Self-administered Exercise Research Articles

Harnessing the Power of Water: A Scoping Review of Hydrokinesiotherapy as a Game-Changer in Knee Osteoarthritis Management.

Background: Knee osteoarthritis (OA) is a prevalent condition that significantly impairs pain, mobility, and quality of life. Hydrokinesiotherapy, a water-based exercise therapy, is gaining traction as a potential alternative to traditional land-based rehabilitation for managing knee OA symptoms. Methods: This scoping review aimed to evaluate the effectiveness of hydrokinesiotherapy compared to standard land-based physical therapy and self-administered exercise regimens in improving pain, joint mobility, quality of life, and physical function in patients with knee OA. Five randomized controlled trials (RCTs) were included, assessing outcomes using measures such as the WOMAC score, Visual Analog Scale (VAS), and SF-12. The studies were critically appraised using the PEDro scale and the RoB-2 tool to determine the quality and risk of bias. Results: Hydrokinesiotherapy consistently demonstrated superior outcomes in pain reduction, joint mobility, and physical function across all studies. Patients in the hydrokinesiotherapy groups reported significant improvements in pain and mobility, which were strongly associated with enhanced quality of life. The review also highlighted the potential for hydrokinesiotherapy to serve as an effective alternative or complement to land-based exercises, particularly in populations experiencing severe symptoms. Conclusions: Hydrokinesiotherapy is an effective intervention for managing knee OA, offering significant improvements in key clinical outcomes. Given its benefits, hydrokinesiotherapy should be considered a valuable addition to knee OA treatment protocols. However, further research is needed to confirm long-term effects and to explore ways to improve accessibility to this therapeutic option.

Development and feasibility of an exercise therapy intervention for older women with advanced epithelial ovarian cancer referred to neoadjuvant chemotherapy prior to possible interval debulking surgery

ObjectiveThis study describes the development and examines the feasibility of an exercise therapy program for women aged 70 years or older with advanced EOC, receiving neoadjuvant chemotherapy (NACT) before possible major surgery. MethodsIn this feasibility study, patients participated in a mainly home-based exercise therapy program, including progressive resistance training, physical activity, and support from the supervising physiotherapist. The program included both supervised virtual and face-to-face sessions and self-administered daily exercise. Clinician-reported, patient-reported and physical performance measures were collected before and after NACT. Retention, adherence, and compliance to the program was monitored, and patient acceptability was explored in semi-structured interviews. ResultsFifteen patients, median age of 77 years (range 70–85) completed the exercise therapy program concurrently to receiving NACT lasting a median of 12 weeks. Patients were physically frail at baseline but improved at follow-up on measures of performance status, level of frailty, patient-reported physical fitness, lower body strength, aerobic functional capacity, basic mobility, balance, and number of steps per day. High levels of participation were found to both supervised and self-administered exercise. Patient interviews highlighted the homebased setting, the individualised tailoring of exercises and the support from the physiotherapist as reasons to complete the exercise therapy program as prescribed. ConclusionsThe exercise therapy program was found to be feasible and acceptable in women aged 70 years or older with advanced EOC, receiving NACT before possible major surgery. The observed improvements and the positive experiences perceived by the patients support future application in research and clinical practice.

Effectiveness and feasibility of the self-administered and repeated episodic future thinking exercises in smoking cessation.

Delay discounting (DD) is associated with smoking behavior and relapses. Episodic future thinking (EFT) is one of the leading interventions shown to reduce DD. The 1-month follow-up study with 60 participants that employed EFT as active intervention and episodic recent thinking (ERT) as control intervention was conducted in participants receiving smoking cessation treatment. In EFT group, there was significant decrease in DD rates from pre-intervention to post-intervention (p = 0.009), whereas no significant change was observed in ERT group (p = 0.497). DD rates in EFT group did not change significantly over 1 month (p = 0.059), while decrease was detected in ERT group (p = 0.011). Smoking cessation rates between groups were similar (p = 0.486). Adherence with completing follow-up evaluation forms and performing relevant exercises was higher in EFT group (p = 0.038, p = 0.006). Adding EFT to usual smoking cessation treatment did not increase smoking cessation rates, however feasibility of the self-administered exercises needs to be improved to clarify clinical effects.

A Study on the Effects of a Self-Administered Eye Exercise Program on the Balance and Gait Ability of Chronic Stroke Patients: A Randomized Controlled Trial.

This study investigates the effects of a self-administered eye exercise (SEE) program on the balance and gait ability of chronic stroke patients hospitalized due to hemiplegia. This study includes 42 patients diagnosed with stroke-related hemiplegia and hospitalized at D Rehabilitation Hospital. The researcher randomly allocated 42 patients into two groups: the experimental group (EG, n = 21, mean age = 58.14 ± 7.69 years, mean BMI = 22.83 ± 2.19 kg/m2) and the control group (CG, n = 21, mean age = 58.57 ± 6.53 years, mean BMI = 22.81 ± 2.36 kg/m2). The SEE program was applied to the EG and the general self-administered exercise (SE) program was applied to the CG. After 4 weeks of intervention, weight distribution of the affected side, the Timed Up and Go test (TUG), step length of the affected side, step length of the unaffected side, gait speed, and cadence were analyzed and compared. In the within-group comparison, both groups showed significant differences in weight distribution (p < 0.05), TUG (p < 0.05), step length of the affected side (p < 0.05), step length of the unaffected side (p < 0.05), gait speed (p < 0.05), and cadence (p < 0.05). In the between-group comparison, a significant difference in the TUG (p < 0.05) was observed. The SEE program had an overall similar effect to the SE program in improving the balance and gait ability of chronic stroke patients, and had a greater effect on dynamic balance ability. Therefore, the SEE program can be proposed as a self-administered exercise program to improve balance and gait ability in stroke patients who are too weak to perform the SE program in a clinical environment or have a high risk of falling.

