Self-directed Exercise Program Research Articles

Development of a Leg And Walking Self-exercise (LAWS) program for older adults during cancer treatment.

We developed a self-directed Leg And Walking Self-exercise (LAWS) program informed by the Exercise is Medicine initiative and evaluated the feasibility and acceptability of this program in older adults with cancer. Over a 1-year period, we prospectively enrolled 40 older adults who received a comprehensive geriatric assessment (CGA) at a geriatric oncology service and initiated a new line of systemic therapy for advanced cancer as inpatients. LAWS is a tailored, self-directed exercise program consisting of leg resistance training and walking. Exercise adherence was recorded using an exercise diary to assess feasibility. Patient perspectives on this program were evaluated using the Feasibility of Intervention Measure (FIM) and Acceptability of Intervention Measure (AIM), with a score range of 1-5, higher being better. Overall, 28% of patients were fit, 53% pre-frail, and 20% frail based on the CGA. During hospitalization (average 12days), 63% of the patients adhered to exercises at lowest intensity during more than 50% of their inpatient stay: on average, 2.8 leg exercises, 23 repetitions a day, 5.6days/week, and 19min of walking a day, 4.9days/week. Patients rated their perceived exertion at 3.0 for leg exercise and 3.0 for walking on a 1-10 Likert scale. During the period between discharge and their first outpatient appointment (average 11days), 71% of patients adhered to the LAWS program. Mean scores of FIM and AIM were 4.2 (SD = 0.5) and 4.2 (SD = 0.7), respectively. For older adults undergoing cancer treatment, LAWS is a feasible and acceptable self-directed exercise program.

Home-based exercise program for people with residual disability following hospitalization for COVID-19: Randomized control trial

BackgroundThe best exercise program for individuals with effort intolerance or hypoxia at rest and/or during exercise post-COVID-19 treatment who have already had in-hospital rehabilitation remains unknown. ObjectiveWe evaluated the efficacy of a home-based rehabilitation exercise program intervention that included teleconsultations with a specialist nurse. MethodsThis was a multicenter randomized controlled trial for individuals who had been diagnosed with, and treated for, COVID-19. Despite inpatient rehabilitation they still had effort intolerance; this was defined as being a) only able to walk <70 % of the predicted distance during the six-minute walking test (6MWT) and/or b) oxygen desaturation all day long/during effort. The primary outcome was effort tolerance, as evaluated by the 6MWT. Secondary outcomes were dyspnea, fatigue, spirometry, respiratory muscle evaluations, and oxygenation. The Intervention group performed 4 weeks of a self-directed exercise program with bi-weekly physiotherapist video calls; the Control group participated in physical activity howsoever they wished. Exercises were divided into 4 intensity levels according to disability and oxygen desaturation. The program progressively increased from low (walking, free-body exercise, sit-to-stand, and balance exercises) to high (speed walking with a pedometer, cycle ergometer, and strengthening exercises). ResultsWe included 79 participants: 40 in the Intervention and 39 in the Control group. Mean (SD) age was 67.1 (10.3) years; 72 % (n = 57) were male. No intergroup differences in effort tolerance were found [Intervention 77.6 (75.4)m vs Control 49.5 (73.3)m (p = 0.109)]. Participants with 6MWT distance results < lower limit of normality values showed best improvements in mean (SD) effort tolerance: Intervention, 120.1 (75.8)m vs Control, 59.1 (75.6)m (p = 0.035). After 2 months, mean (SD) 6MWT distances in the 2 groups were similar: Intervention, 475.9 (82.4)m vs Control, 469.2 (118.9)m (p = 0.807). ConclusionsIn individuals with residual disability post-COVID-19 and after inpatient rehabilitation, a home-based exercise program with teleconsultation significantly improves effort tolerance but only for people who had severe effort intolerance at baseline. Database registrationClinicalTrials.gov number, NCT04821934

Leg and walking self-exercise (LAWS) program for older adults with cancer during treatment.

