Self-reported Exercise Research Articles

Influence of self-reported physical exercise on musculoskeletal pain among Chinese medical students.

From January to April 2020, the COVID-19 pandemic affected eastern China, leading medical students to adopt home protection measures that significantly altered their physical activity and lifestyle habits. This study aimed to assess the prevalence of musculoskeletal pain (MSP) among medical students during home protection and to analyze the influence of demographic factors, physical exercise habits during normal school life, home protection data on MSP. This research provides a foundation for developing interventions to reduce MSP among medical students. A cross-sectional survey was conducted at Nanjing Medical University in Jiangsu Province from January to April 2020, utilizing the Nordic Musculoskeletal Questionnaire (NMQ) to measure MSP. Multivariate logistic regression identified factors influencing MSP. A total of 859 students participated, with a 40.2% prevalence of MSP during home protection. Multivariate analysis showed that female sex (OR: 1.648; 95% CI: 1.157-2.347), irregular physical exercise during school (OR: 1.648; 95% CI: 1.157-2.347), and less than or equal to six hours of sleep per day during home protection (OR: 1.474; 95% CI: 1.020-2.131) were significant risk factors. The high prevalence of MSP underscores the need for interventions that focus on gender-specific risks, promote regular physical exercise, and ensure adequate sleep.

Feasibiliy, safety and patient perceptions of an exercise-based cardiac telerehabilitation programme

Abstract Background Despite proven benefits of exercise-based cardiac rehabilitation (EBCR), few patients with myocardial infarction (MI) complete these programs and there is a need to develop more flexible and evidence-based options. Purpose The aim of this study was to evaluate feasibility, safety, and patient perceptions of remotely delivered EBCR. Methods This study was conducted at 23 cardiac rehabilitation centres during the Covid-19 pandemic (March 2020-September 2022), when access to centre-based EBCR was restricted. A total of 231 patients with MI <80 years were included 2-4 weeks after discharge to participate in a remote EBCR programme 2 times/week for 3-4 months. Exercise was delivered through a real-time group-based video meeting, connecting the physiotherapist to patients exercising at home. Safety monitoring in terms of adverse events (AE) and serious adverse events (SAE) were recorded. Outcomes were assessed before and after remote EBCR completion and comprised tests of physical fitness and questionnaires: self-reported physical activity and exercise (Haskell questionnaire), physical capacity (VAS), kinesiophobia (TSK-Heart), health-related quality of life (EQ5D-VAS), self-efficacy for exercise, and patient acceptance of the program. Results Patients performed in median 19 (Q1 9 - Q3 23) remote EBCR sessions. A total of 16 AEs were registered during exercise (e.g chest pain, syncope, dizziness, musculoskeletal symptoms) which were all resolved. Two SAEs that required hospitalization were reported (chest pain, in-stent restenosis), both unrelated to exercise. At end of remote EBCR, significant improvements in physical fitness, self-reported exercise and physical capacity, kinesiophobia, and health-related quality of life were observed (Table 1). Delta values were similar to previous centre-based EBCR studies. Patients agreed that remote EBCR improved health care access (83%), was easy to use (94%), and 95% found exercise performance and interaction acceptable. Conclusions This study supports that remote EBCR is feasible and safe with a high patient acceptance post-MI. The clinical effectiveness needs to be confirmed in a randomized controlled design.

A full-factorial test of motivational and volitional intervention strategies for promoting exercise habit formation and exercise maintenance among new users of an online exercise class platform.

Interventions often fail to achieve long-term behavioral maintenance. Utilizing motivational and volitional strategies to promote behavioral maintenance factors may improve this. Using a full-factorial experiment, we tested the effects of three intervention components (focused on intrinsic motivation and identity, exercise preparation habit, and exercise instigation habit) on exercise participation over a year, among new users (N = 751; 91% identifying as female, 54% identifying as White race) of a global, online exercise class platform, run by Les Mills International Ltd, called LM+. We also tested the intervention components' theoretical mechanisms of action-habit formation, intrinsic motivation, identity, and self-efficacy. Multi-level models found some support for a main effect of the exercise preparation habit intervention component in promoting self-reported and objective exercise participation (behavioral outcomes measured via monthly surveys and the LM+ platform; mechanisms measured via monthly surveys)-in particular online exercise class frequency (fixed effect estimate = 0.84, p < 0.05, and = 0.12, p < 0.05, respectively). The preparation habit component also significantly increased preparation habit strength (0.30, p < 0.05) and instigation habit strength (0.33, p < 0.05). Other expected effects were nonsignificant. Helping individuals form an exercise preparation habit may facilitate initiating and maintaining exercise over time, in particular for attending online exercise classes, potentially through promoting greater preparation and exercise instigation habit strength.