#596 The Borg Scale—efficient and safe for exercise prescription in self-administered balance and strength exercise in patients with CKD

Abstract Background and Aims With the continued rise in chronic kidney disease (CKD), there is a critical need for sustainable, home-based exercise interventions. While supervised, centre-based exercise improves physical performance in CKD patients, unsupervised, self-administered exercise poses challenges in ensuring adherence, safety, and efficacy. This study investigates the Borg Rating of Perceived Exertion (RPE) scale, a subjective measure of exertion, as a method for prescribing and monitoring the intensity of balance and strength exercise in non-dialysis dependent CKD patients. The aims of this study were: Method This sub study of the RENEXC-trial included 148 patients with CKD stages 3-5, with a mean age of 66 ± 14 years and mean measured GFR of 22 ± 8 ml/min/1.73 m2. Patients were prescribed 90 minutes/week of balance or strength exercise at a Borg RPE of 13-17 (corresponding to an exercise intensity of somewhat hard to very hard), along with 60 minutes/week of endurance exercise. Exercise programs were individually prescribed by a physiotherapist according to randomization and each patient's baseline performance and were performed at home or in a gym according to the patient's preference. Duration and RPE of the performed exercise were reported in an exercise diary. Progress was monitored by the physiotherapist through phone contact, every week for the first three months of the study and every other week for the rest of the study year. The continuous follow up provided motivation and enabled adjustments of the exercise program to maintain the goal RPE, adapt intensity and the weekly duration of exercise. Outcome measures included the Berg Balance Scale (BBS) and Functional Reach Test (FRT), the 30-second sit-to-stand test (30STS) and isometric quadriceps strength (IQS). Balance and strength measures were evaluated at baseline and after 12 months of exercise. Previous publications of the RENEXC-trial showed no difference between patients who performed balance exercise and patients who performed strength exercise; therefore, this sub-study analysed all included patients as one group. Results Of 148 participants, 112 completed the study. At 12 months, 79% reported performed exercise, with 86% of these patients adhering to the prescribed intensity. The median (25th-75th percentile) exercise intensity was a RPE of 14 (13-15) on the Borg scale, and the median (min-max) exercise duration was 48 (0-241) minutes/week. Only 18% of the patients reached the 90-minute/week target. No exercise-related incidents were reported. Significant improvements were noted in BBS (p = 0.0464), FRT (p = 0.009), 30STS (p = 0.047), and IQS (right/left p = 0.022 / p = 0.049). Conclusion The Borg RPE scale is an effective and safe method for prescribing and monitoring self-administered balance and strength exercise in patients with CKD. Using the Borg scale for prescribing and monitoring exercise intensity during balance and strength exercise resulted in a good level of adherence to the 12-months exercise program and the prescribed exercise intensity. As no exercise related incidents were reported, we conclude that the self-administered exercise was safe to perform. Significant improvements in balance and strength were observed with a moderate to high exercise intensity prescription within a wide range of performed weekly duration of exercise, suggesting the Borg scale's value in exercise prescription in both well- and deconditioned patients with CKD. These findings show that the integration of the Borg scale into routine exercise prescription in people with CKD can promote patient autonomy and efficient resource utilization in healthcare.

Changes in femoral neck bone mineral density and structural strength during a 12-month multicomponent exercise intervention among older adults – Does accelerometer-measured physical activity matter?

