Safety Of Exercise In Patients Research Articles

Moderate intensity exercise in pregnant patients with cardiovascular disease: A pilot study

Exercise in pregnancy has proven health benefits, yet the safety of exercise in patients with pre-existing cardiovascular disease (CVD) has not been established. Our aim was to determine the feasibility and safety profile of moderate intensity exercise during pregnancy in patients with CVD, compared with those without CVD. This is a prospective single center pilot study of a moderate intensity exercise regimen, with data collection through wearable fitness trackers and personal exercise logs in pregnant patients with and without pre-existing CVD. The primary outcome was Doppler umbilical artery systolic to diastolic (S/D) ratio measured between 32 and 34 weeks' gestation. The secondary outcomes were adverse maternal and fetal events, trends in wearable fitness tracker data, C-reactive protein levels, and weight changes. At baseline, the CVD group (62% congenital heart disease) took part in more prepregnancy walking, less weightlifting, and had a higher body mass index compared to the control group, and on average walked 539 fewer steps per day during pregnancy than the control group. Resting heart rate (HR) was found to increase in both groups up to 30 weeks' gestation. The cardiovascular disease group displayed an overall lower exercise intensity, as measured by the ability to increase HR with exercise over resting heart rate 1 hour prior to exercise at study baseline (45% vs 59% P < .001). Umbilical artery S/D ratio was normal in both groups. No differences were seen in adverse events between groups. This pilot study of moderate intensity exercise in pregnant individuals with pre-existing CVD demonstrated that patients with CVD were not able to increase their HR during exercise throughout pregnancy compared to those in the control group. Although a small study group, this data supports the hypothesis that exercise interventions during pregnancy for patients with CVD are feasible without evidence abnormal fetal Doppler profiles. Further studies using wearable fitness trackers may provide the opportunity to understand how to safely tailor exercise programs to pregnant individuals with CVD.

Mechanisms of Action and Safety of Exercise in Patients with Epilepsy (Review)

Juvenile myoclonic epilepsy (JME) is a common form of genetic generalized epilepsy. The patients’ intellect and physical development are not affected. However, epilepsy is characterized by a high level of social stigmatization. This is the reason for unjustified restrictions and low physical activity of patients. The review examines the mechanisms of action of exercise on the brain in epilepsy, including the benefits of exercise for preventing seizures. Physical activity in epilepsy provides mechanisms for protecting neurons associated with biochemical and structural changes, including the release of β-endorphins and neurosteroids, which can have an inhibitory effecton the occurrence of abnormal (paroxysmal) electrical activity in the brain. Epileptiform activity on the electroencephalogram may decrease or disappear during exercise, which may reduce the risk of recurrent epileptic seizures. Although exercise can cause epileptic seizures in some patients, the risk is less than 2–10% or lower in JME. Rehabilitation programs that promote exercise in adolescents andyoung patients with epilepsy should aim to improve their physical, psychological, and social well-being.

Effects of Exercise in Patients With Amyotrophic Lateral Sclerosis: A Systematic Review and Meta-Analysis.

The aim of this study was to systematically review the efficacy and safety of exercise in patients with amyotrophic lateral sclerosis (ALS). Randomized controlled trials of exercises for ALS were searched in PubMed, EMBASE, Web of Science, Cochrane Library, China Biology Medicine database, China National Knowledge Internet, VIP database, and Wanfang database. The primary outcomes were functional ability, pulmonary function, and quality of life. The secondary outcomes were muscle strength, fatigue and adverse events. Meta-analysis was performed using the RevMan Version 5.3 software. Seven randomized controlled trials including 322 patients with ALS met the inclusion criteria. Meta-analysis showed that the functional scores at long-term (standardized means difference, 0.47; 95% confidence interval, 0.08-0.86; P = 0.02) and forced vital capacity percentage predicted (mean difference, 1.71; 95% confidence interval, 0.10-3.31; P = 0.04) of patients with ALS in the exercise group were significantly higher than those in the group of no exercise or usual care. No significant difference was observed in muscle strength and quality of life. Endurance or aerobic exercise improved the functional scores of patients with ALS (standardized means difference, 0.36; 95% confidence interval, 0.04-0.68; P = 0.03). Exercise did not aggravate fatigue or result in adverse event. Exercise can significantly improve the functional ability and pulmonary function of patients with ALS safely.

