mass index standard deviation scores (BMI-SDS) were found between the groups. Lifestyle intervention was one of the influencing factors for children's cardiorespiratory endurance capacity and coordination. Moreover, maternal BDNF in the last trimester was significantly associated with running performance, which may be due to better neuronal development. This is the first study evaluating the effects of a lifestyle intervention during pregnancy on the motor performance 9 years after birth. Children's participation in exercise programs over the past 9 years was not continuously recorded and therefore not included in the analysis. Even a cautious interpretation of these results indicates that a healthy lifestyle during pregnancy is essential in promoting child health. Larger studies and randomized control trials are necessary to confirm our results, especially those pertaining to the role of BDNF.

Increasing Physical Activity in Persons With Spinal Cord Injury With an eHealth-Based Adaptive Exercise Intervention: Protocol for a Sequential Multiple Assignment Randomized Trial.

Participating in an adequate amount of physical activity to acquire health benefits is challenging for people with spinal cord injury (SCI) due to personal and logistic barriers. Barriers in the built and social environments may include lack of transportation, lack of accessible facilities or programs, and lack of training among fitness personnel. Low self-efficacy, lack of self-regulation skills, and improper outcome expectations are examples of personal barriers. Current approaches to investigating physical activity programs in people with SCI have been limited to traditional "one-size-fits-all" design, which has yielded low adherence rates, high dropout rates, and participants not maintaining physical activity levels at follow-up. The primary aim of this study is to test the feasibility of a tele-exercise program that applies an adaptive intervention design for 30 adults with SCI, targeting increases in adherence to the exercise program and physical activity participation. The Sequential Multiple Assignment Randomized Trial for Home-based Exercise and Lifestyle Tele-Health (SMART-HEALTH) is a 12-week, home-based, movement-to-music (M2M) program. The goal of a SMART-designed study is to develop an adaptive intervention that modifies support provisions based on response levels. In SMART-HEALTH, 2 groups of participants will undergo 3-week and 6-week asynchronous M2M interventions in the first phase. Participants who did not achieve the desired adherence rate (≥95% of video watch minutes) will be rerandomized into M2M Live (switch) or individualized behavioral coaching (augmented with the asynchronous M2M program). The study will primarily assess rates of recruitment or enrollment, adherence and retention, timing to identify nonresponders, and scientific outcomes (eg, physical activity and exercise self-efficacy). The study will qualitatively evaluate the acceptability of the study using semistructured interviews among participants who complete the 12-week intervention. Recruitment procedures started in June 2022. All data are expected to be collected by September 2023. Full trial results are expected to be published by March 2024. Secondary analyses of data will be subsequently published. Results will include exercise adherence rates; changes in self-reported physical activity levels and blood pressure; and changes in secondary conditions including pain, sleep, and fatigue. Thematic analysis of semistructured interviews will include results on participant enjoyment and acceptability of SMART-HEALTH and inform modifications for future delivery of the program. This study will strengthen our understanding of the potential benefits of the tele-exercise intervention for people with SCI and build upon adaptive intervention design and its delivery strategies that aim to increase adoption and sustainable exercise behavior. This pilot trial will inform future SMART-designed studies and provide new and innovative strategies for investigating intervention effects on physical activity behavior in the SCI population. ClinicalTrials.gov NCT04726891; https://classic.clinicaltrials.gov/ct2/show/NCT04726891. DERR1-10.2196/47665.

Collaborative Ambulatory Orthopaedic Care in Patients with Hip and Knee Osteoarthritis: A Retrospective Comparative Cohort Study on Health Utilisation and Economic Outcomes.

