Physical Activity Program For Patients Research Articles

An Activity Tracker-Guided Physical Activity Program for Patients Undergoing Radiotherapy: Protocol for a Prospective Phase III Trial (OnkoFit I and II Trials).

BackgroundThe positive impact that physical activity has on patients with cancer has been shown in several studies over recent years. However, supervised physical activity programs have several limitations, including costs and availability. Therefore, our study proposes a novel approach for the implementation of a patient-executed, activity tracker–guided exercise program to bridge this gap.ObjectiveOur trial aims to investigate the impact that an activity tracker–guided, patient-executed exercise program for patients undergoing radiotherapy has on cancer-related fatigue, health-related quality of life, and preoperative health status.MethodsPatients receiving postoperative radiotherapy for breast cancer (OnkoFit I trial) or neoadjuvant, definitive, or postoperative treatment for other types of solid tumors (OnkoFit II trial) will be randomized (1:1:1) into 3-arm studies. Target accrual is 201 patients in each trial (50 patients per year). After providing informed consent, patients will be randomized into a standard care arm (arm A) or 1 of 2 interventional arms (arms B and C). Patients in arms B and C will wear an activity tracker and record their daily step count in a diary. Patients in arm C will receive personalized weekly targets for their physical activity. No further instructions will be given to patients in arm B. The target daily step goals for patients in arm C will be adjusted weekly and will be increased by 10% of the average daily step count of the past week until they reach a maximum of 6000 steps per day. Patients in arm A will not be provided with an activity tracker. The primary end point of the OnkoFit I trial is cancer-related fatigue at 3 months after the completion of radiotherapy. This will be measured by the Functional Assessment of Chronic Illness Therapy-Fatigue questionnaire. For the OnkoFit II trial, the primary end point is the overall quality of life, which will be assessed with the Functional Assessment of Cancer Therapy-General sum score at 6 months after treatment to allow for recovery after possible surgery. In parallel, blood samples from before, during, and after treatment will be collected in order to assess inflammatory markers.ResultsRecruitment for both trials started on August 1, 2020, and to date, 49 and 12 patients have been included in the OnkoFit I and OnkoFit II trials, respectively. Both trials were approved by the institutional review board prior to their initiation.ConclusionsThe OnkoFit trials test an innovative, personalized approach for the implementation of an activity tracker–guided training program for patients with cancer during radiotherapy. The program requires only a limited amount of resources.Trial RegistrationClinicalTrials.gov NCT04506476; https://clinicaltrials.gov/ct2/show/NCT04506476. ClinicalTrials.gov NCT04517019; https://clinicaltrials.gov/ct2/show/NCT04517019.International Registered Report Identifier (IRRID)DERR1-10.2196/28524

Benefits of Ehl Factor VIII Replacement Therapy in Hemophilia: Observations on Coverage, Physical Activity and Phisiotherapy

