Supervised Exercise Intervention Research Articles

We like to move it - patients with schizophrenia spectrum disorders are impaired in estimating their physical fitness levels and benefit from individualized exercise.

People with schizophrenia spectrum disorders (SSD) engage less in physical activity than healthy individuals. The impact of subjectively assessed physical fitness levels on motivation for sports engagement and its relation to objective fitness parameters in SSD is unclear. 25 patients with SSD (P-SSD) and 24 healthy controls (H-CON) participated in a randomized controlled study. Individual anaerobic thresholds (AT) were determined by an incremental exercise test and on separate days, aerobic exercise (cycling at 80% of workload at AT) and non-exercise control (sitting on an ergometer without cycling) sessions were performed. Demographic, clinical and objective physical fitness data (i.e., weekly physical activity, workload at AT, heart rate) were collected. Subjective physical fitness parameters were assessed before and after exercise and control sessions. Weekly physical activity in P-SSD was lower than in H-CON (p < 0.05) attributed to reduced engagement in sport activities (p < 0.001). Workload and percentage of predicted maximal heart rate at AT were also reduced in P-SSD compared to H-CON (both p < 0.05). Although objective and subjective physical fitness parameters were related in H-CON (p < 0.01), this relationship was absent in P-SSD. However, during exercise sessions subjective physical fitness ratings increased to a stronger extent in P-SSD than H-CON (p < 0.05). The missing relationship between subjective and objective physical fitness parameters in people with SSD may represent a barrier for stronger engagement in physical activity. Accordingly, supervised exercise interventions with individually adjusted workload intensity may support realistic subjective fitness estimations and enhance motivation for sports activity in individuals with SSD.

Cost-utility analysis of a supervised exercise program for patients with metastatic breast cancer in the PREFERABLE-EFFECT randomized controlled trial (RCT).

11121 Background: Exercise for patients with metastatic breast cancer (mBC) significantly reduced fatigue and improved quality of life (QoL) in the multinational PREFERABLE-EFFECT RCT (NCT04120298). Evidence on the cost-effectiveness of exercise for patients with mBC is lacking, albeit essential for implementation in clinical practice. In this study, we evaluated the cost-utility of an exercise program for patients with mBC in the EFFECT RCT. Methods: We conducted a cost-utility analysis using data from the 357 EFFECT trial participants (mean age 55 ± 11 yrs, 75% on 1st/2nd line treatment). These participants, from centers in NL, DE, SE, PL, ES, AU, were randomized to either a 9-month supervised exercise intervention (n=178) or a usual care control group (n=179). We used a societal perspective with a time-horizon of 9 months. Two different scenario analyses (SA) were used to determine intervention costs using a bottom-up micro-costing method: SA-1) 1-on-1 supervision; SA-2) 4-on-1 supervision. Data on healthcare resource use, productivity loss and QoL (converted to QALYs) were collected with country-adapted, self-report questionnaires, including the iMCQ, iPCQ and EQ-5D-5L, at 3-, 6- and 9-months post-baseline. Multiple imputation was performed, and bootstrapping was used to study uncertainty. Results: Compared to usual care, supervised exercise led to a QALY gain of 0.015 (95% CI: -0.02; 0.05) over a 9-month period, corresponding to an increase of 5.3 days in perfect health. The mean intervention costs were €1,696 in SA-1 and €609 in SA-2. The mean total cost differences (adjusted for center and line of treatment) were -€27 (SA-1), and -€1,112 (SA-2), in favor of the exercise group ( Table). The greatest cost-savings occurred in hospital costs, meaning that the exercise group had lower hospital costs compared to the control group (€4,430 vs €5,211). The probability of supervised exercise being cost effective at a willingness-to-pay threshold of €20.000 or €80.000 per QALY gained was 62% or 76% in SA-1, and 91% or 92% in SA-2, respectively. Conclusions: Exercise for patients with mBC is likely to be cost-effective when individually supervised and even dominant (greater cost-savings and more effective) when group-based. Based on our positive findings for both effectiveness and cost-effectiveness, we recommend supervised exercise to be reimbursed as supportive care during treatment for mBC. Clinical trial information: NCT04120298 . [Table: see text]

Abstract GS02-10: Effects of a structured and individualized exercise program on fatigue and health-related quality of life in patients with metastatic breast cancer: the multinational randomized controlled PREFERABLE-EFFECT study

