Supervised Exercise Intervention Research Articles

Methodology of an exercise intervention program using social incentives and gamification for obese children

BackgroundTraditional exercise [supervised exercise (SE)] intervention has been proved to be one of the most effective ways to improve metabolic health. However, most exercise interventions were on a high-cost and small scale, moreover lacking of the long-term effect due to low engagement. On the other hand, it was noteworthy that gamification and social incentives were promising strategies to increase engagement and sustain exercise interventions effects; as well as mobile technologies such as WeChat also can provide an appropriate platform to deploy interventions on a broader, low-cost scale. Thus, we aim to develop a novel exercise intervention (‘S&G exercise intervention’) that combines SE intervention with gamification and social incentives design through WeChat, with the aim of improving metabolic health and poor behaviors among overweight and obesity children.MethodsWe propose a randomized controlled trial of a ‘S&G exercise intervention’ among 420 overweight and obese children who have at least one marker of metabolic syndrome. Children will be randomized to control or intervention group in a 1:1 ratio. The exercise intervention package includes intervention designs based on integrated social incentives and gamification theory, involving targeted essential volume and intensity of activity (skipping rope) as well as monitoring daily information and providing health advice by WeChat. Participants will undertake assessments at baseline, at end of intervention period, in the follow-up time at months 3,6,12. The primary outcome is outcome of metabolic health. Secondary outcomes include behavioral (e.g., diary physical activity, diet) and anthropometric measures (e.g., body fat rate and muscle mass).DiscussionsThis will be the first study to design an exercise intervention model that combines traditional supervised exercise (SE) intervention with gamification and social incentives theory through WeChat. We believed that this study could explore a low-cost, easy-to-popularize, and effective exercise intervention model for improving metabolic health and promote healthy among obese children. Furthermore, it will also provide important evidence for guidelines to prevent and improve metabolic health and health behaviors.Trial registration10-04-2019;Registration number: ChiCTR1900022396.

2267-PUB: Skeletal Muscle mRNA Transcriptional Signature of Response to Exercise of Patients in Different Stages of Glucose Tolerance

Physical activity is an effective method to prevent and treat type 2 diabetes (T2D); however, the mechanisms of its beneficial effects have not been precisely elucidated. Skeletal muscle is a major contributor to overall glucose homeostasis in the body and is responsible for the efficacy of exercise intervention in the prevention and treatment of T2D. Currently, there is a lack of studies investigating the transcriptional signature of exercise training on skeletal muscles of patients with different stages of glucose tolerance. Thus, the aim of this study was to identify the mRNA signature of skeletal muscle adaptation to three-month exercise intervention in patients with different dysregulations of glucose metabolism. For this project we included 35 sedentary males, aged 24-65 years old, with BMI 26-33 kg/m2, divided into three groups: 15 normoglycemics, 12 prediabetics and 8 subjects with type 2 diabetes, treated with metformin only. RNA samples were obtained from biopsied Vastus lateralis muscles, before and after a 3-month supervised exercise intervention that occurred thrice weekly and consisted of mixed aerobic (60-70% of individual’s VO2max) and strength (60-70% of the repetition maximum for each exercise) activities. Selected groups of patients did not differ in age, BMI, number of performed trainings or diet during the intervention. mRNA sequencing was performed on an Illumina HiSeq 4000. We found highly significant differential mRNA expression in normoglycemics vs. T2D and prediabetic subjects, mostly related to mitochondrial processes, including the oxidative phosphorylation and thermogenesis pathways. Furthermore, we found that exercise intervention mostly affected these pathways, suggesting that a major defect of skeletal muscle in type 2 diabetes development is related to mitochondrial function and can be diminished by exercise. Disclosure L. Szczerbinski: None. M. Niemira: None. K. Szczerbinski: None. U. Puchta: None. A. Citko: None. E. Siewiec: None. J. Zapolska: None. M. Taylor: None. S. Larsen: None. M. Gorska: None. A. Kretowski: None. Funding Polish Diabetes Association; Polish Ministry of Science and Higher Education

Adherence And Attendance During Versus After Chemotherapy In Exercise Influence On Taxane Side Effects