Use of a Single-item Exercise Questionnaire Predicts Prognostic Risk among Patients undergoing Stress PET-MPI

BackgroundExercise activity reduces mortality and favorably influences mediators of risk, including myocardial flow reserve (MFR) and chronotropic responsiveness. Comprehensive research regarding the relationship between exercise activity, MFR, and chronotropic response to pharmacological stress, as assessed by heart rate response (HRR) among patients undergoing PET myocardial perfusion imaging (MPI) has not been performed. Thus, we aimed to evaluate the relationship between exercise activity as assessed by a practical single-item questionnaire, MFR and HRR, and longitudinal clinical risk. MethodsWe studied outpatients who underwent pharmacological stress rubidium-82. PET-MPI and answered a self-reported one-item exercise activity questionnaire (0-10 scale) at the time of PET-MPI. HRR was calculated by the following equation: (stress HR-rest HR)/rest HR*100 (%). The primary outcome was death or myocardial infarction. ResultsOf 1,686 patients, 221 (13%) patients had hard events during our mean follow up of 3.8 years. Patients were divided into four groups: no/minimal exercise (n=551), low exercise (n=468), moderate exercise (n=485), and high exercise (n=182) based on the questionnaire. MFR and HRR increased with exercise activity in a stepwise manner. By Cox analysis adjusted for clinical and PET-MPI variables including MFR and HRR, exercise activity was independently associated with hard events (HR [95%CI] per activity scale, 0.95 [0.91-0.99]; p=0.028). ConclusionsPatients with higher exercise activity assessed by a practical single-item questionnaire had higher MFR and HRR. Exercise activity was an independent predictor of hard events in patients undergoing PET-MPI. Because of its ease of use, this single-item questionnaire should be applied among patients undergoing stress MPI.

Examining Real-World Evidence of Depression-Related Symptom Reduction Through a Comprehensive Holistic Lifestyle Intervention

Depression is a global health concern, with various treatments available. In this study, participants (n = 430) were self-selected or medically referred to a residential lifestyle program at the Black Hills Health &amp; Education Center (BHHEC), with a mean stay of 19 days. Individualized treatment plans included structured physical activity sessions, counseling sessions, and the provision of a vegan diet. Beck Depression Inventory-II, self-reported total exercise minutes, resistance exercise minutes, and sleep, along with the number of holistic treatments and counseling sessions, were evaluated. Paired samples t-tests indicated a significant decrease in depression scores over time (MT1 = 20.14, MT2 = 6.17, P &lt; .001). Results from the multiple linear regression that evaluated total exercise minutes, resistance exercise, number of treatments and counseling sessions, and average reported hours of nightly sleep on depression scores at time 2 indicated that average reported hours of nightly sleep were the only significant predictor of depression scores at time 2 ( P &lt; .05). While depression scores significantly improved from baseline to post-assessment for all participants, it is possible that an unmeasured variable, or the synergistic intervention effect of the wellness program, accounted for changes in depressive symptoms over time. Future studies should incorporate sleep quality and assessing time spent in nature to explore these relationships further.

Decomposition Analysis of Depressive Symptom Differences Among Older Adults With Hypertension Between Urban and Rural Areas: Cross-Sectional Study.

