Significant Improvements In VO2peak Research Articles

ARE THERE NON-RESPONDERS TO HIIT IN CANCER SURVIVORS? CHANGES IN CARDIORESPIRATORY FITNESS, BODY COMPOSITION AND SYSTEMIC INFLAMMATION

INTRODUCTION High intensity interval training (HIIT) has been shown to elicit significant improvements in VO2peak in cancer survivors. Only 46-60% of healthy individuals are reported to respond to exercise interventions, though this rate has not been investigated in cancer survivors. AIMS: To determine the response rate in cancer survivors over 28-weeks of HIIT as measured by changes in cardiorespiratory fitness. Secondarily, the study aimed to observe associations between changes in cardiorespiratory fitness, body composition and inflammatory markers. METHODS 131 survivors of breast, prostate or colorectal cancer were observed over 28-weeks of HIIT (4x4 minutes; 85-95% HRpeak). VO2peak, body composition and markers of systemic inflammation were assessed at baseline, four-, 16- and 28-weeks. An improvement in VO2peak of 3.5 ml.kg-1.min-1 was used as a standard of minimal clinically important difference (MCID). Body composition was measured using DEXA, and inflammatory markers were assessed for each timepoint. RESULTS 59.6% of participants improved their VO2peak greater than MCID (+3.5 ml.kg-1.min-1) and these individuals were retrospectively classified as responders. Responders showed improvements in VO2peak at four- and 16-weeks and maintained this change through to 28-weeks (0-4 weeks: +2.92 ml.kg-1.min-1, p<0.001; 0-16 weeks: +5.70 ml.kg-1.min-1, p<0.001; and 0-28 weeks: +5.30 ml.kg-1.min-1, p<0.001). No significant change in VO2peak was seen in non-responders (40.4%). Time since treatment, cancer type, and cancer treatment were all found to contribute to a model predicting VO2peak change (R=0.464, R2 = 21.5%., adj R2=16.1%, p<0.001). Body composition and inflammatory markers improved in response to training however were not associated with VO2peak change. CONCLUSIONS HIIT elicited a MCID in VO2peak in almost 60% of cancer survivors. Independent to VO2peak change and cancer type, survivors showed significant favourable changes in inflammation and body composition in response to training.

Effectiveness of hybrid comprehensive telerehabilitation in heart failure patients with permanent atrial fibrillation - subanalysis of the TELEREH-HF RCT

Abstract Background Atrial fibrillation (AF) negatively impacts physical fitness and quality of life (QoL). Little is known about efficacy of hybrid comprehensive telerehabilitation (HCTR) in heart failure (HF) patients with AF. Purpose The purpose of this study was to assess safety and effectiveness of HCTR in HF patients with permanent AF. Methods The present analysis formed part of TELEREH-HF multicenter, randomized trial that enrolled 850 HF patients (NYHA I-III, LVEF ≤ 40%). Patients were randomized 1:1 to HCTR plus usual care (UC) or UC alone. Patients underwent either an HCTR (1 week in hospital and 8 weeks at home, five times weekly) or UC with observation. The effectiveness of HCTR was assessed by changes in peak oxygen consumption (VO2 peak), workload duration (t) in cardiopulmonary exercise test and quality of life (QoL) based on Medical Outcome Survey Short Form 36 Questionnaire (SF-36). Measurements were made before and after intervention/observation. Results There were 73 patients with permanent AF in HCTR group and 72 patients with permanent AF in UC group. HCTR resulted in a significant improvement in VO2peak and workload duration. We did not observe these favorable results in the UC group. In the HCTR group, there was a significantly greater improvement in physical component of QoL than in the UC group. All results are presented in Table 1. In neither group were there deaths nor major adverse events. Conclusion In HF patients with permanent AF, hybrid comprehensive telerehabilitation is safe and resulted in a significant improvement in physical capacity and physical component of QoL.

