Self-directed Exercise 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.

Low-volume combined aerobic and resistance high-intensity interval training in type 2 diabetes: a randomised controlled trial

ObjectiveThe objective of this study was to compare the effects of novel, time-efficient, low-volume combined aerobic and resistance high-intensity interval training (C-HIIT), and current exercise guidelines (210 min/week of combined...

Enhancing physical and cognitive function in older adults through walking & resistance exercise: Korean national aging project randomized controlled study

BackgroundThe rapid aging of Korea's population underscores the urgent need for effective programs to enhance the well-being and longevity of the elderly. This study presents preliminary results from the Korean project, examining the impact of cost-effective and accessible exercise programs on functional performance of older people and to determine the long-term maintenance of intervention. MethodsWe randomized 90 older adults aged ≥65 years to the walking group (WG), resistance + walking (RWG), or active control (CG) group. We designed a 12-week main intervention (supervised resistance training 2 d/week and individual walking exercise) and a 12-week follow-up through self-directed exercise (same protocol but unsupervised). The participants’ mini mental state examination, color-word Stroop test and 5-time sit to stand, timed up & go, handgrip strength, and knee extensor strength tests were assessed at pre, post, as well as follow-up. ResultsFor the RWG group, significant improvements were found in timed up & go (P < 0.001), and 5-time sit to stand (P < 0.001) compared to CG, with benefits maintained at follow-up. Both RWG and WG showed significant enhancements in knee extensor power (RWG: P < 0.0001; WG: P < 0.001) and flexor power (RWG: P < 0.01; WG: P = 0.018) compared to CG. Although cognitive performance did not show significant group-by-time interactions, RWG exhibited improvements in the Stroop Color and Color-Word tests at follow-up compared to baseline. ConclusionA resistance training program combined with walking effectively enhanced functional performance in older adults, providing lasting benefits over 12 weeks on physical functions, such as strength and endurance. However, it showed limited benefits on cognitive performance.

Exercise Therapy to Reduce Anxiety (ExTRA) in mid-life and later-life adults: study protocol

BackgroundAnxiety in mid-life and later-life is highly prevalent and causes significant distress and disability. There is increasing evidence supporting the potential effectiveness of exercise interventions for reducing clinically significant anxiety. Self-directed online interventions can be scalable and thus reach more people. AimsThe Exercise Therapy to Reduce Anxiety (ExTRA) project aims to assess the feasibility and acceptability of an 8-week web-based exercise intervention with the innovation of being self-directed, and facilitated by wearable activity monitors (WAMs) and tailored behaviour change strategies to reduce anxiety in mid-life and later-life adults with clinically significant anxiety. MethodsExTRA will recruit 20-30 community dwelling adults aged 40-79 years with clinically significant anxiety. The self-directed 8-week web-based exercise intervention includes information and strategies to support participants to meet Australian national physical activity guidelines. The intervention is adapted from previous face-to-face trials and includes strategies to support participants living with anxiety. Feasibility will be measured by screening and retention rates. Acceptability will be measured by website usage data, online outcome measure completion, and an evaluation questionnaire. Other outcome measures include anxiety measured by the Depression Anxiety Stress Scales, and physical activity measured by the Global Physical Activity Questionnaire and a WAM. ResultsFindings will demonstrate whether this intervention is feasible and acceptable, and provide preliminary efficacy data. ConclusionsThe findings of this pragmatic real-world study will be valuable in guiding development of future trials, including randomised controlled trials of scalable and accessible exercise interventions to reduce the distress, disability and cost of anxiety.

