Supervised Exercise Program Research Articles

Perceived facilitators and barriers by esophageal cancer survivors participating in a post-treatment exercise program

PurposeParticipation in a post-treatment exercise program improves cardiorespiratory fitness and aspects of quality of life for esophageal cancer survivors. For optimal effects, high adherence to the exercise intervention is important. We assessed which facilitators and barriers to exercise adherence are perceived by esophageal cancer survivors, who participate in a post-treatment exercise program.MethodsThe current qualitative study was performed within the randomized controlled PERFECT trial, in which we investigated effects of a 12-week supervised exercise program with moderate-to-high intensity and daily physical activity advice. Semi-structured interviews were conducted with patients randomized to the exercise group. A thematic content approach was used to derive perceived facilitators and barriers.ResultsThematic saturation was reached after inclusion of sixteen patients. Median session attendance was 97.9% (IQR 91.7–100%), and relative dose intensity (compliance) to all exercises was ≥90.0%. Adherence to the activity advice was 50.0% (16.7–60.4%). Facilitators and barriers were captured in seven themes. The most important facilitators were patients’ own intention to engage in exercise and supervision by a physiotherapist. Barriers were mainly experienced in completion of the activity advice, and included logistic factors and physical complaints.ConclusionsEsophageal cancer survivors are well capable to attend a moderate-to-high intensity post-treatment exercise program, and to fulfill the exercises according to protocol. This is facilitated by patients’ own intention to engage in exercise and supervision of the physiotherapist, and only minimally affected by barriers as logistic factors and physical complaints.Implications for cancer survivorsWhen implementing postoperative exercise programs in clinical care, it can be useful to be aware of perceived facilitators and barriers of cancer survivors in order to achieve optimal exercise adherence and maximize beneficial exercise effects.Trial registrationDutch Trial Register NTR 5045

A Double Blind, Placebo Controlled, Randomised Trial of Extracorporeal Shockwave Therapy as a Novel Treatment For Intermittent Claudication

Objective: Peripheral occlusive arterial disease affects 202 million people worldwide, with intermittent claudication as its most prevalent manifestation. The recommended management for non-life limiting intermittent claudication is conservative and includes best medical therapy in the form of antiplatelet and statin therapy, smoking cessation, and supervised exercise. However, provision of supervised exercise programmes and uptake among intermittent claudication patients is very poor. Extracorporeal shockwave therapy (ESWT) technology has been adapted from renal lithotripsy to a variety of musculoskeletal uses and in vitro and in vivo data has shown improved perfusion of the myocardium and hind leg in the setting of arterial ischaemia. Pilot data has demonstrated that ESWT is effective for improving walking distances in patients with intermittent claudication.1 This study aims to consider its effectiveness for improving quality of life in patients with intermittent claudication.

PERSPECTIVEs on supervised exercise programs in people with metastatic breast cancer- a qualitative study in four European countries

PurposeSupervised exercise is a potentially promising supportive care intervention for people with metastatic breast cancer (MBC), but research on the patients’ perspective is limited. The aim of the current focus group study was to gain an in-depth understanding of MBC patients’ perceived barriers, facilitators, and preferences for supervised exercise programs.MethodsEleven online focus groups with, in total, 44 MBC patients were conducted in four European countries (Germany, Poland, Spain, Sweden). Main topics of the semi-structured discussions covered attitudes towards participation in supervised exercise programs, perceived facilitators, experienced barriers, and exercise preferences. Interviews were transcribed verbatim, translated into English, and coded based on a preliminary coding framework, supplemented by themes emerging during the sessions. The codes were subsequently examined for interrelations and re-organized into overarching clusters.ResultsParticipants had positive attitudes towards exercise, but experienced physical limitations and insecurities that inhibited their participation. They expressed a strong desire for exercise tailored to their needs, and supervision by an exercise professional. Participants also highlighted the social nature of group training as an important facilitator. They had no clear preference for exercise type, but rather favored a mixture of different activities. Flexible training modules were considered helpful to increase exercise program adherence.ConclusionsMBC patients were generally interested in supervised exercise programs. They preferred group exercise that facilitates social interaction, but also expressed a need for individualized exercise programs. This suggests the relevance to develop flexible exercise programs that are adjusted to the individual’s needs, abilities, and preferences.

