Structured Exercise Training Program Research Articles

Effectiveness of structured exercise program on insulin resistance and quality of life in type 2 diabetes mellitus-A randomized controlled trial.

Impaired glucose control & Insulin resistance are reported to be risk factors for the development of cardiovascular diseases. To find the effects of a structured exercise program on insulin resistance, glycaemic control, functional capacity, and quality of life in patients with Type 2 diabetes mellitus. Randomized, controlled trial. Diabetic Foot Clinic, Department of Physiotherapy & Department of General Medicine, Kasturba Hospital in Manipal, Karnataka, India. 160 participants aged between 30-65 years with Type 2 diabetes mellitus. A set of structured exercise programs (aerobic, resistance, and combined) along with the standard hospital care was performed 3-5 times weekly for 12 weeks. Fasting Insulin Level, Homa-IR, Six-minute walk test (6MWT), and WHOQOL-BREF questionnaire at baseline and 12th week. Body composition analysis, Fasting Blood Sugar, Postprandial Blood Sugar, Glycated Haemoglobin (HbA1c), and GPAQ questionnaire at baseline and 12th week. Significant differences have been observed in Homeostasis model assessment for insulin resistance (Homa-IR) (F (1, 144) = 89.29, p < 0.001); Fasting insulin (FI) (F (1, 144) = 129.10, p < 0.001); Fasting blood sugar (FBS) (F (1, 144) = 12.193, p< 0.001); Post prandial blood sugar (PPBS) (F (1, 144) = 53.015, p< 0.001); glycated haemoglobin (HbA1c) (F (1, 144) = 80.050, p < 0.001); WHOQOL-Physical health (F (1, 144) = 20.008, p< 0.001), Psychological (F (1, 144) = 77.984, p< 0.001), Social relationship (F (1, 144) = 44.866, p< 0.001); Environmental (F (1, 144) = 69.974, p< 0.001); Six minute walk test (6MWT) (F (1, 144) = 84.135, p< 0.001) in the study group when compared with the control group from baseline to 12th week. The study reveals that a 12-week structured exercise training program effectively reduces insulin resistance, improves quality of life, enhances functional capacity, and improves glycaemic control in type 2 diabetes mellitus.

The effect of combined β-lactoglobulin supplementation and resistance exercise training prior to limb immobilisation on muscle protein synthesis rates in healthy young adults: study protocol for a randomised controlled trial

BackgroundThe decline in skeletal muscle mass experienced following a short-term period (days to weeks) of muscle disuse is mediated by impaired rates of muscle protein synthesis (MPS). Previous RCTs of exercise or nutrition prehabilitation interventions designed to mitigate disuse-induced muscle atrophy have reported limited efficacy. Hence, the aim of this study is to investigate the impact of a complex prehabilitation intervention that combines β-lactoglobulin (a novel milk protein with a high leucine content) supplementation with resistance exercise training on disuse-induced changes in free-living integrated rates of MPS in healthy, young adults.Methods/designTo address this aim, we will recruit 24 healthy young (18–45 years) males and females to conduct a parallel, double-blind, 2-arm, randomised placebo-controlled trial. The intervention group will combine a 7-day structured resistance exercise training programme with thrice daily dietary supplementation with 23 g of β-lactoglobulin. The placebo group will combine the same training programme with an energy-matched carbohydrate (dextrose) control. The study protocol will last 16 days for each participant. Day 1 will be a familiarisation session and days 2–4 will be the baseline period. Days 5–11 represent the ‘prehabilitation period’ whereby participants will combine resistance training with their assigned dietary supplementation regimen. Days 12–16 represent the muscle disuse-induced ‘immobilisation period’ whereby participants will have a single leg immobilised in a brace and continue their assigned dietary supplementation regimen only (i.e. no resistance training). The primary endpoint of this study is the measurement of free-living integrated rates of MPS using deuterium oxide tracer methodology. Measurements of MPS will be calculated at baseline, over the 7-day prehabilitation period and over the 5-day immobilisation period separately. Secondary endpoints include measurements of muscle mass and strength that will be collected on days 4 (baseline), 11 (end of prehabilitation) and 16 (end of immobilisation).DiscussionThis novel study will establish the impact of a bimodal prehabilitation strategy that combines ß-lactoglobulin supplementation and resistance exercise training in modulating MPS following a short-term period of muscle disuse. If successful, this complex intervention may be translated to clinical practice with application to patients scheduled to undergo, for example, hip or knee replacement surgery.Trial registrationNCT05496452. Registered on August 10, 2022.Protocol version: 16-12-2022/1

Compensatory Responses to Exercise Training As Barriers to Weight Loss: Changes in Energy Intake and Non-exercise Physical Activity.

