Supervised Exercise Sessions Research Articles

How do participant experiences and characteristics influence engagement in exercise referral? A qualitative longitudinal study of a scheme in Northumberland, UK

ObjectivesExercise referral schemes (ERSs) are internationally widespread. This study aimed to gain an insight into differential engagement through understanding participant experiences of patients referred by healthcare professionals to one such...

Short-Term Psychological and Physiological Effects of Varying the Volume of High-Intensity Interval Training in Healthy Men.

We assessed the short-term effects of varying the volume of high-intensity interval training (HIIT) on psychological and physiological responses of 23 healthy adult males ( M = 21 years; M peak oxygen uptake [VO2peak] = 47.2 ml·kg-1·min-1). Participants were randomly assigned to low- and very-low-volume HIIT groups and engaged in nine supervised exercise sessions over three weeks. The low-volume HIIT group performed 8-12 60-second work bouts on a cycle ergometer at the peak power output achieved during the incremental test, interspersed by 75 seconds of low-intensity active recovery. The very-low-volume HIIT performed 4-6 work bouts with the same intensity, duration, and rest intervals. During training, participants' ratings of perceived exertion (Borg Category Ratio-10 scale) and their affective responses (Feeling Scale -5/+5) during the last 15 seconds of each work bout were recorded. Physiological data were VO2peak, endurance, and anaerobic performance before and after the intervention. Throughout training, participants in the very-low-volume group (relative to the low-volume group) reported lower ratings of perceived exertion in Week 1 ( M = 4.1 vs. M = 6.3; p < .01) and Week 3 ( M = 4.0 vs. M = 6.2; p < .01), and higher affective response in these same two weeks (Week 1: M = 1.9 vs. M = 0.3; p = .04; Week 3: M = 2.1 vs. M = 0.9; p = .06). Regarding physical fitness, Wingate peak power increased significantly after training in the very-low-volume HIIT group ( M = 1,049 W vs. M = 1,222 W; p < .05), but not in the low-volume HIIT group ( M = 1,050 W vs. M = 1,076 W). No significant change was found after training in physiological variables of peak power output, VO2peak, and endurance performance. In summary, in this short-term training period, the very-low-volume HIIT enhanced anaerobic capacity and was perceived as less strenuous and more pleasurable than low-volume HIIT.

Supervised exercise training with multimodal pre-habilitation leads to earlier functional recovery following colorectal cancer resection.

Exercise training is a component of the pre-habilitation program. While in one previous study the training was home-based, in a subsequent investigation it was supervised in hospital. The hypothesis of this secondary analysis of the two studies was to determine whether supervised exercise further accelerates the return to baseline walking ability. Data from two consecutive randomized control trials (RCT) comparing pre-habilitation to the rehabilitation of cancer patients scheduled for colorectal surgery were pooled for analysis. The interventions were similar and included home-based exercise training, nutritional counseling and protein supplementation, and relaxation techniques administered either before surgery (pre-habilitation) or after surgery (rehabilitation). Patients in the second RCT received additional supervised exercise sessions. Functional capacity was assessed with the 6-minute walk test (6MWT) at baseline, before surgery, and at 4 and 8weeks after surgery. Adjusted logistic regression was used to determine the improvement of the 6-minute walk distance (6MWD). Baseline mean 6MWD of 63 patients in the supervised group was 465.1m (SD, 115), and that of 77 patients in the nonsupervised group was 407.8m (SD, 109) (P<0.01). Perioperative supervised exercise training enhanced further functional capacity and muscle strength when compared with the nonsupervised group (P<0.01). Those receiving exercise supervision had over two times higher chances to return to baseline after surgery. Supervised pre-habilitation was the best combination (4weeks OR=7.71, and at 8weeks OR=8.62). Supervised exercise training leads to meaningful changes in functional capacity thus accelerating the postoperative return to baseline activities.