EffEx-HN trial: study protocol for a randomized controlled trial on the EFFectiveness and feasibility of a comprehensive supervised EXercise program during radiotherapy in Head and Neck cancer patients on health-related quality of life

BackgroundWith over 500,000 annually reported cases worldwide, head and neck cancer (HNC) is the seventh most common type of cancer worldwide. Treatment of HNC with chemoradiotherapy frequently results in serious impairments in physical and psychosocial functioning. Besides, HNC patients typically start their cancer treatment already with poor physical and psychosocial health. It has been shown that a sufficient level of physical activity (PA) before, during, and after cancer treatment is associated with fewer negative treatment-related side effects and a better quality of life (QOL). In order to prevent worsening of functioning and limit the physical impact of the HNC treatment, a comprehensive supervised exercise program (CSEP) may be beneficial during early cancer treatment. However, up to now, the feasibility and effectiveness of such a program are not yet investigated thoroughly in HNC. Therefore, the primary objective of this study is to examine the effectiveness of a CSEP during HNC treatment, in addition to usual supportive care, compared to usual supportive care alone, on health-related QOL up to 1 year post-diagnosis. Secondary objectives entail gathering information on (1) the effectiveness of a CSEP on secondary outcomes such as physical and mental function, activities of daily life, and participation in society and (2) the feasibility, possible barriers, and facilitators for participation in a CSEP during HNC treatment.MethodsTo investigate the effectiveness of the CSEP, a parallel, open-label randomized controlled trial will be performed. To study the feasibility of the CSEP, a mixed-method study will be performed in a subgroup of participants. HNC patients are eligible if they receive radiotherapy at the Radiation-Oncology department of the University Hospital of Leuven. A 4-size permuted block randomization will be used. The control group receives the current standard of supportive care. The intervention group receives a CSEP, additional to the same usual supportive care. The CSEP consists of a 12-week intensive phase with 3 exercise sessions of 1 h per week, where supervision is gradually reduced after 6 weeks. During the maintenance phase (from week 13), patients exercise at home with monthly tele-consultations with a physiotherapist. The CSEP contains supervised aerobic and resistance training. In both groups, outcomes of interest are evaluated through self-reported questionnaires and clinical assessments, at baseline, 6 weeks, 12 weeks, 6 months, and 12 months post-diagnosis. The primary endpoint is health-related QOL, measured with the EORTC QLQ-C30 at 6 months post-diagnosis.DiscussionThe study will be conducted in accordance with the Declaration of Helsinki. This protocol has been approved by the ethical committee of the University Hospitals Leuven (s65549). Recruitment started in January 2022. Results will be disseminated via peer-reviewed scientific journals and presentations at congresses.Trial registrationTrial Registration: ClinicalTrials.govIdentifier: NCT05256238Date of registration: February 25, 2022

Occupational life-style programme over 12 months and changes of metabolic risk profile, vascular function, and physical fitness in blue-collar workers

PurposeOccupational health programmes have been successfully implemented to improve body composition, physical fitness and cardiovascular risk. However, most programmes have been small and have not included long-term evaluation. Therefore, we evaluated a twelve-month life-style change programme in a German refinery.MethodsWe offered a supervised six-week endurance exercise programme (2 × 90 min/week), starting after a two-day life-style seminar. After the active intervention and a half-day refresher seminar, employees were encouraged to continue exercising over one year on their own, with monthly supervised sessions to maintain adherence. Anthropometry, bicycle ergometry, cardio-metabolic risk profile, inflammatory parameters, and vascular function e.g. endothelial function was studied at baseline, after three and after twelve months.ResultsOf 550 employees, n = 327 (age 40.8 ± 9.7 years, 88% males) participated in the study. Twelve-month intervention was associated with a reduced waist circumference (92.6 ± 12.2 to 90.8 ± 11.7 cm, 95% confidence interval for the mean change (CI): -2.5 to -1.1 cm) and a gain in maximal exercise capacity (202 ± 39.6 to 210 ± 38.9 Watt; 95% CI: + 5.1 to + 10.9 Watt). Metabolic and inflammatory parameters likewise HbA1c and C-reactive protein improved in central tendency at a local 95% level of confidence. Vascular function e.g. Reactive-Hyperaemia-Index revealed a slight reduction, whereas no statistically robust changes in mean Cardio-Ankle-Vascular-Index and mean Ankle-Brachial-Index were observed.ConclusionHealth education added by a six-week supervised exercise programme was associated with minor long-term twelve-month improvements of body composition as well as physical fitness and a concomitant improvement of inflammatory state. These changes were, however, not clinically relevant and not accompanied by statistically robust improvements of vascular function.Trial registrationClinTrialsGov: NCT01919632; date of registration: August 9, 2013; retrospectively registered.

Exercise interventions for adults with cancer receiving radiation therapy alone.

Exercise interventions for adults with cancer receiving radiation therapy alone.