Exercise throughout cancer treatment can positively affect clinical and patient-reported outcomes. However, adverse side effects (e.g. fatigue) may reduce exercise adherence during chemotherapy. To potentially further improve patient prognosis, developing strategies to maximize exercise participation across the cancer treatment trajectory is warranted. PURPOSE: To compare adherence and attendance to a supervised multimodal exercise intervention completed during chemotherapy for breast cancer to the same intervention completed after chemotherapy..| METHODS: Women with stage I-III breast cancer were randomized to: 1) immediate exercise during chemotherapy (IE); or 2) delayed exercise after chemotherapy (DE). The exercise intervention matched the length of each participant’s chemotherapy regime (8-12 wks) and included 3x/wk supervised aerobic (50-75% HRR, 30-35 min), resistance (1-2 sets, 10-12 reps, 50-65% estimated 1-RM), and balance training. Mean attendance and adherence to aerobic (i.e. intensity/duration) and resistance (i.e. sets/reps) exercise were calculated. Exercise trainers recorded reasons for missed sessions. RESULTS: 26 women enrolled and attended ≥1 session (IE: n=12, DE: n=14). Attendance did not differ between groups (IE=79±24%, DE=81±21%, p=0.82). No group differences were found for adherence to aerobic duration (IE=94±12%, DE=98±2%, p=0.28) or intensity (IE=78±30%, DE=82±17%, p=0.64), or resistance training (IE=73±35%, DE=90±9%, p=0.13). Among IE participants, top reasons for missed sessions were treatment-related symptoms (38%) (i.e. fatigue) and non-treatment related illness (17%) (i.e. cold/flu). Missed sessions for the DE group were most often due to non-treatment-related injury (43%) and travel (23%). CONCLUSION: Adherence to an identical supervised exercise intervention did not vary based on whether it was completed during or after chemotherapy. Barriers to attendance differed by group, thus strategies to maximize exercise participation during chemotherapy should be unique to the time of intervention delivery. Although feasibility does not appear to vary by timing relative to treatment, further analysis is required to determine if the timepoint of exercise delivery has differing effects on physical and psychological benefits.

Endocrine-related quality of life in a randomized trial of exercise on aromatase inhibitor-induced arthralgias in breast cancer survivors.

The objective of this study was to evaluate the role of a 12-month exercise intervention on endocrine-related quality of life (QOL) and overall QOL among breast cancer survivors with aromatase inhibitor (AI)-induced arthralgia in the Hormones and Physical Exercise (HOPE) Study. This was a randomized controlled trial of 121 breast cancer survivors who were currently receiving AIs and experiencing at least mild arthralgia. QOL was assessed using the Functional Assessment of Cancer Therapy (FACT) questionnaires and the 36-Item Short Form Survey (SF-36) at baseline, 6months, and 12months. Participants were randomized to either a 1-year gym-based, supervised exercise intervention group (150minutes of aerobic exercise and 2 strength-training sessions each week) or a usual care group. Effects of the intervention on QOL were assessed using mixed-model, repeated-measures analysis. At 12months, the exercise group had greater improvement in the overall QOL measures as well as the breast cancer-specific (scores, 2.2 vs 0.7; P=.02), endocrine-specific (scores, 5.6 vs 1.6; P<.001), and fatigue-specific (score, 5.8 vs 0.5; P<.001) subscales compared with the usual care group. The results indicated a stronger effect at 12months versus 6months after the intervention. Combined aerobic and resistance exercise, such as treadmill walking and strength training, improved endocrine-related and overall QOL among breast cancer survivors who were experiencing adverse side effects from AIs. Because adverse side effects associated with AI use are quite common and this is the main reason for treatment discontinuation, this nonpharmacologic intervention could benefit many breast cancer survivors and increase successful adherence to AIs in breast cancer treatment.

Breast Cancer Survivors' Experiences With an Activity Tracker Integrated Into a Supervised Exercise Program: Qualitative Study.