The efficacy and safety of exercise in metastatic solid cancer: A meta-analysis of randomized control trials.

e23107 Background: The prevalence of people living with metastatic solid cancers is increasing. Such patients can experience cancer-related fatigue, decreased physical function (PF), and poor quality of life (QoL). Exercise has been shown to improve these symptoms in the curative setting, but there is uncertainty about the efficacy and safety of exercise in patients with metastatic cancer. Methods: Studies were identified from 3 prior systematic reviews and updated using a search of PubMed. Included studies were prospective randomized controlled trials of any moderate/high intensity aerobic exercise or resistance training intervention versus control in patients with metastatic solid cancers. The mean score and standard deviation (SD) for validated outcome measures (QoL, PF, and fatigue) were extracted for intervention and control groups at baseline and post-intervention. The effect of exercise was evaluated as the pooled change between baseline and post-intervention comparing exercise and control groups. Analysis was performed using the Mann Whitney test. Results: Of 21 trials which met inclusion criteria, 7 were excluded due to incomplete data. Among patients with mean baseline scores, exercise was not associated with significant change in fatigue, PF or QoL, although improvement was noted in 6-minute walk test (6-MWT) (14.7 vs 27.4 meters). QoL scores showed non-significant improvement (0.4 vs 4.9). In those with baseline scores 2SD below mean, exercise provided clinically meaningful improvement in PF using two different subscales (0.44 vs 8.5 and -1.0 vs 5.1) and avoidance of decline in 6-MWT (-29.75 vs -0.38m), although these did not meet statistical significance. There was a statistical improvement in sit-to-stand at the mean and 2 SD below the mean (2.5 vs 6.5, p = 0.029) for both groups. Only 5 papers reported adverse events in a standardized fashion in both groups. No differences in falls, fractures, or pain were reported. Conclusions: In patients with metastatic solid cancers, exercise interventions are associated with clinically meaningful improvements in PF, and statistically improved sit-to-stand scores. The effects are seen in patients with baseline score at the mean or lower.

High-sensitive troponin I measured by a single-molecule counting method to monitor safety of aerobic exercise in patients with cardiac ischemic disease

High-sensitive troponin I measured by a single-molecule counting method to monitor safety of aerobic exercise in patients with cardiac ischemic disease

Effects of Exercise Training on Delaying Disease Progression in Patients with Chronic Kidney Disease: a Review of the Literature.

Chronic Kidney Disease (CKD) is an important public health problem throughout the world. The effects of exercise training are unclear in patients with CKD. This review aimed to evaluate the effects of exercise training to delay the progression of CKD and which training style is most effective. We developed individualized search strategies for the National Library of Medicine including the PubMed MeSH database to June 2015. We searched articles related to exercise training and kidney disease using the terms "CKD", "renal disease", "renal insufficiency", "renal failure", "end-stage renal disease (ESRD)" and "physical therapy". We searched only for reports in English and for full free papers. We also chose papers based on the references in the papers obtained by the search. Our search identified 6 different trials including 131 participants. Our review of these 6 studies suggests that aerobic exercise training may improve exercise capacity, and resistance training may also improve muscle function in patients with CKD. No cardiac events were reported in any of the published exercise training studies reviewed, suggesting the safety of exercise in patients with CKD.

Therapy of myositis: biological and physical.

To give an update on reported use and effects of biological and physical therapies in patients with myositis. The most promising biological treatment in polymyositis, dermatomyositis and juvenile dermatomyositis is B-cell blockade by rituximab. Anti-Jo or anti-Mi-2 antibodies were predictors of response suggesting different molecular pathways in different subsets of myositis. T-cell blockade with abatacept is a new possibility, as is blockade of interleukin-1, interleukin-6 or type I interferon, but controlled studies are needed. Metabolic abnormalities may contribute to muscle impairment, lending support to combine pharmacological therapy with exercise in patients with polymyositis and dermatomyositis. Exercise improved the aerobic milieu in the muscle, along with improved aerobic capacity, and reduced disability. Support is also provided for the safety of exercise in patients with recent-onset polymyositis and dermatomyositis and exercise is well tolerated in patients with juvenile dermatomyositis. There is a strong need to develop new therapies in patients with myositis. To achieve this, more knowledge is needed on the molecular pathogenesis. Targeted therapies using biologics or exercise can be employed to achieve an improved understanding of molecular pathways, provided that clinical outcome measures are combined with molecular studies on muscle and blood.