User-centered design of a mobile app for physical activity advice in cancer care: preliminary study in Morocco at the National Institute of Oncology

ContextUtilizing mobile apps to increase physical activity levels is now standard practice in cancer care. The study’s objective was to provide patients with precise physical activity recommendations and/or initiate self-directed exercise programs.MethodsA multidisciplinary group directed the design procedure. We adhered to the self-determination approach,and accompanying behavior modification strategies, as well as international guidelines in the field of physical activity in cancer care. The design process was user-centered and involved three steps: Understanding the user and the context, conceptualization, and evaluation of the prototype. The testing was carried out by the beneficiaries, healthcare professionals, and two experts. Three criteria were evaluated in the designed solution: usability, quality, and potential for behavior change.ResultsThe evaluation results of the designed solution showed good perception by both beneficiaries and healthcare professionals. The average system usability scale score was 90,6 (SD: 7.33) for beneficiaries, and 92.75 (SD: 3.83) for healthcare professionals. The first expert received a mean overall quality score of 4.51 on the mobile app rating scale, while the second received a score of 4.27. The results of the app behavior change scale gave the first expert a score of 17/21 and the second a score of 15/21.ConclusionBased on the criteria of usability, quality, and potential for behavior change, the designed app demonstrated positive results. This is a preliminary evaluation, which will be followed by additional, in-depth evaluations with larger sample sizes.

Cardiac rehabilitation using intensive lifestyle habituation combined with outdoor exercise in an urban forest environment for primary and secondary prevention of coronary artery disease: a feasibility test

Background: We aimed to examine the feasibility of intensive lifestyle habituation with a subsequent home program, including forest-based exercise, as an alternative approach to conventional cardiac rehabilitation for both primary and secondary prevention of coronary artery disease (CAD).Methods: A total of 28 participants were included in a 1-week intensive education program aimed at fostering desirable lifestyle habits in the study: 17 patients who underwent percutaneous coronary intervention and 11 participants at high risk of CAD. Subsequently, they engaged in a self-directed, home-based program that included unstructured exercise in an urban forest. The terrain of the urban forest was analyzed to estimate metabolic equivalent levels and to assess safety and accessibility for patient exercise.Results: Throughout the program, no adverse cardiac events were reported. Additionally, risk factors for CAD—including body composition, blood sugar levels, hemodynamic variables, total cholesterol levels, and cardiorespiratory endurance—showed significant improvement in both groups.Conclusions: Intensive lifestyle habituation and unstructured, self-directed exercise in the forest were as effective and safe as conventional cardiac rehabilitation for patients with CAD. The study demonstrated that an urban forest could serve as a safe exercise environment in both primary and secondary prevention strategies for CAD.

Abstract CT232: Intense exercise for survival among men with metastatic prostate cancer: 12-month feasibility results from the INTERVAL-GAP4 trial pilot site at Edith Cowan University, Australia

Abstract Introduction: Men with prostate cancer undertaking moderate-to-vigorous exercise have a marked reduction of 30-60% in all-cause and cancer-related mortality based on observational studies. In 2016, the Intense Exercise for Survival among Men with Metastatic Prostate Cancer (INTERVAL-GAP4) was launched to determine if supervised exercise improves overall survival in men with metastatic prostate cancer. Here, we describe the demographic characteristics, completion rates, exercise adherence, and safety of the first 12 months of the intervention at the pilot site, Edith Cowan University in Perth, Australia. Methods: INTERVAL-GAP4 is a multi-center global randomized controlled phase III trial. Patients are randomly allocated (1:1) to: (intervention) a high intensity combined resistance and aerobic exercise supervised program for 1 year tapering to self-management in year 2; or (control) self-directed unsupervised exercise with print materials. Patients were stratified by site and by disease/treatment status (metastatic hormone-sensitive prostate cancer [mHSPC] or metastatic castration-resistant prostate cancer [mCRPC] and if the latter, treatment modality). The study did not meet recruitment goals and closed to further enrollment in February 2023. Results: 240 participants were evaluated between April 2016-Feb 2023, 60 patients were consented, 52 participants were randomized, and two patients did not receive the allocation, resulting in 50 participants (27 intervention and 23 control). Main reasons for exclusion were not meeting clinical criteria (N=81), time commitment (N=24), unable to contact (N=22), not interested (N=19), and poor physical function (N=13). Median age at randomization was 72 years (IQR: 68, 77), median body mass index (BMI) was 31.7 kg/m2 (IQR: 27.5, 35.7), 94% identified as white, and time since diagnosis was 5 years (IQR: 1, 9). 13 participants (26%) had mHSPC and 37 (74%) had mCRPC. Completion rates were the following at 6 months: 84% completed surveys, 62% exercise testing, and 66% biological samples. Of 42 alive at 12 months: 85% completed surveys, 73% testing, and 73% biological samples. Median exercise adherence was 90% (IQR: 78, 97) for the first 12 months of the study. Adherence was not significantly different for those with mCRPC vs. mHSPC status. There were 10 SAEs in first 12 months; all (100%) were unrelated to the intervention. Conclusions: Exercise training was feasible and safe in men with metastatic prostate cancer with no difference observed in exercise session adherence by disease status. Survey completion was high, while in-person completion rates were affected by the COVID-19 pandemic. Additional analysis of the entire study population (N=145) is ongoing and will be compared with the pilot site. Citation Format: Stacey A. Kenfield, Nicolas H. Hart, Jennette Sison, June M. Chan, Kerry S. Courneya, Fred Saad, Robert U. Newton. Intense exercise for survival among men with metastatic prostate cancer: 12-month feasibility results from the INTERVAL-GAP4 trial pilot site at Edith Cowan University, Australia [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 2 (Late-Breaking, Clinical Trial, and Invited Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(7_Suppl):Abstract nr CT232.