e24009 Background: Regular aerobic and resistance exercise during cancer treatment is recommended by guidelines. We developed Leg And Walking Self-exercise (LAWS), a self-directed exercise program informed by the Exercise Is Medicine initiative. The acceptability and feasibility of the LAWS program was evaluated in older adults with advanced cancer during treatment. Methods: This was a prospective study of 40 consecutive older adults who received comprehensive geriatric assessment (CGA) at a geriatric oncology service (GOS) and started a new line of systemic therapy for advanced cancer on a medical oncology floor over a 1-year period. The LAWS consists of three leg exercises (sit-to-stand, calf raise, and knee extension) and walking. We set three intensity levels for the leg exercises based on a number of repetitions per day and for walking based on minutes per day as follows: level 1 = 10, level 2 = 20, level 3 = 30. We instructed patients to adjust the intensity level with a goal rating of perceived exertion (RPE) of 3 or 4 on a 0–10 scale, where 0 = no exertion and 10 = maximal exertion, and encouraged them to do both leg resistance training and walking every day. The LAWS program was introduced to a patient by the GOS during CGA consultation. When the patient was admitted to a medical oncology floor, a nurse went over the LAWS program and gave an exercise diary to the patient. During inpatient stay, a nurse checked exercise diary and helped the patient keep the diary as needed. Upon discharge from hospital, a nurse instructed the patient to continue the LAWS at home and maintain an exercise diary. Adherence was quantified as the proportion of patients who performed the LAWS program at least level 1 intensity more than 50% of each study period. Patient perspectives on the LAWS program were evaluated using the Acceptability of Intervention Measure (AIM) and the Feasibility of Intervention Measure (FIM). A summary score of each measure ranges from 1 to 5 (higher is better). Results: Mean age was 78 years and 48% had colorectal cancer. Overall, 28% of patients were fit, 53% were pre-frail, and 20% were frail based on a CGA. During hospitalization, 63% of the patients adhered to both leg exercise and walking: on average, over 12 days in hospital, 2.8 leg exercises, 23 repetitions a day, 5.6 days/week, with a mean RPE of 3.0 (low intensity) and 19 minutes of waking a day, 4.9 days/week, with a mean RPE of 3.0. During the period between discharge and first outpatient appointment, 71% of patients adhered to the LAWS program: on average, over 11 days at home, 2.6 leg exercises, 22 repetitions a day, 5.9 days/week, with a mean RPE of 3.0 and 22 minutes of waking a day, 5.4 days/week, with a mean RPE of 3.2. Patients reported high acceptability (AIM mean score = 4.2; SD = 0.7) and feasibility (FIM mean score = 4.2; SD = 0.5) of the program. Conclusions: The LAWS is an acceptable and feasible self-directed exercise program for older adults with advanced cancer receiving treatment.

Web-Based Self-Directed Exercise Program Is Cost-Effective Compared to Formal Physical Therapy After Primary Total Knee Arthroplasty

BackgroundWeb-based physical therapy (WBPT) is a potential means to reduce costs following total knee arthroplasty (TKA). Although outcomes data support the use of self-directed therapy after TKA, there is a paucity of literature evaluating its cost-effectiveness. This study aimed to determine utilization trends of either outpatient physical therapy (OPPT) or WBPT after TKA, assess the outcomes of patients based on their use of WBPT, OPPT, or both, and evaluate OPPT costs based on the amount of WBPT used. MethodsA retrospective review of 701 patients (731 TKAs) was performed. Patients were given a prescription for OPPT and access to a self-directed WBPT program. Functional scores were obtained preoperatively and 6 months postoperatively, and the rate of manipulation under anesthesia (MUA), range of motion, and PT costs were recorded. ResultsAbout 49.8% of patients utilized WBPT, 34.7% of patients utilized WBPT and OPPT, and 23% of patients utilized neither source of therapy. Patients that utilized both WBPT and OPPT demonstrated the lowest rates of MUA. There were no differences in postoperative outcomes based on the number of WBPT logins. Overall, PT cost was 3.4× higher for those that underwent MUA. Subgroup analysis of patients that utilized WBPT revealed that the cost and number of PT visits decreased as the number of logins increased. Patients younger than 65 utilized more WBPT and OPPT while demonstrating worse outcomes (lower Knee Injury and Osteoarthritis Outcome Score for Joint Replacement postoperative scores and more MUAs). ConclusionWBPT can be an effective option to offset costs associated with OPPT, without compromising outcomes.

Formal Physical Therapy May Not Be Necessary After Unicompartmental Knee Arthroplasty: A Randomized Clinical Trial

BackgroundThe purpose of this randomized clinical trial was to compare formal outpatient physical therapy (PT) and unsupervised home exercises after unicompartmental knee arthroplasty (UKA). MethodsFifty-two patients were randomized to 6 weeks of outpatient PT or an unsupervised home exercise program after UKA. The primary outcome was change in range of motion at 6 weeks with secondary outcomes including total arc of motion, Knee Society Score, Knee Injury and Osteoarthritis Outcome Score Jr, Lower Extremity Functional Scale, and Veterans Rands-12 score. ResultsTwenty-five patients received outpatient PT, 22 patients the self-directed exercise program, while 3 patients deviated from the protocol, 1 patient withdrew, and 1 patient was lost to follow-up. There was no difference in the change of range of motion (P = .43) or total arc of motion at 6 weeks (P = .17) between the groups and likewise no significant differences were found in any of the secondary outcomes. Two patients who crossed over from the unsupervised home exercise program to formal outpatient PT within the first 2 weeks postoperatively required a manipulation under anesthesia. ConclusionsOur results suggest self-directed exercises may be appropriate for most patients following UKA. However, there is a subset of patients who may benefit from formal PT.