BackgroundThere is growing evidence that physical activity is related to a better prognosis after a breast cancer diagnosis, whereas sedentary behavior is associated with worse outcomes. It is therefore important to stimulate physical activity and reduce sedentary time among patients with breast cancer. Activity trackers offer a new opportunity for interventions directed at stimulating physical activity behavior change.ObjectiveThis study aimed to explore the experience of patients with breast cancer who used an activity tracker in addition to a supervised exercise intervention in the randomized UMBRELLA Fit trial.MethodsA total of 10 patients with breast cancer who completed cancer treatment participated in semistructured in-depth interviews about their experience with and suggestions for improvements for the Jawbone UP2 activity tracker.ResultsThe activity tracker motivated women to be physically active and created more awareness of their (sedentary) lifestyles. The women indicated that the automatically generated advice (received via the Jawbone UP app) lacked individualization and was not applicable to their personal situations (ie, having been treated for cancer). Furthermore, women felt that the daily step goal was one-dimensional, and they preferred to incorporate other physical activity goals. The activity tracker’s inability to measure strength exercises was a noted shortcoming. Finally, women valued personal feedback about the activity tracker from the physiotherapist.ConclusionsWearing an activity tracker raised lifestyle awareness in patients with breast cancer. The women also reported additional needs not addressed by the system. Potential improvements include a more realistic total daily physical activity representation, personalized advice, and personalized goals.

Predictors of Dropout in Exercise Trials in Older Adults: The Generation 100 Study.

Dropout from exercise programs, both in the real world and in research, is a challenge, and more information on dropout predictors is needed for establishing strategies to increase the likelihood of maintaining participants in a prescribed exercise program. The aim of the present study was to determine the dropout rate and its predictors during a 3-yr exercise program in older adults. In total, 1514 men and women (mean ± SD age = 72.4 ± 1.9 yr) were included in the present study. Participants were randomized to either a supervised exercise intervention or to follow national guidelines for physical activity (PA). Self-reported demographics (e.g., education), general health, morbidity (e.g., heart disease, memory loss, and psychological distress), smoking, and PA were examined at baseline. Cardiorespiratory fitness (CRF) and grip strength were directly measured at baseline. Dropout rate was evaluated after 1 and 3 yr. Multivariate logistic regression analysis was used to identify dropout predictors. The total dropout rate was 11.0% (n = 166) after 1 yr and 14.9% (n = 225) after 3 yr. Significant predictors of dropout after 1 yr were low education, low grip strength, lower cardiorespiratory fitness, low PA level, and randomization to supervised exercise. The same predictors of dropout were significant after 3 yr, with reduced memory status as an additional predictor. This is the largest study to identify dropout predictors in a long-term exercise program in older adults. Our findings provide new and important knowledge about potential risk factors of dropout in long-term exercise programs in older adults.

Effectiveness of high-intensity interval training combined with resistance training versus continuous moderate-intensity training combined with resistance training in patients with type 2 diabetes: A one-year randomized controlled trial.

To evaluate the impact of one-year high intensity interval training (HIIT) combined with resistance training (RT) vs continuous moderate intensity training (MCT) combined with RT on glycaemic control, body composition and cardiorespiratory fitness (CRF) in patients with type 2 diabetes. A randomized controlled trial included 96 participants with type 2 diabetes for a one-year supervised exercise intervention with three groups: Control, HIIT with RT and MCT with RT). The control group received standard counseling regarding general PA guidelines, with no structured exercise sessions. The main outcome variable was HbA1c (%). Secondary outcomes were other glycaemic variables, body composition, anthropometry measurements, CRF and enjoyment of exercise. Generalized estimating equations (GEE) were used to model outcomes. Among the 96 participants enrolled in the intervention, 80 were randomized, with a mean (SD) age of 58.5 years (7.7) and a mean HbA1c of 7.2% (1.6). After adjusting the model for sex and total moderate-to-vigorous physical activity (MVPA), we found that both the MCT with RT (β, 0.003; P, 0.921) and the HIIT with RT (β, 0.025; P, 0.385) groups had no effect on HbA1c. A favourable effect was observed in the MCT with RT group, with a reduction in whole body fat index (β, -0.062; P, 0.022), android fat index (β, -0.010; P, 0.010) and gynoid fat index (β, -0.013; P, 0.014). Additionally, CRF increased during the intervention, but only in the MCT with RT group (β, 0.185; P, 0.019). The results from this study suggest that there was no effect of either MCT with RT or HIIT with RT on glycaemic control in individuals with type 2 diabetes. However, the combination of MCT and RT improved body composition and CRF following a one-year intervention.