Pre-exercise screening and prescription guidelines for cancer patients

Over the past decade, research and clinical interest in the therapeutic effectiveness of exercise after cancer diagnosis has greatly increased.1 Positive findings from the first generation of exercise oncology studies, and growing patient demand led the American College of Sports Medicine (ACSM) to assemble an expert panel to formulate exercise guidelines for patients with cancer.2 This comment presents a practical approach to screening and prescribing exercise for patients with cancer. Systematic reviews indicate that exercise is a safe, well-tolerated intervention for patients with curative disease, both during and after adjuvant therapy.3 However, patients with cancer are often older, have a range of comorbid diseases, and receive a diverse range of locoregional and systemic cytotoxic therapies that could increase the risk of exercise-related complications, particularly in sedentary individuals. By incorporating formalised pre-exercise screening into standard practice, oncologists can provide safe and more accurate exercise guidance for patients. A careful history and physical examination of cardiac, pulmonary, neurological, and musculoskeletal signs and symptoms can be used to assess the safety of exercise in patients, or the need for further evaluation. Procedures such as the Physical Activity Readiness Questionnaire or PARmed-X can facilitate the screening process. Patients at moderate or high-risk and those with a positive initial screen should be referred for a symptom-limited exercise stress testing with electrocardiograph diagnostics. ACSM guidelines recommend that patients with cancer should participate in at least 150 min of moderate exercise (eg, brisk walking, light swimming) or 75 min per week of vigorous exercise (eg, jogging, running, hard swimming).2 However, this recommendation is a long-term goal and is not advised as an initial prescription for most sedentary patients either during or immediately after cytotoxic therapy. The key to safe and effective exercise prescriptions is individualisation of the programme to patients’ needs. Providing cancer patients with individually tailored exercise prescriptions is challenging given the considerable variation in pathophysiology, therapeutic management, and prognosis between malignancies and individual patients. Nevertheless, individualised prescriptions can be provided in most scenarios if the fundamental principles of exercise prescription are followed: frequency (sessions per week), intensity (how hard per session), time (session duration), and type (exercise modality)—or the F.I.T.T principle. For individualised exercise prescriptions (figure), the first question should focus on present exercise behaviour. Patients who meet the ACSM guidelines can maintain present behaviour, but 150 min of moderate or 75 min of vigorous exercise per week should be the minimal amount of exercise needed to gain health benefits. Increases in exercise beyond these minimal amounts can lead to further health benefits. Such benefits can be achieved by varying the intensity, frequency, duration, and type of exercise every 2–3 weeks to reduce boredom and ensure continuous improvements in cardiorespiratory fitness. For sedentary patients or those who do not meet the ACSM guidelines, the figure presents a progressive exercise prescription that can be discussed in routine clinical visits. Whether one type of exercise is more effective than another at improving exercise tolerance or symptoms in patients with cancer is not known. Walking is often the preferred choice for most patients, although stationary cycling might be more appropriate for older patients and those who have gait or coordination difficulties. Prescription of the appropriate intensity of exercise is challenging. Intensity of exercise can be explained practically to patients with the talk-test whereby moderate exercise is activity during which one can comfortably hold a conversation, and vigorous exercise is defined as activity that precludes comfortable conversation. More accurate methods are available that use ratings for perceived exertion or heart-rate training zones. Such training zones can be calculated with either age-sex-predicted equations or, preferably, heart-rate responses obtained from the exercise stress test. The addition of resistance training to comprehensive exercise prescription is crucial to increase muscle mass and prevent deterioration in all patients with cancer. The decision of when to include resistance training in the exercise prescription depends on the patient’s needs. In patients with cancer or treatment-related cachexia, or in those whose aerobic exercise is contraindicated, resistance training should be the central focus. In other scenarios, however, it might be more appropriate to start resistance training once aerobic training is part of a patient’s habitual activity. Figure A general approach to individualised exercise prescriptions4 In summary, findings indicate that sedentary behaviour and decreased exercise levels are associated with de-conditioning, poor symptom control, and possibly a poor clinical outcome after cancer diagnosis. Exercise tolerance and several patient-reported outcomes can be improved with structured exercise training across a range of oncological settings. Oncology professionals have a considerable influence on the levels of patient exercise5 and we emphasise the importance of exercise counselling with frequent follow-up whenever appropriate. The ASCM exercise guidelines represent a major benchmark in exercise-oncology research and oncology management. The steps that we describe can help oncology professionals to integrate exercise therapy into their practice. Advancements in the field will continue to modify and refine these guidelines to ensure optimum safety and efficiency of exercise for patients with cancer.