Age-related bone loss is to some extent unavoidable, but it may be decelerated with regular exercise continued into older age. Daily physical activity alongside structured exercise may be an important stimulus for maintaining bone strength, but the relationships of habitual physical activity with bone strength are sparsely investigated in older adults. Therefore, the main aim was to investigate if accelerometer-derived impact-based and intensity-minute-based measures of physical activity were associated with changes in femoral neck bone traits during a 12-month exercise intervention among community-dwelling older men and women.Data comes from the PASSWORD study (ISRCTN52388040), a year-long multicomponent exercise intervention. Participants were 299 older adults (mean age 74 ± 4 years, 58 % women), who self-reported not to meet the physical activity guidelines for older adults but did not have any contraindications for exercising. The multicomponent training program included both supervised and self-administered exercises aimed at improving muscle strength, postural balance, and aerobic endurance. Physical activity was assessed at baseline and at six months into the intervention, and femoral neck bone properties at baseline and at twelve months. Physical activity measures were accelerometer-measured mean daily osteogenic index score, low, medium, and high intensity impact counts, and sedentary, light, and moderate-to-vigorous intensity activity minutes. Femoral neck bone mineral density (BMD) was measured with DXA and structural strength indicators (cross-sectional area [CSA] and section modulus) were subsequently derived from hip structural analysis. Longitudinal associations of physical activity and bone outcomes were analyzed with generalized estimating equation linear models. Sex was included as a moderating factor, and models were further adjusted by potentially confounding factors (age, height, weight, smoking status, medications, chronic disease conditions, and strength training adherence).Participants increased their physical activity by all measures and decreased their sedentary time from baseline to six months. BMD decreased from baseline to post-intervention, while CSA maintained stable and section modulus slightly increased. Osteogenic index, high impacts, and moderate-to-vigorous intensity physical activity, measured across the first half of the study, were positively associated with changes in BMD over 12 months (time х physical activity interaction effect: ß = 0.065, 95 % CI [0.004, 0.126]; ß = 0.169, 95 % CI [0.048, 0.289]; and ß = 0.151, 95 % CI [0.016, 0.286], respectively). That is, the higher the physical activity was, the smaller was the decline in BMD. Any physical activity measure was not associated with changes in CSA or section modulus in the full study sample. Sex did not significantly moderate the longitudinal associations, except the association between sedentary time and CSA (sex х time х PA interaction effect: ß = −0.017, 95 % CI [−0.033, −0.002]). An inverse association was found between sedentary time and changes in CSA in women, but not in men.In conclusion, BMD decline was less pronounced in individuals who accumulated more accelerometer-measured daily physical activity at the intensity of very brisk walking or light lateral jumping or higher intensities in a sample of relatively healthy, previously physically inactive older adults. Our findings support that accumulating the recommended amount of 150 or more weekly minutes of moderate-to-vigorous physical activity is also beneficial for older adults' bone health when incorporated into a multicomponent exercise program.

Associations Among Medical Therapy, SelfAdministered Exercise, and Characteristics of Ménière's Disease.

The aim of the current study was to explore the associations among different therapeutic procedures, self-administered exercise, and characteristics of Ménière's disease. The study used a retrospective design and included 539 people with Ménière's disease who were focusing on self-administered exercise. The mean age and history of Ménière's disease among these participants were 61.9 years and 15.6 years, respectively. Of the participants, 79.5% were female. The data were collected by an electronic questionnaire that focused on symptoms of Ménière's disease, exercise and training habits, balance problems, impacts of the complaints, quality of life, medical treatment, physiotherapy, and psychotherapy. Of the participants, 79.3% used medical treatment. Betahistine (56.8%) was the most popular followed by periodical anti-emetic use (41.0%) and diuretics (22.4%). Of the participants 70% were doing some self-administered training. The frequency of training depended on age, severity of balance problems, vestibular drop attacks, and gait problems. The type of training depended on age, quality of life, vestibular drop attacks, and gait problems. No association was found between vertigo and frequency/type of balance training. The use or effect of therapeutic procedures for Ménière's disease patients was not related to symptoms experienced. Most participants with Ménière's disease used training programs that aimed to alleviate their condition, especially balance-, gait-, and vestibular drop attack-associated problems. Patient support organizations should be working to help characterize the types of balance disorders people are dealing with in order to individually tailor a rehabilitation program to the patient's needs.

Early Rehabilitation with Exergame Which Muscle Groups are Addressed by Bedside-Based Knee Exercises?

Background. Knee exercises are generally recommended following knee-related operations. Nevertheless, compliance in performing self-administered exercises is varying. The use of exergames may alter patient compliance. These computer games encourage the user to exercise. Exergames are not yet used much in orthopedic rehabilitation. The aim of this study was to analyze the influence of different seating positions in electromyography while performing knee exercises with the exergame GenuSport.Material and methods. 72 healthy women and men were tested in 6 seating positions using an application-based knee-training device (KT). Positions were 1. user seated 90 upright with straight leg on KT, 2. 90 upright with leg exercising in external rotation on KT, 3. 90 upright with leg exercising in internal rotation on KT, 4. 90 upright with straight leg on 30mm elevated KT, 5. 45 upright with straight leg on KT and 6. 45 upright with straight leg on 30mm elevated KT. Electromyogram was recorded for biceps femoris, rectus femoris, semitendinosus, vastus medialis, adductor magnus and vastus lateralis.Results. No significant difference was shown in position 2, 3 or 4 compared to position 1. In position 5 and 6, EMG reported significantly higher values compared to positions 1 to 4 (ischiocrural: 130% and quadriceps: 90%). The quadriceps was activated significantly less in position 6 compared to 5.Conclusion. 1. Bedside-based knee extension exercises are most effective in a seated position of 45 trunk inclination. 2. A slightly more bent knee (KT elevation of 30mm) leads to a higher activation of the ischiocrural muscles.