To evaluate a novel healthcare programme for the treatment of patients with hip and knee osteoarthritis in southern Germany in terms of clinical and health economic outcomes. The study is based on claims data from 2014 to 2017. We conducted a retrospective comparative cohort study of 9768 patients with hip and knee osteoarthritis, of whom 9231 were enrolled in a collaborative ambulatory orthopaedic care programme (intervention group), and 537 patients received usual orthopaedic care (control group). Key features of the programme are coordinated care, morbidity-adapted reimbursement and extended consultation times. Multivariable analysis was performed to determine effects on health utilisation outcomes. The economic analysis considered annual costs per patient from a healthcare payer perspective, stratified by healthcare service sector. Besides multivariable regression analyses, bootstrapping was used to estimate confidence intervals for predicted mean costs by group. Musculoskeletal-disease-related hospitalisation was much less likely among intervention group patients than control group patients [odds ratio (OR): 0.079; 95% CI: 0.062-0.099]. The number of physiotherapy prescriptions per patient was significantly lower in the intervention group (RR: 0.814; 95% CI: 0.721-0.919), while the likelihood of participation in exercise programmes over one year was significantly higher (OR: 3.126; 95% CI: 1.604-6.094). Enrolment in the programme was associated with significantly higher ambulatory costs (€1048 vs. €925), but costs for inpatient care, including hospital stays, were significantly lower (€1003 vs. €1497 and €928 vs. €1300 respectively). Overall annual cost-savings were €195 per patient. Collaborative ambulatory orthopaedic care was associated with reduced hospitalisation in patients with hip and knee osteoarthritis. Health costs for programme participants were lower overall, despite higher costs for ambulatory care.

Cancer-Related Fatigue Is Associated With Objective Measures of Physical Function in Survivors of Cancer

Purpose: Cancer-related fatigue (CRF) is a common and limiting symptom reported by survivors of cancer and may have a negative impact on functional activities. The purpose of this study was to investigate the relationships between CRF and objective measures of physical function in survivors. Methods: A retrospective analysis was performed on 428 survivors initiating a clinical exercise oncology program. A physical assessment was performed prior to program start and included a six-minute walk test (6MWT), handgrip strength assessment, and a 10 m walk test to measure both usual and fast gait speed. CRF was measured with the Functional Assessment of Chronic Illness Therapy Fatigue scale (FACIT-Fatigue), a commonly used 13-item questionnaire, with scores ranging from 0–52. Lower scores indicate greater CRF. Participant demographics, cancer diagnosis, and treatment information were self-reported at program start. Four multiple linear regression analyses were performed, with 6MWT, handgrip strength, usual gait speed, and fast gait speed as the dependent variables. In each model, FACIT-Fatigue was entered as a predictor and covariates were age, gender, cancer diagnosis, and cancer treatment (currently receiving chemotherapy or radiation or not). Results: Participants were on average 55.2 (SD = 14.1) years old, majority women (64%) and breast cancer survivors (30.5%). Approximately half were currently receiving cancer treatment (48%). The means (SD) of measures of physical function were: 6MWT = 582 (120) m; grip strength = 32.7 (10.5) kg; usual gait speed = 1.36 (0.25) m/s; and fast gait speed = 1.9 (0.38) m/s. The mean (SD) FACIT-Fatigue score was 33.7 (10.8). All regression models were significant (P < 0.01). FACIT-Fatigue was significantly associated with 6MWT (Î2 = 3.39, P < 0.01), handgrip strength (Î2 = 0.13, P < 0.01), usual gait speed (Î2 = 0.005, P < 0.01), and fast gait speed (Î2 = 0.009, P < 0.01). Conclusions: Findings demonstrated that higher CRF was significantly associated with reduced performance on objective measures of physical function, providing insight on how CRF may contribute to limitations of functional day-to-day activities. Future studies should investigate whether reductions in CRF mediate the improvements in physical function seen after participation in exercise programs.