Physical Function Assessment of Older Veterans With Serious Mental Illness

To characterize the physical function of older veterans with serious mental illness (SMI) across endurance, strength, and mobility domains. Retrospective analysis of clinical performance data. Gerofit program, a national outpatient supervised exercise program for older veterans, delivered in Veterans Health Administration sites. Older veterans aged 60 and older (n=166 with SMI, n=1,441 without SMI) enrolled across eight national Gerofit sites between 2010 and 2019. Performance measures of physical function covering endurance (6-minute walk test), strength (chair stands, arm curls), and mobility (10-m walk, 8-foot-up-and-go), were administered at Gerofit enrollment. Baseline data from these measures were analyzed to characterize the functional profiles of older veterans with SMI. One sample t tests were examined to compare functional performance of older veterans with SMI to age- and sex-based reference scores. Propensity score matching (1:3) and linear mixed effects models were used to evaluate differences in function between veterans with and without SMI. Older veterans with SMI performed worse on all measures of function (chair stands, arm curls, 10-m walk, 6-minute walk test, 8-foot-up-and-go) compared to age- and sex-based reference scores with statistically significant differences present in the male sample. Functional performance of those with SMI was also worse compared to propensity-score matched older veterans without SMI with statistically significant differences on chair stands, 6-minute walk test, and 10-m walk. Older veterans with SMI have compromised strength, mobility, and endurance. Physical function should be a core component of screening and treatment for this population.

Abstract P6-05-27: FEASIBILITY, SAFETY AND EFFICACY OF A COMBINED SUPERVISED PHYSICAL EXERCISE AND NUTRITIONAL PROGRAM IN A SELECTED POPULATION OF LUMINAL METASTATIC BREAST CANCER PATIENTS: ONCARE-01 PILOT STUDY

Abstract Background: Supervised exercise programs (SEP) have demonstrated an improvement in quality of life (QoL), cardiovascular health, treatment tolerance and disease outcomes in early breast cancer patients. In metastatic breast cancer (MBC), previous data suggest SEP are safe but no impact on QoL and a low adherence to programs were shown. These studies included a heterogenous population in terms of type of treatments received, numbers of previous lines or comorbidities. From our perspective, MBC profile that could benefit most from SEP needs to be explored. Thus, we conducted a pilot study to assess adherence, safety and impact on QoL of a combined SEP and nutritional program (NP) in a selected population of MBC of patients treated with cyclin-dependent kinase 4/6 inhibitors (iCDK 4/6). Methods: This is a prospective, single center, single arm pilot study. SEP consisted in a 12-week intervention with twice a week in-person resistance exercise session. Patients also completed weekly aerobic exercise goals in self-managed sessions monitored with activity trackers. SEP was conducted by registered Physical Activity and Sports Science instructors that followed American College of Sports Medicine guidelines. In addition, participants had an initial nutritional assessment and personalized counselling by a qualified nutritionist. Adherence to treatment, biological variables and QoL assessments (FACIT-Fatigue and QLQ-C30 questionnaires) were collected at baseline (B) and week-12 (w12). Primary endpoint was global adherence (≥70% of attended sessions relative to scheduled sessions). Secondary endpoints included safety, changes in biological variables and QoL. Paired samples t-tests (Wilcoxon) were used to assess biological changes and QoL. Results: Patients (n=26) were recruited from October 2020 to November 2021. Median age was 47,5 years (45-55); 84,6% of patients were ECOG 0. 42,3% of patients were receiving Abemaciclib; 34,6% Ribociclib and 23,1% Palbociclib in first (73,1%) or second (26,9%) line treatment. Patients had bone (69,2%); visceral metastasis (57,7%) or both (30,8%). 2 patients did not start the intervention and additional 7 patients discontinued the program prematurely, the majority of them due to COVID-related concerns. Considering all patients who at least attended one session, global adherence was 66% (39-77,5%) and 45,8% of patients achieved an adherence of ≥ 70%. Patients reported an improvement in QoL [B global QLQ-C30 66,6 (50-75), w12 75 (66,6-83,3); p 0,0121] and fatigue [B FACIT-Fatigue 37 (30-44), w12 42 (38-48); p 0,0017]. Sit-to-stand repetitions in 30-second period also improved [(B 15 (12-17), 19 (15-23); p 0,0002]. Same benefits were seen in patients with adherence ≥ 70%. No statistically significant changes were seen in body fat or muscular composition and handgrip scores. Importantly, no safety issues related to study intervention were reported. Conclusions: Even though the study was conducted during COVID-19 pandemic, global adherence was 66%. For the first time in MBC, SEP and NP combined program demonstrated to be safe and improved QoL in patients with first or second line MBC treated with iCDK4/6. Further research is needed to identify strategies that improve QoL in MBC. Citation Format: Alfonso Cortés, Alejandro Riquelme, Gemma Ferrero, Federico Longo, Manuel Garví, Lisandro Lamas, Ángela Morales, Lidia García, Patricia Cortez-Castedo, Maria Gión, Cristina Saavedra, Noelia Martínez-Jáñez, María Fernández-Abad. FEASIBILITY, SAFETY AND EFFICACY OF A COMBINED SUPERVISED PHYSICAL EXERCISE AND NUTRITIONAL PROGRAM IN A SELECTED POPULATION OF LUMINAL METASTATIC BREAST CANCER PATIENTS: ONCARE-01 PILOT STUDY [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-05-27.