Abstract INTRODUCTION: Patients with metastatic breast cancer (mBC) often experience cancer- and treatment-related side effects that can impair daily life activities and health-related quality of life (HRQoL). Interventions are needed that improve HRQoL by alleviating fatigue and other side effects during palliative BC cancer treatment. Recent evidence-based international guidelines (ASCO, ACSM) recommend exercise for patients with BC during adjuvant treatment for reducing side effects. However, evidence of the effectiveness of exercise in patients with mBC is scarce. The PREFERABLE-EFFECT study (NCT04120298) was designed to assess the effects of a 9-month supervised exercise program in patients with mBC on fatigue, HRQoL, and other cancer- and treatment-related side effects. METHODS: PREFERABLE-EFFECT is a multinational, randomized controlled trial including patients with mBC from five European countries (Germany, Poland, Spain, Sweden, The Netherlands) and Australia. Participants were randomly assigned to usual care or an individualized, structured exercise program consisting of aerobic, resistance, and balance training. The first six months included twice weekly supervised exercise sessions of one hour. In the last three months, one supervised session was replaced by an unsupervised session, supplemented by an exercise App. All participants received general exercise advice (physical activity ≥ 30 min/day) and an activity tracker. Our primary outcomes, physical fatigue (subscale of the EORTC QLQ-FA12) and HRQoL (summary score of the EORTC QLQ-C30), were assessed at baseline, 3, 6, and 9 months. Among other physical fitness outcomes, maximal short exercise capacity was assessed with the Steep Ramp Test. The intervention effects (intention-to-treat) were determined by comparing the change from baseline to 3, 6 (i.e., primary endpoint) and 9 months between groups using separate mixed models for repeated measures, adjusted for baseline values of the outcome variable and stratification factors (mBC line of treatment (1st/2nd vs. 3rd or higher) and study center). A significant improvement of either or both primary outcomes (applying the Bonferroni-Holm method) was considered as successful. RESULTS: Between 2019-2022, we included 357 patients with mBC, with 178 patients randomized to the exercise intervention and 179 to usual care. Patients were, on average, 55.4 years of age (SD=11.1), most patients received 1st or 2nd line of treatment at study enrollment (74.8%) and had bone metastases (73.9%). At 6 months (primary endpoint), participation in the exercise intervention resulted in statistically significant positive effects on both primary outcomes, compared to usual care: physical fatigue was lower (mean difference: -5.3, 95% CI -10.0; -0.6, p=0.027, effect size (ES)=0.22) and HRQoL was better (+4.8, 95% CI 2.2; 7.4, p=0.0003, ES=0.33). Beneficial effects were also found at 3 months (physical fatigue: -3.4, -7.8; 1.0, ES=0.14 and QoL: 3.9, 1.5; 6.3, ES=0.27) and 9 months (physical fatigue: -5.6, -10.9; -0.4, ES=0.24 and QoL: +4.3, 1.4; 7.3, ES=0.31). Further, at the primary endpoint, we found positive exercise effects on physical fitness (+24.3 Watts, 15.5; 33.1, ES=0.42) and numerous QLQ-C30 scales, including social functioning (+5.5, 0.2; 10.8, ES=0.20), pain (-7.1, -12.1; -1.9, ES=0.28) and dyspnea (-7.6, -12.2; -3.0, ES=0.28). Two SAEs occurred (one wrist fracture and one sacral stress fracture), neither related to bone metastases. CONCLUSION: This large multinational study demonstrated significant beneficial effects of a supervised exercise intervention offered during palliative treatment on mBC patients’ fatigue, HRQoL, and other clinically relevant outcomes. Based on these findings, we recommend supervised resistance and aerobic exercise as part of supportive care regimens during palliative treatment of mBC. Citation Format: Anne May, Anouk Hiensch, Johanna Depenbusch, Martina Schmidt, Evelyn Monninkhof, Mireia Pelaez, Dorothea Clauss, Philipp Zimmer, Jon Belloso, Mark Trevaskis, Helene Rundqvist, Joachim Wiskemann, Jana Muller, Carlo Fremd, Renske Altena, Joanna Kufel-Grabowska, Rhode Bijlsma, Lobke van Leeuwen-Snoeks, Daan ten Bokkel-Huinink, Gabe Sonke, Bruce Mann, Prudence Francis, Gary Richardson, Isabel Álvarez, Wolfram Malter, Elsken Van der Wall, Neil Aaronson, Elżbieta Senkus, Ander Urriticoechea, Eva Zopf, Wilhelm Bloch, Martijn Stuiver, Yvonne Wengström, Karen Steindorf. Effects of a structured and individualized exercise program on fatigue and health-related quality of life in patients with metastatic breast cancer: the multinational randomized controlled PREFERABLE-EFFECT study [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr GS02-10.