Exercise can increase total energy expenditure to very high levels and therefore induce sizable energy deficits that, under carefully controlled conditions, elicit clinically significant weight loss. In real life, however, this is seldom the case among people with overweight or obesity, suggesting the existence of compensatory mechanisms that mitigate exercise-induced negative energy balance. Most studies have focused on possible compensatory changes in energy intake, and comparably little attention has been paid to compensatory changes in the physical activity patterns outside of the prescribed exercise, i.e., non-exercise physical activity (NEPA). The purpose of this paper is to review studies that have assessed changes in NEPA in response to an increase in exercise-induced energy expenditure. The available studies examining changes in NEPA in response to exercise training are methodologically heterogeneous, conducted in participants with different age, gender, and body adiposity, and examined responses to varying exercise regimens over a varying duration. About 67% of all studies-80% of short-term (≤ 11 wks, n = 5) and 63% of long-term (> 3months, n = 19) studies-demonstrate a compensatory decrease in NEPA upon starting a structured exercise training program. A compensatory decrease in other physical activities of daily life upon starting exercise training is a relatively common compensatory response-and probably more common than an increase in energy intake-that may be instrumental in attenuating the energy deficit caused by exercise, and thus preventing weight loss.

Curtailing the Burden of Resistant Hypertension among some African Americans within a Specific age group through a Specific Treadmill Exercise Regime

Background: Previous studies showed that aerobic exercise actually curtails oxidative stress and decreases BP but little to no studies showed which racial ethnicity benefited most from conditioning treadmill exercises. The purpose of this study is to increase awareness of supportive care in the form of treadmill exercise for African Americans of a specific age group with resistant hypertension. We hypothesized that a structured exercise training program along with reducing regular three or four medications after the study improves symptoms and quality of life for African American patients within a specific age group with resistant hypertension. Methods: Total number of recruited patients were one hundred and eighty (180) between ages eighteen-forty-eight (18-48). Ninety patients (90) were in the experimental group while ninety (90) were in the non-experimental/control group. Forty-five (45) males each were in both research groups while forty-five (45) females each were in both the experimental and control group. Weight of participants was between 200-230 pounds. Data was collected from National in Patient sample (NIS) HCUP and extracted using SAS ver. 9.4 from ICD-9 for 2016. Control group used the treadmill exercise one to two days within the week for about 45 minutes while the experimental group exercised at least 3-5 days on treadmill for 45 minutes and attained accumulated weekly mileage of ≥ 2. Results: The study showed that decreasing blood pressure from ≥130/80 to normal bp of &lt;120/80 mmHg for African Americans of a specific age group was statistically significant (p-value for AA males and females respectively 0.0166 and 0.0125. That is; p&lt;0.05). Conclusion; our structured exercise training program plus medication adjustments improved symptoms and quality of life for African American patients with resistant hypertension within a specific age and weight group

Disability and Fatigue in Multiple Sclerosis: Can Rehabilitation Improve Them through a Structured Retraining Program?

Functional rehabilitation programs in multiple sclerosis have demonstrated their efficacy in improving fatigue. The assessment of functional impairment, however, is more difficult. The purpose is to assess fatigue and disability as a first study measure and to verify their improvement after a specific functional rehabilitation program. An analytical, longitudinal, prospective, and experimental study was carried out with 51 patients aged 18-55 years, with an Expanded Disability Status Scale (EDSS) between 2 and 6.5 who were being followed up in outpatient clinics of the Rehabilitation Service of La Princesa Hospital. The fatigue and disability outcomes before and after a structured exercise training program were evaluated, with each subject acting as their own control. The variables were measured using the Modified Fatigue Impact Scale (MFIS), Barthel Index (BI), and Functional Independence Scale (FIM). Differences according to recurrent or progressive course of the disease are assessed. Improvement in the FIM scale was observed after the retraining program (p = 0.016) and was maintained in the medium term (p = 0.042). This improvement is not statistically significant in Barthel Index. Improvement in MFIS is observed after the program (p < 0.001) and 4-6 months after the end. Both disease courses experience the same improvements with no statistically significant differences between them. The retraining program improves fatigue and multiple sclerosis-related functionality in the short and medium term. There are no differences according to disease course. Both experience the same positive changes with our intervention.