Reducing Falls by Upgrading Lighting in Nursing Homes

•Falls are exceedingly common in post-acute and long-term care residents and a leading cause of injuries, deaths, and worry for residents, families, and caregivers. Fall prevention strategies are resource intensive and multimodal interventions done at the resident level. There is little evidence to date to support environmental modifications to reduce falls. •Does an upgraded, dynamic lighting system reduce the rate of falls in long-term nursing home residents? Reference: Grant LK, St Hilaire MA, Heller JP, Heller RA, Lockley SW, Rahman SA. Impact of Upgraded Lighting on Falls in Care Home Residents. J Am Med Dir Assoc 2022;23:1698–1704.e2. This observational study looked at two pairs of long-term care nursing homes. One member of the pair underwent an upgraded, dynamic lighting system and was compared with the other member who continued standard lighting. The rate of falls was reduced by 43% in the lighting upgrade group versus the standard group. Falls are a common but pathologic part of aging and a classic geriatric syndrome. Many different contributing factors combine to result in a fall. However, falls are preventable through the practice of high-quality geriatric care, which looks to optimize modifiable risk factors, encourage adequate nutrition, stop offending medications, and advocate for participation in exercise and restorative care programs. Despite the success of reducing falls on an individual level, successful fall prevention programs in clinics or nursing homes have low success rates. When a study is published reporting that the fall rates in nursing homes can be reduced by almost 50% with a one-size-fits-all approach, it deserves a closer look. The authors of this study wanted to see what effect an “upgraded” lighting system would have on “care home residents.” Compared with the conventional solid-state lighting, where light has a constant wavelength and brightness, the upgraded lighting had changing intensity and increased blue light exposure during the day and reduced blue light exposure at night. The theoretical benefit of an improved lighting system that illuminates the room is obvious: it will make areas more visible for residents and staff. The health benefits of alternating blue light on improving alertness, cognition, and sleep are less known. This study compared two pairs of long-term care nursing homes owned by the same parent company with the same standardized policies and protocols. The company selected one site from each pair for a lighting upgrade while the other kept its solid-state lighting (fluorescent lamps). The researchers collected data one year before and after the lighting upgrade. To determine fall rates, the researchers reviewed the medical record as documented by the facility staff using the standard reporting tool in the site’s medical record system. There were important differences between the control and experimental groups after they underwent lighting upgrades. First, the experimental group had a higher rate of patients with dementia (42% vs 30%). Second, the experimental group also had more residents and more resident-days, suggesting longer stays in those facilities (146 vs. 98 resident-days, respectively; compared with 151 vs. 126 resident-days before the upgrade). This study found that the rate of falls was about 43% lower in the lighting upgrade sites; the experimental group went from 6.94 to 4.82 falls per 1,000 resident-days compared with the control group, which went from 6.62 to 8.44 falls per 1,000 resident-days. Perhaps of greater interest was that the distribution of falls went from a majority at night to a majority during the day after the lighting upgrade. There was no difference in fall frequency based on time of day in the control sites. These results are exciting in that they suggest a simple lighting upgrade may significantly reduce the rate of falls in nursing homes with minimal to no harm to the residents and little to no ongoing effort from staff. In addition, the early indication is that this fall reduction is perhaps due to improved sleep cycles, which may help in deprescribing potentially dangerous sleep aids. However, caution is needed in interpreting the results. The fall reduction rate is due partly to decreased falls in the experimental group and partly to increased falls in the control group. This may indicate uncaptured differences between the two groups, especially given that the owners selected the sites they wanted to upgrade. In addition, the reduced number of resident-days may reflect that the control groups focused on “short stay” residents undergoing skilled rehabilitation, who may be more likely to fall given their dynamic functional levels. This study is intriguing and warrants additional research to examine the effect of upgraded lighting solutions in nursing homes. If these results can be replicated, there may be a safe, cost-effective solution to prevent falls and their negative consequences for residents. Dr. Salaami is a geriatrician and SNFist with Scripps Clinic in San Diego, CA.