PREHABILITATION AND SUPPORTIVE CARE IN ONCOLOGY TREATMENT OF BREAST CANCER: PROACTIVE-B

INTRODUCTION &amp; AIMS Neoadjuvant therapy has become standard treatment for patients with Stage II/III HER2 positive and triple negative breast cancer and in selected patients with locally advanced and borderline resectable high risk, luminal B breast cancer (1). Side effects such as fatigue, cardiotoxicity, neurotoxicity, anxiety, insomnia, vasomotor symptoms, gastrointestinal disturbance as well as a raft of immune-related adverse events, impact treatment tolerance, long term outcomes and quality of life. Post-treatment, many women increase body fat and decrease lean mass and develop metabolic syndrome (2) and accelerated cardiac aging (3). All of these are modifiable targets of exercise. The aim of this study was to determine if an early multi-modal supportive care program, designed through a qualitative study from consumers and healthcare professionals, can mitigate these side effects and improve chemotherapy completion, cardiometabolic, residual cancer burden (pCR) and surgical outcomes. METHODS This was a prospective, mixed-method, feasibility study that recruited 23 women receiving neoadjuvant therapy for breast cancer, combining qualitative and quantitative data collection and analysis. The supervised exercise intervention was designed to include aerobic interval, resistance and balance training twice/week, adapted for symptom burden in each session with relative training dose intensity calculated. An optional home program as also provided with therabands. Body composition, upper and lower body strength and cardiometabolic outcome measures were collected at baseline, end of first and second line of treatment and then 6 months post-surgery. RESULTS Full data will be completed in March 2024 to be presented. There was a high rate of complete pathological response (18/22). Currently, 13 participants have completed 6 month post-surgery assessments and preliminary analyses indicate increases in strength and maintenance of muscle mass during and after treatment. The program was found to be acceptable and feasible with high attendance and satisfaction ratings. The additional home program had poor uptake. Of interest to exercise physiologists was participant responses to cluster set training, how poorly rate of perceived exertion reflected training and strength testing loads, heart rate and blood pressure responses and treatment toxicities including cases of immunotherapy induced hepatitis. Many participants were stronger at the end of chemotherapy than before and reported that exercise gave them a sense of control. CONCLUSION Adapting exercise during neoadjuvant chemotherapy with additional supportive therapies for symptom management, improved physical and psychosocial functioning. The program was feasible and acceptable, with high satisfaction reported. Muscle mass can be maintained with supervised exercise training and maintained and 6 months after surgery.

LEGACY EFFECT OF EXERCISE TRAINING TRIALS ON COGNITION IN OLDER ADULTS: SYSTEMATIC REVIEW AND META-ANALYSIS

INTRODUCTION &amp; AIMS Exercise training trials consistently show efficacy for improving cognitive outcome in older adults, especially when the intervention is supervised. However, whether this improvement in cognition is sustained long-term (i.e. a legacy effect) is unknown. While this is likely impacted by long-term adherence to exercise, the legacy effect of exercise training trials on cognition has not been established. Therefore, the aim of this study was to review the literature and investigate the legacy effect of an exercise trial on cognitive function in older adults. METHODS A systematic review of the literature published in English was conducted in PubMed, Scopus, CINAHL, SPORTdiscus, Web of Science and Cochrane Central Register of Controlled Trials electronic databases. Study screening and data extraction were undertaken by two independent researchers. The main inclusion criteria were randomised controlled trial design with non-exercise control, older adult cohort (average age ≥50 years), supervised exercise intervention and cognitive assessments at post-trial and follow up (≥3 months). Pairwise random-effects restricted maximum likelihood meta-analysis estimated the standardised mean difference (Hedges’ g) between intervention and control groups for each cognitive function outcomes at post-trial and follow-up. RESULTS A total of 12,539 articles were screened with 21 trials (n=2,504 participants aged 75.2±6.4 and mostly (56%) female) included in a meta-analysis. After 5.2±3.2 months, a legacy effect was seen with a small-to-moderate between-group effect for the cognitive domain of executive function favouring the exercise interventions (SMD=0.30, 95% CI 0.11 to 0.49; p=0.002). No effect was observed for other cognitive domains. The Cochrane risk-of-bias tool for randomized trials (RoB2) tool identified that 73.7% of the trials had “some concerns” and 26.3% had high risk for bias. CONCLUSION In older adults who received an exercise intervention there was a small-to-moderate legacy effect for improved executive function compared to controls, five months after trial completion.

RETHINKING THE MANAGEMENT OF HEALTH IN PEOPLE WITH DIABETES-RELATED FOOT ULCERS FROM AN AEP PERSPECTIVE: AN UPDATE FROM THE DFUEX STUDY

INTRODUCTION &amp; AIMS Current treatments for people with diabetes-related foot ulcers (DFUs) focus on foot outcomes - potentially at the expense of broader health and wellbeing considerations. There are barriers to exercise for people with DFU and hesitancy in promoting physical activity by clinicians. AEPs may have the clinical skills to help people with DFUs engage in safe and effective exercise. The aim of this study was to examine the impact of AEP supervised exercise intervention on cardiorespiratory fitness, health and wound healing in adults with DFU. METHODS Using a randomised control trial design (ANZTR registration: 12622000885796p) adults aged 18 to 70 years (n=32) with active DFU are being recruited from an interdisciplinary High-Risk Foot Service (iHRFS) at Royal Prince Alfred Hospital Sydney Australia, and randomised to receive 12 weeks of supervised exercise (aerobic and resistance) training (Exercise) with usual care or usual care (Control) Measurements including fitness, metabolic and wound outcomes are acquired at baseline and after 12 weeks. RESULTS Preliminary baseline demographic, fitness and health data will be presented. Consideration for the scope of practice for AEPs in the multidisciplinary management of DFUs will be discussed incorporating observations and guidance on implementing exercise in a high risk DFU population, where there is limited patient and practitioner knowledge about safe and effective exercise options, and historical avoidance of physical activity to lessen the risk of wound deterioration. This will include consideration of aspects around exercise which are unique to people with DFUs, such as working with iHRFS, patient ambulation and transport, wound type and location, diversity of wound offloading devices and individual facilitators and barriers to exercise participation. CONCLUSIONS There is a need for robust evidence concerning the efficacy and safety of exercise intervention, and a need for strategies to engage AEPs into the multidisciplinary care of people with DFUs. Supported by the Exercise and Sports Science Australia Research Grant.