5 Large-Scale Network Connectivity and Cognitive Function after Exercise Training in Older Adults

Objective:Despite growing evidence regarding the association between exercise training (ET) and functional brain connectivity, little is known about the effects of ET on within- and between-network functional connectivity (FC) of core brain networks. We investigated the effects of ET on within- and between-network functional connectivity of the default mode network (DMN), frontoparietal network (FPN), and salience network (SAL) in older adults with intact cognition (CN) and older adults diagnosed with mild cognitive impairment (MCI). We further examined whether the ET-induced changes in FC were associated with changes in cognitive performance.Participants and Methods:33 older adults (78.0±7.0 years; 16 MCI and 17 CN) participated in the present study. Before and after a 12-week walking ET intervention, participants underwent cardiorespiratory fitness tests, the Controlled Oral Word Association Test (COWAT), the Rey Auditory Verbal Learning test (RAVLT), a narrative memory test (logical memory; LM), and a resting-state fMRI scan. We examined the within- and between-network connectivity of the DMN, FPN, and SAL before and after ET. We also used linear regression to examine associations between ET-related changes in the within- and between-network connectivity and cognitive function.Results:There were significant improvements in VO2peak, COWAT, RAVLT, and LM after ET across participants. Significant increases in within-network connectivity of the DMN and SAL were observed in response to ET across participants. FC between the DMN-FPN, DMN-SAL, and FPN-SAL were also increased after ET. Moreover, greater SAL within connectivity and FPN-SAL between connectivity were associated with enhanced LM immediate recall performance after ET. There were no significant interactions between Time (before vs after ET) and Group (CN vs MCI) for network connectivity or cognitive function.Conclusions:Our findings suggest that increased within- and between-network connectivity following 12-weeks of walking exercise may subserve improvements in memory performance in older individuals with intact cognition and in those diagnosed with MCI.

Improving Cardiorespiratory and Muscular Function of Korean Firefighters: A Kinect-Based Mixed Reality Device Exercise Intervention Randomized Control Trial.

This study addresses declining physical fitness among Korean firefighters due to a low exercise participation rate caused by the absence of exercise instructors. The research explores Virtual Mate (VM), a Kinect-based mixed reality device, as a potential solution, but its capacity to replace training instructors in enhancing physical fitness remains uncertain. Twenty Korean male firefighters were divided into two groups: the exercise group received an 8-week intervention using VM, while the control group maintained regular physical activity. Cardiopulmonary function and muscle function were measured. After 8 weeks, the exercise group demonstrated a significant improvement in VO 2peak . Furthermore, there were notable enhancements in the strength and endurance of most knee, shoulder, and trunk flexors and extensors. Integrating VM into an exercise program can effectively improve cardiorespiratory and muscular function in Korean firefighters.

Aerobic and Anaerobic Fitness according to High-Intensity Interval Training Frequency in Youth Soccer Players in the Last Stage of Rehabilitation.

In the last stage of rehabilitation, high-intensity interval training (HIIT) for improving physical fitness is appropriate for return-to-play; however, some youth athletes visit the rehabilitation center less frequently due to conflict with their distance to center, and academic schedule. We tested the effects of short-term low-frequency HIIT in 54 youth male soccer players, after dividing them into a low-frequency group (LFG, n = 27 players) and a high-frequency group (HFG, n = 27 players). Muscle mass and body fat were measured using a body composition test, and VO2peak and exercise duration were measured using a treadmill. Five sets of anaerobic peak power and fatigue were measured repeatedly using the Wingate test. To evaluate knee joint muscle function, 60°/s, 180°/s, and 240°/s were measured using the isokinetic muscle function equipment. HIIT sessions were conducted twice a week for LFG and five times a week for HFG for 4 weeks. In this study, Wilcoxon signed-rank test and Mann-Whitney U test were mainly used for analysis. Significant improvements in VO2peak, anaerobic peak power, and knee strength were observed after intervention in both groups (p < 0.05). In the post test, there were significant differences between groups in VO2peak (LFG, 56.4 vs. HFG, 57.1 mL/kg/min; p = 0.035), exercise duration (LFG, 972.3 vs. HFG, 990.4 s; p = 0.041), Wingate anaerobic peak power 5 sets (LFG, 606.3 vs. HFG, 629.3 Watt; p = 0.039), and muscle function test 240°/s (LFG, 68.5 vs. HFG, 70.2 Jouls; p = 0.010). However, neither group showed significant changes in body composition, such as muscle mass or body fat (p > 0.05). In conclusion, although it is a short-term training, the effect of HIIT was shown in the HFG as well as LFG. Although HFG improved physical fitness, significant improvement was also achieved in LFG. Therefore, in the last stage of rehabilitation, low frequency as well as high frequency HIIT would be an appropriate training method to improve physical fitness for youth soccer players.

The role of resistance exercise training for improving cardiorespiratory fitness in healthy older adults: a systematic review and meta-analysis.