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

Effectiveness of shoulder mobilization combined with muscle energy technique in the management of adhesive capsulitis: A randomized control trial

Background: Adhesive capsulitis is a debilitating condition characterized by a gradual, painful loss of shoulder motion. As a part of physical therapy programs, mobilization techniques are an important part of the intervention. However, the potential utility of mobilization along with other interventions under supervision is not explored, especially compared to home program exercises. Aim: The objective of the study was to compare the effects of the combination of Maitland’s mobilization protocol and muscle energy techniques (METs) with self-directed nonsupervised general home exercise program (HEP) in frozen shoulder patients. Methods: A total of 24 subjects (14 females and 10 males) were randomized into mobilization with supervised exercise therapy (MSE) group (n = 12) and HEP group (n = 12). Subjects in the MSE group were given Maitland’s mobilization technique and MET for 3 sets (10 glides per set), 3 times/week for 6 weeks, and nonsupervised general HEP for the HEP group. Pain intensity and range of motions (ROMs) of the shoulder were measured for both the groups at the completion of the study duration. Results: Both the groups showed alleviation in pain, but a significant improvement was found in the MSE group than the HEP group. The within-group study showed that ROM was improved in flexion, abduction, external rotation (ER), and internal rotation in the two groups; however, the percentage change was higher in the MSE group than in the HEP group. Significant group effect (P = 0.041 and P = 0.009), time effect (P &lt; 0.001 and P &lt; 0.001), and group × time effects (P &lt; 0.001 and P &lt; 0.001) were found for flexion and ER ROM. Conclusions: A supervised protocol that includes mobilization and other exercises can be an alternative protocol used for the treatment of frozen shoulder without profound adverse effects.

Development of a curricular thread to foster medical students' critical reflection and promote action on climate change, health, and equity.

Due to the health consequences arising from climate change, medical students will inevitably interact with affected patients during their training and careers. Accordingly, medical schools must incorporate education on the impacts of climate change on health and equity into their curricula. We created a curricular thread called "Climate Change, Health, and Equity" in the first-year preclinical medical program to teach foundational concepts and foster self-reflection and critical consciousness. The authors developed a continuum of practice including administrators, educators and faculty members, students, and community partners to plan and design curricular activities. First-year medical students at Duke University School of Medicine participated in seven mandatory foundational lectures and two experiential learning opportunities in the local community. Following completion of activities, students wrote a critical reflection essay and completed a self-directed learning exercise. Essays were evaluated using the REFLECT rubric to assess if students achieved critical reflection and for thematic analysis by Bloom's Taxonomy. All students (118) submitted essays. A random sample of 30 (25%) essays underwent analysis. Evaluation by the REFLECT rubric underscored that all students were reflecting or critically reflecting on thread content. Thematic analysis highlighted that all students (30/30, 100%) were adept at identifying new areas of medical knowledge and connecting concepts to individual experiences, institutional practices, and public health and policy. Most students (27/30; 90%) used emotionally laden words, expressing negative feelings like frustration and fear but also positive sentiments of solidarity and hope regarding climate change and effects on health. Many students (24/30; 80%) expressed actionable items at every level including continuing self-directed learning and conversing with patients, minimizing healthcare waste, and advocating for climate-friendly policies. After participating in the curricular thread, most medical students reflected on cognitive, affective, and actionable aspects relating to climate change, health, and equity.