Reduced LVEDD following a 12 week exercise training program in patients with symptomatic chronic heart failure is associated with reduction in serum levels of Troponin I

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Norwegian University of Science and Technology Danish Research Council Background Exercise training (ET) exerts many beneficial effects on the cardiovascular system, and longitudinal observational data from epidemiological studies suggest that higher physical activity is associated with lower concentrations of cardiac troponins. We have previously shown that ET can reduce Left Ventricle End-diastolic diameter (LVEDD), and improve exercise capacity. Purpose Our aim was to explore the relationship between changes in LVEDD and changes in high-sensitive plasma troponin I (hs-TnI) levels in patients with symptomatic heart failure undergoing a 12 week structured exercise training program in the randomized multicenter SMARTEX trial. Methods This was a post hoc analysis in 199 patients with symptomatic HF with LVEF &amp;lt;35% and NYHA II-III that were randomly assigned to High Intensity Interval Training (HIIT, n = 73), Moderate Continuous Training (MCT, n = 59) or Recommendation of Regular Exercise, (RRT, n = 67) for 12 weeks. Log-transformed Hs-TnI measurements and clinical data acquired before (BL) and after a 12 week exercise training intervention (12 weeks) and at 1 year follow-up (1 year) were analysed using a linear mixed model. For Troponin analysis the STAT Troponin-I from Abbott Diagnostics was used. Nakagawa’s marginal R2 and conditional R2 were used to evaluate variance explained by fixed effects only and by fixed and random effects together, respectively. Changes of LVEDD between baseline and 12 weeks and baseline and 52 weeks were evaluated using linear mixed model. The outcome variable were measures of LVEDD, while age, sex, visit and training group and their interaction [visit × training group] were included as fixed effects. Patient id and training center were random effects. Covariance structure was compound symmetry. Linear association between log-transformed TnI and LVEDD baseline was evaluated using Pearson correlation coefficient (R). Results Serum was available for hs-TnI analyses in 199 patients. In the HIIT group there was a sustained significant reduction in LVEDD at both 12 and 52 weeks. In the MCT group this reduction was statistically significant at 52 weeks only. Mixed model analysis predicts that each 1 mm decrease in LVEDD is associated with 1.2% decrease in TnI levels (95% CI: 0.6 – 1.9%, p &amp;lt;0.001). Neither time nor training group were associated with changes of TnI (overall test p = 0.739 and p = 0.987, respectively). Dynamics of TnI is highly patient-specific with Intraclass correlation coefficient (ICC) = 0.86. Mixed model explains 87% variation of the data (conditional R2), however, only 7% is attributed to the fixed effects (marginal R2). At baseline, TnI and LVEDD have modest but statistically significant correlation (R = 0.2, p= 0.004). Conclusions A reduction of LVEDD following a 12-week exercise-training program is associated with a reduction in plasma troponin levels, in patients with mild to moderate chronic heart failure. Abstract Figure.

Comparison of the effectiveness of a structured exercise program on nonspecific neck pain in string and woodwind players.

To investigate the effect of a structured exercise training program on pain, functional status, physical function and quality of life (QoL) in string and woodwind players with nonspecific cervical pain. This study had a prospective cohort design and conducted on 40 musicians (26 male, 14 female) aged between 18 and 65years with persistent nonspecific neck pain in the previous 3months. Forty musicians were assigned to either violin (n = 20, median age; 26.5year, height; 1.67m, body mass; 65kg, BMI; 23.04kg/m2) or ney group (n = 20, median age; 27.5year, height; 1.81m, body mass; 75kg, BMI; 23.35kg/m2) and followed the same structured exercise program (3days/per week for 8weeks). The primary outcome was neck pain intensity and assessed on a visual analog scale (VAS). Secondary outcomes; cervical range of motion (ROM) was measured using a goniometer, the jaw-to-sternum and jaw-to-wall distances were used for the assessment of cervical mobility, neck, shoulder and back muscles strength were assessed with a hand-held dynamometer, the Northwick Park Neck Pain and Short Form 36 (SF-36) questionnaires were also used. Normality of data distribution was checked using the Kolmogorov-Smirnov test. For evaluating the training effectiveness on outcome measures, Mann-Whitney U and Wilcoxon test were used compare pre-test and post-test values with/within groups, respectively. The primary outcome (pain intensity) was lowered %33 in both groups. However, the mean change was found similar (median mean changes; -2 for both groups) (p > 0.05). The secondary outcomes; cervical mobility, cervical flexion ROM, disability and muscle strength of the left middle trapezius, left hand grip, anterior and middle parts of the right deltoid, and cervical flexors also significantly improved in both groups (p < 0.05). Only the mean changes of right serratus anterior, middle trapezius and cervical flexor muscles were higher in violin group than ney group (p < 0.05). There was no significant difference in the cervical extension, right rotation, left rotation, right lateral flexion and left lateral flexion after the treatment in both groups (p > 0.05). There was no significant difference between the groups after the exercise program in terms of pain, mobility, range of motion and SF-36 subdomains (p > 0.05). Specific exercise program had similar positive effects on pain, cervical mobility, cervical fexion ROM and disability in string and woodwind players. Although several muscles showed similar improvements in strength, some muscle groups recovered differently. Physical needs specific to the instrument and performance should be taken into account when prescribing exercises to musicians having the same problem, but playing different instruments.