Hypertension is the most prevalent chronic disease among China's older population, which comprises a growing proportion of the overall demographic. Older individuals with chronic diseases have a higher risk of developing depressive symptoms than their healthy counterparts, as evidenced in China's older population, where patients with hypertension exhibit varying rates of depression depending on residing in urban or rural areas. This study aimed to investigate factors influencing and contributing to the disparities in depressive symptoms among older urban and rural patients with hypertension in China. We used a cross-sectional study design and derived data from the 8th Chinese Longitudinal Health Longevity Survey of 2018. The Fairlie model was applied to analyze the factors contributing to disparities in depressive symptoms between urban and rural older populations with hypertension. The sample size for this study was 5210, and 12.8% (n=669) of participants exhibited depressive symptoms. The proportions of depressive symptoms in rural and urban areas were 14.1% (n=468) and 10.7% (n=201), respectively. In rural areas, years of education (1-6 years: odds ratio [OR] 0.68, 95% CI 1.10-1.21; ≥7 years: OR 0.47, 95% CI 0.24-0.94), alcohol consumption (yes: OR 0.52, 95% CI 0.29-0.93), exercise (yes: OR 0.78, 95% CI 0.56-1.08), and sleep duration (6.0-7.9 hours: OR 0.29, 95% CI 0.17-0.52; 8.0-9.9 hours: OR 0.24, 95% CI 0.13-0.43; ≥10.0 hours: OR 0.22, 95% CI 0.11-0.41) were protective factors against depressive symptoms in older adults with hypertension, while gender (female: OR 1.94, 95% CI 1.33-2.81), self-reported income status (poor: OR 3.07, 95% CI 2.16-4.37), and activities of daily living (ADL) dysfunction (mild: OR 1.69, 95% CI 1.11-2.58; severe: OR 3.03, 95% CI 1.46-6.32) were risk factors. In urban areas, age (90-99 years: OR 0.37, 95% CI 0.16-0.81; ≥100 years: OR 0.19, 95% CI 0.06-0.66), exercise (yes: OR 0.33, 95% CI 0.22-0.51), and sleep duration (6.0-7.9 hours: OR 0.27, 95% CI 0.10-0.71; 8.0-9.9 hours: OR 0.16, 95% CI 0.06-0.44; ≥10.0 hours: OR 0.18, 95% CI 0.06-0.57) were protective factors, while years of education (1-6 years: OR 1.91, 95% CI 1.05-3.49), self-reported income status (poor: OR 2.94, 95% CI 1.43-6.08), and ADL dysfunction (mild: OR 2.38, 95% CI 1.39-4.06; severe: OR 3.26, 95% CI 1.21-8.76) were risk factors. The Fairlie model revealed that 91.61% of differences in depressive symptoms could be explained by covariates, including years of education (contribution 63.1%), self-reported income status (contribution 13.2%), exercise (contribution 45.7%), sleep duration (contribution 20.8%), ADL dysfunction (contribution -9.6%), and comorbidities (contribution -22.9%). Older patients with hypertension in rural areas had more depressive symptoms than their counterparts residing in urban areas, which could be explained by years of education, self-reported income status, exercise, sleep duration, ADL dysfunction, and comorbidities. Factors influencing depressive symptoms had similarities regarding exercise, sleep duration, self-reported income status, and ADL dysfunction as well as differences regarding age, gender, years of education, and alcohol consumption.

Self-Reported Exercise Activity Predicts Hard Events Independently of Myocardial Flow Reserve and Chronotropic Response in Patients Undergoing PET-MPI

Self-Reported Exercise Activity Predicts Hard Events Independently of Myocardial Flow Reserve and Chronotropic Response in Patients Undergoing PET-MPI

The Impact of High Levels of Compensatory Exercise on Treatment Outcomes in Threshold and Subthreshold Bulimia Nervosa.

Bulimia nervosa (BN) and other specific feeding or eating disorders with subthreshold BN symptoms (OSFED-BN) are characterized by recurrent binge eating episodes accompanied by compensatory behaviors, including excessive exercise. We aimed to examine the role of compensatory exercise on several clinical disorder-related variables and the treatment outcomes. The sample included 478 patients diagnosed with either BN or OSFED-BN admitted for a 16-week eating disorder-specific treatment program. A battery of questionnaires was administered to evaluate eating and general psychopathology, and personality traits. Other clinical disorder-related data, including levels of compensatory exercise, were assessed through a semi-structured clinical interview. Between-group comparisons of compensatory exercise levels were analyzed, as a predictive model of risk of poor treatment outcomes. Path analysis was conducted using structural equation models to estimate the direct and indirect effects between the main variables. Higher levels of self-reported compensatory exercise were associated with greater eating psychopathology, general psychopathology, and more dysfunctional personality traits and were a predictor of poor treatment outcomes. Additionally, these levels achieved a mediating role in several paths contributing to a higher likelihood of a poor outcome. Further research is required to determine how psychotherapeutic approaches can be optimized to adequately include adaptive exercise for these patients.