Effects of Preoperative Exercise on Physical Fitness and Body Composition in Pancreatic Cancer Survivors Receiving Neoadjuvant Therapy: A Case Series

Background and Purpose: Poor preoperative physical fitness and muscle mass are associated with increased morbidity and mortality in pancreatic cancer survivors. While neoadjuvant therapy improves viability for and effectiveness of a surgical resection in patients with borderline-resectable pancreatic adenocarcinoma, it also reduces preoperative fitness and muscle mass. The purpose of this investigation was to prevent fitness and muscle mass declines in this population with a supervised, preoperative exercise program. Methods: Patients recently diagnosed with borderline-resectable pancreatic adenocarcinoma and prescribed neoadjuvant therapy were recruited. Assessments of body composition, physical fitness, and health-related quality of life were assessed at baseline (&lt;4 weeks from diagnosis), preoperatively, and 6 weeks after hospital discharge. Participants attended 2 to 3 supervised exercise sessions per week for the duration of neoadjuvant therapy. Sessions consisted of aerobic, resistance, and flexibility exercises tailored to the individual. Adherence to the exercise program was recorded to assess feasibility. Results: Only 3 participants were recruited in an 8-month window, primarily due to location limitations, and are presented as a case series. All participants increased lean muscle mass and physical fitness after the exercise program. Two participants met cancer cachexia diagnostic criteria at baseline but not after the exercise program. One participant developed metastatic disease and did not receive surgery. Neither of the participants who underwent surgery was readmitted to the hospital after discharge. Conclusion: This study provides preliminary evidence that a preoperative exercise program during neoadjuvant therapy may be effective at maintaining or improving muscle mass and physical fitness in pancreatic cancer survivors.

1747P - EXTEND: Safety and efficacy of exercise training in men receiving enzalutamide (ENZ) in combination with conventional androgen deprivation therapy (ADT) for hormone naïve prostate cancer (HSPC)

Background: ADT is associated with physical side effects and a decline in cardiorespiratory fitness that can be mitigated with exercise (EX). Addition of a more potent androgen receptor inhibitor such as ENZ might worsen these effects. In this pilot study, we investigated whether an EX program could mitigate adverse changes from ADT + ENZ treatment. Methods: Men starting ADT for M0 HSPC were treated with ADT + ENZ for 8 months and randomized to usual care (UC) or EX for 16 weeks. EX began 4 weeks prior to starting ADT + ENZ and consisted of 48 supervised exercise sessions delivered 3x/week between 55-80% of exercise capacity (VO2peak) for aerobic training and 60-85% of one repetition maximum (1-RM) for resistance training. The primary endpoint was change in VO2peak from baseline to 16 weeks. Secondary endpoints included 6 minute walk distance (6MWD), upper and lower body strength (1-RM), body composition (DXA), and patient reported outcomes (FACT-P, FACIT-Fatigue). The study was originally designed to recruit 56 subjects (N = 28/arm) but was halted early due to funding issues. Results: 26 men (UC, N = 13; EX, N = 13) completed the protocol. Baseline age and BMI (mean ± standard deviation [SD]) were 65.0 ± 8.1 yr and 28.5 ± 4.6 kg/m2. Intention to treat analyses for mean 16-week change from baseline with a 95% confidence interval (CI) for each assessment by arm are presented in the table.Table: 1747PEndpointUC + ADT + ENZ (mean change [95% CI])EX + ADT + ENZ (mean change [95% CI])VO2peak (ml kg-1 min-1)-3.2 (-6.3, -0.2)-0.9 (-2.4, 0.5)6MWD (ft)-32.0 (-71.2, 7.3)+42.0 (5.6, 78.4)1-RM Leg Press (lbs)+6.7 (-46.7, 60.0)+107.1 (43.2, 171.0)1-RM Chest Press (lbs)+4.9 (-11.0, 20.9)+24.3 (9.2, 39.4)1-RM Row (lbs)+3.0 (-10.5, 16.5)+14.9 (0.7, 29.0)Fat Mass (g)+2949 (565, 5333)-122 (-1593, 1350)Lean Mass (g)-3088 (-5384, -792)-2094 (-3549, -640)FACT-P TOI-11.6 (-20.3, -2.9)-5.4 (-10.8, 0.1)FACIT-F Score-9.2 (-16.0, -2.4)-5.0 (-8.0, -2.1) Open table in a new tab Conclusions: Supervised aerobic and resistance EX resulted in less decline in VO2peak, as well as improved function and strength in men treated with ADT + ENZ for M0 HSPC. EX was associated with less fat gain and muscle mass loss, less decline in QOL, and less increase in fatigue. Larger trials of EX in this setting are warranted. Clinical trial identification: NCT02256111. Legal entity responsible for the study: Duke University Health System. Funding: Pfizer (Medivation), Astellas. Disclosure: All authors have declared no conflicts of interest.