Effects of a Self-Directed Nutrition Intervention Among Adults With Chronic Health Conditions.

Chronic diseases are common among adults. A healthy diet may be beneficial for managing the consequences of such conditions. The purpose of this study was to evaluate the effects of a self-directed nutrition program on dietary behaviors among adults with chronic health conditions. As part of a larger trial examining the effects of a self-directed exercise program, participants with arthritis were randomized to a 12-week self-directed exercise or nutrition intervention. Self-reported fruit and vegetable consumption, fat- and fiber-related behaviors were assessed at baseline, 12 weeks, and 9 months. Repeated measures analyses of covariance examined Group × Time changes in dietary behaviors. Effect sizes were computed. Participants ( n = 321) were, on average, 56.5 ± 10.5 years old, had a mean body mass index of 32.9 ± 8.3 kg/m2, and had 2.0 ± 1.0 chronic health conditions; 88% were female, 65% White, 88% had at least some college education, and 62% married. There were significant Group × Time interactions favoring the nutrition group at 12 weeks for all dietary behaviors ( p < .05) but not at 9 months. Between-group effect sizes were small at 12 weeks and decreased at 9 months. Within-group effect sizes were larger for the nutrition group (small to medium) than the exercise group (none to small) at both time points. A self-directed nutrition intervention can result in meaningful improvements in dietary behaviors among adults with chronic health conditions in the short term.

“Participation, satisfaction, perceived benefits, and maintenance of behavioral self-management strategies in a self-directed exercise program for adults with arthritis”

A process evaluation was conducted in conjunction with a controlled trial of a self-directed exercise program among people with arthritis to describe the program’s reach; self-management behaviors, exposure to materials, program perceptions, satisfaction, and perceived benefits; compatibility with targeted participants’ needs; and maintenance. Participants (n=197) were predominantly white, middle-aged, college-educated women. At 12 weeks, 73.2% had read ≥90% of the program materials (at nine months>70% had “occasionally” or “often” looked back over each of the five parts of the materials); 63.3% had set goals (52.5% at nine months), and 83.9% had “some” or “a lot” of success following their plan (64.2% at nine months), while 90.4% rated the program “good” or “excellent” (87.5% at nine months). At 12 weeks, the majority (89.3%) used written logs to self-monitor (mean=9.3 logs); by nine months, >70% never kept logs. Most (>80%) rated twelve of thirteen program components as helpful, and 98.6% would recommend the program. From 38% to 62.4% endorsed each of eight program benefits, with small declines of ≤9% at nine months. Qualitative response identified ways the program met and did not meet expectations. The main program compatibility issue was targeting all adults with arthritis, while featuring older adults in materials.

Impact of Different Exercise Programs on Severe Fatigue in Patients Undergoing Anticancer Treatment—A Randomized Controlled Trial

ContextPhysical exercise can alleviate cancer-related fatigue. Randomized controlled trials in patients with advanced cancer are scarce. ObjectivesWe test the impact of a structured, individual sports program on fatigue in patients with advanced cancer. MethodsSeventy-seven patients were invited to participate in this randomized controlled trial exploring the effects of physical exercises on fatigue 12 and 24 weeks after baseline. Patients were randomized into three groups. Group A received treatment as usual, Group B was taught a structured, individual sports program, and Group C received additional ambulatory physiotherapeutical supervision. Primary outcome was general fatigue, secondary outcomes included rate of severe general fatigue, further dimensions of the Multidimensional Fatigue Inventory (MFI), as well as walking distance. ResultsMean score of general fatigue as well as other MFI subdimensions differed nonsignificantly between all groups at 12 weeks. However, the mental fatigue score demonstrated a statistically significant difference between the three groups. The rate of severe general fatigue was significantly reduced within Intervention Group C. Significant longitudinal change of MFI-dimension mental fatigue was found and reached the threshold for minimal clinically important difference, while all MFI-dimensions increased in Group A. ConclusionOur results imply that tumor-patients' severe general fatigue can be reduced when patients conduct appropriate physical exercise. This study amends previous knowledge, as it describes the impact of outpatient physical exercise on fatigue in a heterogeneous patient cohort with various advanced cancer entities. Furthermore, this trial differentiates between patients with only a self-directed exercise program versus those receiving additional partially professional supervision.