Attitudes and doping prevalence among Norwegian youth across exercise activities

BackgroundUse of image and performance enhancing drugs (IPEDs), such as anabolic-androgenic steroids, has in the last decades spread from elite athletes to recreational exercisers seeking a shortcut to a lean and muscular physique. The drugs are associated with multiple potential negative health consequences, some of which may be particularly harmful for adolescents. To better develop adequate and targeted preventive measures, identifying individuals and groups at risk for using IPEDs are important. MethodsBy analyzing quantitative data extracted from Ungdata, a national data collection survey on adolescent health and well-being, this study describe self-reported physical activity and exercise habits, IPED prevalence, and attitudes and intentions towards IPEDs among 88 412 Norwegian adolescents aged 13–19 years. Results72 % participated in weekly sport or physical exercise. Young adolescents mostly exercised in sport clubs while older adolescents preferred training in gyms. Average lifetime IPED prevalence was 2.2 % (0.7 %–4.0 % depending on exercise activity). Respondents reported more favorable attitudes and higher intentions to use IPEDs when it was related to increasing muscle size (18 % and 5.8 %, respectively) and reducing weight (19 %, 8.1 %), compared to improving sport performance (5.6 %, 3.0 %). Large variations in attitudes and intentions were found between exercise groups, with individuals exercising in gyms having more favorable attitudes toward IPEDs than other groups. ConclusionThe study finds a low relative prevalence, but high acceptance for IPED use in certain exercise groups. Education and preventive measures should specifically target groups at risk for future use of these drugs.

Digital Gaming and Exercise Among Youth With Type 1 Diabetes: Cross-Sectional Analysis of Data From the Type 1 Diabetes Exercise Initiative Pediatric Study.

Regular physical activity and exercise are fundamental components of a healthy lifestyle for youth living with type 1 diabetes (T1D). Yet, few youth living with T1D achieve the daily minimum recommended levels of physical activity. For all youth, regardless of their disease status, minutes of physical activity compete with other daily activities, including digital gaming. There is an emerging area of research exploring whether digital games could be displacing other physical activities and exercise among youth, though, to date, no studies have examined this question in the context of youth living with T1D. We examined characteristics of digital gaming versus nondigital gaming (other exercise) sessions and whether youth with T1D who play digital games (gamers) engaged in less other exercise than youth who do not (nongamers), using data from the Type 1 Diabetes Exercise Initiative Pediatric study. During a 10-day observation period, youth self-reported exercise sessions, digital gaming sessions, and insulin use. We also collected data from activity wearables, continuous glucose monitors, and insulin pumps (if available). The sample included 251 youths with T1D (age: mean 14, SD 2 y; self-reported glycated hemoglobin A1c level: mean 7.1%, SD 1.3%), of whom 105 (41.8%) were female. Youth logged 123 digital gaming sessions and 3658 other exercise (nondigital gaming) sessions during the 10-day observation period. Digital gaming sessions lasted longer, and youth had less changes in glucose and lower mean heart rates during these sessions than during other exercise sessions. Youth described a greater percentage of digital gaming sessions as low intensity (82/123, 66.7%) when compared to other exercise sessions (1104/3658, 30.2%). We had 31 youths with T1D who reported at least 1 digital gaming session (gamers) and 220 youths who reported no digital gaming (nongamers). Notably, gamers engaged in a mean of 86 (SD 43) minutes of other exercise per day, which was similar to the minutes of other exercise per day reported by nongamers (mean 80, SD 47 min). Digital gaming sessions were longer in duration, and youth had less changes in glucose and lower mean heart rates during these sessions when compared to other exercise sessions. Nevertheless, gamers reported similar levels of other exercise per day as nongamers, suggesting that digital gaming may not fully displace other exercise among youth with T1D.

Relationships among age, motivation, and exercise among women Veterans

Physical activity (PA) and exercise are central to maintaining health, however research has shown steep declines in PA and exercise among women Veterans as they age. Though motivation may be an important contributor to initiating and sustaining exercise that may change across the lifespan, little is known about exercise motivation and its relation to age and exercise behavior among women Veterans. This cross-sectional study sought to describe exercise motivations, examine relationships among exercise motivations and age, and explore the degree to which age and motivation predict self-reported exercise behavior among women Veterans. We conducted a secondary data analysis from a regional mail survey of 197 women Veterans (mean age = 51; SD = 10.5) enrolled in Veterans Health Administration primary care in a northeastern region (N = 180 in analysis). Measures included demographics (age, body mass index), self-reported exercise motivation, and an estimate of average weekly exercise. Participants endorsed multiple motivators for exercise, most prominently fitness and health management. Age was significantly negatively related to amount of exercise and with socializing as an exercise motivation. After accounting for body mass index, age was a significant predictor of exercise behavior, and exercise motivations accounted for an additional 7.3% of variance in self-reported weekly exercise. Our results suggest that although motivation is a potentially important predictor of exercise, factors beyond motivation may better predict exercise in women Veterans. Further research is needed on personal and practical facilitators and barriers to exercise in this population.