Feasibility, Usability, and Safety of ParaGym, an Intelligent Mobile Exercise App for Individuals With Paraplegia: Protocol for a Pilot Block-Randomized Controlled Trial

Exercise is crucial for individuals with paraplegia to reduce the risk of secondary diseases and improve independence and quality of life. However, numerous barriers such as inadequate accessibility restrict their participation in exercise programs. Digital exercise apps can help overcome these barriers. Personalization is considered a crucial feature of mobile exercise apps, as people with paraplegia have individual requirements regarding exercise programs depending on their level of impairment. Despite the increasing popularity of mobile exercise apps, there are none available that target the individual needs of this cohort. The ParaGym mobile exercise app prototype was designed to automatically tailor exercise sessions to the individual needs of users with paraplegia. This study aims to evaluate the feasibility, usability, safety, and preliminary effectiveness of the ParaGym mobile exercise app prototype. This pilot block-randomized controlled feasibility trial will include 45 adult participants with paraplegia. Eligible participants will be block randomized to either the intervention or waitlist control group. The intervention group will perform a 6-week exercise program using the ParaGym mobile exercise app, comprising three 35-minute exercise sessions per week. The waitlist control group will continue their usual care and receive access to the app after study completion. Participants will record all exercise sessions conducted with the app as well as additional exercise sessions conducted during the study period using exercise diaries. The primary outcomes include feasibility, usability, and safety. Feasibility will be assessed through semistructured interviews, study adherence, and retention rates. Usability will be measured using the System Usability Scale. Safety will be determined by the occurrence of adverse events. Secondary outcomes include the effects of the intervention on peak exercise capacity (VO2 peak); handgrip strength; independence, which will be measured using the Spinal Cord Independence Measure III (SCIM III); and health-related quality of life, which will be measured using the Short Form-36 Health Survey (SF-36). Recruitment commenced in November 2022. Overall, 12 participants were enrolled at the time of submission. Data collection commenced in January 2023, with completion expected in April 2023. To the best of our knowledge, this is the first study to assess the feasibility, usability, and safety of an intelligent mobile exercise app for individuals with paraplegia. Thereafter, the app should be adapted according to the findings of this trial. Future trials with an updated version of the app should aim for a larger sample size, longer intervention duration, and more diverse target group. In the long term, a fully marketable version of the ParaGym app should be implemented. This would increase the access to personalized, independent, and evidence-based exercise training for this cohort and, in the future, other people who use wheelchairs. German Clinical Trials Register DRKS00030370; https://drks.de/search/de/trial/DRKS00030370. DERR1-10.2196/45652.

Does participation in therapeutic exercise programs after finishing oncology treatment still ensure an adequate health status for long-term breast cancer survivors? A ≥ 5 years follow-up study.

The aims of this study were to evaluate whether the effects of two therapeutic exercise programs are sustained over time (≥ 5 years) in long-term breast cancer survivors (LTBCS). Second, to determine the influence of the current level of physical activity (PA) performed on cancer-related fatigue (CRF) that these patients may present ≥5 years later. A prospective observational study was conducted with a cohort of 80 LTBCS in Granada during 2018. Firstly, considering their participation in one of the programs, they were allocated into two groups: usual care and therapeutic exercise program, to assess CRF, pain and pressure pain sensitivity, muscle strength, functional capacity, and quality of life. Secondly, they were also classified into 3 groups according to current level of weekly PA performed: ≤ 3, 3.1-7.4, and ≥ 7.5 (MET-hour/week) respectively, to assess its impact over CRF. Although the positive effects of the programs are not sustained over time, a trend toward significance can be observed for a greater reduction in overall CRF levels, lower intensity of pain in the affected arm and cervical region, and greater functional capacity and quality of life in the group that underwent therapeutic exercise. Additionally, 66.25% of LTBCS are inactive ≥ 5 years after completion of the program and furthermore, such inactivity is accompanied by higher CRF levels (P .013 to .046). The positive effects of therapeutic exercise programs are not maintained over time for LTBCS. Additionally, more than half of these women (66.25%) are inactive ≥ 5 years after completion of the program, this inactivity being accompanied by higher levels of CRF.

Lower All-Cause Mortality Risk in Females and Males with Peripheral Artery Disease following Pain-Free Home-Based Exercise: A 7-Year Observational Study.