Necessity of Structured Exercise Training Program and Its Feasability on Physical Capacity and Health Statuswith Post COVID-19 Syndrome Patients

Abstract: Corona virus Disease 2019 (COVID-19) has spread worldwide and has become a global public health emergency. The World Health Organization declared the outbreak a pandemic. Pulmonary Rehabilitation has shown good impact on Quality of life , Functional capacity and health status of patients with Chronic Respiratory Disease Recently there are various guidelines and consensus available for Pulmonary Rehabilitation in Post – COVID patients that has been extrapolated from other respiratory condition. There is paucity of literature that has shown the effect of Exercise training program on Physical capacity and Health status of patient with Post COVID 19 syndrome. So the present study uses the available evidence on COVID 19 patients to prepare the exercise program and implement it on post COVID syndrome patients.Thus, the aim of this study is to evaluate the effect of supervised Exercise Training Program on Post COVID-19 syndrome patients&#x0D; Methodology: In this experimental study total 70 patients with Post Covid Syndrome will be included and they will be equally divided into two groups. Group A will receive supervised exercise training, while Group B will receive unsupervised exercise training. Participant will be evaluated at the beginning of therapy or after 6 weeks.&#x0D; Discussion: This study is conducted to evaluate effectiveness of structured exercise training program and its feasibility on physical capacity and health status of patients with Post COVID19 syndrome.&#x0D; Conclusion: Its effectiveness of a structured exercise program and its feasibility on physical capacity and health status of patients with Post COVID19 syndrome will be evaluated.

Kefir Is a Viable Exercise Recovery Beverage for Cancer Survivors Enrolled in a Structured Exercise Program.

This study investigated the effects of 12 wk of postexercise kefir consumption in cancer survivors who have undergone chemotherapy and/or radiation therapy. All participants were enrolled in a structured exercise training program and separated into kefir (KEF) or control (CON) treatment groups. KEF consumed 8 oz. of kefir after exercise sessions (3 d·wk-1) for 12 wk. Outcome measures included assessments for body size and composition, aerobic fitness and muscular strength, medical history, and psychological state at pre- and postintervention time points. Blood was collected and analyzed for C-reactive protein (CRP), interleukin 6 (IL-6), and lipopolysaccharide (LPS) concentrations, and LPS-stimulated whole blood IL-6 and tumor necrosis factor α production were obtained using enzyme-linked immunosorbent assays at both time points. Monocyte numbers and phenotype were obtained using flow cytometry. Participants (N = 24; 9 males and 15 females) were an average of 61 ± 9.9 yr old. Kefir consumption was associated with 6.3% (P = 0.034) improvements in lean body mass, as well as 51.4% (P = 0.046), 39.3% (P = 0.017), and 64.7% (P = 0.021) improvements in measures of depression, fatigue, and gastric distress, respectively. KEF also experienced a significant 35.4% (P = 0.01) reduction in circulating LPS along with an 18.0% increase (P < 0.001) in classical monocytes % and a 22.3% decrease (P = 0.04) in nonclassical monocytes %. There were no significant changes in any other variables. Twelve weeks of kefir consumption improved lean body mass, depression, fatigue, gastric distress, and a biomarker of gut dysbiosis. Kefir improved overall and classical monocyte numbers. Kefir should be considered as a component of a postexercise dietary regimen for cancer survivors.

Effect Of Structured And Maintenance Exercise Programs On Physical And Mental Functioning Of Dementia Patients