The effects of exercise referral schemes in the United Kingdom in those with cardiovascular, mental health, and musculoskeletal disorders: a preliminary systematic review

BackgroundExercise referral schemes within clinical populations may offer benefits for inactive and sedentary individuals, and improve and aid treatment of specific health disorders. This systematic review aims to provide an overview, and examine the impact, of exercise referral schemes in patients with cardiovascular, mental health, and musculoskeletal disorders. This review focuses on populations within the United Kingdom (UK) only, with an aim to inform national exercise referral policies and guidelines.MethodData was collected from specific sources using validated methodology through PRISMA. Systematic searches were performed using Locate, PubMed, Scopus and Pro Quest: Public Health databases. Thirteen studies met inclusion criteria set for each sub group. This included that all studies aimed to prevent, observe, or decrease ill-health relating to the disorder, participants over the age of sixteen, and health disorders and outcomes were reviewed. All studies were conducted in the UK only.ResultsIn the 13 articles, a variety of modes and types of exercise were utilised. One-to-one supervised exercise sessions based in a gym environment were most frequently employed. Results showed that longer length schemes (20+ weeks) produced better health outcomes, and had higher adherence to physical activity prescribed, than those of shorter length (8–12 weeks). In patients referred with cardiovascular disorders, cardiovascular-related measures showed significant decreases including blood pressure. Schemes increased physical activity levels over the length of scheme for all disorders.ConclusionLonger length schemes (20+ weeks) improved adherence to physical activity prescribed over the course of the scheme, and could support longer term exercise adherence upon completion, however additional research on larger samples should examine this further. An implication is that schemes currently recommended in guidelines do not tailor programmes to support long term adherence to exercise, which must be addressed. There is currently a lack of research examining programmes tailored to suit the individual’s health conditions thus further research might allow providers to tailor delivery and build upon policy recommendations in the UK.

Effect of a rehabilitation program on performance-related musculoskeletal disorders in student and professional orchestral musicians: a randomized controlled trial

Objective: To explore the feasibility of a rehabilitation program and its effect on the performance-related musculoskeletal symptoms and functional limitations of orchestral musicians. Design: Single-blind pilot randomized controlled trial with exercise group and control group. Setting: Workplace of professional symphony orchestra and tertiary-level conservatory orchestral musicians. Participants: Professional and student orchestral musicians with or without performance-related musculoskeletal disorders. Interventions: A rehabilitation program including an educational presentation, an 11-week home exercise program and three supervised exercise sessions, versus no intervention. Measures: Feasibility measures included adherence and drop-out rate. The Musculoskeletal Pain Intensity and Interference Questionnaire for professional orchestra Musicians (MPIIQM) measured symptom intensity and functional limitations, while the Nordic Musculoskeletal Questionnaire (NMQ) measured symptom prevalence and frequency. Results: A total of 30 participants were recruited (n = 15 per group). Exercise group adherence was 97.7% for the supervised sessions and 89% for the home exercise program. There were no drop-outs. Significant group-time interactions were obtained for both the pain intensity (partial η2 = 0.166; P = 0.025) and pain interference (partial η2 = 0.186; P = 0.017) sections of the MPIIQM. Mean (standard deviation) pain intensity score changes from baseline to 11 weeks were control group: 0.40 (5.04); P = 0.763; partial η2 = 0.007; and exercise group: –4.07 (5.31); P = 0.010; partial η2 = 0.386. For pain interference, mean score changes were control group: 0.20 (9.10); P = 0.933; partial η2 = 0.001; and exercise group: –9.00 (10.73); P = 0.006; partial η2 = 0.430. NMQ analyses revealed no significant interaction (P > 0.05). Conclusion: Results suggest that the studied program is feasible and effective in decreasing the intensity and functional impact of musicians’ symptoms. However, no significant medium-term effect on the prevalence and frequency of symptoms was shown.

"Kicked out into the real world": prostate cancer patients' experiences with transitioning from hospital-based supervised exercise to unsupervised exercise in the community.

Regular exercise is recommended to mitigate the adverse effects of androgen deprivation therapy in men with prostate cancer. The purpose of this study was to explore the experience of transition to unsupervised, community-based exercise among men who had participated in a hospital-based supervised exercise programme in order to propose components that supported transition to unsupervised exercise. Participants were selected by means of purposive, criteria-based sampling. Men undergoing androgen deprivation therapy who had completed a 12-week hospital-based, supervised, group exercise intervention were invited to participate. The programme involved aerobic and resistance training using machines and included a structured transition to a community-based fitness centre. Data were collected by means of semi-structured focus group interviews and analysed using thematic analysis. Five focus group interviews were conducted with a total of 29 men, of whom 25 reported to have continued to exercise at community-based facilities. Three thematic categories emerged: Development and practice of new skills; Establishing social relationships; and Familiarising with bodily well-being. These were combined into an overarching theme: From learning to doing. Components suggested to support transition were as follows: a structured transition involving supervised exercise sessions at a community-based facility; strategies to facilitate peer support; transferable tools including an individual exercise chart; and access to 'check-ups' by qualified exercise specialists. Hospital-based, supervised exercise provides a safe learning environment. Transferring to community-based exercise can be experienced as a confrontation with the real world and can be eased through securing a structured transition, having transferable tools, sustained peer support and monitoring.