A Randomized Phase II Trial of Preoperative Exercise to Reduce Operative Risk in Gastric Cancer Patients with Metabolic Syndrome: Adjuvant Exercise for General Elective Surgery (AEGES) Study Group

This study is conducted to evaluate the efficacy and safety of preoperative exercise in patients with T1N0/T1N1/T2N0 gastric cancer and metabolic syndrome, which has emerged as a global health care issue. The primary endpoint is an incidence of perioperative complications and the secondary endpoints are weight change, change in high density lipoprotein cholesterol, operation time, intraoperative blood loss, number of dissected lymph nodes. The sample size is 86 (43 for surgery alone and 43 for exercise group) to select promising treatment for Phase III trial in a randomized Phase II setting.

Safety of exercise in patients with rheumatoid arthritis

Patients with rheumatoid arthritis benefit from long-term moderate or high-intensity exercises. Moderate or high-intensity exercises were found to improve aerobic capacity, muscle strength, functional ability, and psychological well-being, and slow the age-related and sex-related decrease in bone mineral density of the hip. Despite these positive findings, there is also concern about its risks. Studies on the effects of exercise on disease activity and joint damage are reviewed. Studies on the effects of moderate or high-intensity exercise in rheumatoid arthritis demonstrate either decreased or stable disease activity. From the few available studies that address exercise and radiologic progression of the small joints, results indicate that exercises are safe for the joints of hands and feet. However, a recent study suggests caution in prescribing long-term high-intensity weight-bearing exercises to patients who have significant radiologic damage of large joints, as some patients might develop additional damage. Moderate or high-intensity weight-bearing exercises are safe with respect to disease activity and radiologic damage of the hands and feet. In the absence of sufficient data on exercise and radiologic progression of the large joints, patients with significant radiologic damage of the large joints should not be encouraged to participate in moderate to high-intensity weight-bearing exercise unless individualized to protect affected joints. A broader dissemination of the effectiveness and safety of moderate and high-intensity exercise for patients with rheumatoid arthritis is needed among rheumatologists, physical therapists, and patients.

Current concepts in cardiac rehabilitation

This article has presented the historical basis for cardiac rehabilitation and the available data related to the four most important questions that remain: (1) Does exercise increase survival after myocardial infarction? Although it is generally thought that clinical trials have failed to demonstrate that cardiac rehabilitation prolongs life after a myocardial infarction, analysis of pooled data from all published studies shows that this conclusion is unjustified. (2) Can each individual patient's risk for a future cardiac event be determined? We have developed a method using serial application of Bayes' theorem to determine each patient's risk. By so doing, we can stratify patient groups by previous risk and then assess the effect of cardiac rehabilitation on altering risk without limiting the analysis to subsequent myocardial infarction and cardiac death. (3) Can regression of atherosclerosis be demonstrated? Regression of atherosclerosis has been clearly demonstrated in animal models, but new evidence suggests that it can also occur in human subjects. (4) Do all patients require monitored exercise after a myocardial infarction? Evidence documenting the safety of exercise in patients recovering from a myocardial infarction has resulted in inclusion of sick patients in cardiac rehabilitation programs and exercise of the healthier patients in unmonitored settings. Major changes in cardiac rehabilitation programs are now taking place, with the emphasis moving away from prolongation of life toward improvement in the quality of life. As a result, cardiac rehabilitation is no longer confined to exercise alone; equal emphasis is placed on dietary and psychologic aspects of patient recovery.