Is supine exercise associated with adverse maternal and fetal outcomes? A systematic review.

Theoretical concerns regarding the supine position at rest due to the gravid uterus obstructing aorta and vena caval flow may impinge uterine blood flow (UBF) to the fetus and maternal venous return. Systematic review. Online databases up to 11 December 2017. Eligible population (pregnant without contraindication to exercise), intervention (frequency, intensity, duration, volume or type of supine exercise), comparator (no exercise or exercise in left lateral rest position, upright posture or other supine exercise), outcomes (potentially adverse effects on maternal blood pressure, cardiac output, heart rate, oxygen saturation, fetal movements, UBF, fetal heart rate (FHR) patterns; adverse events such as bradycardia, low birth weight, intrauterine growth restriction, perinatal mortality and other adverse events as documented by study authors), and study design (except case studies and reviews) published in English, Spanish, French or Portuguese. Seven studies (n=1759) were included. 'Very low' to 'low' quality evidence from three randomised controlled trials indicated no association between supervised exercise interventions that included supine exercise and low birth weight compared with no exercise. There was 'very low' to 'low' quality evidence from four observational studies that showed no adverse events in the mother; however, there were abnormal FHR patterns (as defined by study authors) in 20 of 65 (31%) fetuses during an acute bout of supine exercise. UBF decreased (13%) when women moved from left lateral rest to acute dynamic supine exercise. There was insufficient evidence to ascertain whether maternal exercise in the supine position is safe or should be avoided during pregnancy.

PO-285 A review of effects of exercise on the quality of life in breast cancer survivors

Objective Breast cancer is one of the most common malignant tumors in women.The number of women diagnosed with breast cancer each year is also increasing.It is also the leading cause of cancer deaths in women, accounting for 14-23% of cancer deaths.However, with the development of medical technology, the survival rate of breast cancer patients is improving.In general, the treatment of breast cancer mainly includes surgical treatment, adjuvant chemotherapy and radiotherapy，But these treatments can do a lot of damage to breast cancer patients.These injuries can limit some of the physical activity of breast cancer patients, and can be accompanied by significant psychological damage，Therefore, the quality of life of breast survivors is largely destroyed.Physical exercise is one of the important ways to improve the overall health of the human body.It also plays an important role in increasing people's mood and quality of life.So whether physical exercise has a positive impact on improving the quality of life of breast cancer survivors or there is some doubt.Therefore, the main purpose of this study is to explore the impact of physical exercise on the quality of life of breast cancer survivors, and then to prove the impact of supervised exercise and individual exercise on the quality of life of breast cancer survivors.&#x0D; Methods Data bases searched were MEDLINE, EMBASE, CINAHL, PubMed.Keywords were“breast cancer and quality of life” in combination with “exercise”or “physical activity”.At the same time, the references of the included articles were reviewed to obtain more relevant studies.In terms of the criteria for inclusion and exclusion of literature, the paper was initially screened to determine whether the title and abstract of the paper were consistent with the research topic.The criteria for inclusion are ①the subjects were breast cancer survivors,②the type of intervention was physical exercise,③the measured result is quality of life,④the type of experiment is randomized controlled trial.The exclusion criteria of the article are ①the subject's occupation was athlete，②quality of life is not measured on a formal scale，③article type is review or abstract.&#x0D; Results A total of 14 articles are included in our review.Quality of life was measured using scale tools in all included studies, of which two scales were used in all included articles.The two scales used can reflect the real life quality of the subjects, of which FACT-G is a mass life quality scale and FACT-B is a life quality scale designed specifically for breast cancer patients. Both scales are globally recognized by the public.In our review, we found that exercise significantly improved the quality of life of breast cancer survivors, particularly aerobic exercise.In the studies included in our study, except Nanette et al. used aerobic exercise combined with resistance strength training as the intervention method in their study, all the other studies used aerobic exercise as the intervention method for the subjects.Among the 14 included studies, 10 indicated that physical exercise significantly increased the quality of life of breast cancer survivors, and 4 found that compared with the control group, the quality of life of breast cancer survivors did not have significant changes, but there was a trend of improving the quality of life.At the same time, our review found that monitoring breast cancer survivors improved quality of life.In two of the studies we included, subjects were divided into individual exercise groups and supervised exercise groups.In their study, Anne et al. divided the recruited research samples into the supervision intervention group and the routine control group. Among them, the supervision intervention group received physical exercise 5 times a week for 12 weeks, and the quality of life of breast cancer survivors was significantly improved.In the study of Cadmus et al., the subjects recruited were divided into individual exercise group, supervised exercise group and routine control group, and the exercise group performed physical exercise with the same load and frequency. The result was that there was no physical activity in the home individual exercise group or the routine control group that improved the quality of life for breast cancer survivors.However, in the supervised exercise group, breast cancer survivors' scores for FACT-B and SF-36 (a measure reflecting quality of life) were significantly improved.&#x0D; Conclusions Exercise can improve the quality of life for breast cancer survivors, especially aerobic exercise. Supervised exercise intervention for breast cancer survivors can better improve their quality of life and alleviate social and psychological problems than individual exercise.The supervised aerobic exercise can be integrated into the life of breast cancer survivors so as to better promote the recovery of breast cancer survivors.