Gardening and subjective cognitive decline: a cross-sectional study and mediation analyses of 136,748 adults aged 45+ years

BackgroundGiven the benefits of gardening for physical and psychological health, we explored whether gardening was associated with lower risks of subjective cognitive decline (SCD), a precursor of dementia, and SCD-related functional limitations.MethodsIncluded in this cross-sectional study were 136,748 participants aged 45 + years old from the Behavioral Risk Factor Surveillance System 2019 survey, who were then categorized into three groups according to self-reported exercise status: non-exercisers, gardeners, and other exercisers. SCD was assessed via a questionnaire, and SCD-related functional limitations were referred to as having difficulties in engaging in household or social activities due to SCD. The odds ratio (OR) and 95% confidence interval (CI) were calculated to assess the associations of gardening with SCD and SCD-related functional limitations, adjusted for age, sex, socioeconomic status, lifestyle factors, and health status. Mediation analyses were conducted to examine whether the observed association between gardening and SCD was mediated by energy expenditure (MET-hours/week), depression status, and consumption of fruits and vegetables.ResultsOverall, 11.1% and 5.4% of participants self-reported experiencing SCD and SCD-related functional limitations, respectively. The adjusted OR for gardeners vs. non-exercisers, was 0.72 (95% CI 0.62–0.83) for SCD and 0.57 (95% CI 0.44–0.73) for SCD-related functional limitations. The observed association between gardening and SCD was explained by higher energy expenditure (39.0%), lower likelihood of having depression (21.5%), and higher consumption of fruits and vegetables (3.4%) (P<0.05 for all). Similar patterns were observed for SCD-related functional limitations.ConclusionIn this nationally representative sample, gardening was associated with better cognitive status, which may be mainly attributed to better depression status and energy expenditure.

A commentary on 'The obesity challenge in joint replacement: a multifaceted analysis of self-reported health status and exercise capacity using NHANES data - a population-based study'.

A commentary on 'The obesity challenge in joint replacement: a multifaceted analysis of self-reported health status and exercise capacity using NHANES data - a population-based study'.

Implementing Safewards on Children and Young People’s Wards: A Process and Outcomes Evaluation

Safewards reduces conflict and containment on adult inpatient wards but there is limited research exploring the model in Children and Young People (CYP) mental health services. We investigated whether Safewards can be successfully implemented on twenty CYP wards across England. A process and outcomes evaluation was employed, utilizing the Integrated Promoting Action on Research Implementation in Health Sciences (i-PARiHS) framework. Existing knowledge and use of Safewards was recorded via a self-report benchmarking exercise, verified during visits. Implementation of the 10 Safewards components on each ward was recorded using the Safewards Organizational Fidelity measure. Data from 11 surveys and 17 interviews with ward staff and four interviews with project workers were subject to thematic analysis and mapped against the four i-PARiHS constructs. Twelve of the 20 wards implemented at least half of the Safewards interventions in 12 months, with two wards delivering all 10 interventions. Facilitators and barriers are described. Results demonstrated Safewards is acceptable to a range of CYP services. Whilst implementation was hindered by difficulties outlined, wards with capacity were able and willing to implement the interventions. Results support the commissioning of a study to evaluate the implementation and outcomes of Safewards in CYP units.

Abstract PO3-11-07: Dose-response association between post-diagnosis exercise and clinical outcomes among survivors of breast cancer (BC)