Understanding the effects of a self-directed exercise program on depressive symptoms among adults with arthritis through serial mediation analyses

The burden of comorbid depression among adults with arthritis is of concern. The purpose of this study is to understand how a self-directed exercise intervention among adults with arthritis exerted its effects on depressive symptoms by performing serial mediation analyses. MethodsParticipants were randomized to a self-directed exercise program or to self-directed nutrition program (control). Self-reported physical activity, arthritis symptoms (pain, stiffness, fatigue), disability, and depressive symptoms were measured at baseline and 12 weeks. Serial mediation models were conducted to examine the indirect effects of the exercise intervention on changes in depressive symptoms through changes in physical activity and changes in arthritis symptoms/disability (i.e., intervention group→increased physical activity → decreased arthritis symptoms/disability → decreased depressive symptoms). ResultsA total of 315 participants with complete data were included in these analyses. Results from the serial mediation models found significant indirect effects of the exercise intervention on decreases in depressive symptoms through (1) increases in physical activity and decreases in pain, and (2) increases in physical activity and decreases in disability. There were no significant indirect effects through (1) increases in physical activity and decreases in fatigue, or (2) increases in physical activity and decreases in stiffness. ConclusionsThis study highlights the importance of physical activity in reducing depressive symptoms, and the means by which it helps (i.e., reducing pain and disability). Understanding these pathways may help researchers design more efficacious interventions.

Baseline predictors of physical activity in a sample of adults with arthritis participating in a self-directed exercise program

ObjectivesTo examine baseline predictors of moderate-to-vigorous intensity physical activity (MVPA) at the 12-week follow-up in a sample of adults with arthritis participating in a self-directed, multicomponent exercise program. Study designPretest–posttest. Analyses were limited to those randomized to the exercise intervention. MethodsParticipants (n = 152) completed a survey assessing demographic, health-related, and arthritis-related factors, and completed anthropometric and functional measurements at baseline. Self-reported MVPA was assessed at baseline and 12 weeks. Participants were classified as engaging in ≥2.5 or <2.5 h/week of MVPA at the 12-week follow-up. Baseline demographic, health-related, arthritis-related, and functional factors were examined as predictors of engaging in ≥2.5 h of MVPA. ResultsAt the 12-week follow-up, 66.5% (n = 101) of participants engaged in ≥2.5 h/week of MVPA. Those with a higher body mass index, more days with poor physical health, a greater number of health conditions, self-reported hypertension, self-reported high cholesterol, and greater pain and stiffness were less likely to engage in ≥2.5 h of MVPA at the 12-week follow-up; those with greater arthritis self-efficacy and better performance on the 6 minute walk test were more likely. None of the other factors examined were associated with MVPA. ConclusionsThis study uncovered health-related, arthritis-related, and functional factors associated with MVPA that may help guide intervention strategies. Participants with less severe symptoms, better functional performance and fewer comorbidities at baseline were more likely to achieve the recommended MVPA level at 12 weeks; therefore self-directed PA interventions may be best suited for those with relatively good health status despite arthritis, while those with worse symptoms and health status may benefit more from other intervention delivery modalities such as structured, individualized programs where additional support for managing arthritis symptoms and comorbidity can be addressed.

Exercise and Stress Management Training Prior to Hematopoietic Cell Transplantation: Blood and Marrow Transplant Clinical Trials Network (BMT CTN) 0902

Studies show that engaging patients in exercise and/or stress management techniques during hematopoietic cell transplantation (HCT) improves quality of life. The Blood and Marrow Transplant Clinical Trials Network tested the efficacy of training patients to engage in self-directed exercise and stress management during HCT. The study randomized 711 patients at 21 centers to receive 1 of 4 training interventions before HCT: a self-directed exercise program, a self-administered stress management program, both, or neither. Participants completed self-reported assessments at enrollment and up to 180 days after HCT. Randomization was stratified by center and transplant type. There were no differences in the primary endpoints of the Physical Component Summary and Mental Component Summary scales of the Medical Outcomes Study Short Form 36 at day +100 among the groups, based on an intention-to-treat analysis. There also were no differences in overall survival, days of hospitalization through day +100 post-HCT, or in other patient-reported outcomes, including treatment-related distress, sleep quality, pain, and nausea. Patients randomized to training in stress management reported more use of those techniques, but patients randomized to training in exercise did not report more physical activity. Although other studies have reported efficacy of more intensive interventions, brief training in an easy-to-disseminate format for either self-directed exercise or stress management was not effective in our trial.

The effect of self-directed exercise program on physical function of older adults with frailty

Introduction: Frailty is a common syndrome in older adults. Frailty is associated with increase of morbidity and reduced functional ability. However, few studies have introduced an exercise intervention for frailty. The purpose of this study was i) to investigate the effect of elastic band training, and ii) to evaluate the efficacy of self-directed group exercise as a follow-up after supervised exercise on physical function of frail older adults.