Abstract P5-07-13: Effect of a 12 Week Virtual Supervised Exercise Program on Cardiorespiratory Fitness in Breast Cancer Patients Undergoing Chemotherapy: Results from the STRENGTH Trial

Abstract Background: Chemotherapy (CTX) for breast cancer (BC) can have a detrimental effect on cardiorespiratory fitness (CRF), as measured by VO2max. This decline may be attenuated by physical activity, which can also reduce mortality risk and improve quality of life (QoL) for patients (pts) with BC. During the COVID-19 pandemic, many have pivoted to home-based exercise routines, which have been shown to be safe and feasible for pts with BC receiving CTX. We conducted the STRENGTH Trial to evaluate the effect of a 12-week virtual supervised exercise program in BC pts receiving CTX on CRF. Methods: This is a single-center, prospective, single-arm study designed to evaluate the effect of a 12-week virtual supervised exercise training program on CRF in BC pts receiving CTX. Participants aged ≥18 years with stage I-IV BC who were planned to receive at least 12 weeks of CTX of investigator’s choice were eligible for inclusion. Participants were asked to complete a total of 150 minutes (min) of moderate intensity physical activity/week, as a combination of a 45 min weekly virtual personal training session and workout classes streamed from the Peloton® Digital platform (i.e. walking, running, cardio, yoga, strength training, and cycling). The primary endpoint was the distance walked on a Six-Minute Walk Test (6MWT), an accepted surrogate marker for VO2max, at the start and completion of the program. Secondary endpoints included assessment of QoL using the Functional Assessment of Cancer Therapy - General (FACT-G) and symptom assessment using the MD Anderson Symptom Inventory (MDASI) questionnaires at the beginning, middle and end of the study. Exploratory endpoints included treatment adherence, toxicities, completion and response. Results: 33 participants signed consent for the clinical trial and 2 withdrew voluntarily prior to beginning the program. 5 participants discontinued prematurely due to a diagnosis of COVID-19 (N=3) and pulmonary embolism (N=2) and were not included in the primary endpoint. One participant remains on study at this time. Median age 49 yrs; range 33-68. Mean BMI 29.55; range 18.1-46.5. 13 HR+/HER2-, 7 HR-/HER2-, 11 HER2+. 14 (45%) pts had Stage I, 11 (35%) pts had Stage 2, 5 (16%) pts had Stage 3, 1 (3%) pt had Stage 4. 23 pts (70%) received either an anthracycline or HER2-based therapy. 19 pts (61%) received neoadjuvant CTX on study, 11 pts (35%) received adjuvant CTX and 1 pt (3%) received treatment in metastatic setting. The average number of exercise min per week per participant was 123.2 min (95% CI, 104.1-142.2), with a relative dose intensity of 82%. In the pts that completed the study thus far (N=25), there was no statistically significant difference between the distance walked during the 6MWT at the start and end of the study (median difference= -10m, range: -129-150m, p= 0.67). There was no statistically significant difference in the FACT-G score at the start and end of the study (median difference= -1.0, range -17.83- 30.0, p=0.54). Pts scored higher on the MDASI (median difference= 0.33, range -1.55-4.62, p=0.04) at the end of the exercise program compared to the beginning. There were no new or unexpected treatment toxicities observed. Conclusion: Pts who participated in a 12-week virtual supervised exercise program during CTX for BC did not experience a statistically significant difference in the distance walked during the 6MWT between the beginning and end of the exercise program. Exercise may attenuate the decline in cardiorespiratory function that has historically been observed with CTX for BC. Some pts were not able to adhere to the recommended 150 min of exercise/week suggesting a potential need for modified exercise targets for pts with BC undergoing CTX. This study is limited by a small sample size and larger, randomized clinical trials are needed to further evaluate optimal exercise recommendations for patients with BC undergoing CTX in order to maintain and potentially, even improve, cardiorespiratory function. Citation Format: Eleonora Teplinsky, Amanda Podolski, Kasey Bessada, John Rutledge, Benita Burke, Moira Christoudias, Laura Klein, Kariann Abbate. Effect of a 12 Week Virtual Supervised Exercise Program on Cardiorespiratory Fitness in Breast Cancer Patients Undergoing Chemotherapy: Results from the STRENGTH Trial [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P5-07-13.