BackgroundDeclines in cardiorespiratory fitness (CRF) and muscle mass are both associated with advancing age and each of these declines is associated with worse health outcomes. Resistance exercise training (RET) has previously been shown to improve muscle mass and function in the older population. If RET is also able to improve CRF, as it has been shown to do in younger populations, it has the potential to improve multiple health outcomes in the expanding older population.MethodsThis systematic review aimed to identify the role of RET for improving CRF in healthy older adults. A search across CINAHL, MEDLINE, EMBASE and EMCARE databases was conducted with meta-analysis performed on eligible papers to identify improvements in established CRF parameters (VO2 peak, aerobic threshold (AT), 6-minute walking distance test (6MWT) following RET intervention. Main eligibility criteria included older adults (aged over 60), healthy cohorts (disease-specific cohorts were excluded) and RET intervention.ResultsThirty-seven eligible studies were identified. Meta-analysis revealed a significant improvement in VO2 peak (MD 1.89 ml/kg/min; 95% confidence interval (CI) 1.21–2.57 ml/kg/min), AT (MD 1.27 ml/kg/min; 95% CI 0.44–2.09 ml/kg/min) and 6MWT (MD 30.89; 95% CI 26.7–35.08) in RET interventions less than 24 weeks. There was no difference in VO2 peak or 6MWT in interventions longer than 24 weeks.DiscussionThis systematic review adds to a growing body of evidence supporting the implementation of RET in the older population for improving whole-body health, particularly in time-limited timeframes.

Blood Lactate AUC Is a Sensitive Test for Evaluating the Effect of Exercise Training on Functional Work Capacity in Patients with Chronic Heart Failure.

Purpose Exercise training is an essential treatment option for patients with chronic heart failure (CHF). However, it remains controversial, which surrogate measures of functional work capacity are most reliable. The purpose of this paper was to compare functional capacity work measured as capillary lactate concentrations area under the curve (AUC) with standard cardiopulmonary exercise testing (CPET) with VO2peak and the 6-minute walk test (6 MWT). Methods Twenty-three patients in New York Heart Association (NYHA) class II/III with left ventricular ejection fraction (LVEF) <35% were randomised to home-based recommendation of regular exercise (RRE) (controls), moderate continuous training (MCT) or aerobic interval training (AIT). The MCT and AIT groups underwent 12 weeks of supervised exercise training. Exercise testing was performed as standard CPET treadmill test with analysis of VO2peak, the 6 MWT and a novel 30-minute submaximal treadmill test with capillary lactate AUC. Results All patients had statistically significant improvements in VO2peak, 6 MWT and lactate AUC after 12 weeks of exercise training: 6 MWT (p =0.035), VO2peak (p =0.049) and lactate AUC (p =0.002). Lactate AUC (p =0.046) and 6MWT (p =0.035), but not VO2peak revealed difference between the exercise modalities regarding functional work capacity. Conclusion 6-MWT and lactate AUC, but not VO2peak, were able to reveal a statistically significant improvement in functional capacity between different exercise modalities.

Efficacy of High-Intensity Intermittent Training for Improving Cardio-Metabolic Health in Women With Polycystic Ovary Syndrome

Abstract Polycystic ovary syndrome (PCOS) is a common and complex endocrinopathy with significant metabolic and reproductive manifestations, carrying a major health and economic burden. Consistent improvements in clinical outcomes have been reported as a result of exercise training, but shortfalls with exercise prescription are evident. Research suggests that high-intensity intermittent training (HIIT) is feasible, well tolerated and enjoyable for people with or at risk of chronic disease and can address many of the shortfalls and barriers to exercise participation. To investigate the effects of high-intensity exercise on cardio-metabolic health, twenty-four reproductive aged, overweight or obese, sedentary women with PCOS were recruited from the community and randomised to complete either 12 weeks of moderate intensity continuous cycling training (MICT; 60–65% of maximal heart rate [HRmax]; n=11) or HIIT (90–100% HRmax; n=13). All exercise was supervised by an exercise physiologist and completed 3 times per week on a cycle ergometer. Baseline and post-testing measures consisted of peak oxygen consumption (VO2peak) determined by a graded maximal exercise test, body composition by DXA scan and insulin sensitivity determined by euglycaemic-hyperinsulinaemic clamp. Significant improvements in VO2peak were seen after both HIIT (P &amp;lt;0.001) and MICT (P &amp;lt;0.013) with a significant between-group interaction favouring HIIT (P = 0.014). The insulin sensitivity index significantly improved after HIIT (P = 0.009) with no changes observed after MICT (P = 0.860), also resulting in a significant between-group difference favouring HIIT (P = 0.046). No changes were observed for body weight, BMI or fat mass, however, there was a significant increase in percentage of lean mass after HIIT (P = 0.026). The present study is the first to compare current exercise recommendations of moderate and vigorous intensities in women with PCOS. The results of this study provide preliminary validation of HIIT, suggesting that vigorous intensity exercise should be considered in order to improve cardio-metabolic health in women with PCOS.