Introduction: Prevention of haemophilic arthropathy and quality of life´s (QoL) improvement are still the main goals in the haemophilia community. Haemophilic arthropathy is the result of clinical and subclinical bleeding during everyday activities and/or traumatic situations. Prophylaxis with extended half-life (EHL) factor replacement therapy is understood as an improvement solution for factor VIII (FVIII) PK properties, as half-life (T1/2) and area under the curve (AUC), however few real world data are yet available. EHL improved pharmacokinetic (PK) properties might directly drive into a reduction of the bleeding risk during physical activity (both therapeutical or leisure) for a longer period of time, allowing an increase in QoL. World Health Organization (WHO) has set recommendations focused on the benefits of moderate and intense physical activity to improve joint health as well as to prevent common pathologies (obesity, diabetes, hypertension, cancer, depression, anxiety) and even the risk of death (since the absence of physical activity is the 4th factor risk worldwide). The aim of this study was to define a safe program of physical activity, sport and physiotherapy along the time according the PK profile of patients treated with the EHL rurioctocog alfa pegol. Materials and methods: PK parameters (infusion frequency, dosage, T½, peak level, trough level at 24, 48 and 72 hours (NV24/NV48 and NV72), and time to reach 5%, 2% and 1% FVIII levels (T5,T2 and T1) were analyzed in patients with hemophilia A after switching from an standard half-life (SHL) FVIII to the EHL (rurioctocg alfa pegol) FVIII replacement therapy. Tailored physical activity and physiotherapy programmes in place during SHL treatment were re-evaluated after switching to the EHL according the new individual PK profile. The Functional Independence Score in Hemophilia (FISH) form was used to measure ambulation. Results: Ten patients with hemophilia A (9 severe and 1 moderate) with a mean age of 34.49 (9.46) were analyzed. All the PK parameters evaluated showed a significant statistical improvement after the switch from an SHL to this FVIII EHL (Figure 1, A.). Specifically, higher T½, peak levels and trough levels were achieved using a lower dosage and infusion frequency (Figure 1, B). After switching to the EHL, FVIII trough levels were higher than 5% until 3.4 days (81.5 hours) (Figure 1, C) post-infusion. This allowed us to establish a physiotherapy program as well as an intense-moderate physical activity program in patients without clinical evidence of bleeding events (Figure 1, D). The potentiation physical program to develop muscle tone for elbows, knees and ankles was authorized until the third day of EHL FVIII post-infusion. However, during SHL treatment, vigorous physical activity was never performed after 24 hours of FVIII post-infusion. No joint bleeding events appeared during everyday physical activities nor during physiotherapy programs aimed to maintain joint trajectory and muscle power. Regarding ambulation (FISH), all patients had hemophilic arthropathy in one joint. The results in the item "Run" were: 3 points for 3 patients (activity non comparable to normal activity), 2 points for 3 patients (requires an orthesis) and 1 point for 4 patients (activity not feasible). Conclusions: EHL FVIII replacement with rurioctocog alfa pegol improved significantly all PK parameters compared to SHL factors. The administration of this EHL allows moderate and vigorous physical activity after more than 72 hours post-infusion, due to higher FVIII coverage along the time. Disclosures Querol: Baxalta US INC.: Research Funding. Pérez-Alenda:Baxalta US INC.: Research Funding. Megias:Baxalta US INC.: Research Funding; Grifols: Research Funding. Carrasco:Baxalta US INC.: Research Funding. Cid:Novo Nordisk: Honoraria; Shire, a Takeda company: Honoraria. Bonanad Boix:Baxalta US INC.: Research Funding.

Programme d’activité physique et troubles graves de santé mentale : étude de cas d’une équipe communautaire de traitement intensif (ÉCTI)

Context: As a therapeutic intervention, physical activity has the potential to improve the quality of life of individuals with severe mental illnesses.Objectives: The goal of this case study was to conduct an in-depth examination of an individualized physical activity program for patients suffering from severe mental illnesses that was implemented by an Assertive Community Treatment (ACT) team in Ottawa, Canada.Method: Using a mixed-methods design, physical health parameters were measured over a nine-month period and semi-structured interviews were conducted with fourteen patients and five staff members.Results: The findings showed a significant reduction in weight following the evaluation period, as well as positive effects in terms of patients' self-esteem, autonomy, and socialization. The quality of the therapeutic relationship, the elimination of barriers, and the continued involvement of staff members were some of the key characteristics that led to the program's success.Discussion/conclusion: These promising results are an indication of the feasibility of this type of intervention among patients with severe mental illnesses as a therapeutic approach to improve their quality of life and support their recovery and social integration.

Effect of exercise training on heart rate variability in patients with obstructive sleep apnea: A randomized controlled trial.

While obstructive sleep apnea (OSA) increases chemoreflex, leading to an autonomic dysfunction in the long term, no studies have yet assessed the potential benefit of exercise on cardiac autonomic activity in these patients. The aim of this study was to evaluate potential improvement in cardiac autonomic function (CAF) measured through heart rate variability (HRV) after a 9-month physical activity program in patients with OSA. Seventy-four patients with moderate OSA, aged 40-80years, were randomly assigned to an exercise group (n=36, 3×1h/wk) or a control group (n=38) during 9months. Linear and nonlinear HRV parameters were measured during night using a Holter ECG. After 9months, mean R-R intervals increased in the exercise group without any changes in HRV parameters, while controls decreased global (standard deviation of normal-to-normal intervals, total power) and parasympathetic (root mean square successive difference of N-Ns, very low frequency, high frequency, and standard deviation of the instantaneous beat-to-beat variability) indices of HRV (P<0.05 for all). Significant correlations with moderate effect size were found between changes in apnea severity and changes in R-R intervals (P<0.05). Improvement in moderate-to-vigorous physical activity was also correlated to improvement in nocturnal oxygen parameters (P<0.05). In conclusion, supervised community physical activity may prevent a decline in nighttime CAF observed in nontreated community-dwelling patients with moderate OSA over a 9-month period. Thus, beyond apnea-hypopnea index improvement, exercise may be cardioprotective in OSA patients through bradycardia, CAF preservation, and VO2peak increase.