A self-directed digital exercise program for hip osteoarthritis (“My Hip Exercise”): protocol for a randomised controlled trial

BackgroundHip osteoarthritis (OA) is a leading global cause of chronic pain and disability. Given there is no cure for OA, patient self management is vital with education and exercise being core recommended treatments. However, there is under-utilisation of these treatments due to a range of clinician and patient factors. Innovative service models that increase patient accessibility to such treatments and provide support to engage are needed. This study primarily aims to determine the effects of a self-directed digital exercise intervention comprising online education and exercise supported by a mobile app to facilitate adherence on the primary outcomes of changes in hip pain during walking and patient-reported physical function at 24-weeks when compared to online education control for people with hip OA.MethodsWe will conduct a two-arm, superiority parallel-design, randomised controlled trial involving 182 community volunteers aged 45 years and over, with painful hip OA. After completing the baseline assessment, participants will be randomly assigned to either: i) digital exercise intervention; or ii) digital education (control). Participants randomised to the intervention group will have access to a website that provides information about hip OA and its management, advice about increasing their physical activity levels, a 24-week lower limb strength exercise program to be undertaken at home three times per week, and a mobile app to reinforce home exercise program adherence. Participants in the control group will have access to a website containing only information about hip OA and its management. All participants will be reassessed at 24 weeks after randomisation. Primary outcomes are severity of hip pain while walking using an 11-point numeric rating scale and physical function using the Western Ontario and McMaster Universities Osteoarthritis Index subscale. Secondary outcomes are the Hip dysfunction and Osteoarthritis Outcome Score subscales of pain, hip-related quality of life, and function, sports and recreational activities; global change in hip condition; health-related quality of life; measures of physical activity levels; fear of movement; self efficacy for pain and for exercise; and use of oral pain medications.DiscussionInnovative and scalable approaches to OA education, physical activity, and exercise are required in order to improve exercise participation/engagement and mitigate physical inactivity in the hip OA population. This will help minimise the burden of this major public health issue on individuals and society.Trial registrationAustralia New Zealand Clinical Trials Registry (ACTRN12622001533785).

Impact of self-directed exercise intervention in a minority rich, hematopoietic stem cell transplant (HSCT) inpatient population at high risk for sarcopenia and falls.