Satisfaction of a Virtually Delivered Supervised Exercise Program Specific to Breast Cancer Survivors on Endocrine Therapy

Background Only 11% of breast cancer survivors currently meet the exercise oncology guidelines, and the restrictions to gyms and time outside of home related to the COVID-19 pandemic may have aggravated this situation. To address this, we are testing the efficacy of a twice-weekly, 8-week, supervised, synchronous exercise program delivered virtually for participants diagnosed with breast cancer, called the BE-FIT program. Objective The aim of this paper is to examine the preliminary participant's satisfaction in participating in the BE-FIT program. Methods Participants are asked to complete a “Participant Satisfaction Questionnaire” using a range of 1-5 for each question (1 represents “very difficult,” 2 “difficult,” 3 “neutral,” 4 “easy,” and 5 “very easy”). The questions were related to the following: level of difficulty to access classes; level of clarity of information received during classes; level of capacity to continue practicing exercises independently after finishing the exercise program; and level of how likely one would recommend the program to a friend. Results For the ongoing efficacy trial, we collected responses from 40 participants. The participants reported that it was “very easy” and “easy” to access and participate in the virtual exercise session (63% and 37%, respectively). When asked if the information received from the exercise training was clear and easy to understand during virtual exercise sessions, 93% reported “very easy,” and the remainder reported “easy.” Regarding continuing the exercise independently with the content learned in the program, 87% of the participants reported “very easy” or “easy” (31% and 56%, respectively), and 13% reported “neutral.” Lastly, 80% of participants reported “very easy” to recommend the BE-FIT program to a friend, 18% reported “easy,” and 2% reported “neutral.” Conclusions A virtually delivered supervised program seems to be an excellent alternative to in-person supervised exercise programs to provide easy access and clear information during the classes with potential influence on the future practice of exercises. Conflicts of Interest None declared. Trial Registration ClinicalTrials.gov NCT04824339; https://clinicaltrials.gov/ct2/show/NCT04824339

The effectiveness of effectiveness of premenopausal empowerment strategies on stress, depression and quality of life among premenopausal women’s

Introduction: Middle age is one of the turning points in one’s life as it brings along many changes. It roughly starts in the early 40s, when for most of the people; it is the best period in their life when their achievement is at the highest point. The challenges between adulthood and despair of old age, becomes the change of menopause in women and during which lives take a compulsory change of direction. Methodology: The research design adopted for this study was pre experimental design and research approach adopted for this was to evaluative the educative approach. The sample size was 100 teachers. Non-probability purposive sampling method was used. Result: The mean of post-test knowledge scores was 26.6, which is significantly higher than mean of pre-test knowledge scores of 12.4. Standard deviation of post-test score and pre-test score is 9.4 and 13.3 respectively. The computed paired “t” value (18.67, df=99 at the level of P= 0.05) is greater than table value (1.66) which represents significant gain in knowledge. Hence the hypothesis H1is is accepted. It is evident from the results that RH2: There will be significant association between the pre-test knowledge score and selected demographic variables at the level of P≤ 0.05. is accepted as there is significant association between pretest knowledge score and selected demographic variables like educational qualification, years of experience, child psychology in syllabus and attended in-service education. Conclusion: Therefore, the investigator realized that the need to create awareness on menopause among premenopausal women is necessary. Hence this study is planned to investigate the effectiveness of premenopausal empowerment startegies –a combination of educational empowerment and supervised exercise programme on menopause related problems and quality of life of the premenopausal women.

The role of moderate- and high-intensity supervised aerobic training in reducing steatosis and hepatic fibrosis in patients with non-alcoholic fatty liver disease; a randomized controlled trial.

This study aimed to compare the effect of the same volume of moderate- and high-intensity aerobic exercise on patients' liver steatosis and fibrosis. Exercise is known strategy to deal with non-alcoholic fatty liver disease (NAFLD). This Randomized Control Trial was performed on 60 patients randomly assigned to three arms of the study (1:1:1). Fibrosis and steatosis of liver including Control Attenuated Parameter (CAP) determined using Transient Elastography (TE). The control group was advised to adjust their lifestyle, as a routine management. The intervention groups additionally, participated on supervised exercise programs with two different intensities but the same volume of 1000 KCal per week. The intensities of 50% and 70% of V02 reserve were considered for moderate-intensity and vigorous programs, respectively. On six-month follow-up, none of outcomes were statistically significant among three arms of study. However, changes in some outcomes were reached to statistically significant difference in follow-up in comparison with baseline. The mean of CAP score changes was -19.43 (31.43) (P=0.03), 9.92 (26.81) (P=0.21), and 14.61 (18.03) (P=0.01) in control, moderate- and high-intensity groups, respectively. In the high-intensity group, in addition to steatosis, this difference was also observed in the rate of fibrosis. Besides, the level of serum aminotransferases in the group with moderate exercise after six months had a significant decrease compared to baseline. (P=0.01). Improvement in steatosis and fibrosis was more evident in high- intensity group. As the rate of drop out was high, caution is needed in interpretation of the results.