\u201cAs du Coeur\u201d study: a randomized controlled trial on quality of life impact and cost effectiveness of a physical activity program in patients with cardiovascular disease

BackgroundPhysical activity programs (PAP) in patients with cardiovascular disease require evidence of cost-utility. To assess improvement in health-related quality of life (QoL) and reduction of health care consumption of patients following PAP, a randomized trial was used.MethodsPatients from a health insurance company who had experienced coronary artery disease or moderate heart failure were invited to participate (N = 1891). Positive responders (N = 50) were randomly assigned to a progressively autonomous physical activity (PAPA) program or to a standard supervised physical activity (SPA) program. The SPA group had two supervised sessions per week over 5 months. PAPA group had one session per week and support to aid habit formation (written tips, exercise program, phone call). To measure health-related quality of life EQ-5D utility score were used, before intervention, 6 months (T6) and 1 year later. Health care costs were provided from reimbursement databases.ResultsMobility, usual activities and discomfort improved significantly in both group (T6). One year later, EQ-5D utility score was improved in the PAPA group only. Total health care consumption in the intervention group decreased, from a mean of 4097 euros per year before intervention to 2877 euros per year after (p = 0.05), compared to a health care consumption of 4087 euros and 4180 euros per year, in the total population of patients (N = 1891) from the health insurance company. The incremental cost effectiveness ratio was 10,928 euros per QALYs.ConclusionA physical activity program is cost-effective in providing a better quality of life and reducing health care consumption in cardiovascular patients.Trial registrationISRCTN77313697, retrospectively registered on 20 November 2015.

Physical activity program in patients with metastatic colorectal cancer who receive palliative first-line chemotherapy: A randomized controlled phase III trial—(ACTIVE-2 SAKK 41/14).

TPS3621Background: Exercise has become a main focus of basic and clinical research worldwide during the current pandemic of physical inactivity. A clear link between inactivity and cancer incidence...

The effect of a physical activity program on chronic psychiatric patients' positive and negative symptoms and depression levels: A randomized controlled trial

Physical activity is widely recognized as an important behavioral means of risk prevention and illness management, or alternatively, recovery and the realization of well-being. Mental health nurses have a holistic approach to the health care of those with mental illness and physical activity is an important component of holistic care. This research was undertaken in order to analyze the effect a physical activity program has on positive and negative symptoms of patients with schizophrenia and their depression levels. This is a randomly controlled experimental study designed with a pre-test and post-test. The Scale for the Assessment of Positive Symptoms, the Scale for the Assessment of Negative Symptoms and the Calgary Depression Scale for Schizophrenia were used in this research. The study was carried out with 60 patients, 30 in the experimental and 30 in the control group. The Mann-Whitney U and Wilcoxon tests were used, and the Cronbach's alpha coefficient was calculated. It was found that there was a significant difference between the mean scores on the Scale for the Assessment of Positive Symptoms and the Scale for the Assessment of Negative Symptoms (p<0.05.) According to this study's findings, the physical activity program for patients with schizophrenic had a statistically significant positive effect on their positive and negative symptoms and depression levels. As a results; 1) this randomized-controlled trial investigated the effect of physical activity program on positive and negative symptoms depression levels among of patients with schizophrenia, 2) results of this study on 60 patients with schizophrenia showed that an 12-week group physical activity program was significantly effective in patients with schizophrenia’ positive and negative symptoms depression, 3) physical activity should be routinely included in plans of psychiatric nursing care.

Educational Level Is Related to Physical Fitness in Patients with Type 2 Diabetes - A Cross-Sectional Study.