Exercise in African American and White Colorectal Cancer Survivors: A Mixed Methods Approach.

African-American (AA) colorectal cancer (CRC) survivors tend to be more obese and less physically active compared to white survivors. To test the feasibility of an aerobic exercise program as well as explore perceptions about supervised exercise among AA CRC survivors. A prospective supervised exercise intervention performed on a cycle ergometer 2 days/week for 12 weeks. Peak (VO2peak) and sub-maximal exercise (6MWT) along with questionnaires (SF-36, Memorial Sloan Kettering Cancer Center Bowel Function Instrument (BFI), Functional Assessment of Cancer Therapy Scale-Colorectal (FACT-C) and Fatigue (FACIT-F), Brief Symptom Inventory (BSI). A second group of survivors participated in an interview evaluating perceptions regarding exercise. Prospective case series and qualitative interview. Research university and academic medical center. African American and white colorectal cancer survivors. Quantitative: A total of 237 letters were mailed to CRC survivors (112 white, 126 AAs). From the letters, 25 white and 15 AAs expressed interest; only five white (4.5%) and four AAs (3.2%) enrolled. Two AAs and five white survivors (7/9) finished the program. There was an improvement in peak exercise (p=0.011) and quality of life (QoL) (SF-36 total, p=0.035) post-training. Qualitative: 30 CRC survivors (12 AA and 18 white) participated in qualitative interviews and selected co-morbidity, motivation and location as primary barriers to exercise. Small sample size. Recruiting CRC survivors (regardless of race) into an exercise program is challenging, however, there are exercise and QoL benefits associated with participation. Barriers to exercise are similar between AA and white CRC survivors.

Metabolic Profile and Myocardial Performance of Renal Transplant Recipients Participating in Unsupervised Physical Exercise as a Prescription Program.

Introduction: Renal transplant recipients (RTRs) are at high cardiovascular risk (CV) compared to the general population, especially after surgical treatment. The literature supports the role of supervised exercise intervention; however no data are available regarding the effects of unsupervised exercise programs. We investigated whether a home exercise program could reduce CV risk in RTR based on possible changes in renal and cardiometabolic parameters and myocardial performance measured by echocardiography. Methods: From a large cohort of 60 RTRs, 30 RTRs (12 females and 18 males 48.3 ± 12.3 years) participated in individualized and unsupervised training programs for 6 months, at moderate intensity. Cardiometabolic risk factors, anthropometric parameters, lipid and glycemic blood sample profiles were studied as was myocardial performance from the 2D echo examination at T0, and T6 months. Results: The lipid profile remained in the range of a low level of risk, although there was no significant improvement, whereas myocardial performance, in particular the EF, was significantly improved. Conclusions: A home exercise program for at least 6 months produces positive effects on myocardial function and helps maintain a low cardiovascular risk profile. The trend supports the importance of highlighting the role of a correct reconditioning of lifestyle in RTR, from the exercise program without supervision to moderate intensity, where well tolerated.