390 Background: Extended hospitalizations in the adult HSCT population increase patients’ risk for deconditioning and sarcopenia. Sarcopenia negatively impacts overall survival in adult HSCT patients (Armenian et al, 2019) and is strongly associated with falls among older adults (Yeung et al, 2019; Marques A &amp; Queirós C., 2018; Wheatley et al, 2021). Methods: In a safety net, minority rich, academic medical center in suburban NYC, stationary pedals were placed inside patient rooms in a 31-bedded inpatient HSCT unit starting Q4 2020. Intentional, inpatient room placement prevented additional risk of infectious exposures to COVID-19 in late 2020-2021, allowed for safe access to pedals from a seated position in chairs inside patient rooms, and provided insight into self-directed exercise participation. Attending MDs, PAs and RNs encourage HSCT patients to utilize stationary pedals up to 3 times daily, while usage remains self-directed. Direct observation of patient pedal usage and patient-verbalized interest in participation reflects positive acceptance and consistent usage since implementation. Results: 2019-2023 Midas Event Reporting data was reviewed by the author. Total numbers of Weak/Impaired Gait patient falls decreased in the post-implementation period: 19 falls at baseline versus 13 falls in 2021, 11 falls in 2022, and 3 falls in Q1 2023. Pre-intervention 2019 data indicates 63.3% of falls are among Weak/Impaired Gait patients. (2020 falls data is not included due to unit closures during the COVID-19 pandemic). Post-intervention 2021-2023 data reveals a mean of 51.2% of falls are in Weak/Impaired Gait patients, indicating a 12.1% decline in falls in the post-intervention period of 2.25 years. Conclusions: Sarcopenia and inpatient falls impact patient outcomes (i.e., injuries, extended hospitalizations, and survival) and are financially burdensome. Each inpatient fall, whether injurious or not, costs hospitals approximately 35,000 (Dykes et al, 2023). Reductions in numbers of inpatient falls at this institution are potentially associated with the following hospital cost savings: 210K in 2021, 280K in 2022 and a projected 245K in 2023. Reduction in sarcopenia during extended hospitalizations, when reviewed alongside the financial impact of inpatient falls, supports the ongoing implementation of self-directed exercises in this population. Next steps include self-directed use of resistance bands, chair-based and bed-based stretches, and utilizing self-tracking devices to record exercise duration. (Full references available upon request).

194 Weekend warrior: a structured self-directed physiotherapy exercise programme that enhances weekend exercise in older persons inpatient rehabilitation

Abstract Background Strength and mobility exercise improve functional recovery in older persons rehabilitation. Internal audits and patient feedback show that exercise levels are lower on weekends where no physiotherapy service is available. Weekend physiotherapy intervention reduces length of stay in older persons rehabilitation. Additional interventions may be cost-effective, improve function and quality of life on discharge. This quality improvement project investigates the effect of a structured, self-directed weekend exercise programme on perceived exercise levels and satisfaction with weekend exercise levels. This project also investigates the workload of the programme for ward staff. Methods Surveys were completed after patients’ first weekend of admission. Patients self-reported time spent exercising at the weekend and their satisfaction. Weekend Warrior programmes (WWP) were given on week two of admission. Programmes matched manual handling guidelines with a traffic light system (seated = red, standing independently = amber, walking independently = green). Patients completed follow-up surveys after completing 3–4 weeks of WWP. Surveys were given to healthcare assistants to assess WWP workload burden. Results Before completing WWP, patients’ (n = 23) self-assessed exercise times were: 0-10mins exercise n = 8;10-20mins n = 7; 20-30mins n = 6 and &amp;gt; 40mins n = 2. N = 9 reported satisfactory exercise levels on weekends. After completing WWP, patients (n = 17) self-assessed exercise times were: 0-10mins n = 1; 10-20mins n = 11 and 20-30mins n = 5. N = 11 reported satisfactory exercise levels on weekends. N = 14 patients enjoyed participating in WWP. All staff (n = 6) reported that WWP did not significantly increase workload burden and supported the programme’s continuation. No adverse events were reported. Conclusion Weekend Warrior structured, self-directed exercise programme is safe and feasible in this setting. Patients reported enjoying WWP. This programme did not additional workload burden for ward staff.

185 Outcomes from a nutrition and exercise group targeting sarcopenia in older adults attending an integrated care for older persons hub