IntroductionLow educational level (EL) and low physical fitness are both predictors of increased morbidity and mortality in patients with type 2 diabetes. It is unknown if EL is related to physical fitness. This would have important implication for the treatment approach of patients of low EL.Materials and MethodsIn 2011/12, we invited participants of a new nationwide Swiss physical activity program for patients with type 2 diabetes to participate in this study. EL was defined by self-report and categorized as low (mandatory education), middle (professional education) or high (high school/university). Physical fitness was determined using 5 validated measures that assessed aerobic fitness, functional lower limb muscle strength, walking speed, balance and flexibility. Potential confounder variables such as other socio-cultural factors, physical activity level, body composition, diabetes-related parameters and complications/co-morbidities as well as well-being were assessed.ResultsAll invited 185 participants (mean age 59.6 ±9.8 yrs, 76 women) agreed to be included. Of all patients, 23.1% had a low, 32.7% a middle and 44.2% a high EL; 41.8% were professionally active. The study population had a mean BMI of 32.4±5.2 kg/m2 and an HbA1c of 7.3±1.3%. The mean diabetes duration was 8.8±7.4 years. In the baseline assessment, higher EL was associated with increased aerobic fitness, increased functional lower limb muscle strength, and increased walking speed using linear regression analysis (values for low, middle and high EL, respectively: 91.8 ± 27.9, 116.4 ± 49.7 and 134.9 ± 60.4 watts for aerobic fitness (p = 0.002), 15 ± 4.7, 13.9 ± 2.7, 12.6 ± 2.9 seconds for strength (p = 0.001) and 8.8 ± 1.6, 8.3 ± 1.4, 7.8 ± 1.4 seconds for walking speed (p = 0.004)). These associations were independent of potential confounders. Overall, aerobic fitness was 46%, functional limb muscle strength 16%, and walking speed 11% higher in patients of high compared to those of low EL. EL was not related to balance or flexibility.DiscussionA main strength of the present study is that it addresses a population of importance and a factor (EL) whose understanding can influence future interventions. A second strength is its relatively large sample size of a high-risk population. Third, unlike studies that have shown an association between self-reported fitness and educational level we assessed physical fitness measures by a quantitative and validated test battery using assessors blinded to other data. Another novelty is the extensive evaluation of the role of many relevant confounder variables.ConclusionsIn conclusion, we show that in patients with type 2 diabetes EL correlates favorably and independently with important health-related physical fitness measures such as aerobic fitness, walking speed, and lower limb strength. Our findings underline that diabetic patients with low EL should be specifically encouraged to participate in physical activity intervention programs to further reduce social disparities in healthcare. Such programs should be structured and integrate the norms, needs and capacities (financial, time, physical capacities and self-efficacy) of this population, and their effectiveness should be tested in future studies.Trial RegistrationUniversity of Lausanne clinicaltrials.gov NCT01289587

The importance of a physical activity program for patients with multiple sclerosis on life satisfaction and psychological well-being

The importance of a physical activity program for patients with multiple sclerosis on life satisfaction and psychological well-being

Reduction of health risk factors through an adapted physical activity program in patients with breast cancer

Reduction of health risk factors through an adapted physical activity program in patients with breast cancer

Physical activity program for patients with dementia and their relative caregivers: randomized clinical trial in Primary Health Care (AFISDEMyF study).

BackgroundThe aging of the population has led to the increase of chronic diseases, especially dementia and cardiovascular diseases, and it has become necessary for their relatives to dedicate more time in caregiving.The objective in the first phase of this study is to evaluate the effectiveness of a Primary Health Care procedure to increase the physical activity of people with dementia and their relative caregivers. Also the effect on the cognitive state and cardiovascular risk will be assessed.Methods/DesignDesign: Clinical, multicentric and randomized trial. A simple random sampling to select 134 patients diagnosed with dementia will be carried out. After contacting their relatives, his/her participation in the trial will be requested. A basal assessment will be made and the participants will be asigned to control or intervention group (1:1). Variables: The main measure will be the assessment of physical activity (podometer and 7-PAR) in patients and caregivers. In patients with dementia: ADAS-cog, functional degree and cardiovascular risk. In caregivers: cardiovascular risk, general health and quality of life. Intervention: For 3 months, participants will receive instructions to do physical activity with an adapted program. This program will be designed and applied by Primary Health Care professionals in patients with dementia and their caregivers. The control group will receive regular care. Analysis: An intention-to-treat analysis will be carried out by comparing the observed differences between basal, 6 and 12 months measures. Change in the mean of daily steps assessed with the podometer and 7-PAR will be the main result.DiscussionIf the main hypothesis is confirmed, it could be useful to improve the cognitive state of patients with dementia, as well as the cardiovascular risk of all of them. The results can be good to improve technical features of the devices that register the physical activity in the patients with dementia, and it could facilitate its commercialization.Trial registrationClinical Trials.gov Identifier: NCT02044887.

Reduction of health risk factors through an adapted physical activity program in patients with breast cancer

After a breast cancer diagnosis, patients are at high risk of reducing their physical activity and gaining weight. Lack of physical activity and weight gain are known negative but modifiable prognostic factors. An observational study of a 3-month adapted physical activity (APA) program was performed to assess its effectiveness in improving physical activity level and reducing risk factors related to health during or after breast cancer treatments. Height, weight, and waist circumference (WC) were measured at the beginning and end of the 26-session program. Body mass index (BMI) and WC to height ratio (WHtR) were calculated. Physical activity profile, aerobic capacity, and usual average daily energy expenditure were estimated. Median values were compared using nonparametric tests. Sixty-one (61) voluntary breast cancer patients attended 80% of the sessions. At baseline, median (minimum-maximum) BMI was 23.3 (16.1-36.8) kg.m(-2) and WC and WHtR showed metabolic risks. After 3 months, anthropometric data remained stable. Moderate physical activity significantly improved (+13 min/day) and sedentary tended to decrease (-18 min/day). A 3-month APA program allows patients to limit risk factors related to health such as physical inactivity and metabolic risks. This study reinforces the need to promote physical activity as early as possible in cancer patients' care.