PURPOSE: This study examined the effects of a structured exercise training program and of a subsequent maintenance exercise program on physical and mental abilities of Elderly Care Unit (ECU) patients with early to middle stage of dementia. METHODS: Eighteen patients with early to middle dementia (16 females and 2 males, age: 80.4 ± 1.8 yrs, 69.4 ± 2.8 kg, 163 ± 2 cm, mean ± SE) participated in the study. The volunteers were randomly assigned to either the intervention group (IG), which received a 50-min structured exercise program 3 days/week, or the control group (CG), which followed the usual care, for an experimental period of 9 months. After the completion of the 9-month structured exercise training program, patients of the IG continue receiving a 30-min maintenance exercise program, 2 days/week for 9 more months, while patients in the CG continue following the usual care. Functional and cognitive parameters were evaluated in both groups before (0 months, t0), after the completion of the structured exercise program (9 months, t1) and at the end of the maintenance program (18 months, t2). RESULTS: Compared to pre-exercise values (t0), significant improvements (p < 0.05-0.01) were found at t1 and t2 in the IG: HG (12.3 ± 2.0 vs 13.4 ± 2.3 vs 16.3 ± 2.7), TUG (12.2 ± 2.0 vs 10.3 ± 1.8 vs 9.9 ± 1.7 sec), Berg Balance Scale-BBS (37.4 ± 4.9 vs 40.3 ± 5.3 vs 39.1 ± 5.2, Functional Rating Scale for Symptoms of Dementia-FRSSD (4.6 ± 1.3 vs 2.4 ± 1.1 vs 3.3 ± 1.3), Geriatric Depression Scale-GDS (5.1 ± 1.0 vs 2.6 ± 0.8 vs 2.3 ± 0.7). In the CG, no changes or deterioration (p < 0.05) was observed over time compared to baseline: HG (11.4 ± 1.5 vs 10.5 ± 1.6 vs 8.8 ± 0.8), CST (9.2 ± 1.7 vs 6.4 ± 1.4 vs 5.3 ± 1.2 reps), BBS (20.2 ± 8.2 vs 17.1 ± 7.2 vs 16.4 ± 7.0), 6MWT (148.3 ± 61.8 vs 125.0 ± 56.2 vs 103.3 ± 49.3 m), FRSSD (4.2 ± 0.8 vs 7.8 ± 0.9 vs 9.6 ± 0.6), GDS (2.7 ± 1.0 vs 4.9 ± 1.2 vs 5.3 ± 0.9). CONCLUSIONS: A 9-month structured exercise training program leads to significant improvements of physical and mental performance of ECU patients in early and middle stages of dementia, while a subsequent maintenance exercise program of the same duration appears to preserve the beneficial effects of exercise training in those patients.

How can we minimize the risks by optimizing patient's condition shortly before thoracic surgery?

The “moderate-to-high-risk” surgical patient is typically older, frail, malnourished, suffering from multiple comorbidities and presenting with unhealthy life style such as smoking, hazardous drinking and sedentarity. Poor aerobic fitness, sarcopenia and “toxic” behaviors are modifiable risk factors for major postoperative complications. The physiological challenge of lung cancer surgery has been likened to running a marathon. Therefore, preoperative patient optimization or “ prehabilitation “ should become a key component of improved recovery pathways to enhance general health and physiological reserve prior to surgery. During the short preoperative period, the patients are more receptive and motivated to adhere to behavioral interventions (e.g., smoking cessation, weaning from alcohol, balanced food intake and active mobilization) and to follow a structured exercise training program. Sufficient protein intake should be ensured (1.5–2 g/kg/day) and nutritional defects should be corrected to restore muscle mass and strength. Currently, there is strong evidence supporting the effectiveness of various modalities of physical training (endurance training and/or respiratory muscle training) to enhance aerobic fitness and to mitigate the risk of pulmonary complications while reducing the hospital length of stay. Multimodal interventions should be individualized to the patient's condition. These bundle of care are more effective than single or sequential intervention owing to synergistic benefits of education, nutritional support and physical training. An effective prehabilitation program is necessarily patient-centred and coordinated among health care professionals (nurses, primary care physician, physiotherapists, nutritionists) to help the patient regain some control over the disease process and improve the physiological reserve to sustain surgical stress.

Plasma levels of troponin I is reduced after a 12 week exercise training program in patients with uncomplicated heart failure. A substudy of the SMARTEX-HF study

Abstract Background Low-level elevation of cardiac troponins has been associated with adverse outcome, and concentrations even within the normal range provide independent information concerning risk in heart failure (HF). Exercise training exerts many beneficial effects on the cardiovascular system, and longitudinal observational data from epidemiological studies suggest that higher physical activity (PA) is associated with lower concentrations of cardiac troponins. Purpose Our aim was to compare changes in plasma troponin I (TnI) levels (Abbott Diagnostics) in patients with symptomatic heart failure undergoing a 12 week structured exercise training program (Intervention group, IG) with changes in controls on a recommendation of regular exercise (RRE); control group, (CG) in a randomized clinical trial. Methods This was a post hoc analysis of the SMARTEX-HF trial in 199 patients with symptomatic HF with LVEF &amp;lt;35% and NYHA II-III. The patients were randomly assigned to High Intensity Interval Training (HIIT, n=73), Moderate Continuous Training (MCT, n=59) or RRE, (n=67) for 12 weeks. HIIT and MCT groups constituted the intervention group (IG). Measurements and clinical data acquired before and after the 12-week exercise training intervention were analysed. Statistical analysis Changes of TnI levels from baseline to 12 weeks are presented as medians and interquartile ranges. One-sample Wilcoxon sign rank test was used to determine if for a specific group of patients, the median change of troponin levels was equal to zero. In addition, Mann-Whitney U test was used to compare reductions of TnI between two groups. Results After 12 weeks plasma levels of TnI were reduced for all patients (median 11.9 to 11.4 ng/L, p=0.032) and there was no difference between the study groups (p=0.072). However, when the groups were studied separately, reduction of plasma levels of TnI was statistically significant in the IG only (12.5 to 11.7 ng/L, p=0.011), (CG 11.4 to 10.7 ng/L, p=0.955). For the study cohort restricted to patients without additional complicating factors (i.e. no atrial fibrillation, no history of hypertension, diabetes or chronic obstructive pulmonary disease, n=77), difference in changes of plasma levels of TnI between IG (n=54) and CG (n=23) was found to be statistically significant (p=0.004). IG changed from 11.3 to 9.5 ng/L (p=0.002), (CG 12.6 to 12.7 ng/L, p=0.467). Conclusions A 12 weeks exercise-training program was associated with a reduction of plasma TnI levels in patients with mild to moderate HFrEF without additional complicating factors. Figure 1 Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Western Norway Regional; Health Authority [Grant Number 911 715]. St. Olavs Hospital; Faculty of Medicine, Norwegian University of Science and Technology; Norwegian Health Association