Abstract Background: Higher levels of pre and post-diagnosis physical exercise lead to reduced risk of death among survivors of BC. However, the effect of exercise on recurrence remains unclear. Furthermore, previous studies assumed a linear relationship between exercise and clinical outcomes, used discrete classifications of exercise and did not report results according to BC subtype. The aim of this study was to investigate the dose–response relationship of exercise and clinical outcomes among survivors of BC and by BC subtypes. Methods: We included pts diagnosed with stage I-III BC from the CANTO cohort (NCT01993498). CANTO collects longitudinal data, including self-reported exercise exposure using the Global Physical Activity Questionnaire (GPAQ-16), at diagnosis (dx), 1 (T1), 2 (T2) and 4 (T3) years after dx. Exercise exposure in travel and leisure time was calculated according to GPAQ16 guidelines to derive a total MET-hours per week (MET-h/w) at dx and T1 and absolute change in exercise was computed between these timepoints. Outcome of interest was distant relapse-free interval (DRFI) according to STEEP criteria. Restricted cubic splines from unadjusted Cox models assessed the dose-response relationship between exercise and DRFI in the overall cohort and by BC subtype. Kaplan-Meier estimator, log-rank test and multivariate Cox models assessed the prognostic role of exercise. Results: In the overall cohort with available data on exercise at dx (N=10,359) mean (SD) age and BMI were 56.3 (11.2) years and 25.9 (5.4) kg/m2, 38.7% of pts were premenopausal, 52.9% received chemotherapy and 81.9% hormonal therapy, 57.1% were meeting WHO exercise recommendations at dx. At a median (IQR) follow-up of 5.5 (3.9-6.5) years, 541 DRFI events were observed. In the overall cohort, the spline showed a significant non-linear relationship between exercise at dx and DRFI: exposure greater than ≈5 MET-h/w was associated with an inverse linear risk reduction up to ≈25 MET-h/w. A similar relationship was observed in the HR+/HER2- and HR-/HER2- cohorts. On this basis, exercise was categorized as ‘no exercise’ (0 MET-h/w) and ‘exercise’ (≥ 5 MET-h/w). Pts reporting exercise ≥ 5 MET-h/w had longer DRFI compared to those reporting no exercise in the overall (log-rank p&amp;lt; 0.0001), HR+/HER2- (log-rank p&amp;lt; 0.0113) and HR-/HER2- (log-rank p&amp;lt; 0.0001) cohorts. In multivariate analyses, reporting exercise ≥ 5 MET-h/w was associated with a significant lower risk of DRFI events in the overall (HR 0.75, 95%CI 0.62-0.90) and HR-/HER2- cohorts (HR 0.54, 95%CI 0.37-0.80). Absolute change in exercise exposure from dx to T1 was available in 8,516 pts: 34.2% increased exercise (≥ 5 MET-h/w), 25.9% decreased exercise (≤ -5 MET-h/w) and 39.8% maintained exercise ( &amp;gt; –5 and &amp;lt; +5 MET-h/w). The spline showed a non-significant relationship between change in exercise and risk of DRFI events and change in exercise was not significantly associated with risk of DRFI events in multivariate analyses. Conclusions: In this large, prospective cohort of survivors of BC, higher exercise at diagnosis was associated with reduced risk of DRFI events. The relationship between exercise dose and clinical outcomes appears non-linear and to differ based on subtype. Change in exercise after breast cancer diagnosis does not appear to impact on clinical outcomes. Future studies should aim at validating these findings in independent cohorts. XX XX Citation Format: Davide Soldato, Ines Vaz Luis, Julie Havas, Antonio Di Meglio, Neil Iyengar, Barbara Pistilli, Paul Cottu, Florence Lerebours, Charles Coutant, Aurélie Bertaut, Olivier Trédan, Laurence Vanlemmens, Christelle Jouannaud, Ioana Hrab, Sibille Everhard, Anne-Laure Martin, Fabrice André, Lee Jones. Dose-response association between post-diagnosis exercise and clinical outcomes among survivors of breast cancer (BC) [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-11-07.

THE POTENTIAL ROLE OF EXERCISE IN DELAYING GENETIC DESTINY: EXAMINING THE RELATIONSHIP BETWEEN EXERCISE AND KEY BIOMARKERS IN DOMINANTLY INHERITED ALZHEIMER’S DISEASE

INTRODUCTION Greater physical activity is associated with reduced risk for Alzheimer’s disease (AD), and lower levels of AD-related biomarkers, such as beta-amyloid (Aβ) and tau, measured in the cerebrospinal fluid (CSF) and brain. A small proportion of Alzheimer’s disease (&amp;lt;1%) cases are caused by a rare dominant genetic mutation. The aim of the current study was to examine associations between self-reported exercise participation and AD-related biomarkers (from CSF and brain imaging) over time, in individuals we know will develop Alzheimer’s disease at an early age (i.e., dominant AD mutation carriers). METHODS The sample included n = 308 mutation carriers from the Dominantly Inherited Alzheimer’s Network (DIAN) study with data available for self-reported exercise participation, brain imaging (hippocampal volume, total brain volume, gray matter volume, white matter hyperintensities, brain Aβ levels), and biomarkers quantified from CSF (several Aβ and tau species and ratios). Participants were assessed regularly (time interval depending on mutation type) from baseline to 10+ years post-baseline. Associations between exercise and AD biomarkers (i.e., from brain imaging and CSF) were examined using linear mixed models, corrected for various confounding variables. RESULTS The sample had a mean age of 39.7 ± 10.8 years and were 56% female. Greater baseline exercise was associated with a slower decrease in right (B=0.06, p &amp;lt; 0.001) and left (B=0.06, p&amp;lt;0.05) hippocampal volume; and slower accumulation of brain Aβ (B=0.04, p&amp;lt;0.001). CONCLUSION These findings demonstrate that exercise is associated with more favourable profiles of AD-related biomarkers in those with ADAD mutations. This work may have implications for our understanding of how exercise influences disease development in late-onset sporadic AD. Nevertheless, the causal direction of our findings is difficult to ascertain, and future study designs investigating the therapeutic potential of exercise in both ADAD and late-onset AD should be considered.