The design and feasability of a web-based physical activity program for patients with osteoarthritis of hip or knee

Background: A large proportion of patients with osteoarthritis (OA) do not meet the recommended levels of physical activity (PA). Although inactivity may enhance in short-term pain reduction, prolonged inactivity may augment functional decline. Therefore, we developed a web-based intervention that provides a highly individualized behaviourally based physical activity program for patients with hip and/or knee OA. Objective: The aim of this study is to describe the systematic development process, a pilot study and the usability of a 9-week web-based intervention on PA behaviour change in individuals with hip and/or knee OA. Methods: An iterative design approach was used to develop, test and enhance various prototypes. End-users (i.e. patients with knee and/hip OA) were involved continuously throughout the development process. The intervention incorporates core principles of the behaviour graded activity theory. A pilot study prototype was tested through a non-randomized pilot study among 20 patients with hip and/or knee OA. PA levels, pain scores and physical function were measured through online questionnaires (week 0, 6 and 12). Subsequently, two usability methods (heuristic evaluation and a thinking aloud approach) were applied to determine the usability of the intervention. Results: After several iterations of testing and revising, we developed the final version, entitled as Artrose In Beweging (AIB). The program includes an introduction module (module 1) and 8 text based week assignments (module 2). OA patients, between 50 and 80 years of age, participated in the pilot study and received the intervention. After 12 weeks, there was a non-significant increase in PA (1697 to 2044 minutes per week). After six weeks, pain scores increased from 5.3 to 6.6 (p=0.04). After 12 weeks, however, this significant increase disappeared. Considering physical function, a non-significant small increase was observed. Although participants were enthusiastic about the web-based intervention, users perceived difficulties to login and completing the entire introduction module. Furthermore, users rated the rigid character of the intervention, i.e. the inability edit and undo executed actions, as annoying. Based on 16 the interviews after the pilot study, we adjusted the functions into a more flexible format. Conclusion: This paper outlines the preliminary effectiveness, development and usability of a web-based PA intervention. The results suggest that the intervention is feasible in promotion of PA among patients with hip and/or knee OA. The intervention was easy to use and the satisfaction with the program was high. Preliminary results from the pilot study revealed that PA scores increased, although differences were not statistical significant. Pain scores increased significantly after six week and decreased to baseline values after twelve weeks. Findings require validation in other studies. Therefore, the intervention will be further tested in a one year randomized controlled trial. (aut. ref.)

Protocol for the "four steps to control your fatigue (4-STEPS)" randomised controlled trial: a self-regulation based physical activity intervention for patients with unexplained chronic fatigue.

BackgroundUnexplained Chronic Fatigue is a medical condition characterized by the presence of persistent, severe and debilitating medically unexplained fatigue, leading to impaired functioning and lower quality of life. Research suggests that physical activity can contribute to the reduction of fatigue and other somatic symptoms and can thus significantly improve physical functioning and quality of life in these patients. Based on the self-regulation (SR) theory of behaviour change, we developed a brief physical activity program for patients suffering from unexplained chronic fatigue which focuses on the training of self-regulation skills, the "4-STEPS to control your fatigue" program.Methods/DesignThis is a multi-centre, randomised controlled trial (RCT) that will be carried out in local primary care centres and at the Portuguese Fibromyalgia and Chronic Fatigue Syndrome Patients Association. Patients aged between 18 and 65 and fulfilling operationalized criteria for Idiopathic Chronic Fatigue (ICF) and Chronic Fatigue Syndrome (CFS) will be recruited and randomly allocated to standard care (SC) or standard care plus a self-regulation based physical activity program (4-STEPS). Patients will be assessed at baseline, after the intervention (3 months) and at 12 months follow-up. The primary outcome is fatigue severity.DiscussionThe results of the RCT will provide information about the effectiveness of a brief self-regulation intervention for promoting physical activity in patients with unexplained chronic fatigue. If the program proves to be effective, it may be considered as an adjunctive treatment for these patients.Trial RegistrationISRCTN: ISRCTN70763996