Home Based Exercise Intervention in Pregnant Indian Women: Effects on Weight and Obesity Markers

Abstract Background and Aims: The purpose of this study was to investigate the effect of a home based physical activity intervention during pregnancy on weight and various obesity markers resulting in metabolic syndrome in future. Methods: The paper presents a pilot experimental study (pre-post comparison) from a larger ongoing trial, with40 pregnant women (20 each) having singleton pregnancy of &gt;16 weeks of gestation, BMI &gt;18.5 Kg/m2 and declared fit by gynecologist for physical activity during pregnancy. They were assigned to either home exercise group receiving antenatal weight loss intervention delivered via 2 exercise demonstration sessions and informative brochures with advised regular 30 minutes walking during pregnancy, while control group was advised once at initial recruitment for maintaining active lifestyle during pregnancy. The data was analyzed using IBM-SPSS-(version 21) software. Results: Though the exercise group had less weight gain and weight retention than the control group, the pregnancy home intervention alone was not effective in controlling obesity parameters like body mass index (BMI), waist circumference (WC), hip circumference (HC) and waist to hip ratio (W/H).Conclusion: Home based pregnancy exercise intervention should include other adjunct components, which could be diet advice or timely supervised exercise sessions to have appreciable obesity control during pregnancy.

How does a lifestyle intervention during pregnancy influence perceived barriers to leisure-time physical activity? The Norwegian fit for delivery study, a randomized controlled trial

BackgroundTo develop effective health promotional and preventive prenatal programs, it is important to understand perceived barriers to leisure-time physical activity during pregnancy, including exercise and sport participation. The aims of the present study was 1) to assess the effect of prenatal lifestyle intervention on the perceived barrier to leisure-time physical activity during pregnancy and the first year after delivery and 2) identify the most important perceived barriers to leisure-time physical activity at multiple time points during and after pregnancy.MethodsThis secondary analysis was part of the Norwegian Fit for Delivery study, a combined lifestyle intervention evaluated in a blinded, randomized controlled trial. Healthy, nulliparous women with singleton pregnancy of ≤20 gestational weeks, age ≥ 18 years and body mass index ≥19 kg/m2 were recruited via healthcare clinics in southern Norway, including urban and rural settings. Participants were randomized to either twice-weekly supervised exercise sessions and nutritional counselling (n = 303) or standard prenatal care (n = 303). The principal analysis was based on the participants who completed the standardized questionnaire assessing their perceived barriers to leisure-time physical activity at inclusion (gestational week 16, n = 589) and following intervention (gestational week 36, n = 509), as well as six months (n = 470) and 12 months (n = 424) postpartum.ResultsFollowing intervention (gestation week 35.4 ± 1.0), a significant between-group difference in perceived barriers to leisure-time physical activity was found with respect to time constraints: “... I do not have the time” (intervention: 22 vs. control: 38, p = 0.030), mother-child safety concerns: “... afraid to harm the baby” (intervention: 8 vs. control: 25, p = 0.002) and self-efficacy: “... I do not believe/think that I can do it” (intervention: 3 vs. control: 10, p = 0.050). No positive effect was seen at postpartum follow-up. Intrapersonal factors (lack of time, energy and interest) were the most frequently perceived barriers, and consistent over time among all participants.ConclusionThe intervention had effect on intrapersonal perceived barriers in pregnancy, but not in the postpartum period. Perceived barriers to leisure-time physical activity were similar from early pregnancy to 12 months postpartum.Trial registrationClinicalTrials.gov: NCT01001689, registered July 2, 2009.