Safety of Epidural Hyaluronic Acid Injections in Managing the Symptoms of Lumbar Foraminal Stenosis: A Prospective Preliminary Study

Lumbar foraminal stenosis (LFS) of degenerative origin is a common reason for distorted neurodynamics of nerve roots, causing radicular pain that is difficult to resolve with conservative treatments. A hyaluronic acid (HA), providing a sliding layer in the mechanical interface of a nerve root in a narrowed lateral recess, could potentially improve its neurodynamics and the trophic, leading to radicular pain reduction and improvement of function. This study aimed to assess the usefulness of ultrasound-guided HA epidural injections combined with neuromobilization in the conservative treatment of LFS. A group of 10 consecutively admitted patients with MRI-confirmed LFS and reduced straight leg raise (SLR) test results were qualified for a single HA epidural injection along with self-performed neuromobilization. Three measurement tools were used for primary outcomes: the numeric rating scale (NRS) for pain intensity, the Oswestry disability index (ODI) and the Roland-Morris questionnaire (RMQ) for disability level, and the angle of pain-free elevation in the SLR test as a functional assessment. The treatment was accomplished in all patients (100%). Overall, 60% of the patients completed all follow-up visits. There were no statistically significant differences regarding the results of the NRS, ODI, or RMQ; however, a statistically significant increase in the results of the SLR test was noted (p = 0.015). Three patients reported a flare-up of the symptoms shortly after injection but without neurological deficits. In conclusion, an epidural HA injection combined with a self-administered exercise program is a promising method and might be a beneficial way to enhance the neurodynamics of nerve roots in LFS and offer an option for steroid treatment. However, this method of epidural HA administration in LFS should be verified in further studies to confirm its efficiency and safety.

Abstract CT171: Can supervised exercise impact on metabolic markers and physical activity during androgen-deprivation therapy in prostate cancer patients? - randomized controlled pilot trial

Abstract Introduction: Androgen-deprivation therapy (ADT) is standard in treatment of advanced prostate cancer (PCa). Common adverse effects include fatigue, weight gain, sarcopenia, and decreased libido leading to lowered quality of life (QoL). Supervised exercise improves overall QoL among PCa patients. Less is known, however, how it may affect metabolic adverse effects of ADT.The aim of the study was to explore the effect of exercise intervention on glucose and cholesterol levels, body composition, and to find out whether supervised exercise leads to greater physical activity in long-term compared to self-administered exercise in men with ADT. Materials and methods: Altogether, 45 men were recruited. One man withdrew the consent at baseline and 5 dropped out during the study. Thus, 39 men completed the study. Subjects were randomly assigned into either supervised exercise for 3 months (n=27) or control group of self-administered exercise (n=17). In the supervised group, participants attended 1.5-hour group exercise session twice per week. Training program included both aerobic and muscle strength exercises. The 3-month intervention was followed by 3-month follow-up of self-administered exercise. Control group received the same introduction to exercise and training instruction as the supervised group but exercised independently for the entire study period. Fasting cholesterol, plasma glucose, and body composition were evaluated at the baseline, 3 months after randomization, and at the end of the study, 6 months after randomization. Physical activity during the study period was measured using activity bracelets (Polar A370). Study protocol was approved by Pirkanmaa hospital ethics committee (R18021) and registered to Clinicaltrials.gov (NCT04050397). Results: Median total cholesterol increased during 6-month follow-up in both groups, but less in the supervised group compared to the control group (0.1 vs 0.4 mmol/l, respectively, p=0.02). LDL remained stable in supervised group but increased slightly in the control group (0 vs. 0.4 mmol/l, respectively, p=0.01). Fasting plasma glucose lowered slightly in both groups (-0.2 vs -0.4 mmol/l). Total active time per day was slightly higher in the supervised group compared to the control group after 3-month intervention (median 364 vs 293 min/day, respectively). This difference persisted after intervention stopped (median 331 vs 267 min/day, respectively). Median change in body fat percentage at 6 months was 0 in the supervised arm and -0.9 in the control arm. None of the participants dropped out due to exercise-related side-effects. Conclusion: This pilot study showed that it is safe to perform strength exercise in men with ADT. Supervised exercise is likely more effective in mitigating metabolic adverse effect of ADT and inducing long-term changes in physical activity than self-administered exercise. Larger studies with longer follow-up are needed to investigate whether this leads to survival advantage. Citation Format: Lauri Rantaniemi, Aino Siltari, Eeva Harju, Teemu J. Murtola. Can supervised exercise impact on metabolic markers and physical activity during androgen-deprivation therapy in prostate cancer patients? - randomized controlled pilot trial [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr CT171.

The Borg scale is a sustainable method for prescribing and monitoring self-administered aerobic endurance exercise in patients with chronic kidney disease

Aim To examine adherence, performance, and safety of self-administered aerobic endurance exercise when exercise intensity was prescribed and self-monitored with the Borg RPE scale in patients with chronic kidney disease (CKD), and the relationship between performed exercise and change in walking distance. Materials and Methods 97 men and 50 women (age 66 ± 14 years, measured GFR 22 ± 8 mL/min/1.73m2) were prescribed 60 min aerobic endurance exercise/week at RPE 13–15. The 6-minute walk test was measured at 0, 4, 8 and 12 months of exercise. Results 100 patients completed the study, 80% reported exercise intensity at 12 months, 74% performed exercise within the prescribed RPE. Median RPE was 13 (13–15). Median duration was 56 (33–109) minutes/week. Patients with a short walking distance at baseline performed significantly less minutes of exercise/week (p = 0.039). There was no correlation between weekly duration and change in walking distance. No exercise-related incidents were recorded. Walking distance improved significantly by 30 ± 56 metres (p < 0.001). Conclusions The Borg RPE scale is useful, acceptable, simple and safe for prescribing and monitoring intensity of self-administered aerobic endurance exercise in patients with CKD. A RPE of 13–15 improved walking distance in well-functioning and deconditioned patients, within a wide range of weekly duration of exercise.