Feasibility and adherence to moderate intensity cardiovascular fitness training following stroke: a pilot randomized controlled trial

BackgroundStroke is a leading cause of disability worldwide and the cardiovascular fitness levels of stroke survivors are diminished to an extent that impairs functioning and activities of daily living performance. While cardiovascular training seems an empirically appropriate intervention, the optimal dosage and intensity of cardiovascular training in stroke survivors remains unclear. The aim was to determine the safety and feasibility of moderate-intensity cardiovascular training following stroke, including measurement of adherence to training.MethodsA pilot, prospective, patient- and assessor-blinded randomised controlled trial conducted in a tertiary, metropolitan hospital-based community rehabilitation centre. Eligibility criteria included ambulant (> 100 m), 6 weeks-12 months post stroke. Moderate-intensity fitness training or control (low-intensity) exercise was offered biweekly for 12 weeks. Outcome measures included adverse events, peak oxygen uptake (VO2), functional exercise capacity (6-Minute Walk Test, 10-m Walk Test) and health-related quality of life (Short Form-36) and mood (Patient Health Questionnaire, PHQ9).ResultsFeasibility: Seventy-one (50%) of 141 screened participants were eligible (29% did not agree to participate). Twenty participants (10 intervention, 10 control) were recruited. The median (%; IQR) supervised sessions was 19.5 (81%; 12, 20); and 20 (83%; 19, 22) in the intervention and control groups, respectively. Progression of duration and intensity was limited; mean of 10 sessions to achieve target duration (30 min). There were no adverse events. Baseline peak oxygen uptake (VO2) levels were low (15.94 ml/kg/min). Significant improvements in VO2 peak in both groups were observed (p < 0.05). Although there were no significant between-group differences, this feasibility trial was not powered to detect change.ConclusionsModerate-intensity fitness training was safe but achievement of target duration and intensity was challenging for stroke survivors. A definitive adequately-powered randomised trial is required. Alternative fitness training protocols may need to be explored.Trial registrationThe trial protocol was prospectively registered on the Australian New Zealand Clinical Trials Registry (ACTRN 12613000822785) on 25/07/2013.

Concurrent training effects on heart rate variability, blood pressure and fitness of middle-aged men and women

The concurrent training led to beneficial effects on aerobic fitness and muscle strength. However, its effects on blood pressure (BP) and autonomic control marks are little studied. This study aimed to evaluate the concurrent training effects on BP, autonomic control, aerobic fi tness and muscle strength of middle-aged men and women. Thirty-two volunteers (51.4 ± 4.2 years, systolic BP 115 ± 12 mmHg and diastolic BP 78 ± 8 mmHg) were divided into 4 groups of 8 volunteers: male concurrent training (MCT), female concurrent training (FCT), male sedentary control (MSC) and female sedentary control (FSC) groups. A minimum absence of menstruation for 12-months was required. Concurrent training, six resistance exercise for whole body followed by 30 min of jogging and/or running at 55%–85% of VO2peak, was performed three times a week. The main assessments were rest BP and cardiovascular autonomic markers evaluated through heart rate variability (iRR, LF, HF, LF/HF, RMSSD, pNN50, SD1 and SD2), aerobic fitness measured by cardiorespiratory test (VO2peak) and muscle strength by one repetition maximum (1-RM - arm curl, bench press and leg press). The concurrent training did not change any cardiovascular variables. Regarding fitness the MCT and FCT groups demonstrated signifi cant improvement in VO2peak (13.12% e 8.51%, respectively). Muscle strengthimproved significantly in the MCT group in all three exercises (arm curl: 26.53%; bench press: 25.04%; leg press: 65.37%), while FCT in just two exercises (arm curl: 12.79%; bench press: 17.25%). Although concurrent training appears to be a good alternative for inducing improvements in various physical fitnessvariables in male, its can induce concurrence in leg strength of female. Concurrent training is not an effective strategy to improve BP and autonomic nervous system.

A randomized controlled trial of a structured exercise intervention after the completion of acute cancer treatment in adolescents and young adults.