Title: How should we use corticosteroids in lateral epicondylitis? Local injection or phonophoresis? Running title: Corticosteroid use in lateral epicondylitis

Objective: This study, it was aimed to compare and evaluate the effectiveness of local corticosteroid injection and corticosteroid phonophoresis on grip strength, functional status, pain, and quality of life in lateral epicondylitis. Materials and Methods: Patients with a diagnosis of lateral epicondylitis who underwent corticosteroid phonophoresis or local corticosteroid injection were included in the study. Patients were grouped according to the treatment they received. In the first group, corticosteroid phonophoresis was applied to the lateral epicondyle region using a continuous mode ultrasonic at 1.0 W/cm2 and 1mHz dose with 0.1% betamethasone valerate cream as a conductive agent. In the second group, corticosteroid and local anesthetic injections were applied to the lateral epicondyle region. Two groups received the supervised exercise program. Before treatment and two weeks after treatment, visual analog scale, muscle strength, grip strength, Quick Disabilities of the Arm, Shoulder, and Hand scores, and Nothingom Health Profile results for both groups were recorded from patient files and compared. Results: A total of 43 patients (23 phonophoresis, 20 corticosteroid injections) were enrolled. Although the pain, function, and quality of life of patients improved significantly with both groups, no significant difference was recorded between the groups. Grip and palmar pinch strength significantly increased in only the phonophoresis group. In addition, changing of grip and palmar pinch strength was significantly better in the phonophoresis group than in the corticosteroid injection group. Conclusion: It was determined that corticosteroid administration via phonophoresis instead of injection was more beneficial in terms of grip and palmar pinch strength.

Effects of a concurrent training, respiratory muscle exercise and self-management recommendations on recovery from post-COVID-19 conditions: the RECOVE trial.

The aim of this study was to determine the effectiveness of physical exercise, respiratory muscle training and the self-management WHO recommendations leaflet on the recovery of physical fitness, quality of life and symptom status in people with post COVID-19 conditions. Eighty non-hospitalized adults with a post-COVID-19 condition were randomly assigned to one of four 8-week parallel intervention groups: multicomponent exercise program based on concurrent training- CT (n= 20; 3 resistance and endurance supervised sessions per week at low-moderate intensity); b) inspiratory muscle training- RM (n= 17; 2 standardized daily sessions); c) a combination of both of the above- CTRM (n= 23); d) control group- CON (n= 20; following the WHO guidelines for post-COVID-19 related illness rehabilitation). No significant differences between groups were detected at baseline. While no significant differences between interventions were detected in the VO2max, significant individual improvements were identified in the CT (7.5%; ES=0.38) and CTRM (7.8%; ES=0.28) groups. Lower body muscle strength significantly improved in the CT and CTRM (14.5-32.6%; ES=0.27-1.13) groups compared to RM and CON (-0.3-11.3%; ES=0.19-0.00). The CT and CTRM groups improved significantly for dyspnea and fatigue, as did the health status. In addition, significant differences between interventions were described in fatigue and depression scales favouring CT and CTRM interventions. An individualized and supervised concurrent training with or without respiratory muscle training was safer and more effective than self-care recommendations and inspiratory muscle training alone, to regain cardiovascular and muscular fitness, improve symptom severity and health status in outpatients with post-COVID-19 conditions.

Patients with Shoulder Dysfunction After Mastectomy Can Benefit from Nurse-Assisted Home-Based Range of Motion Exercises

Background: Shoulder dysfunction is very common after mastectomy, and there is also less follow-up for physiotherapy services among patients with mastectomy. Objective: A study was conducted to determine the role of nurse-assisted home-based range of motion (ROM) exercises in patients with shoulder dysfunction after mastectomy. Methods: A pre- and post-interventional study design was used to collect data from 30 post-mastectomy patients. The subjects were selected on a voluntary basis. Informed consent was obtained from post-mastectomy patients who were discharged from different oncology hospitals in Pakistan prior to their inclusion in this study. After obtaining a baseline measurement, the patients were supervised with nurse-assisted ROM exercises at home. The nurse-assisted home-based ROM exercise program was designed for such patients, and the patients were followed-up for up to 1 month. The total duration of the study was 1 year from August 2015 to August 2016. Post-intervention measurement was performed at the patients’ home. The difference in terms of pain reduction and ROM improvement at the shoulder joint was recorded using goniometric measurements and the 100 mm visual analogue scale (VAS). Results: The mean age of the 30 subjects was 39.83 ± 5.89. The mean ROM of shoulder flexion before the exercise program was 106.03°, which improved to 133.93° after 1 month of the exercise program. The mean ROM of shoulder abduction before treatment was 94.83°, which improved to 127.13° after 1 month of supervised exercise program. The mean ROM of shoulder rotation before the exercise program was 127.53°, which improved to 152.03° after 1 month of the exercise program. Conclusion: The nurse-assisted home-based shoulder ROM exercise program is effective in terms of improving the range of motion and reducing pain at the shoulder joint in post-mastectomy patients.