We evaluated the sex-specific difference in response upon participation in an exercise program with respect to the risk of adverse clinical outcomes among patients with peripheral artery disease (PAD) and claudication. The records of 400 PAD patients were assessed between 2012 and 2015. Two hundred of them were addressed to a walking program prescribed at the hospital and executed at home at symptom-free walking speed (Ex), while the remaining 200 acted as a control group (Co). The number and date of deaths, all-cause hospitalizations, and amputations for a 7-year period were collected from the regional registry. At baseline, no differences were observed (MEXn = 138; FEXn = 62; MCOn = 149; FCOn = 51). The 7-year survival rate was significantly higher in FEX (90%) than in MEX (82% hazard ratio, HR: 0.542 95% CI 0.331-0.885), FCO (45%, HR: 0.164 95% CI 0.088-0.305), and MCO (44%; HR: 0.157 95% CI 0.096-0.256). A significantly lower rate of hospitalization (p < 0.001) and amputations (p = 0.016) was observed for the Ex group compared to the Co group, without differences by sex. In conclusion, in PAD patients, active participation in a home-based pain-free exercise program was associated with a lower rate of death and better long-term clinical outcomes, particularly among women.

Effects of multimodal cognitive exercise program on cognitive function, bone density, blood lipid, fitness, and depression in old women with mild cognitive impairment.

The purpose of this study is to verify the effects of participation in 12-week multimodal cognitive exercise program on cognitive function, bone mineral density, blood lipids, senior functional fitness, and depression of the old women with mild cognitive impairment and osteopenia. As a result, the exercise group showed significant effects in cognitive function, depression, bone mineral density, blood lipid, lower extremity flexibility, upper extremity flexibility, dynamic balance, and body endurance. Such results prove that multimodal cognitive exercise program is an effective interventional exercise program for improving cognitive function in the old women with mild cognitive impairment.

Safety, Feasibility, and Efficacy of Exercise Interventions for People With Multiple Myeloma: A Systematic Review.

Bone lesions and other disease- and treatment-related side effects commonly experienced by people with multiple myeloma (MM) may impede their ability to exercise. This systematic review evaluated the safety, feasibility, and efficacy of exercise program participation on the physiological and/or psychological health of people with MM. Literature searches were conducted through five electronic databases and appraised using the Delphi list of criteria. Controlled trials that assessed the safety and feasibility of an exercise intervention and its effects on disease- or treatment-related symptoms in people with MM were included. Seven studies of varying quality involving 563 participants were included. All studies concluded that exercise was safe, reporting zero serious and 4 adverse events attributable to exercise testing or training. Attendance ranged from 58% to 96%, however no study reported adherence to the exercise prescription. Compared to a control group, exercise did not appear to affect fatigue, depression, anxiety, body composition, quality of life, or sleep. Isolated studies identified between-group differences favoring exercise in lower limb strength (+8.4 kg, 95% CI 0.5, 16.3, P= .04), peak oxygen uptake (+1.2 mL/kg/min, 95% CI 0.3, 3.7, P= .02), physical activity (+6.5MET-hs/wk, P< .001), stem cell collection attempts (1.1 ± 0.2 vs. 1.5 ± 0.9, P< .01), and red blood cell (1.8 ± 2.2 vs. 2.4 ± 2.6, P< .05) and platelet transfusions (2.3 ± 1.6 vs. 3.5 ± 3.4, P < .05) during transplantation. Exercise interventions appear safe and well attended by people with MM. The lack of improvements in disease- and treatment-related symptoms requires further exploration to determine whether exercise is a sufficient stimulus to elicit benefits in this unique population.