The Role of Tele-Exercise for People with Type 2 Diabetes: A Scoping Review.

Supervised exercise interventions tend to be more effective than unsupervised exercises or physical activity advice alone. However, people with type 2 diabetes may find it difficult to attend supervised exercise interventions due to several obstacles. Tele-exercise, or utilizing technology to deliver home-based exercise, might be a solution. This scoping review aimed to explore clinical trials investigating the impact of tele-exercise interventions in individuals with type 2 diabetes Methods: Four electronic databases were searched for the period up to January 2024 for clinical trials investigating the impact of tele-exercise on health-related outcomes in adults with type 2 diabetes. Seven trials involving 460 individuals with type 2 diabetes met the inclusion criteria. In these trials, combined aerobic and resistance exercise programs were the main types delivered remotely. To deliver such programs, both synchronous (n = 4) and asynchronous (n = 3) delivery modes were adopted. Regardless of the delivery mode, all tele-exercise interventions led to improvements in various factors related to type 2 diabetes and its complications, including glycemic control, blood lipids, body composition, functional capacity, muscle strength, and quality of life. The improvements were also found to be as effective as those of supervised exercise. Tele-exercise interventions seem to be feasible and as effective as supervised exercise interventions in terms of improving glycemic control, blood lipids, functional capacity, muscle strength, body composition, and quality of life for people with type 2 diabetes.

Virtually Supervised Exercise Programs for People With Cancer: A Scoping Review.

Exercise has been shown to improve physical function and quality of life for individuals with cancer. However, low rates of exercise adoption and commonly reported barriers to accessing exercise programming have demonstrated a need for virtual exercise programming in lieu of traditional in-person formats. The aim of this study was to summarize the existing research on supervised exercise interventions delivered virtually for individuals living with and beyond cancer. We conducted a scoping review of randomized controlled trials, pilot studies, or feasibility studies investigating virtually supervised exercise interventions for adults either during or after treatment of cancer. The search included EMBASE, MEDLINE, CINAHL, SPORTDiscus, Cochrane Library, and conference abstracts. Fifteen studies were included. The interventions were delivered mostly over Zoom in a group format, with various combinations of aerobic and resistance exercises. Attendance ranged from 78% to 100%, attrition ranged from 0% to 29%, and satisfaction ranged from 94% to 100%. No major adverse events were reported, and only 3 studies reported minor adverse events. Significant improvements were seen in upper and lower body strength, endurance, pain, fatigue, and emotional well-being. Supervised exercise interventions delivered virtually are feasible and may improve physical function for individuals with cancer. The supervision included in these virtual programs promoted similar safety as seen with in-person programming. More randomized controlled trials with large cohorts are needed to validate these findings. Individuals living with and beyond cancer can be encouraged to join virtually supervised exercise programs because they are safe, well enjoyed, and may improve physical function and quality of life.

Genome-Wide Genetic Analysis of Dropout in a Controlled Exercise Intervention in Sedentary Adults With Overweight or Obesity and Cardiometabolic Disease.

Despite the benefits of exercise, many individuals are unable or unwilling to adopt an exercise intervention. The purpose of this analysis was to identify putative genetic variants associated with dropout from exercise training interventions among individuals in the STRRIDE trials. We used a genome-wide association study approach to identify genetic variants in 603 participants initiating a supervised exercise intervention. Exercise intervention dropout occurred when a subject withdrew from further participation in the study or was otherwise lost to follow-up. Exercise intervention dropout was associated with a cluster of single-nucleotide polymorphisms with the top candidate being rs722069 (T/C, risk allele = C) (unadjusted p = 2.2 × 10-7, odds ratio = 2.23) contained within a linkage disequilibrium block on chromosome 16. In Genotype-Tissue Expression, rs722069 is an expression quantitative trait locus of the EARS2, COG7, and DCTN5 genes in skeletal muscle tissue. In subsets of the STRRIDE genetic cohort with available muscle gene expression (n = 37) and metabolic data (n = 82), at baseline the C allele was associated with lesser muscle expression of EARS2 (p < .002) and COG7 (p = .074) as well as lesser muscle concentrations of C2- and C3-acylcarnitines (p = .026). Our observations imply that exercise intervention dropout is genetically moderated through alterations in gene expression and metabolic pathways in skeletal muscle. Individual genetic traits may allow the development of a biomarker-based approach for identifying individuals who may benefit from more intensive counseling and other interventions to optimize exercise intervention adoption. STRRIDE I = NCT00200993; STRRIDE AT/RT = NCT00275145; STRRIDE-PD = NCT00962962.