Evaluating a Remotely Delivered Cardio-Oncology Rehabilitation Intervention for Patients With Breast Cancer (REMOTE-COR-B): Protocol for a Single-Arm Feasibility Trial.

Exercise rehabilitation is a promising strategy for reducing cardiovascular disease risk among patients with breast cancer. However, the evidence is primarily derived from programs based at exercise centers with in-person supervised delivery. Conversely, most patients report a preference for home-based rehabilitation. As such, there is a clear need to explore strategies that can provide real-time supervision and coaching while addressing consumer preferences. Evidence from cardiac rehabilitation has demonstrated the noninferiority of a smartphone-based telerehabilitation approach (REMOTE-CR) to improve cardiorespiratory fitness in people with cardiovascular disease compared to a center-based program. This study aims to assess the feasibility, safety, and preliminary efficacy of the REMOTE-CR program adapted for patients with breast cancer at risk of cardiotoxicity (REMOTE-COR-B). We will also assess the satisfaction and usability of REMOTE-COR-B. We will conduct a single-arm feasibility study of the REMOTE-COR-B program among patients with stage I-III breast cancer who are at risk of cardiotoxicity (taking treatment type and dose, as well as other common cardiovascular disease risk factors into account) and who are within 24 months of completing primary definitive treatment. Participants (target sample size of 40) will receive an 8-week smartphone-based telerehabilitation exercise program involving remotely delivered real-time supervision and behavior change support. The platform comprises a smartphone and wearable heart rate monitor, as well as a custom-built smartphone app and web application. Participants will be able to attend remotely monitored exercise sessions during set operating hours each week, scheduled in both the morning and evening. Adherence is the primary outcome of the trial, assessed through the number of remotely monitored exercise sessions attended compared to the trial target (ie, 3 sessions per week). Secondary outcomes include additional trial feasibility indicators (eg, recruitment and retention), safety, satisfaction, and usability, and objective and patient-reported efficacy outcomes (cardiovascular fitness, quality of life, fatigue, self-reported exercise, self-efficacy, habit strength, and motivation). Adherence, feasibility, and safety outcomes will be assessed during the intervention period; intervention satisfaction and usability will be assessed post intervention; and objective and patient-reported efficacy outcomes will be assessed at baseline, post intervention (2-month postbaseline assessment), and at follow-up (5-month postbaseline assessment). Recruitment for this trial commenced in March 2023, and 7 participants had been recruited as of the submission of the manuscript. The estimated completion date for the project is October 2024, with results expected to be published in mid-2025. The REMOTE-COR-B intervention is a novel and promising approach to providing exercise therapy to patients with breast cancer at risk of cardiotoxicity who have unique needs and heightened safety risks. This project will provide important information on the extent to which this approach is satisfactory to patients with breast cancer, safe, and potentially effective, which is necessary before larger-scale research or clinical projects. Australian New Zealand Clinical Trials Registry ACTRN12621001557820; www.anzctr.org.au/ACTRN12621001557820.aspx. DERR1-10.2196/53301.

Maximal cardiopulmonary exercise testing in glioblastoma patients undergoing chemotherapy: assessment of feasibility, safety, and physical fitness status.