Contributions of social participation to the dynamic balance, mobility, and muscle strength of different age groups of older people: a cross-sectional study

ABSTRACT This study aimed to investigate the contributions of social participation in health promotion groups and regular physical exercise programs to the physical and functional performance of different age groups of community-dwelling older adults. This is a cross-sectional study including 266 older adults. Physical and functional performances (dependent variables) were characterized based on dynamic balance (alternate step test), mobility (timed up and go test), upper (handgrip dynamometer) and lower limbs muscle strength (Sit-to-stand test). Participants were questioned about active social participation in primary care groups and in physical exercise programs. The data were analyzed by linear regressions. Among individuals aged over 80 years, women participated in less health promotion groups and both sexes practiced less physical exercise. Age combined with regular exercise significantly explained 18.7% of dynamic balance and 22.8% of lower limb muscle strength in women. Despite social participation, for men, age alone explained 11.9% of lower limb strength and 11.5% of mobility. Therefore, social participation in physical exercise programs was a protective factor for these physical and functional differences between women’s age groups. Among men, mobility and lower limb strength performance reduced with aging, regardless of social participation.

지자체에서 운영하는 복지관 운동프로그램 참여가 초고령자의 체력과 인지기능에 미치는 영향: 24주 중심으로

The purpose of this study is to suggest an exercise program that can be applied to the elderly and the elderly on the effects of participation in an exercise program in a welfare center operated by a local government on the physical and cognitive function of the super-aged, and to determine the effectiveness of the program provided by the public sector and provide basic data for individual health prevention and management.BR The subjects of this study were 13 elderly women who use welfare centers in D city, and their physical strength and cognitive function were compared before and after the 24 weeks of local government exercise program. The results of the study are as follows. First, statistically significant results were shown in all variables of basal physical strength (upper extremity, lower extremity muscle strength, agility (dynamic) balance, upper extremity flexibility, lower extremity flexibility, cardiorespiratory endurance) (p.05). Second, there were no statistically significant differences in orientation, comprehension and judgment in cognitive function, but statistically significant results in memory, attention and calculation, and language function (p.05). Through these results, it can be seen that participation in a welfare center exercise program operated by local governments for 24 weeks has a positive effect on basic physical strength and cognitive function.

Adherence and Barriers to Home Exercise Program Participation in Adults With Musculoskeletal Pain

<h3>Research Objectives</h3> Home Exercise Programs (HEPs) are cost-effective and efficacious treatments for musculoskeletal pain conditions. The objective of this study was to examine adherence and barriers to clinician-prescribed HEPs in adult patients with musculoskeletal pain. <h3>Design</h3> Retrospective cohort study. <h3>Setting</h3> Suburban, academic medical center outpatient facility. <h3>Participants</h3> A total of 203 patients with musculoskeletal pain conditions seen in the pain clinic who were prescribed physical therapy and HEP from 2019-2020 were included in this analysis. <h3>Interventions</h3> Not applicable. <h3>Main Outcome Measures</h3> Demographic and clinical information, including the targeted body part(s) addressed in PT and HEP were collected from electronic medical records. Patients were asked if enough instructions and/or handouts were given for their HEP, how frequently they adhered to HEP, and their reasons for non-adherence. <h3>Results</h3> Patients had a mean age of 54.1 ± 15.8 years with a range of 17-84 and included 133 (65.5%) females, and 101 (40.8%) patients receiving a HEP for more than one body part. Of 203 patients, 99 (48.8%) adhered to HEP programs, 56 (27.6%) partially adhered, and 48 (23.6%) did not adhere. 187 (92.1%) patients reported receiving enough HEP instructions, and 175 (86.2%) reported receiving handouts. Chi-square and t-test analyses revealed "age" (t, p=0.019) and "sufficient instructions" (p=0.012) as significant determinants of adherence, while gender and handouts were not. The presence of pain in more than one body part was significantly associated with motivational barriers for non-adherence (p< 0.001). Fear/confidence barriers to HEP adherence were significantly associated with gender (p=0.0119), with males showing a higher frequency of fear/confidence. <h3>Conclusions</h3> Age as well as patients' perception of sufficiently provided instructions were significant determinants of non-adherence. Pain in more than one body part was associated with a motivational barrier to HEP adherence, while male gender was associated with a confidence barrier. These results emphasize the importance of therapist-provided instructions to overcome physical, motivational, and confidence-based barriers. <h3>Author(s) Disclosures</h3> The authors have no conflicts of interest to declare.