Efficacy of Home Versus Centre-Based Cardiac Rehabilitation in Improving Functional Capacity and Left Ventricular Ejection Fraction in Coronary Artery Bypass Graft (CABG) Patients

Background: Coronary Artery Bypass Grafting (CABG) surgery is the most commonly performed surgery for the coronary artery disease patients. Cardiac Rehabilitation (CR) is an essential, useful and safe part of the care for patients with coronary artery disease and who underwent CABG surgery. Regular physical activity can improve functional capacity in patients after CABG. Objectives: To determine the efficacy of home and centre-based cardiac rehabilitation in improving functional capacity and left ventricular ejection fraction (LVEF) in patients underwent CABG surgery. Materials and Method: Total twenty four (n=24) CABG surgery participants were selected. They were divided into 2 groups by utilizing convenient (purposive) sampling method. Group ‘A’ i.e. centre- based (n=12, mean age: 53.83±7.61) and Group ‘B’ i.e. home- based (n=12, mean age: 55.91±5.79). Both the groups received an eight (8) weeks of CR program. Group-A participants attended a supervised structured exercise training program for 3 days per week in hospital set-up. Group-B participants were given an individualized tailored program of aerobic exercises to do at home. All the participants were screened and evaluated for baseline measurements and all the values were recorded at the day of discharge from hospital. After 8 weeks of CR program participants were re-assessed for LVEF and functional capacity. Results: Statistical analysis was done by using SPSS 22.0. After an eight week of CR program, significant improvements were observed in 6-MW distance, LVEF and Rate of Perceived Exertion (RPE) (p=0.0001). Conclusion: The home-based and centre-based cardiac rehabilitation programs were equally effective in improving functional capacity and left ventricular ejection fraction in CABG patients.

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 AN 8-WEEK INTERMITTENT AEROBIC EXERCISE ON THE ELECTROCARDIOGRAM AND PHYSIOLOGICAL PARAMETERS OF INSTITUTIONAL SECURITY PERSONNEL IN NIGERIA

This study determined the effects of an 8-week intermittent aerobic exercise training on the resting electrocardiogram and physiological parameters of institutional security personnel in Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC). The study adopted a pretest-posttest-control group experimental design. The population for the study were male security personnel of OAUTHC, Ile-Ife. Forty middle-aged volunteers who met the inclusion criteria were randomly assigned to either of Intermittent Training Group, ITG (n = 20) or control (n = 20). A structured exercise training programme, Intermittent Exercise Training Programme was used to train the ITG for 8 weeks. Resting ECG was recorded pre and post-intervention with a 12-lead Electrocardiograph, weight and height were measured with an electronic BMI scale. Blood pressure was recorded before and after exercise sessions. Participants in ITG performed the 12-minutes run/walk test before and after the 8 weeks intervention. Borg’s rating of perceived exertion scale was used to gauge exercise intensity and a structured data sheet was used for recording data. Paired- sample t- Test statistics was used to analyse data. The results showed that intermittent aerobic exercise training neither produced significant effect on the resting ECG parameters in terms of intervals; RR- interval (t = -0.79; p > 0.05), P- wave duration (t = -0.64; p > 0.05), PR- interval (t = -0.08; p > 0.05), QRS- Complex (t = -0.99; p > 0.05) and QTC (t = -1.20; p > 0.05) nor axes P- Axis (t = -0.06; p > 0.05), QRS- Axis (t = 0.78; p > 0.05) and T- Axis (t = 0.60; p > 0.05). It however affected participants’ heart rate (t = 4.41; p < 0.05) and VO2 max (t = -11.25; p < 0.05). The study concluded that intermittent aerobic exercise training produced no significant effect on the resting ECG parameters but significantly reduced heart rate and increased VO2 max. Article visualizations:

Response to a Supervised Structured Aerobic Exercise Training Program in Patients with Type 2 Diabetes Mellitus – Does Gender Make a Difference? A Randomized Controlled Clinical Trial

ObjectiveBecause of the globally increasing occurrence of diabetes mellitus (DM) in the population, exercise is becoming vitally important for prevention and disease management, along with medical and dietary interventions. This study was designed to test the hypothesis that women with DM would respond similarly to men with DM following supervised structured aerobic exercise training (SSAET) program. MethodsThis randomized, single blind, controlled clinical trial was conducted on 102 patients with T2DM with ranging in age from 40 to 70 years. All the participants were randomly allocated to either an experimental or a control group. The experimental group participated in an SSAET program, routine medication, and dietary plan, while the control group was treated with routine medication and dietary plan, for 25 weeks. Assessments of physical and biochemical variables were carried out at baseline and after 25 weeks' intervention and gender-based response to the SSAET program was analyzed. ResultsBoth the male and female patients responded to 25 weeks of SSAET, routine medication, and dietary plan equally in the experimental group, whereas in the control group IL-6 and NOS-1 showed slight differences. All male and female patients in the experimental group treated with SSAET, routine medication, and dietary plan showed significant improvement in all variables (P < 0.05), while in the control group, deterioration or no change was noted except in HDL and LDL. ConclusionSSAET is equally effective in both male and female patients with T2DM when compared with a non-exercise control group, but no gender-based difference was found.(Trial ID ISRCTN16466697/ http://orcid.org/0000-0002-6682-9896).

Effects of supervised structured aerobic exercise training program on high and low density lipoprotein in patients with type II diabetes mellitus.

Background and Objective:Hyperlipidemia and dyslipidemia are very common conditions among patients with Type-2 diabetes mellitus (T2DM) and associated with increased risk of coronary heart diseases. Physical activity and exercises along with medical management and dietary plan are common strategies to use for the management of deranged lipid profile in patients with T2DM. We aimed to determine the effects of supervised structured aerobic exercise training (SSAET) program on high and low density lipoprotein in patients with T2DM.Methods:This randomized control trial study was conducted at Riphah Rehabilitation Research Centre (RRRC), Pakistan Railway General Hospital (PRGH) Rawalpindi from 1st January 2015 to 30th March 2016. The inclusion criteria was Type-2 diabetes patients of both gender aged between 40 to 70 years. Patients with severe complications like coronary artery diseases (CAD), and other serious complications like diabetic foot, and severe knee and hip osteoarthritis (OA) were excluded from the study. A total of 195 patients diagnosed with T2DM were screened out and 102 were selected for the study as per the inclusion criteria. All participants were randomly assigned into two groups, experimental ‘A’ (n=51) and control ‘B’ (n=51). Patients in group A were treated with SSAET program of 25 weeks at 3 days a week in addition to routine medical management, while patients in Group-B were on their routine medications and dietary plan. Serum LDL, and HDL were tested at baseline and after 25 weeks. The data was analysed through SPSS 20.Results:Mean and standard deviation of LDL in group A (n=51) was 118.56±19.17 (pre) and 102.64±13.33 (post), while the mean and standard deviation for Group-B (n=51) was 116.50±18.45 (Pre) and 109.88±17.13 (post). Both groups showed improvement but, Group-A treated with SSAET along with RMM showed significantly higher (P Value ≤ 0.05) improvement as compared with group B treated with RMM alone. Mean and standard deviation of HDL in Group-A was 42.70±8.06 (pre) and 47.47±7.16 (post), while the mean and standard deviation of group B is 43.37±8.15 (Pre) and 44.41±7.91 (post). Both groups showed improvement but Group-A treated with SSAET program along with RMM showed significantly higher (P Value ≤ 0.05) improvement than group B treated with RMM alone.Conclusion:SSAET program along with RMM is more effective strategy for the management of deranged lipid profile in patients with T2DM.

Effects of supervised structured aerobic exercise training program on fasting blood glucose level, plasma insulin level, glycemic control, and insulin resistance in type 2 diabetes mellitus.