Abstract Background Sarcopenia refers to the generalised loss of skeletal muscle mass, strength and function. It is closely related to physical frailty, and is a common contributor to the presentation of older adults to integrated care teams. Research has shown that resistance exercises combined with adequate dietary protein intake can reverse sarcopenia. Methods Screening for probable sarcopenia using handgrip strength was introduced as part of the routine comprehensive geriatric assessment. Suitable candidates meeting the inclusion criteria were offered an 8-week program, led by a physiotherapist and a dietitian, incorporating a home-based resistance exercise and nutrition intervention. Measures of strength (using handgrip), muscle mass (using BIA [bioelectrical impedance analysis]) and physical performance (using ‘Timed Up &amp; Go’ [TUG], and gait speed) were taken pre and post intervention. Results 10 participants (2 female, 8 male) completed the program. Following the 8 week intervention, changes were observed in measures of grip strength (median 1.5 kg, P = 0.04), and in physical performance using gait speed (median − 0.355 seconds, P value = 0.8). This was not seen when using TUG to measure physical performance (median + 0.02 seconds). Issues measuring muscle mass in routine clinical practice using BIA were encountered making analysis non uniform within the group. Frailty scores using the fried frailty scale were taken for 6 out of 10 participants in which the median change was −1 on the Fried scale (p = 0.025). Conclusion Participation in this self-directed nutrition and exercise program over an 8 week period was associated with improvements in measures of muscle strength, physical performance (to a lesser extent), and frailty scores. Future work will aim to explore the feasibility of a longer duration of intervention, and to examine whether this results in a greater treatment effect.

The effect of exercise on physical function and medication adherence in women receiving endocrine therapy for breast cancer: The breast cancer endocrine therapy fitness (BE-FIT) randomized controlled trial.

12069 Background: Approximately 20% of women receiving endocrine therapy (ET) for early-stage breast cancer (BrCa) discontinue their regimen due to side effects, including vasomotor symptoms and arthralgias, subjecting them to higher rates of disease recurrence. Exercise is one approach to mitigate ET-related toxicity and potentially improve medication adherence by mitigating ET-related symptoms. However, only 11% of women with BrCa adhere to recommended exercise guidelines. Purpose: To examine the effect of a virtual supervised exercise program for women receiving ET for early-stage BrCa on physical function (PF) (primary outcome) and adherence to ET (secondary outcome). Methods: Participants were recruited through referral by oncology care providers from multiple BC Cancer sites and self-referral. Eligible participants were: females with stage I-III BrCa being treated with curative intent, 19-75 years, taking ET for at least 3 months up to 3 years. Using a partial cross-over design (NCT04824339), participants were randomized to the immediate exercise group (INT) or the delayed exercise group (CON), which crossed over at 8 weeks. The 8-week intervention was comprised of a 50-minute resistance exercise circuit, delivered virtually by an exercise physiologist twice per week via Zoom, and self-directed aerobic exercise (progressing to 90 minutes or more per week of at least moderate intensity). PF was assessed using the 30-second chair stand test. ET adherence was measured by the Voils self-reported medication non-adherence questionnaire. Values reported as means and standard deviations. The difference at 8 weeks by intervention arm was examined using two sample t-test (continuous) or kappa measure of agreement (categorical). Results: A total of 132 women were randomized. On average, women were 54 years, White (European) (47%), married (64%), had at least a bachelor’s degree or higher (51%), and had a body mass index of 27.7 kg/m2. The most common type of ET women received was Letrozole (43%), followed by Tamoxifen (36%). At 8 weeks, there was a significant improvement in PF for INT versus CON (mean change +2.5±2.9 vs. +0.7±2.2 stands, p&lt; 0.001). There was no difference between groups in change in medication adherence status (k = 0.35). Conclusions: An 8-week virtual supervised exercise program for women receiving ET for early-stage BrCa significantly improved PF but did not change medication adherence at 8 weeks. The potential impact of the intervention on long-term medication adherence will be explored up to one year and with covariates. Based on improvement in PF, future trials to establish effectiveness and inform implementation are warranted. Clinical trial information: NCT04824339 .

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.

Exercise Perceptions and Experiences in Adults With Crohn's Disease Following a Combined Impact and Resistance Training Program: A Qualitative Study.