Time-restricted eating and supervised exercise for improving hepatic steatosis and cardiometabolic health in adults with obesity: protocol for the TEMPUS randomised controlled trial

IntroductionMetabolic dysfunction-associated steatotic liver disease is a major public health problem considering its high prevalence and its strong association with extrahepatic diseases. Implementing strategies based on an intermittent fasting approach...

Number of completed exercise sessions is associated with slower brain atrophy in MCI over 12 months in the EXERT trial

AbstractBackgroundMid‐ and late‐life exercise has been associated with lower dementia risk. The EXERT trial tested whether aerobic training (AX), compared to stretching/balance/range‐of‐motion training (SBR), could slow cognitive decline in MCI. While no difference was detected between exercise arms, EXERT participants overall showed little cognitive change over 12 months. It is possible that the amount of exercise, rather than the type, may be protective against decline. In this exploratory, post‐hoc analysis of EXERT data, we assessed whether intervention adherence, operationalized as the number of supervised exercise sessions completed, was associated with slower brain atrophy over 12 months.Method194 EXERT participants with baseline and follow‐up MRI were included in this analysis. For each participant, the number of supervised exercise sessions of at least 40 minutes in duration completed during the first 12 months was determined. MRI data were processed using FreeSurfer. Repeated measures ANOVAs were conducted using regional volume or thickness as the dependent variable, and the interaction between number of sessions (continuous scale) and study visit as the independent variable. Baseline age and sex, as well as their interactions with time were included in the model. FDR‐adjusted p‐values &lt;0.05 were considered significant.ResultGreater number of sessions completed was associated with less brain atrophy over 12 months in the hippocampus and parahippocampus, and less ventricular expansion in the lateral and inferior lateral ventricles (Table 1, Figure 1; FDR‐corrected p&lt;0.05 for interaction term). Results remained unchanged when including exercise type (AX vs. SBR), baseline CDR‐SB, or baseline plasma Aβ42/40 in the model. Findings were similar when analyses were restricted to participants who completed the study prior to the onset of the COVID‐19 pandemic.ConclusionOur results show that higher adherence to a supervised exercise intervention over 12 months was associated with reduced brain atrophy in adults with amnestic MCI. These findings were obtained in post‐hoc, exploratory analyses, so causality should be interpreted with caution. EXERT was supported by the Alzheimer’s Disease Cooperative Study and funded by the National Institutes of Health grant U19‐AG010483.

Abstract 17211: Barriers and Predictors of Physical Activity Maintenance: The STRRIDE I Reunion Cohort

Introduction: STRRIDE I (Studies of Targeting Risk Reduction Interventions through Defined Exercise) was an 8-month exercise intervention conducted from 1998-2003. Participants were randomized to an inactive control group or one of three exercise groups differing in amount and intensity. Ten years later, participants returned for follow-up assessments as part of the STRRIDE I Reunion study. Hypothesis/Research Questions: 1) What barriers influence physical activity (PA) maintenance ten years following a supervised exercise intervention? 2) What factors predict PA maintenance ten years following a supervised exercise intervention? Methods: At baseline and post-intervention STRRIDE I assess clinical markers including height, weight, blood pressure, waist circumference, body composition, peak V˙O 2 , glucose, insulin, and lipids. For the Reunion study, 104 participants completed a 3-month PA recall questionnaire, which included self-reported barriers to current PA participation. For the clinical variables, baseline, post-intervention, and change scores (post minus baseline values) were used to generate three separate predictive models. Models were generated using a backward bootstrap variable selection algorithm followed by multiple linear regression. Results: Ten years after completing STRRIDE I, the mean self-reported PA was 77.9 + 76.5 minutes/week. The most commonly reported barriers to PA maintenance were lack of self-motivation (41%), time constraints (33%), illness or injury (29%), and family obligations (23%). The model utilizing baseline variables as predictors of PA maintenance had an adjusted R 2 value of 0.05, while the model utilizing post-intervention variables had an adjusted R 2 of 0.12. The model utilizing change scores to predict PA maintenance had an adjusted R 2 of 0.17; changes in mean heart rate explained the greatest variance in PA maintenance (partial R 2 = 0.10). Conclusions: Continued PA participation beyond a structured exercise intervention setting continues to be challenging for individuals. When trying to predict PA maintenance, where you start or how you finish the intervention may not be as imperative; rather, how you respond in certain variables may be the most important predictors of PA maintenance.