Cancer treatments are frequently associated with impaired physical fitness, quality of life (QOL), and fatigue, often persisting into survivorship. Studies in older adults with cancer have demonstrated benefits from exercise; however, this has not been rigorously investigated in adolescents and young adults (AYA). The aim of this study was to determine whether a structured 10-week exercise intervention was associated with improved cardiorespiratory fitness (VO2peak ), fatigue, and QOL in AYA who have recently completed cancer treatment. Forty-three AYA (median age 21 ± 6 years) were randomly assigned to an exercise group (n=22) or a control group (n=21). The exercise group received a structured 10-week exercise program comprising progressive aerobic and resistance exercise; the control arm received routine care. VO2peak was measured at baseline, 10weeks, and six months. Fatigue and QOL were assessed by the FACIT fatigue scale and the PEDS QL, respectively. Mean VO2peak at baseline was 26.5 ± 7.2mL.kg-1 .min-1 , which is substantially lower than population norms. The exercise group demonstrated significant improvement in VO2peak at 10weeks compared with controls (33.8 ± 8.1vs 29.6 ± 7.6mL.kg-1 .min-1 , P=0.0002), but by six months, the difference was no longer significant (32.9 ± 7.0vs 30.9 ± 11.0mL.kg-1 .min-1 , P=0.21). There were no significant differences in fatigue or total QOL scores between groups. Cancer treatment is associated with reduced VO2peak in AYA. Improvement in VO2peak was accelerated by a 10-week exercise program; however, no significant benefit was observed in QOL or fatigue. The plateau in VO2peak at six months suggests that a maintenance exercise program may be beneficial.

Combined resistance and aerobic exercise intervention improves fitness, insulin resistance and quality of life in survivors of childhood haemopoietic stem cell transplantation with total body irradiation

To investigate the effects of a supervised combined resistance and aerobic training programme on cardiorespiratory fitness, body composition, insulin resistance and quality of life (QoL) in survivors of childhood haematopoietic stem cell transplantation (HSCT) with total body irradiation (TBI). HSCT/TBI survivors (n=20; 8 females). Mean (range) for age at study and time since HSCT/TBI was 16.7 (10.9-24.5) and 8.4 (2.3-16.0) years, respectively. After a 6-month run-in, participants undertook supervised 45- to 60-minute resistance and aerobic training twice weekly for 6 months, with a 6-month follow-up. The following assessments were made at 0, 6 (start of exercise programme), 12 (end of exercise programme) and 18 months: Body composition via dual energy X-ray absorptiometry, homeostatic model assessment of insulin resistance (HOMA-IR), cardiorespiratory fitness (treadmill-based peak rate of oxygen uptake (VO2 peak) test), QoL questionnaires (36-Item Short Form Health Survey (SF-36) and Minneapolis-Manchester Quality of Life Instrument (MMQL). Results expressed as mean (standard deviation) or geometric mean (range). There were significant improvements in VO2 peak (35.7 (8.9) vs 41.7 (16.1) mL/min/kg, P=0.05), fasted plasma insulin (16.56 (1.48-72.8) vs 12.62 (1.04-54.97) mIU/L, P=0.03) and HOMA-IR (3.65 (0.30-17.26) vs 2.72 (0.22-12.89), P=0.02) after the exercise intervention. There were also significant improvements in the SF-36 QoL general health domain (69.7 (14.3) vs 72.7 (16.0), P=0.001) and the MMQL school domain (69.1 (25.2) vs (79.3 (21.6), P=0.03) during the exercise intervention. No significant changes were observed in percentage body fat, fat mass or lean mass. The supervised 6-month combined resistance and aerobic exercise programme significantly improved cardiorespiratory fitness, insulin resistance and QoL in childhood HSCT/TBI survivors, with no change in body composition, suggesting a metabolic training effect on muscle. These data support a role for targeted physical rehabilitation services in this group at high risk of diabetes and cardiovascular disease.

A Retrospective Comparison of Fitness and Exercise Progression in Patients With Coronary and Peripheral Artery Disease in Cardiac Rehabilitation

BackgroundCardiac rehabilitation (CR) is recommended for patients with coronary (CAD) and peripheral (PAD) artery disease. However, no study has compared changes in cardiorespiratory fitness (VO2peak) or exercise prescription progression among PAD, CAD, and concomitant PAD and CAD (BOTH). The objectives of this study were to 1) compare change in VO2peak among patients with PAD, CAD, and BOTH, and 2) examine progression in exercise prescription parameters in a comprehensive 6-month cardiac rehabilitation (CR) program. MethodsA retrospective analysis of patient data recorded from 2006 to 2017 from a large urban hospital was conducted. Patients with PAD (n = 63) and BOTH (n = 164) were included in the analyses. Patients with CAD (n = 63) were matched to PAD by sex (36.5% female), age (69 years), smoking status, diabetes, and year in program. ResultsThere were significant improvements in VO2peak from baseline to 6 months in all groups (CAD +2.7 ± 3.4 mL⋅kg−1⋅min−1, PAD +2.4 ± 3.8 mL⋅kg−1⋅min−1, BOTH +1.8 ± 3.1 mL⋅kg−1⋅min−1; all P < 0.001). Between-group differences were significant between PAD and CAD as well as between CAD and BOTH (P = 0.001). Walking distance, duration, and pace increased for all groups over 6 months (P < 0.001), with a significant difference in pace between CAD and BOTH (P = 0.006). ConclusionsPatients with PAD, CAD, and BOTH had significant improvements in VO2peak following a 6-month CR program. However, despite similar prescribed walking distance and duration, improvements in VO2peak were mitigated in PAD and BOTH compared with CAD. These results support benefits of CR for patients diagnosed with PAD, but alternate exercise strategies should be explored for patients with PAD.