Protocol for a randomised controlled trial of interventions to promote adoption and maintenance of physical activity in adults with mental illness

IntroductionPhysical activity (PA) has diverse benefits for physical and mental health and can reduce symptoms of mental illness. Adults with mental illness face practical, psychosocial and socioeconomic barriers to adopting...

Abstract A057: Examining the link between obesity, inflammation, and exercise in patients with metastatic prostate cancer—An interim analysis from the ExPeCT trial

Abstract Background: Globally, prostate cancer (PrCa) is the fourth most common cancer type. Obesity and inflammation have been shown to play significant roles in PrCa disease progression. Obesity and a high body mass index (BMI) are associated with increased PrCa-specific mortality in patients with advanced disease. Furthermore, proinflammatory cytokines can aid metastatic potential and promote angiogenesis. The ExPeCT (Exercise, Prostate Cancer and Circulating Tumor Cells) trial seeks to examine the effectiveness of a structured exercise program in modulating inflammatory mediators and obesity in patients with metastatic PrCa. Methods: ExPeCT (CTRIALIE 15-21 (ClincalTrials.gov identifier NCT02453139)) is a multicenter, randomized trial for patients with metastatic PrCa (n=67). Participants were randomized to either control or exercise arms. Participants in the exercise arm completed six months of prescribed aerobic exercise, which was monitored using percentage heart-rate reserve. Serum samples were collected for all participants at baseline (T0), three months (T3), and six months (T6), and assayed for 16 interlinked adipokines and cytokines using the Meso Scale Discovery platform. An interim statistical analysis was performed (n=26) comparing median change in serum analyte levels between control (n=13) and exercise (n=13) arms using non-parametric Wilcoxon rank-sum tests. Results: Among 26 patients included in our interim analysis, mean age at baseline was 71 years, median BMI was 29.1 kg/m2, and median waist circumference (WC) was 107 cm, with no significant differences between arms (all p&amp;gt;0.3). Between T0 and T6, WC decreased by a median of 3.8 cm in the exercise group and 2.6 cm in the control group (p=0.412), with a similar trend for BMI. Interim serum cytokine analysis showed a 3-fold increase in IL-10 levels in the exercise arm at T3 when compared to the control arm (p=0.036). No significant change in IL-10 levels was recorded at T6 between arms (p=0.776). Similarly, CXCL8 (IL-8) levels were increased by 1.8-fold at T3 in the exercise arm in comparison to the control arm (p=0.017), with no significant change reported at T6 (p=0.191). While changes were evident in serum TNFα, IL-6, VEGF, IL-17a, MMP9 and CCL5 (RANTES) levels, these did not reach significance. Differences in levels of adipokines leptin and resistin were also reported. A 1.5-fold increase in resistin expression was observed in the exercise arm at T6; however, it was not significant (p=0.293). A 2-fold decrease in leptin in the control arm relative to the exercise arm at T6 was also detected (p=0.676). Analysis of adiponectin, MMP2, and CCL2 is ongoing. Conclusion: Our interim analysis of ExPeCT trial participants demonstrated a significant increase in serum CXCL8 and IL-10 levels after three months of a supervised exercise intervention. These preliminary data suggest that a structured exercise program has the potential to modify inflammatory status in patients with metastatic PrCa. Citation Format: Lauren Brady, Grainne Sheill, Anne-Marie Baird, Emma H. Allott, Tatjana Vlajnic, John Greene, Orla Casey, Brian Hayes, Emer Guinan, Juliette Hussey, Fidelma Cahill, Mieke Van Hemelrijck, Nicola Peat, Sarah Rudman, Moya Cunningham, Liam Grogan, Thomas Lynch, Rustom P. Manecksha, John McCaffrey, Orla Sheils, Dearbhaile M. O’Donnell, John O’Leary, Ray McDermott, Stephen P. Finn. Examining the link between obesity, inflammation, and exercise in patients with metastatic prostate cancer—An interim analysis from the ExPeCT trial [abstract]. In: Proceedings of the AACR Special Conference: Prostate Cancer: Advances in Basic, Translational, and Clinical Research; 2017 Dec 2-5; Orlando, Florida. Philadelphia (PA): AACR; Cancer Res 2018;78(16 Suppl):Abstract nr A057.