MO552: Self-Administered Exercise and Bone Mineral Density in Patients With Chronic Kidney Disease: A Substudy of Renexc—A Randomized Controlled Trial

Abstract BACKGROUND AND AIMS The aim of the study was to evaluate the effects of 12 months self-administered exercise training on bone mineral density (BMD) in non-dialysis-dependent patients with chronic kidney disease stages 3–5. METHOD In this single-centre, randomized controlled trial, 151 patients were allotted 60 minutes of endurance training in combination with 90 minutes of either balance or strength training. The exercise was prescribed and monitored by a physiotherapist and performed at home or a gym. Total body-, hip- and lumbar BMD (g/m2), T-score and Z-score were measured at baseline (T0) and after 12 months (T12) using dual-energy X-ray absorptiometry (DEXA). A total of 112 patients completed the study. Of these, five patients were excluded from analysis because they missed either the T0 or T12 DEXA evaluation. To evaluate between-group changes after the study period delta BMD, delta T-score and delta Z-score values (T12 value–T0 value) were calculated. These results were also used to define progressors and non-progressors. Statistical analyses were performed using SPSS for Windows 24. Statistical significance was assessed using Student's t-test, paired-sample t-test, Mann–Whitney or Wilcoxon matched-pairs signed-rank tests depending on normality of data distribution. The two-tailed chi-squared test was used to compare categorical variables. Values are given as mean ± SD or median (min-max). A P-value &amp;lt; 0.05 was accepted as the level of significance. RESULTS A total of 107 patients [69 men, 38 women; age 66 ± 13.5 years, measured glomerular filtration rate (GFR) 22 ± 8 mL/min/1.73 m2] were analysed. There were 50 patients (34 men, 16 women) in the strength group and 57 (35 men, 22 women) in the balance group. After 12 months of training the whole group showed a statistically significant decrease in hip BMD [0.886 (0.479–1.922) T0 versus 0.873 (0.521–2.045) T12, P = 0.002], hip T score [−1.177 ± 1.419 T0 versus − 1.4 (−4.0 to 6.6) T12, P = 0.049] and total body BMD (1.156 ± 0.508 T0 versus 1.149 ± 0.164 T12, P = 0.032). When data were analysed separately within each group, the strength group showed a decrease in total body BMD (1.152 ± 0.151 T0 versus 1.141 ± 0.153 T12, P = 0.001). Changes in total body T-score and Z-score did not reach the level of significance (T-score − 0.392 ± 1.56 T0 versus − 0.484 ± 1.56 T12, P = 0.138; Z-score 0.07 ± 1.19 T0 versus − 0.012 ± 1.21 T12, P = 0.052). The balance group showed a statistically significant increase after 12 months training in total body T-score (−0.312 ± 1.659 T0 and − 0.196 ± 1.707 T12, P = 0.035) and total body Z-score [0.05 ± 1.626 T0 and 0.4 (−5.1 to 6.8) T12, P = 0.003] but not in total body BMD [1.16 ± 0.151 T0 versus 1.123 (0.668 to 1.818) T12, P = 0.135]. Delta total body T-score was negative in the strength group [−0.10 (−1.0 to 2.1) and unchanged in the balance group 0.00 (−0.60 to 1.00), showing a significant between-group difference (P = 0.005)]. Delta total body Z-score was negative in the strength group (−0.092 ± 0.430) and positive in the balance group (0.1158 ± 0.403) showing a significant between-group difference (P = 0.001). Moreover, the proportion of progressors was higher in the strength group as shown by the delta total body T-score (60%) strength versus (40%) balance group (P = 0.006) and delta total body Z-score (61%) and (40%) respectively (P = 0.029). CONCLUSION Balance—in combination with endurance training seemed to be superior to strength—in combination with endurance training in preserving and even improving bone health. The 12 months of balance training resulted in an increase in total body T-score and Z-score, respectively. The strength group showed a decrease in total body BMD after 12 months of training. Moreover, when comparing the delta values there were significant between-group effects with the balance group showing an unchanged T-score in comparison with the strength group's decreased T-score and a positive Z score in comparison with the strength group's negative value. Finally, a greater proportion of participants in the strength group were classified as progressors with a deterioration of bone health.