Effect of a Self-directed and Supervised Pulmonary Rehabilitation Approach on Cough and Sputum Expectoration in Chronic Obstructive Pulmonary Disease

Background. Chronic obstructive pulmonary disease (COPD) is a multifactorial, progressive chronic lung disease. COPD was rated as the third largest cause of death by the World Health Organization (WHO) in 2016. Cough and sputum are present in about 60% of COPD patients. For persons with COPD who are unable to attend the standard centre-based program, home-based pulmonary rehabilitation offers a cost-effective option. The aim. To compare the effects of supervised and self-directed pulmonary rehabilitation on cough and sputum expectoration in patients with chronic obstructive pulmonary disease. Methods. Forty COPD-diagnosed subjects with ages between 40 to 60 years were recruited for this randomized clinical trial. The participants were randomly distributed into self-managed (n=18) and supervised (n=19) groups. Data was collected using a 6-minute walk test, the Leicester Cough Questionnaire and a cough and sputum assessment questionnaire at baseline after 6 weeks post treatment. Results. There was a significant difference found between self-managed and supervised groups for six-minute walk test with P value to be P > 0.005. While analysing LCQ, overall no significant difference was observed demonstrating between two groups with P > 0.05; besides, physical factors showed a significant difference during the pre-session which showed P = 0.004. No significant difference was found while analysing values from Cough and sputum assessment questionnaire with P > 0.05 Conclusion. Supervised exercise program and self-managed group show equal improvement in COPD patients. Self-management exercise should be encouraged for active involvement of patient during the treatment and to promote self-preventive behavior. Keywords: sputum, cough, self-management, pulmonary rehabilitation.

Telehealth exercise to Improve Physical function and frailty in patients with multiple myeloma treated with autologous hematopoietic Stem cell transplantation (TIPS): protocol of a randomized controlled trial

BackgroundAdvances in autologous hematopoietic stem cell transplantation (HSCT) and supportive care have led to marked improvements in survival for patients with multiple myeloma. Despite these improvements, patients with multiple myeloma remain at high risk of physical dysfunction and frailty due to HSCT and its associated exposures. Although traditional supervised exercise programs can improve frailty in cancer patients and survivors, rehabilitation facilities are typically far from a patient’s residence, are offered on fixed days/hours, contain uniform activities for everyone, and carry a higher risk of contact cross-infection due to immunosuppression, which can be barriers to exercise participation. Innovative personalized interventions are needed to overcome the limitations of traditional exercise interventions. The purpose of this study is to determine the efficacy and sustainability of a telehealth exercise intervention on physical function and frailty in patients with multiple myeloma treated with HSCT.MethodsThis randomized controlled trial will assess the efficacy of an 8-week telehealth exercise intervention in 60 patients with multiple myeloma who underwent autologous HSCT (30–180 days post-transplant) and are pre-frail or frail. There will be 30 intervention participants and 30 delayed controls. We will administer remote baseline assessments (week 0), followed by an 8-week telehealth intervention (week 1–8), post assessment (week 9), and an additional follow-up assessment (week 17). Our primary endpoint will be improved physical function, as assessed by the Short Physical Performance Battery test. Our secondary endpoint will be a decrease in frailty characteristics such as gait speed, strength, and fatigue. We will also evaluate the sustainability of improved physical function and frailty at week 17. Participants randomized to the intervention group will perform at least 90 min of exercise per week throughout the 8 weeks.DiscussionThis study will help optimize the delivery of safe, low-cost, and scalable telehealth exercise interventions to improve health outcomes in patients with multiple myeloma, an understudied population at high risk for physical dysfunction and frailty. Our study may provide the foundation for sustainable telehealth exercise interventions to improve physical function and frailty for other hematologic cancer patients (e.g., acute leukemia, lymphoma) as well as any other cancer population of interest.Trial registrationClinicalTrials.govNCT05142371. This study was retrospectively registered on December 2nd, 2021, and is currently open to accrual.

Core stability exercise versus movement control exercise in chronic mechanical low back pain

Purpose. The aim of this study was to compare the efficacy of two types of therapeutic exercise: core stability exercises and movement control exercises in pain and function. Methods. Thirty-five patients were diagnosed and referred to physiotherapy as CMLBP, their age ranged from 25–40 years old, patients divided randomly into two groups and assessed for their current level of pain using a visual analog scale (VAS) and for disability using Oswestry disability index (ODI) before and after the study. Both groups received a well-documented fully supervised exercise program as group I movement control exercise, and group II received core stability exercises. Results. Showed significant effect of both exercise approaches on reducing pain level and restoring function. Although the group I exercises showed to be more effective in reducing pain than group II, their difference regarding improving function was non-significant. Conclusion. Conservative forms of treatment (therapeutic exercises) still prove it is a successful, cost-effective treatment of choice in patients with chronic mechanical low back pain. Movement control exercises are superior in reducing pain to core stability exercises.