Prehabilitation With High Intensity Inverval Training Before Major Abdominal Surgery

PURPOSE: Improving cardiopulmonary reserve, or peak oxygen consumption (VO2peak) measured during cardiopulmonary exercise testing (CPET), may reduce complications after surgery. This feasibility study determined the effectiveness of a supervised, preoperative High Intensity Interval Training (HIIT) program in increasing VO2peak by 2ml/kg/min. Clinical outcomes were documented to determine the endpoint most sensitive to improved fitness. METHODS: In this prospective study, participants aged 50-85 undergoing major abdominal surgery were randomised to standard care or 14 sessions of HIIT over 4-6 weeks. HIIT sessions involved approximately thirty minutes of stationary cycling (5 warm-up, 20 interval training, 5 cool-down). Interval training alternated 1 minute of high and low intensity pedalling, with the goal of reaching 90% maximum heart rate during the session. Clinical outcomes included complications, postoperative morbidity survey, length of stay, and Short Form-36 quality of life questionnaire (SF-36). RESULTS: Of 63 participants, 46 completed both CPETs and 51 completed clinical follow-up. On per protocol analysis, mean VO2peak increased 14%, from 20.3-23.2ml/kg/min in the exercise group and 0.7%, from 21.8-22.0 ml/kg/min in the control group. Change in VO2peak was 2.87 vs. 0.14 ml/kg/min (p<.001). Exercisers increased peak work rate by 25 watts. Although there were no significant differences in the clinical outcomes, those most responsive to improved fitness with exercise were: the total number of postoperative complications (0.64 in exercisers vs. 1.16 in controls per patient, p=.07) and the physical component score of the SF-36 (p=.07), with the greatest difference six weeks after surgery indicating a quicker postoperative recovery. CONCLUSION: There was a significant improvement in VO2peak and peak work rate with preoperative HIIT. We also noted a trend towards fewer postoperative complications and a more rapid recovery after surgery. Preoperative HIIT results in a clinically important improvement in cardiopulmonary reserve for patients undergoing abdominal surgery.

Effects of an exercise intervention for patients with advanced inoperable lung cancer undergoing chemotherapy: A randomized clinical trial

ObjectiveExercise can improve treatment-related side effects, quality of life, and function in patients with various types of cancer; however, more evidence is needed for patients with advanced inoperable lung cancer. Material and methodsWe randomized 218 patients with advanced inoperable lung cancer to a 12-week supervised, structured exercise training program (aerobic, strength, and relaxation training) twice weekly versus usual care. Primary outcome was change in maximal oxygen uptake (VO2 peak). Secondary outcomes were muscle strength, functional capacity, forced expiratory volume in 1 s, health-related quality of life, anxiety, and depression. ResultsThere was no significant difference between the intervention and control groups in VO2 peak. There was a significant improvement in muscle strength. There was also a significant difference between the two for social well-being (Functional Assessment of Cancer Therapy—Lung, FACT-L), anxiety, and depression. ConclusionThere was a significant reduction in the level of anxiety and depression and a significant increase in all muscle strength outcomes in the intervention group compared to patients randomized to usual care. There was a significant difference between the groups for social well-being. The primary outcome did not show a significant improvement in VO2 peak. Based on our results, future patients with advanced inoperable lung cancer should be considered for supervised exercise during the course of their disease.

Effects of Continuous vs Discontinuous Aerobic Training on Cardiac Autonomic Remodeling.