Self-Rehabilitation Through Dance: An Ethnographic Study on Candy Girls Breast Cancer Survivor Group in Kuala Lumpur, Malaysia

This study intends to examine a breast cancer survivor group called the Candy Girls. Candy Girls comprises 26 to 30 women (aged between 40 and 73 years), who are breast cancer survivors in the post-clinical phase. They all have successfully undergone various combinations of treatment such as lumpectomy, mastectomy, radiotherapy and chemotherapy for breast cancer and are on the path to recovery and post-recovery. In 2010, this group came together for a year-long research conducted by the Universiti Malaya’s Faculty of Medicine through the Department of Rehabilitation Medicine. Realising the benefits of exercise for the well-being of cancer survivors, Candy Girls decided to continue dancing on their own even after the completion of the research study. With the support of breast surgeons at the University of Malaya Medical Centre (UMMC), this group began a weekly three-hour self-administered exercise session, that is still, to this day, taking place every Saturday. Their activities focus primarily on dance. The group gradually expanded dance genres by incorporating line dance, Latin dances-based Zumba sessions, Malay folk dance forms such as joget and zapin, and Bollywood dance. While the multi-ethnic women are determined to stay healthy and happy through their weekly dance routines, they have made significant impact on women at large by performing dances at Breast Cancer Relays, Awareness Campaigns and Health Conferences. By engaging with this community of survivors, the researchers have not only been able to observe their activities but also to support them through additional yoga and dance trainings. The act of giving back to the community has further strengthened the researchers' relationship with the study subjects and has allowed deeper engagement with the community. This ethnographic research shows that dance as self-rehabilitation, not only enhances physical mobility and emotional well-being, but forges a strong group solidarity among the women as a much-needed support system for survivors.

Tailored individual Yoga practice improves sleep quality, fatigue, anxiety, and depression in chronic insomnia disorder

BackgroundChronic insomnia disorder (CI) is a prevalent sleep disorder that can lead to disturbed daytime functioning and is closely associated with anxiety and depression. First-choice treatment is cognitive behavioral therapy (CBT-I). Other mind–body interventions, such as Tai-chi and Yoga, have demonstrated subjective improvements in sleep quality. The purpose of this study was to assess the efficacy of Yoga for improvement of subjective and objective sleep quality as well as measures of anxiety, depression, sleepiness, and fatigue in patients with CI.MethodsAdults with CI were prospectively included in this single group pre-post study. Baseline assessments included home polysomnography (PSG), 7-day actigraphy, and questionnaires (Pittsburgh Sleep Quality Index questionnaire (PSQI), Hospital Anxiety Depression scale (HADS), Epworth Sleepiness Scale (ESS), Pichot fatigue scale (PS)). Patients practiced Viniyoga, an individualised Yoga practice with daily self-administered exercises, for 14 weeks. Assessments were repeated at the end of Yoga practice.ResultsTwenty-one patients completed the study. Objective sleep measurements revealed no change in PSG parameters after Yoga practice, but a decrease in arousals on actigraphy (p < 0.001). Subjective symptoms improved for all questionnaires (PSQI, p < 0.001; HAD-A, p = 0.020, HAD-D, p = 0.001, ESS, p = 0.041, PS, p = 0.010). In univariate correlations, decrease in PSQI was associated with increase in sleep stage N3 (p < 0.001) on PSG.ConclusionsWe have demonstrated a positive impact of individualized Yoga practice on subjective parameters related to sleep and daytime symptoms in CI, resulting in fewer arousals on actigraphy. Yoga could be proposed as a potentially useful alternative to CBT-I in CI, as it is easy to practice autonomously over the long-term. However, given the design of the present study, future prospective controlled studies should first confirm our results.Trial registrationClinicalTrials.gov identifier: NCT03314441, date of registration: 19/10/2017.

Effect of an e-home based symptom management and mindfulness training program on quality of life in breast cancer survivors: A randomized clinical trial.

12080 Background: The first five years post-treatment for breast cancer are a critical phase, when the survivors may face a multitude of physical and psychosocial problems. We aimed to develop an e-home based symptom management and mindfulness training program to support women with breast cancer in transition to survivorship and to determine its effect on the endpoints including quality of life, symptom distress, psychosocial adjustment, and psychological morbidity. Methods: This parallel 4-arm, superiority randomized clinical trial together with a process evaluation using semi-structured interview recruited women who had completed cancer treatment for stage 0 to 3 breast cancer between 6 months to 5 years previously, from November 2016 through March 2020 at two tertiary hospitals. A total of 593 women were eligible, of these, 402 refused to participate and 191 women were randomized. However, 19 subjects withdrew from the study without completion of baseline assessments. Hence, 172 subjects were included in the intention-to-treat analysis (e-home based breast cancer survivorship program, experimental group; n = 44), comparison group 1 (online symptom management program only; n = 41), comparison group 2 (online mindfulness training program only; n = 44) or the usual care group (n = 43). The e-home based breast cancer survivorship program involved 5 weekly online education module regarding self-management strategies of common symptoms + various online self-administered mindfulness exercises. The primary endpoint included change of Quality of Life-Cancer Survivor Scale (QoL-CS) score measured at 8, 12 and 24 weeks from baseline. Secondary endpoints were changes of Social Support Questionnaire, Breast Cancer Survivor Self-Efficacy Scale, Memorial Symptom Assessment Scale, Psychosocial Adjustment to Illness Scale, Fear of Recurrence Scale, Hospital and anxiety Depression Scale, and Five Facet Mindfulness Questionnaire scores. Results: Of 172 subjects, mean ± SD age was 51.2 ± 9.4 years; 118 (77.7%) were in the first two years of cancer treatment completion; 165 (98.2%) underwent surgery; and 111 (73.5%) treated with adjuvant chemotherapy. All demographic and clinical characteristics were comparable among the four groups ( p&gt;.05). There was no between-group difference in the primary endpoint; QoL-CS scores among groups at 8, 12 and 24 weeks from baseline ( p&gt;.05). Secondary endpoints were also not different among groups ( p&gt;.05). Two main themes; positive impact and gap/barrier, emerged from process evaluation data. Conclusions: In women who were in the first five years post-breast cancer treatment, an e-home based multidimensional cancer survivorship program did not affect outcomes. Nevertheless, the interview data revealed a positive experience in regards to the home-based approach in cancer survivorship care program. Clinical trial information: NCT02931864.