Cardiotoxicity is mitigated after a supervised exercise program in HER2-positive breast cancer undergoing adjuvant trastuzumab.

BackgroundTrastuzumab is used, alone or in conjunction with standard chemotherapy, to treat HER2-positive breast cancer (BC). Although it improves cancer outcomes, trastuzumab. can lead to cardiotoxicity. Physical exercise is a safe and effective supportive therapy in the management of side effects, but the cardioprotective effects of exercise are still unclear.ObjectivesThe primary aim of this study was to test whether trastuzumab-induced cardiotoxicity [left ventricular ejection fraction (LVEF) under 50%, or an absolute drop in LVEF of 10%] was reduced after a supervised exercise program of 3 months in patients with HER2-positive breast cancer. Secondary endpoints were to evaluate (i) cardiotoxicity rates using other criteria, (ii) cardiac parameters, (iii) cardiorespiratory fitness and (iv) whether a change in LVEF influences the cardiorespiratory fitness.Methods89 women were randomized to receive adjuvant trastuzumab in combination with a training program (training group: TG; n = 46) or trastuzumab alone (control group: CG; n = 43). The primary and secondary endpoints were evaluated at the end of the supervised exercise program of 3 months (T3).ResultsAfter exercise program, 90.5 % of TG patients and 81.8% of CG patients did not exhibit cardiotoxicity. Furthermore, whatever the used criterion, percentage of patients without cardiotoxicity were greater in TG (97.6 and 100% respectively) than in CG (90.9 and 93.9% respectively). LVEF and GLS values remained stable in both groups without any difference between the groups. In contrast, at T3, peak VO2 (+2.6 mL.min−1.kg−1; 95%CI, 1.8 to 3.4) and maximal power (+21.3 W; 95%CI, 17.3 to 25.3) increased significantly in TG, whereas they were unchanged in CG (peak VO2: +0.2 mL.min−1.kg−1; 95%CI, −0.5 to 0.9 and maximal power: +0.7 W, 95%CI, −3.6 to 5.1) compared to values measured at T0. No correlation between LVEF changes and peak VO2 or maximal power was observed.ConclusionA 12-week supervised exercise regimen was safe and improved the cardiopulmonary fitness in particular peak VO2, in HER2-positive BC patients treated with adjuvant trastuzumab therapy. The study is under powered to come to any conclusion regarding the effect on cardiotoxicity.Clinical trial registrationwww.ClinicalTrials.gov, identifier: NCT02433067.

P08.12.B Conceptual development of an intensive supervised exercise program for brain tumor patients: summary of clinical experience

Abstract Background Several studies have identified beneficial effects of physical activity on reducing cancer-related symptoms. However, the number of such studies in neuro-oncology is limited, and even today, brain tumor patients are often advised against physically strenuous exercise. Here we summarize our experience with an individualized training program in brain tumor patients over a period of more than 8 years. Material and Methods Patients with primary brain tumors were invited to participate in the individual training program as part of the psycho-oncological consultation. If interested and free of major comorbidity, a professional sport scientist/diploma coach individualized two 60-minute sessions/week adapted to the patients’ respective symptoms and trained them on a 1:1-basis. One session consisted of bicycle ergometry at an average workload of 75% of the max. age-adjusted heart rate (up to 95% at peak; continuous monitoring throughout entire session), the other session was progressive whole-body resistance training based on 10 separate, but standardized exercise tasks using the university’s training facilities. Both training sessions were complimented by challenging elements to improve coordination. Exercise tasks were adapted as needed, and exercise levels were enhanced over time, if possible. Results From 2011 to 2019, 45 patients (19 women, 26 men) aged 20-76 years (mean 49) with different tumor types (65% high-grade gliomas, 22% low-grade gliomas, 13% other) participated in the program. The majority of patients started the program following concurrent radio-chemotherapy and in parallel with adjuvant systemic therapy. On average, 41 training sessions were performed. No training-related adverse events (e.g., falls, head pain, etc.) occurred during the entire period. In a total of 1828 training sessions, two minor epileptic seizures occurred (1 speech arrest; 1 simple focal seizure, left hand affected). Both patients were familiar with the respective type of seizure before entering the program and training could be continued immediately, with reduced intensity. Seizures did not reoccur during subsequent training sessions. Conclusion This supervised intensive physical training program with submaximal exertion zones was feasible, safe, and highly rated by all participants. Based on these experiences and the reported well-being of the patients, we launched a prospective oligocentric study to objectify the improvements in physical performance and quality of life in patients with glioblastoma (ClinicalTrials.gov Identifier: NCT05015543).