Circulating MicroRNA Markers for Pulmonary Hypertension in Supervised Exercise Intervention and Nightly Oxygen Intervention

Rationale: Therapeutic exercise training has been shown to significantly improve pulmonary hypertension (PH), including 6-min walking distance and right heart function. Supplemental nightly oxygen also has therapeutic effects. A biomarker tool that could query critical gene networks would aid in understanding the molecular effects of the interventions.Methods: Paired bio-banked serum (n = 31) or plasma (n = 21) samples from the exercise or oxygen intervention studies, respectively, and bio-banked plasma samples (n = 20) from high altitude induced PH in cattle were tested. MicroRNAs (miRNAs) markers were chosen for study because they regulate gene expression, control the function of specific gene networks, and are conserved across species.Results: miRNAs that control muscle (miR-22-3p, miR-21-5p) or erythrocyte function (miR-451a) were chosen based on pilot experiments. Plasma samples from cattle that developed PH in high altitude had significantly higher miR-22-3p/(relative to) miR-451a values when compared to control cattle tolerant to high altitude. Measurements of miR-22-3p/miR-451a values in serum from patients receiving exercise training showed that the values were significantly decreased in 74.2% of the samples following intervention and significantly increased in the remainder (25.8%). In samples obtained after exercise intervention, a higher composite miRNA value, made of miR-22-3p and miR-21-5p/miR-451a and spike RNA, was significantly decreased in 65% of the samples and significantly increased in 35% of the samples. In the study of nightly oxygen intervention, when comparing placebo and oxygen, half of the samples showed a significant down-ward change and the other half a significant up-ward change measuring either of the miRNA markers. Samples that had a downward change in the miRNA marker following either intervention originated from patients who had a significantly higher 6-min-walking-distance at baseline (mean difference of 90 m or 80 m following exercise or oxygen intervention, respectively) when compared to samples that had an upward change in the miRNA marker.Conclusion: These natural animal model and human sample studies further highlight the utility of miRNAs as future biomarkers. The different directional changes of the miRNA markers following supervised exercise training or nightly oxygen intervention could indicate different PAH molecular pathomechanisms (endotypes). Further studies are needed to test this idea.

Turning disability into ability: barriers and facilitators to initiating and maintaining exercise among older men living with HIV

ABSTRACTPhysical activity reduces the risk for comorbidities, but little is known about barriers to exercise among older adults living with HIV. Three focus groups were conducted among 19 adults living with HIV, aged ≥ 50 years, who were enrolled in or recently completed a supervised exercise intervention. Sessions were recorded, transcribed, and coded first using inductive methods. All participants were male, and the majority were white, non-Hispanic; 53% were receiving disability benefits. All had suppressed HIV infection on antiretroviral therapy, with almost 20 years since HIV diagnosis. Participants noted a lack of self-efficacy, motivation, and physical limitations that contributed to a sense of “disability” as barriers to exercise prior to the intervention. Through social support and improvements in self-efficacy, participants were motivated to start and continue exercising. Perceived sense of disability may impede (or interfere with) exercise initiation and maintenance; self-efficacy and social support may facilitate exercise maintenance in older adults living with HIV.

The Effect Of Exercise On Endothelial Function And Glycemic Control In Type 2 Diabetes