The Effect of Physical Exercise Training on Neck and Shoulder Muscle Function Among Military Helicopter Pilots and Crew: A Secondary Analysis of a Randomized Controlled Trial.

Introduction: This study presents secondary outcome analyses, in terms of muscle function [i.e., maximal voluntary contraction (MVC) and rate of torque development (RTD)] from a parallel group, single blinded, randomized controlled trial introducing a physical exercise training intervention aiming to reduce neck pain among military helicopter pilots and crew-members.Methods: Participants (50 pilots, 58 crew-members) were recruited from the Royal Danish Air Force and randomized to either an exercise-training-group (ETG; n = 35) or a reference-group (REF; n = 34). Participants in ETG received 20 weeks of self-administered exercise training specifically tailored to target the neck and shoulder muscles. REF received no training. Outcome: (1) MVC was measured for cervical extension and flexion as well as shoulder elevation and abduction, (2) RTD was measured for cervical extension and flexion. Adherence to training was self-reported and categorized as regular if performed at least once a week.Results: MVC for cervical extension was significantly increased at follow-up in ETG (37.5 ± 11.2 Nm at baseline, change: 2.1 ± 8.3 Nm) compared to REF (38.1 ± 10.7 Nm at baseline, change: −2.4 ± 6.8 Nm) according to intension-to-treat analysis (p = 0.018). Likewise, RTD was significantly increased in ETG for cervical extension (149.6 ± 63.3 Nm/s at baseline, change: 14.7 ± 49.0 Nm/s) compared to REF (165.4 ± 84.7 Nm/s at baseline, change: −16.9±70.9 Nm/s) (p = 0.034). The cervical extension/flexion MVC-ratio was significantly different at follow-up (p = 0.039) between ETG (1.5 ± 0.5 at baseline, change: −0.0 ± 0.3) compared to REF (1.5 ± 0.5 at baseline, change: −0.2 ± 0.4). Per-protocol analysis of MVC, including only participants in ETG with regular training adherence (n = 10), showed a significant increase for cervical extension (33.2 ± 7.3 Nm at baseline, change: 6.0 ± 5.4 Nm) and shoulder elevation right side (143.0 ± 25.8 Nm at baseline, change: 15.8 ± 18.1 Nm).Conclusion: Physical exercise training significantly improved MVC and RTD in the upper neck extensors. Only approximately 1/3 of participants in ETG adhered to training regularly, which likely attenuated the effectiveness of the training intervention on neck and shoulder muscle function. Future studies should focus on the practical implementation of self-administered exercise training to improve adherence.

Feasibility of preoperative supervised home-based exercise in older adults undergoing colorectal cancer surgery - A randomized controlled design.

Preoperative physical exercise is emerging as a growing field of research globally. There are still challenges in recruiting vulnerable older people, and time constraints in preoperative cancer care to consider. We therefore evaluated the feasibility of short-term supervised home-based exercise in older people prior to colorectal cancer surgery. This feasibility study was conducted between September 2016 and June 2018. People ≥70 years scheduled for colorectal cancer surgery were recruited and randomized to an intervention group receiving supervised home-based physical exercise at a high level of estimated exertion or a standard care group following the standard preoperative path. The exercise (respiratory, strength, and aerobic) consisted of 2–3 supervised sessions a week in the participants’ homes, for at least 2–3 weeks or until surgery, and a self-administered exercise program in between. The primary outcome was process feasibility, including aspects specifically related to recruitment rate, compliance to the intervention, and acceptability. The secondary outcome was scientific feasibility including treatment safety, description of dose level and response, and estimation of treatment results. Twenty-three participants were included (recruitment rate 35%). A median of 6 supervised sessions was conducted over a 17-day exercise period. Compliance with the supervised sessions was 97%, and participants found the intervention acceptable. Concerning the self-administered exercise, a median of 19 inspiratory muscle training, 6 functional strength, and 8.5 aerobic sessions were reported. Challenges reported by program instructors were time constraints and difficulties in achieving high exercise intensities on the Borg CR-10 scale. A statistically significant between-group difference was only found in inspiratory muscle strength, favoring the intervention group (p<0.01). A short-term preoperative supervised home-based physical exercise intervention can be conducted, with respect to compliance and acceptability, in older people with similar physical status as in this study prior to colorectal cancer surgery. However, modifications are warranted with respect to improving recruitment rates and achieving planned intensity levels prior to conducting a definitive trial.