The aim of this study was to examine the cardiac autonomic nervous system differences following either continuous vs. discontinuous exercise in males and females. Forty-seven healthy male and female subjects (M=19, F=28; Age=36.95±13.79) underwent a baseline test for VO2peak and tilt table testing. They were assigned to a one-month control period before returning to repeat the testing and then begin one month of either continuous aerobic treadmill work for 30 min at 70% peak heart rate (N=23) or 3 bouts of 10 min at 70% of peak heart rate with two 10-min break periods in between (N=24). Following exercise, both groups demonstrated a significant improvement in VO2peak (p<0.001). Treatment differences were detected while tilted in continuous as a decreases in the percentage of instances within an hour that the normal sinus interval exceeds 50 ms (p=0.036) and in the high-frequency component (p=0.023). While supine, the discontinuous group saw reduction in heart rate (p=0.004), and an increase in high-frequency (p=0.018). These data suggest that for healthy people either continuous or discontinuous aerobic training is effective in improving measures of fitness; however discontinuous is better able to improve supine indices of vagal activity on heart rate variability.

Combined aerobic exercise and high-intensity respiratory muscle training in patients surgically treated for non-small cell lung cancer: a pilot randomized clinical trial.

Lung resection surgery further decreases exercise capacity and negatively affects respiratory muscle function in patients with non-small cell lung cancer (NSCLC). The best design for exercise interventions in these patients has not been determined yet. To assess the impact of aerobic exercise and high-intensity respiratory muscle training on patient outcomes following lung cancer resection surgery. Prospective, single-blind, pilot randomized controlled trial. Outpatient cardiopulmonary rehabilitation unit of two university hospitals. Thirty-seven patients with NSCLC after tumor resection. Patients were randomly assigned to exercise training or usual post-operative care. The training program consisted of aerobic exercises and high-intensity respiratory muscle training (24 supervised sessions, 3 per week, 8 weeks). Primary outcome was exercise capacity assessed with peak oxygen uptake (VO2peak) during cardiopulmonary exercise test. Secondary outcomes included changes in respiratory muscle strength, levels of serum insulin growth factor I (IGF-I) and IGF binding protein 3 (IGFBP-3), and quality of life assessed with the European Organization for Research and Treatment of Cancer (EORTC QLQ-C30) questionnaire. The 8-week training program was associated with significant improvement in VO2peak (2.13 mL/Kg/min [95%CI 0.06 to 4.20]), maximal inspiratory and expiratory pressures (18.96 cmH2O [95% CI 2.7 to 24.1] and 18.58 cmH2O [95% CI 4.0 to 33.1], respectively) and IGFBP-3 (0.61 µg/mL [%95 CI 0.1 to 1.12]). No significant differences were observed in the EORTC QLQ-C30. An 8-week exercise program consisting of aerobic exercise and high-intensity respiratory muscle training improved exercise capacity, respiratory muscle strength, and serum IGFBP-3 levels in NSCLC patients after lung resection. There was no impact on the other outcomes assessed. A combination of aerobic exercise and respiratory muscle training could be included in the rehabilitation program of deconditioned patients with NSCLC after lung resection surgery.

Cancer Stage Does Not Affect Fatigue or VO2peak Improvements Following an Exercise-Based Cancer Rehabilitation Program

INTRO: Cancer stage reflects the severity and extent of the disease, with stage IV reflecting advanced cancer and poorer prognosis. Exercise has been shown to improve a number of psychological and physiological variables in cancer survivors, such as cancer-related fatigue (CRF) and cardiovascular fitness (VO2peak). However, the effect of stage on these improvements is unknown. PURPOSE: To examine whether diagnosed cancer stage affects or modifies improvements in CRF and VO2peak. METHODS: A total of 384 cancer survivors (57 ± 12 years of age) completed initial assessments of CRF and VO2peak via the Piper Fatigue Scale and the University of Northern Colorado Cancer Rehabilitation Institute’s cancer-specific treadmill protocol, respectively. Participants were divided into four groups based on diagnosed cancer stage (I, II, III, and IV). Survivors completed supervised, one-on-one exercise sessions three days per week, 60 minutes per day for 12 weeks. The intervention consisted of individualized and progressive cardiovascular, whole-body strength, balance, and flexibility training. Participants’ CRF and VO2peak were reassessed following the intervention. RESULTS: Collectively, pre-to-post assessments demonstrated significant overall improvements in CRF (-25%) and VO2peak (11%) across all stages (p<0.01). No significant differences in CRF (p=0.92) or VO2peak (p=0.44) improvements occurred between the stages. When evaluating individual cancer stage CRF, significant improvements (p<0.01) were observed with each stage (I, -32%; II, -27%; III, -29%; IV, -29%). Similarly, significant improvements in VO2peak (p<0.01) occurred with each cancer stage (I, 16%; II, 14%; III, 12%, IV, 11%). CONCLUSION: Exercise-based cancer rehabilitation during and following cancer treatment has been shown to have positive effects on CRF and VO2peak, but the effect of stage diagnosis on these improvements has been unclear. We observed no significant differences in improvement of CRF and VO2peak between cancer stages, and all stages experienced significant benefits following a 12-week cancer rehabilitation program. These results suggest that reductions in CRF and improved cardiovascular function are possible in all cancer patients, regardless of cancer stage.