PURPOSE: Vascular endothelial dysfunction induced by hyperglycemia and elevated insulin resistance is a potent risk factor for cardiovascular disease (CVD) and likely contributes to multiple chronic disease complications associated with aging like dementia. The aim of this study was to systematically review and quantify the effects of exercise on endothelial function (EF) in type 2 diabetes (T2D). METHODS: Five electronic databases were searched (until June 2017) for studies that met the following criteria: (i) randomized controlled trials; (ii) T2D aged ≥18 years; (iii) measured EF by brachial artery flow-mediated dilation (FMD); (iv) structured and supervised exercise intervention for ≥8 weeks. RESULTS: Thirteen cohorts of eight studies (306 patients, average age 59 years) met the inclusion criteria. Exercise training significantly increased FMD (mean ES = 0.41, 95% CI = 0.21 to 0.62, P < 0.001). Low to moderate intensity subgroups and aerobic exercise (AE) subgroups significantly increased FMD more than moderate to high intensity subgroups and combined AE and resistance exercise (RE) subgroups respectively (P < 0.01, P < 0.05). Exercise training significantly decreased glycated hemoglobin (HbA1c) (mean ES = -0.40, 95% CI = -0.61 to -0.19, P < 0.001). Low to moderate intensity subgroups significantly decreased HbA1c more than moderate to high intensity subgroups (P < 0.05). CONCLUSIONS: Our results suggest that in patients with T2D, lower intensity exercise has physiological meaningful effects on EF, in support of the emerging concept that the lower efforts of exercise are not necessarily less cardioprotective than higher intensity training.

Feasibility and effects of a home-based intervention using activity trackers on achievement of individual goals, quality of life and motor performance in patients with paediatric cancer

Objectives Supervised exercise interventions during inpatient care are feasible. The objective was to evaluate the usability of activity trackers and centralised monitoring to conduct a home-based exercise intervention during cancer...

Inter-individual differences in weight change following exercise interventions: a systematic review and meta-analysis of randomized controlled trials.

Previous reports of substantial inter-individual differences in weight change following an exercise intervention are often based solely on the observed responses in the intervention group. Therefore, we aimed to quantify the magnitude of inter-individual differences in exercise-mediated weight change. We synthesized randomized controlled trials (RCTs) of structured, supervised exercise interventions. Fourteen electronic databases were searched for relevant studies published up to March 2017. Search terms focused on structured training, RCTs and body weight. We then sifted these results for those RCTs (n=12, 1500 participants) that included relevant comparator group data. Standard deviations (SDs) of weight change were extracted, thereby allowing the SD for true inter-individual differences in weight loss to be calculated for each study. Using a random effects meta-analysis, the pooled SD (95% CI) for true individual responses was 0.8 (-0.9 to 1.4)kg. The 95% prediction interval (based on 2SDs) for true inter-individual responses was -2.8 to 3.6kg. The probability (% chance) that the true individual response variability would be clinically meaningful (>2.5kg) in a future study in similar settings was 23% ('unlikely'). Therefore, we conclude that evidence is limited for the notion that there are clinically important individual differences in exercise-mediated weight change.

Heart Rate Variability following Combined Aerobic and Resistance Training in Sedentary Hypertensive Women: A Randomised Control Trial

ObjectiveTo investigate the effect of combined aerobic and resistance training (CART) on heart rate variability in sedentary, hypertensive women. ParticipantsA total of twenty-eight hypertensive (Stage 1 and 2) sedentary women (Age 40.54 ± 4.2 yrs; Height 155.14 ± 5.4 cm; Weight 70.96 ± 10.2 kg; BMI 29.6 ± 4.4; Duration of HTN: 6.43 ± 2.5 yrs) were recruited for the study. MethodsParticipants were randomly assigned to either the CART group that performed combined aerobic and resistance exercise of moderate intensity [aerobic exercise 50–80% of HRmax (maximum heart rate) and resistance exercises at 50–80% of 1 Repetition Maximum (RM)], 5 times/week for 4 weeks, or to the control group that followed conventional treatment without any supervised exercise intervention. Main outcome measuresResting blood pressure was measured and standard heart rate variability (HRV) indices were calculated using time domain (SDNN, pNN50, RMSSD) and frequency domain (LFnu, HFnu, LF/HF and TP) analysis. ResultsCART group demonstrated an increase in HFnu, TP, SDNN, and RMSSD, (p < 0.05) along with a significant decrease in LFnu, LF/HF ratio, systolic blood pressure, and diastolic blood pressure (p < 0.05). ConclusionCART showed significant improvement in HRV parameters indicating vagal dominance in middle-aged hypertensive women. Therefore, exercise training in combined form (aerobic and resistance) may be incorporated in the management programs of the patients suffering from hypertension in order to augment improvement in their cardiac autonomic control.

Physical Activity and Diabetes.

Physical Activity and Diabetes.