Adherence to a long-term progressive resistance training program, combining supervised and home-based exercise for breast cancer patients during adjuvant treatment

Background: The purpose of the study was to examine adherence and identify patient- and treatment-related factors associated with adherence to a 20-week combined supervised and home-based progressive resistance training program in women treated for breast cancer.Methodology: The study population consisted of the intervention group in a randomized clinical trial examining the effect of resistance exercise on lymphoedema prevention (n = 82). The full program lasted 50 weeks, with an initial 20 weeks combined supervised and home-based exercise followed by 30 weeks self-administered exercise. Information about attendance rates (supervised exercise) and exercise dairies (home-based exercise) in the first 20 weeks was available for 74 and 62 participants, respectively. Adherence was measured as numbers of exercise sessions performed divided by expected number of exercise sessions with >2/3 categorized as high adherence. Age-adjusted odds ratios (OR) were used to assess the associations between patient- and treatment-related factors with adherence.Results: The number of participants with high adherence to supervised exercise decreased in the late period (from week 11 onward) compared to the early period (65% vs. 48%) whereas the proportion of participants with high adherence to home-based exercise remained close to 55%. The most prominent factor associated with high adherence to supervised exercise was neoadjuvant chemotherapy [OR 7.09; 95% confidence interval (CI), 1.12–44.62]. For home-based exercise, lower adherence was seen in obese participants (OR 0.16; 95% CI, 0.04–0.65) and in participants with average or below average lower body muscle strength at baseline (OR 0.12; 95% CI, 0.03–0.46).Conclusion: The results of this study offer valuable information on factors associated with adherence to a program of supervised and home-based exercise. Interventions may be adapted to ensure higher adherence rates through supportive efforts targeted to women who are obese, have low muscle strength and who receive no or adjuvant chemotherapy (as opposed to neoadjuvant chemotherapy) during exercise.

Progressive resistance training to prevent arm lymphedema in the first year after breast cancer surgery: Results of a randomized controlled trial.

Existing research suggests that progressive resistance training (PRT) after breast cancer (BC) surgery is safe, but the preventive effect on arm lymphedema has yet to be determined. Women aged 18 to 75 years who were undergoing BC surgery with axillary lymph node dissection were eligible for the study. Recruited on the day of surgery, participants were allocated to intervention or usual care by computer randomization. The intervention consisted of PRT 3 times per week: in the first 20 weeks as a supervised group exercise and in the last 30 weeks as a self-administered exercise. The primary outcome was arm lymphedema, which was defined as a >3% increase in the interlimb volume difference by water displacement. Measurements were made at the baseline and at a 12-month follow-up by physiotherapists blinded to group allocation. Analyses of effects included t tests and regression models; missing data were addressed by multiple imputation. Among the 158 randomized women, no mean group difference was found in arm volume (0.3%; 95% confidence interval, -1.7% to 2.3%) or lymphedema incidence (adjusted odds ratio, 1.2; 95% confidence interval, 0.5-2.8). None of the participants exited the program because of adverse events. This study provides no evidence that PRT can prevent arm lymphedema in the first year after BC, but the results corroborate the importance and safety of resistance training for patients, including women at high risk for lymphedema.

Comparing effects of 4 months of two self-administered exercise training programs on physical performance in patients with chronic kidney disease: RENEXC - A randomized controlled trial.

BackgroundExercise training is recommended to patients with chronic kidney disease (CKD). However, the level of evidence is still low. This randomized controlled trial (RCT) compared two different and self-administered exercise training programs in a representative CKD population.MethodsThis single centre RCT included 151 non-dialysis dependent CKD patients, irrespective of age and comorbidity. Self-administered exercise training of 150 minutes per week was prescribed for 4 months and consisted of 60 minutes endurance training in combination with 90 minutes of either strength or balance training (strength versus balance group). Overall endurance (6-minute walk-test (6-MWT), stair climbing), muscular endurance (30-seconds sit-to-stand (30-STS), heel rises and toe lifts, handgrip (HGS) and isometric quadriceps (IQS) strength, balance (functional reach (FR) and Berg´s balance scale (BBS)) and fine motor skills (Moberg´s picking up test (MPUT)) were measured at baseline and after 4 months. Intention to treat analyses with mixed models was used.Results53 women and 98 men, mean age 66 ± 14: range 19 to 87 years, eGFR 20 ± 7: range 8 to 48 ml/min/1.73m2 participated. The strength group (n = 76) improved significantly in 6-MWT, stair climbing, 30-STS, heel rises right and left, toe lifts right, IQS right and left, and MPUT with closed eyes with the right and left hand. The balance group (n = 75) improved significantly in heel rises right and left, IQS left, BBS and left-handed MPUT with open and closed eyes. A significant effect between the groups was found for IQS right.ConclusionsTwo different exercise training programs, consisting of endurance in combination with either strength or balance exercise training, improved or maintained overall endurance, muscular strength and endurance, balance and fine motor skills after 4 months of 150 minutes/week self-administered exercise training in a representative CKD population, regardless of age and comorbidity.