A survey of physical activity (PA) across the stroke pathway of care: physiotherapists’ routine practice and knowledge

Background Stroke research mainly focuses on ambulant participants attending supervised exercise interventions, delivered by physiotherapists, that are not informed by behaviour change theory or measured accurately. It is not clear whether the findings are reflected in clinical practice across the stroke pathway. Objective This survey investigated physiotherapists’ practice, knowledge, training and understanding of PA interventions across the stroke pathway of care. Design An online self -administered 26-item survey was completed by physiotherapists working in the stroke population across the United Kingdom (UK) and Republic of Ireland (ROI). Results 77 valid responses were analysed. Tailored individual exercise (28% n = 21) was the most common PA intervention description and Treadmill training, the least common. Walking ability (68%) and Berg balance scale (62%) were the most common outcome measures reported to measure PA. Lack of time (n = 50) and services to signpost to (n = 48) were the most reported barriers to providing PA interventions. Conclusions We showed that physiotherapists have good awareness of, but mixed knowledge on, the PA guidelines, and valid measures of daily PA. In terms of implementation, there continues to be a focus on tailored exercise, particularly in non-ambulant people with stroke. Common barriers to the implementation of PA interventions across the stroke pathway were lack of time, limited community services to signpost to, and low patient responsiveness. Future studies should explore knowledge gaps in more detail, and address the barriers to implementation of PA in people with stroke.

Design and methods of a randomized telehealth-based intervention to improve fitness in survivors of childhood cancer with exercise intolerance

BackgroundExercise intolerance among childhood cancer survivors substantially increases risk for early mortality, reduced cognitive function, poor quality of life, emotional distress, and sub-optimal participation in social roles. Fortunately, exercise intolerance is modifiable, even among individuals with impaired cardiopulmonary and neuromuscular health. This study aims to evaluate the impact of tailored exercise intervention remotely supervised by fitness professionals in survivors with exercise intolerance. Telehealth-based delivery of the intervention aims to enhance uptake by removing the burden of travel and allowing participants to gain confidence with exercise and physical activity at home. MethodsThis is an ongoing single-blind, two-arm, prospective, clinical trial that will randomize 160 participants 1:1 to intervention (n = 80) and attention control (n = 80) groups. The intervention group receives an individually tailored exercise prescription based on results from baseline assessments performed remotely via a Health Insurance Portability and Accountability Act-compliant virtual platform and personal preferences for aerobic exercise. Each prescription includes aerobic and strengthening components designed to progress gradually to 150–300-min of moderate aerobic activity and twice weekly strengthening exercises over 20-weeks. The first two weeks are supervised for 6 sessions, tapering to twice/week for weeks 3–4, once/week for weeks 5–8, every other week for weeks 9–16 and once midway between weeks 17–20. The schedule is modifiable depending on participant need, adherence, and response to exercise. Each session is approximately one hour. ConclusionThis study tests the efficacy of an individually prescribed, virtually supervised exercise intervention on exercise intolerant childhood cancer survivors.Clinicaltrials.gov registration: NCT04714840.

P09.05.A IMPACT OF A 16-WEEK SUPERVISED EXERCISE INTERVENTION ON CANCER-RELATED FATIGUE IN PATIENTS WITH NEWLY DIAGNOSED GLIOBLASTOMA UNDERGOING ADJUVANT CHEMOTHERAPY

Abstract BACKGROUND Cancer-related fatigue (CRF) is considered one of the most prevalent symptoms in brain tumor patients undergoing concurrent chemoradiation (approx. 80 % of those affected). Several studies have identified beneficial effects of physical activity on reducing CRF. However, few studies have examined the reduction of CRF by exercise in glioma patients. Here we present prospective data showing the effect of an intensive 16-week supervised exercise intervention on CRF in neuro-oncological patients. MATERIAL AND METHODS Between July 2020 and April 2023, patients with newly diagnosed glioblastoma and after surgery and concomitant radiochemotherapy have been recruited for this single-arm trial in progress. Participants have received a 16-week supervised training intervention on a 1:1-basis consisting of two intensive 50-minute sessions per week (bicycle ergometry at an average of 75 % of maximum heart rate and progressive whole-body resistance training). CRF has been assessed using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ C30). We calculated change scores (scores: 0-100; 100=max. fatigue) from baseline, after 8 weeks, and post-intervention (week 16). RESULTS So far, 26 glioblastoma patients (13 women) aged 35-84 years (mean 59 years) participated in the exercise intervention. All patients received adjuvant chemotherapy (50 % Stupp, 42 % CeTeG, 8 % other). Paired t-test indicated a statistically significant reduction in CRF from baseline to post-intervention (p=.030; 95 % CI: -0.5 - 24.2). Mean scores reduced from 40.4 to 36.2 (week 8) to 26.9 (week 16). However, the decrease between week 0 and week 8 was not yet significant (p=.281; 95 % CI: -7.6 - 13.6). CONCLUSION The present trial shows that a 16-week supervised exercise program can reduce CRF in glioblastoma patients despite adjuvant chemotherapy. Thus, and consistent with studies of exercise interventions in patients of other tumor types, glioblastoma patients have the opportunity to actively contribute to the reduction of tumor- and therapy-induced side effects through intensive physical training.