Effects of an Exercise Intervention on Lung Cancer Patients Who Have Undergone a Lobectomy

Lung cancer is the second most commonly diagnosed form of cancer, and is often treated surgically via tumor resection and lobectomy. Removal of lung tissue often impairs cardiopulmonary function, reduces activities of daily living, and lowers quality of life. Exercise interventions improve cardiopulmonary health and may attenuate the negative effects of lung cancer and its treatment. PURPOSE: To evaluate the response of lung cancer patients who had previously undergone a lobectomy to a structured, supervised 12- week exercise intervention, and compare these results with all other cancer patients completing the same exercise intervention. METHODS: Nine male and female lung cancer survivors who had previously undergone a lobectomy, were recruited to participate in a 12-week exercise-based rehabilitation program. The program consisted of one hour sessions, three days per week, and included cardiovascular endurance, muscular strength and endurance, balance, and flexibility exercises. Subjects completed pre and post assessments of cardiopulmonary function, consisting of a graded exercise test, yielding peak oxygen consumption (VO2 peak), and spirometry, yielding forced vital capacity (FVC) and forced expiratory volume (FEV1). Subjects were divided into two groups: surgical resection including lobectomy (LOB, n = 9), and all other cancers (AOC, n = 205). RESULTS: There were significant improvements in VO2 peak in the LOB group (Pre: 15 ± 2 mL/kg/min, Post: 19 ± 5 mL/kg/min; +20%; p = 0.03) and no significant changes in FVC and FEV1. There were significant improvements in VO2 peak (Pre: 21 ± 0.5 mL/kg/min, Post: 24 ± 0.6 mL/kg/min; +13%; p = 0.00) and FEV1 (Pre: 95 ± 1 %-predicted, Post: 97 ± 1 %-predicted; +2.2%; p = 0.02) in the AOC group. Between group comparisons yielded no significant difference in improvement to VO2 peak for LOB vs AOC (p = 0.77). CONCLUSION: Results from this study demonstrate that lung cancer patients who have previously undergone a lobectomy can safely and effectively complete an individualized, prescriptive exercise intervention. These data also show that lung cancer survivors who have previously undergone a lobectomy are able to improve cardiopulmonary function to the same degree as all other cancer survivors completing a rehabilitative exercise intervention.

To Evaluate the Efficacy of Heart Failure Reversal Therapy Using NT-Probnp Levels in Patients with Chronic Heart Failure

Heart failure is considered as a life-threatening epidemic disorder affecting about 26 million world's population and associated with considerable morbidity, mortality and healthcare expenses. Despite the availability of a range of advanced treatments and sophisticated therapies the prevalence of heart failure represents a herculean challenge. To address the challenge, the current investigation was conducted by evaluating the efficacy of Heart Failure Reversal Therapy (HFRT) in reducing left ventricular distress by assessing N-terminal pro-brain natriuretic peptide (NT-proBNP) levels in congestive heart failure (CHF) patients. Total 76 CHF patients with NYHA Class II and III were screened from March to May 2017 and 15 CHF patients with NT-proBNP = 300-1500 pg/ml were selected for the study. NT-proBNP is measured as a marker, the value of which increases with an increase in severity of CHF. The study therapy, HFRT comprises of traditional procedure of panchkarma that includes snehana (external oleation), swedana (passive heat therapy), hrudaydhara (concoction dripping treatment) and basti (medicated enema) was administered twice daily for 7 days. Post-HFRT, ARJ kadha was administered for next 12 weeks follow-up. NT-proBNP levels were measured after a follow-up period of 90 days along with some other parameters like BMI, VO 2peak (evaluated by cardiac stress test with modified Bruce protocol) and weight. The findings of the investigation revealed significant reduction in NT-proBNP levels (42.46%, p = 0.009), weight (4.82%, p = 0.0007) and BMI (3.67%, p = 0.034) at the end of the follow-up period. The study also yielded significant improvements in VO 2peak (50.96%, p = 0.004). The overall results suggest that HFRT can possibly be explored as add-on therapy or a feasible alternative for the effective management of CHF.