Maximal cardiopulmonary exercise testing (max. CPET) provides the most accurate measurement of cardiorespiratory fitness. However, glioblastoma (GBM) patients often undergo less intensive tests, e.g., 6-min walk test or self-rating scales. This study aims to demonstrate feasibility and safety of max. CPET in GBM patients, concurrently evaluating their physical fitness status. Newly diagnosed GBM patients undergoing adjuvant chemotherapy were offered participation in an exercise program. At baseline, max. CPET assessed cardiorespiratory fitness including peak oxygen consumption (VO2peak), peak workload, and physical work capacity (PWC) at 75% of age-adjusted maximal heart rate (HR). Criteria for peak workload were predefined based on threshold values in HR, respiratory quotient, respiratory equivalent, lactate, and rate of perceived effort. Data were compared to normative values. Adverse events were categorized according to standardized international criteria. Further, self-reported exercise data pre- and post-diagnosis were gathered. All 36 patients (median-aged 60; 21 men) met the predefined criteria for peak workload. Mean absolute VO2peak was 1750 ± 529 ml/min, peak workload averaged 130 ± 43 W, and mean PWC was 0.99 ± 0.38 W/kg BW, all clinically meaningful lower than age- and sex-predicted normative values (87%, 79%, 90%, resp.). Only once (3%) a minor, transient side effect occurred (post-test dizziness, no intervention needed). Self-reported exercise decreased from 15.8 MET-h/week pre-diagnosis to 7.2 MET-h/week post-diagnosis. Max. CPET in this well-defined population proved feasible and safe. GBM patients exhibit reduced cardiorespiratory fitness, indicating the need for tailored exercise to enhance health and quality of life. CPET could be essential in establishing precise exercise guidelines.

Association between gardening and multiple sleep complaints: A nationwide study of 62,098 adults

BackgroundPhysical activity was suggested to be related to sleep health, while the gardening-sleep association among the community population remained unrevealed. Therefore, this study aimed to explore whether gardening was associated with sleep complaints. MethodsA total of 62,098 adults from the 2017 Behavioral Risk Factor Surveillance System (BRFSS) were included in this study and further categorized as non-exercisers, gardeners, and other exercisers, based on their self-reported exercise status. Sleep complaints including short/prolonged sleep duration, probable insomnia, daytime sleepiness, and sleep apnea were surveyed via a questionnaire. Primary outcome was multiple sleep complaints (coexistence of ≥2 sleep complaints) and secondary outcomes referred to individual sleep complaints. The adjusted odds ratios (ORs) and 95 % confidence intervals (CIs) were estimated to assess the associations between gardening or tertiles of gardening duration and the outcomes using multivariable logistic regression models. ResultsThe sample included 16,707 non-exercisers, 4243 gardeners, and 41,148 other exercisers. Relative to non-exercisers, gardeners (OR 0.58, 95%CI 0.49–0.67) and other exercisers (OR 0.67, 95%CI 0.61–0.72) had a lower likelihood of experiencing multiple sleep complaints. The adjusted OR comparing the highest gardening duration tertile to non-exercise was 0.45 (95%CI 0.33–0.63) for multiple sleep complaints (P for trend <0.001). Similar patterns persisted in several individual sleep complaints, such as short sleep duration, probable insomnia, daytime sleepiness, and sleep apnea. LimitationsCross-sectional study design and use of self-reported variables. ConclusionsThis nationwide study observed an inverse association of gardening with multiple sleep complaints and several individual sleep complaints, in a dose-response manner.

Long-term recreational exercise patterns in adolescents and young adults: Trajectory predictors and associations with health, mental-health, and educational outcomes.

Individual and societal factors influencing the formation of long-term recreational exercise habits during the transition from adolescence to young adulthood are not well explored. Using data from the Longitudinal Survey of Australian Youth (LSAY), a population-representative cohort study of Young People followed from age 15 to 25, we aimed to (1) model longitudinal recreational exercise trajectories from age 16 to 24, (2) examine predictors at age 15 of entering these trajectories, and (3) explore the association between the trajectories and health, mental health and educational achievement outcomes measured at the final study wave (age 25). Self-reported recreational exercise frequency data from 9353 LSAY participants were analysed using group-based trajectory modelling. We modelled the evolution of two patterns of recreational exercise behaviour: daily exercise, as per public health guidelines (Model 1); and at least once weekly exercise (Model 2). Model 1 trajectories were guideline-adherent exercisers (17.9% of the sample), never guideline exercisers (27.5%), guideline drop-outs (15.2%) and towards guideline (39.4%); Model 2 trajectories were weekly exercise (69.5% of the sample), decreasing (17.4%), increasing (4.8%), and infrequent (8.3%). For both models, at age 15, trajectory membership was predicted by gender, self-efficacy, time spent participating in sport, time spent watching TV, parental socioeconomic status, and academic literacy. At age 25, people in the guideline-adherent exerciser trajectory (model 1) reported better general health relative to other trajectories, Those in the weekly exerciser trajectory (model 2) had better general health and reduced rates of psychological distress, were happier with life and were more optimistic for the future relative to participants in less than weekly trajectory groups. Exercise-promoting interventions for Young People should specifically address the needs of females, people with low self-efficacy, reluctant exercisers, higher academic achievers, and those experiencing socioeconomic disadvantage.