Exercise is increasingly being recognized to counteract specific complications of Crohn's disease (CD). The aim of this study was to explore exercise experiences and perceptions after engaging in a combined impact and resistance training program, involving both intervention and control group viewpoints. Semistructured telephone interviews, involving a convenience sample of participants with CD (n = 41; aged 49.1 ± 12 years) were undertaken up to 6 weeks following completion of the program. Data were analyzed using thematic analysis. Four overarching themes emerged, along with 11 subthemes: (1) Lack of confidence and knowledge, fears surrounding physical ability and symptoms, coupled with issues not addressed as part of the healthcare pathway played a part in transitioning to inactivity; (2) Improvements in strength, mental well-being, physical fitness, fatigue, abdominal and joint pain, comorbidities, and self-management strategies were among the reported benefits of exercise participation; (3) Seeing progress, goal setting, enjoyment, and a peer-led program receiving support and advice increased motivation. Whereas work-related tiredness, other commitments, and self-directed exercise were reported as exercise barriers; (4) The intervention design was well received and the journey from start to finish was positively discussed, important considerations for future interventions and implementation strategies. The study yielded novel perceptions on the transition to inactivity following receiving a diagnosis, physical and psychological benefits accruing from the intervention, and views on program design. Information that will provide an essential step in the development of implementing exercise guidelines into the clinical pathway and supporting individuals with self-management options.

A qualitative evaluation of a clinic versus home exercise rehabilitation program for adults with multiple sclerosis: The tele-exercise and multiple sclerosis (TEAMS) study

BackgroundSubstantial evidence supports therapeutic exercise for improving health and function in people with multiple sclerosis (MS). However, few studies have considered the patients’ perspective. ObjectiveThis study explored perspectives of adults with MS following participation in a 3-month clinic- and home-based exercise rehabilitation program. MethodsTwenty participants with MS were interviewed using a semi-structured interview guide on the design and implementation processes of the exercise programs as well as any perceived facilitators or barriers to exercise. Data analysis was conducted using a thematic analysis approach to generate themes from the transcribed interviews. ResultsKey facilitators of exercise for people with MS included perceived improvements in physical health and function, activity participation, and psychosocial health. Mismatched level of exercise with their stage of post-diagnosis and/or functional ability and limited human interaction emerged as barriers to exercise. ConclusionsParticipation in the exercise program was a positive experience for people with MS. Despite the provision of a high level of adaptation and tailored exercise plan and delivery, self-directed exercise continued to present challenges for people with MS. Additionally, the importance of seeking cost-effective ways to maintain motivational support was implicit in participant responses. The findings provided an improved understanding of personal experiences and exercise perspectives that can inform future intervention strategies aimed at promoting sustained exercise participation.

Exercise Self-efficacy Improvements During Cardiac Rehabilitation: IMPACT OF SOCIAL DISPARITIES.

The objective of this study was to determine exercise self-efficacy improvements during cardiac rehabilitation (CR) and identify predictors of exercise self-efficacy change in CR participants. Patients with coronary heart disease at four metropolitan CR sites completed the Exercise Self-efficacy Scale at entry and completion. A general linear model identified independent predictors of change in exercise self-efficacy. The mean age of patients (n = 194) was 65.9 ± 10.5 yr, and 81% were males. The majority (80%) were married or partnered, 76% were White, and 24% were from an ethnic minority background. Patients received CR in-person (n = 91, 47%) or remote-delivered (n = 103, 54%). Exercise self-efficacy mean scores improved significantly from 25.2 ± 5.8 at CR entry to 26.2 ± 6.3 points at completion ( P = .025). The majority of patients (59%) improved their self-efficacy scores, 34% worsened, and 7% had no change. Predictors of reduced exercise self-efficacy change were being from an ethnic minority (B =-2.96), not having a spouse/partner (B =-2.42), attending in-person CR (B =1.75), and having higher exercise self-efficacy at entry (B =-0.37) (adjusted R2 = 0.247). Confidence for self-directed exercise improves in most, but not all, patients during CR. Those at risk for poor improvement (ethnic minorities, single patients) may need extra or tailored support, and screening for exercise self-efficacy at CR entry and completion is recommended. Differences identified from CR delivery mode need exploration using robust methods to account for complex factors.

Evaluation of two electronic-rehabilitation programmes for persistent knee pain: protocol for a randomised feasibility trial

IntroductionPersistent, knee pain is a common cause of disability. Education and exercise treatment are advocated in all clinical guidelines; however, the increasing prevalence of persistent knee pain presents challenges for...