Objective:To determine the effects of supervised structured aerobic exercise training (SSAET) program on fasting blood glucose level (FBGL), plasma insulin level (PIL), glycemic control (GC), and insulin resistance (IR) in type 2 diabetes mellitus (T2DM).Methods:Riphah Rehabilitation and Research Centre (RRRC) was the clinical setting for this randomized controlled trial, located at Pakistan Railways General Hospital (PRGH), Rawalpindi, Pakistan. Study duration was 18 months from January 1, 2015 to June 30, 2016. Patients of both genders ranging 40-70 years of age with at least one year of history of T2DM were considered eligible according to WHO criteria, while patients with other chronic diseases, history of smoking, regular exercise and diet plan were excluded. Cohorts of 195 patients were screened out of whom 120 fulfilled the inclusion criteria. Amongst them 102 agreed to participate and were assigned to experimental (n=51) and control (n=51) groups. Experimental group underwent SSAET program, routine medication and dietary plan, whereas the control group received routine medication and dietary plan, while both group received treatment for 25 weeks. The blood samples were taken at baseline and on the completion of 25 weeks. The investigation of fasting blood glucose level, plasma insulin level, and glycemic control was conducted to calculate IR.Results:Patients with T2DM in experimental group (n=51) treated with SSAET program, routine medication and dietary plan significantly improved FBGL (pre-mean= 276.41±25.31, post-mean=250.07±28.23), PIL (pre-mean=13.66±5.31, post-mean=8.91±3.83), GC (pre-mean=8.31±1.79, post-mean 7.28±1.43), and IR (pre-mean=64.95±27.26, post-mean 37.97±15.58), as compared with patients in control group treated with routine medication and dietary plan in whom deteriorations were noted in FBGL (pre-mean=268.19±22.48, post-mean=281.41±31.30), PIL(pre-mean=14.14±5.48, post-mean=14.85±5.27) GC (pre-mean=8.15±1.74, post-mean=8.20±1.44, and IR (pre-mean=64.49±23.63. post-mean=70.79 ±23.30). Statistically at the baseline the results were not significant (p>0.05), but at the completion of 25 weeks intervention all the variable showed significant results (p<0.05.Conclusion:It is concluded that a 25 weeks SSAET program along with routine medical management is more effective treatment in the management of fasting blood glucose level, glycemic control, plasma insulin level and insulin resistance as compared with routine medical management and dietary plan in the management of T2DM.

Oral contraceptives versus physical exercise on cardiovascular and metabolic risk factors in women with polycystic ovary syndrome: a randomized controlled trial.

Although oral contraceptives (OCs) are one the most widespread therapy in young polycystic ovary syndrome (PCOS) women and physical exercise represents a crucial first step in the treatment of overweight and obese PCOS, no studies were performed to compare the effects on cardiovascular risk (CVR) of OCs and physical exercise in PCOS. To compare the effects of OCs administration and physical exercise on the CVR, clinical, hormonal and metabolic parameters in PCOS women. One hundred and fifty PCOS women were enrolled and were randomized to OCs (3 mg drospirenone plus 30 μg ethinyloestradiol), structured exercise training programme (SETP) or polyvitamin tablets. The intervention phase study was of 6 months. Primary outcome was intima-media thickness (IMT) and flow-mediated dilation (FMD). Secondary outcomes were clinical, hormonal and metabolic changes. A significant reduction of IMT and a significant increase of FMD were observed in the SETP group after treatment. Compared to baseline, in the SETP group, a significant improvement in anthropometric measures, insulin sensitivity indexes, lipid profile, cardiopulmonary function, inflammatory markers and frequency of menses was observed. Oral contraceptives use was associated with a significant decrease of hyperandrogenism and a significant improvement of frequency of menses. Further, OCs use had a neutral effect on CVR risk factors. OCs effectively treat hyperandrogenism and menstrual disturbances, while SETP is more effective in improving cardiometabolic profile and cardiopulmonary function in PCOS.

Postural Tachycardia Syndrome: Beyond Orthostatic Intolerance.

Postural tachycardia syndrome (POTS) is a form of chronic orthostatic intolerance for which the hallmark physiological trait is an excessive increase in heart rate with assumption of upright posture. The orthostatic tachycardia occurs in the absence of orthostatic hypotension and is associated with a >6-month history of symptoms that are relieved by recumbence. The heart rate abnormality and orthostatic symptoms should not be caused by medications that impair autonomic regulation or by debilitating disorders that can cause tachycardia. POTS is a "final common pathway" for a number of overlapping pathophysiologies, including an autonomic neuropathy in the lower body, hypovolemia, elevated sympathetic tone, mast cell activation, deconditioning, and autoantibodies. Not only may patients be affected by more than one of these pathophysiologies but also the phenotype of POTS has similarities to a number of other disorders, e.g., chronic fatigue syndrome, Ehlers-Danlos syndrome, vasovagal syncope, and inappropriate sinus tachycardia. POTS can be treated with a combination of non-pharmacological approaches, a structured exercise training program, and often some pharmacological support.