HAPI Fit: An Exercise Intervention to Improve Peak Aerobic Capacity in Young Adults Born Very Preterm.

Individuals born preterm have reduced aerobic capacity, which could be related to impaired organ development. Their capacity to improve aerobic capacity with exercise training could therefore be limited but this remains unknown. We aimed to test an exercise intervention to improve cardiorespiratory fitness in adults born preterm. 21 very preterm and 37 full-term individuals, aged 18-33 years, took part in a 14-week supervised exercise intervention of cardiovascular, resistance and flexibility training (2 groups and 1 individual sessions/week). Adherence and compliance to intervention was recorded. Primary outcome was change in peak oxygen consumption (peak O2) measured pre- and post-intervention. Within and between-groups differences were estimated using non-parametric tests. Of 219 eligible individuals, 58 were enrolled and 14 participants dropped out over the course of the intervention. Among the 44 who completed the intervention, mean adherence was 82% and 66% for group and individual sessions, respectively. Compliance with training requirement varied between 71-100%. There was no difference in adherence between the preterm and full-term groups. Because only one preterm male met adherence criteria, subsequent analyses were done exclusively on females. Both the term and preterm groups achieved higher peak O2 following the intervention [term = +4.2 (standard deviation 4.3) mL·min-1·kg-1, P < 0.01; preterm = +4.7 (2.9) mL·min-1·kg-1, P < 0.01]. There was no between-group difference in the response to the intervention (P = 0.729). Recruitment and adherence to an exercise intervention are challenging. Results could indicate improvements in cardiorespiratory fitness in young women born preterm following current exercise program. Adaptation of this intervention is needed for wider uptake.

Examining the safety and effectiveness of a 4-week supervised exercise intervention in the treatment of frailty in patients with chronic kidney disease.

The optimal duration of antifrailty interventions and how best to deliver them to patients with chronic kidney disease (CKD) is unknown. The aim of this study was to examine the safety, feasibility and preliminary efficacy of a 4-week supervised exercise intervention on frailty in patients with CKD. We conducted a prospective feasibility study involving patients with ≥stage 3 CKD (1 patient with stage 3 CKD, 7 patients with stage 4 CKD and 17 patients with stage 5 CKD) who were either frail or prefrail according to the physical frailty phenotype and/or had a Short Physical Performance Battery (SPPB) score ≤10. The exercise intervention consisted of two supervised outpatient sessions per week for 4weeks (eight total sessions). Frailty and other study measures were assessed at baseline and after 4weeks of exercise. Of the 34 participants who completed the baseline assessment and were included in the analyses, 25 (73.5%) completed the 4-week assessment. Overall, 64.0% of patients were on dialysis and 64.0% had diabetes mellitus. After 4weeks of exercise, frailty prevalence, total SPPB scores and energy/fatigue scores improved. No adverse study-related outcomes were reported. The 4weeks of supervised exercise was safe, was associated with an excellent completion rate and improved frailty parameters in CKD patients with CKD. This study provides important preliminary data for a future larger prospective randomized study. registration: NCT03535584.

Effect of a Multimodal Supervised Therapeutic Exercise Program on Quality of Life, Pain, and Lumbopelvic Impairments in Women With Endometriosis Unresponsive to Conventional Therapy: A Randomized Controlled Trial

ObjectiveTo evaluate the effectiveness of “Physio-EndEA”, a multimodal nine-week supervised exercise intervention, on quality of life, pain, and lumbopelvic impairments in women with endometriosis unresponsive to conventional therapy. DesignParallel-group randomized controlled trial. Outcomes were measured at baseline, post-intervention, and at 1 year. SettingTwo Public University Hospitals. ParticipantsThis trial included 31 women with endometriosis (N=31) randomly allocated to “Physio-EndEA” group (n=16) or control group (n=15). Four participants dropped out of the study for causes unrelated to the intervention. InterventionsThe “Physio-EndEA” program consisted of a 1-week lumbopelvic stabilization learning phase followed by an 8-week phase of stretching, aerobic, and resistance exercises focused on the lumbopelvic area. It was sequentially instructed and supervised by a trained physiotherapist (with volume and intensity progression) and adapted daily to the potential of each participant. Control group received the usual treatment stipulated by their gynecologist. Main Outcome MeasuresThe primary outcome was quality of life. Secondary outcomes were pain intensity, pressure pain thresholds, pain-related catastrophic thoughts, abdominal and back strength, lumbopelvic stability, and muscle architecture. ResultsAdherence rate was 90.6% and mean (±standard deviation) satisfaction was 9.44±0.73 out of 10. No remarkable health problems were reported during the trial. In comparison with controls, the quality of life was improved post-intervention and at 1 year in the Physio-EndEA group with large effect sizes (d>0.80). This group also evidenced: a reduced intensity of dyspareunia, catastrophic thoughts; an increase in pelvic, lumbar, and distal pressure pain thresholds; increases in abdominal and back strength and lumbopelvic stability; and increased thickness of transversus abdominis (right side) and width of lumbar multifidus (left side). ConclusionA 9-week program of multimodal supervised therapeutic exercise is a feasible and effective intervention to improve QoL in women with endometriosis. This program also offers benefits in terms of pain/sensitization and lumbopelvic impairments.

Comparison of the effects of high-intensity interval and moderate-intensity continuous training on inflammatory markers, cardiorespiratory fitness, and quality of life in breast cancer patients

BackgroundAs the effectiveness of breast cancer treatment has improved, a growing number of long-term breast cancer survivors are seeking help for unique health problems. These patients may be at increased risk of cardiovascular disease due to the side effects of treatment. The positive impact of most types of exercise has been repeatedly reported in people with cancer, but the most effective exercise approaches for maximum beneficial adaptations remain controversial. Thus, this study aimed to compare the effects of high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT) on inflammatory indices, adipokines, metabolic markers, body composition, cardiorespiratory fitness, and quality of life in breast cancer patients during adjuvant endocrine therapy. MethodsThirty non-metastatic breast cancer patients during adjuvant endocrine therapy who had been treated with chemotherapy and/or radiotherapy were recruited from Iran and randomized to HIIT, MICT, or control groups for a supervised exercise intervention that took place 3 times a week for 12 weeks. The training intensity was determined based on the peak oxygen uptake (VO2peak), and the volume of training was matched in HIIT and MICT based on the VO2peak. Body composition, functional capacity, cardiorespiratory fitness, metabolic indices, sex hormones, adipokines, and inflammatory markers were assessed before and after the intervention. ResultsThe VO2peak increased by 16.8% in the HIIT group in comparison to baseline values (mean difference = 3.61 mL/kg/min). HIIT significantly improved the VO2peak compared to control (mean difference = 3.609 mL/kg/min) and MICT (mean differences = 2.974 mL/kg/min) groups. Both HIIT (mean difference = 9.172 mg/dL) and MICT (mean difference = 7.879 mg/dL) interventions significantly increased high-density lipoprotein cholesterol levels compared to the control group. The analysis of covariance showed that physical well-being significantly improved in MICT compared to control group (mean difference = 3.268). HIIT significantly improved the social well-being compared to the control group (mean difference = 4.412). Emotional well-being subscale was significantly improved in both MICT (mean difference = 4.248) and HIIT (mean difference = 4.412) compared to the control group. Functional well-being scores significantly increased in HIIT group compared with control group (mean difference = 3.35) . Significant increase were also observed in total functional assessment of cancer therapy-General scores in both HIIT (mean difference = 14.204) and MICT groups (mean difference = 10.036) compared with control group. The serum level of suppressor of cytokine signaling 3 increased significantly (mean difference = 0.09 pg/mL) in the HIIT group compared to the baseline. There were no significant differences between groups for body weight, body mass index, fasting blood glucose, insulin resistance, sex hormone binding globulin, total cholesterol, low-density lipoprotein cholesterol, adipokines, interleukin-6, tumor necrosis factor-α, or interleukin-10. ConclusionHIIT can be used as a safe, feasible, and time-efficient intervention to improve cardiovascular fitness in breast cancer patients. Both HIIT and MICT modalities enhance quality of life. Further large-scale studies will help determine whether these promising results translate into improved clinical and oncological outcomes.

Impact of nutritional-behavioral and supervised exercise intervention following bariatric surgery: The BARI-LIFESTYLE randomized controlled trial.

The study's aim was to investigate the impact of a 12-month adjunctive lifestyle intervention on weight loss and health outcomes after bariatric surgery. A total of 153 participants (78.4% females; mean [SD], age 44.2 [10.6] years; BMI 42.4 [5.7] kg/m2 ) were randomized to intervention (n = 79) and control (n = 74). The BARI-LIFESTYLE program combined 17 nutritional-behavioral tele-counseling sessions plus once-weekly supervised exercise for 12 weeks. The primary outcome was percentage weight loss at 6 months post surgery. Secondary outcomes included body composition, physical activity levels, physical function and strength, health-related quality of life, depressive symptomatology, and comorbidities. Longitudinal analysis of the entire cohort showed significant reductions in body weight, fat mass, fat-free mass, and bone mineral density at the total hip, femoral neck, and lumbar spine (all p < 0.001). The 6-minutewalk test, sit-to-stand test, health-related quality of life, and depressive symptomatology improved significantly (all p < 0.001). The time spent in moderate-to-vigorous physical activity and sedentary behavior remained the same as before surgery (both p > 0.05). There was no significant difference in the primary outcome between the intervention versus control (20.4% vs. 21.2%; mean difference = -0.8%; 95% CI: -2.8 to 1.1; p > 0.05) and no between-group differences in secondary outcomes. An adjunctive lifestyle program implemented immediately after surgery had no favorable impact upon weight loss and health outcomes.