The Influence Of Non-exercise Physical Activity During Aerobic Exercise On Cardiometabolic Risk Factors

PURPOSE: To determine the impact of changes in non-exercise physical activity on changes in cardiometabolic risk factors in participants performing aerobic exercise training. METHODS: Obese adults (N=25) were randomized to an aerobic training group or an aerobic training and increasing non-exercise physical activity group. Both groups performed supervised aerobic training (50%-75% VO2 max) for 24 weeks at a dose of 12 kcals per kg per week. Non-exercise physical activity (total steps, minutes in low, moderate to vigorous [MVPA] physical activity) was quantified during the entire intervention using Fitbit One accelerometers (removed during supervised exercise sessions). Cardiometabolic assessments included lipids, glucose, insulin, 2-hour glucose/insulin from an oral glucose tolerance test, fitness, and body composition measures (% body fat, weight, and waist circumference). Linear regression models were run with change in the cardiometabolic variable as the dependent variable and baseline value, age, race, sex, supervised exercise time, adherence to exercise dose, change in non-exercise physical activity variables (change in total steps, minutes in light intensity and minutes in MVPA) as predictor variables. RESULTS: Change in total steps was a significant predictor for change in weight (r2= 0.17, p=0.04), percent weight loss (r2= 0.18, p=0.03, waist circumference (r2=0.31, p=0.004), triglycerides (r2= 0.30, p=0.01) and relative fitness (r2= 0.19, p=0.03). Change in total steps approached significance as a predictor for absolute fitness (p=0.052) and body fat (p=0.059). Change in minutes in low intensity was a significant predictor of the change in 2-hour glucose (r2= 0.20, p=0.03). Change in MVPA was not associated with change in any cardiometabolic variables (all ps>0.05). Change in non-exercise physical activity did not predict changes in glucose, insulin, 2-hour insulin, low density lipoprotein, high density lipoprotein, total cholesterol, or lean mass levels (all ps>0.05). CONCLUSIONS: Change in non-exercise physical activity outside of aerobic training was associated with changes in several cardiometabolic variables. Increasing total steps or minutes in low intensity may represent a clinical target to maximize the health benefits of aerobic exercise training in obese adults.

Reducing Attrition and Improving Program Adherence in a Physician-Referred Weight Loss Program for Adults.

It has been shown that physician-referred hospital-based team-approach programs can be effective interventions for weight loss for adults. Programs that include strategies in behavior change may assist in successfully completing a weight loss program. PURPOSE: The purpose of this project was to evaluate the effectiveness of behavioral contracting to improve program adherence and reduce attrition in a physician-referred weight loss program for adults. METHODS: Participants included obese (BMI≥30) adults (Age 53.4±1.3yrs) enrolled in a physician-referred program. Participants were enrolled without signing an accountability contract (CONTROL, N=48) or enrolled after signing an accountability contract (CONTRACT, N=48). Starting and final weights were recorded before and after a 16-24 week intervention period that included supervised exercise sessions (EX), and scheduled consultations with a registered dietitian (RD, N=4) and a behavioral health specialist (BHS, N=4). The CONTRACT group signed an accountability statement that listed program goals, standards/expectations, and an acknowledgment of commitment statement. Attendance for EX, RD, and BHS sessions was recorded. Program completion was determined if a final weight was recorded for a participant at the end of the program. Independent sample t-tests (p<0.05) were used to determine differences in participant characteristics. RESULTS: There were no significant differences in participant characteristics for CONTRACT as compared to CONTROL (Age 53.0±13.6 vs. 53.8±12.0; Sex 81.3% vs. 81.3% female; Starting Weight (lbs) 238.1±44.7 vs. 228.1±38.9; % Weight Loss -6.7±3.3% vs. -4.8±4.5%). Program completion was higher for CONTRACT as compared to CONTROL (87.5% vs. 58.3%). The proportion of participants who attended 75-100% of required consultation visits was higher for CONTRACT as compared to CONTROL (RD 85% vs. 29%; BHS 77% vs. 25%). However, EX attendance was slightly lower for CONTRACT as compared to CONTROL (44% vs. 52%). CONCLUSION: Behavioral contracting may be an effective tool for increasing specialized consultation adherence and reducing attrition in a physician- referred weight loss program. Additional research is required to determine how to increase exercise session adherence.

A 6-week hip muscle strengthening and lumbopelvic-hip core stabilization program to improve pain, function, and quality of life in persons with patellofemoral osteoarthritis: a feasibility pilot study

BackgroundPatellofemoral joint (PFJ) osteoarthritis (OA) is prevalent in middle-aged and older adults. Despite this, there are minimal studies which have examined conservative interventions for PFJ OA. Weakness of proximal lower extremity muscles is associated with PFJ OA. It is unknown if a hip muscle strengthening and lumbopelvic-hip core stabilization program will improve symptoms and function in persons with PFJ OA. This study examined the feasibility and impact of a 6-week hip muscle strengthening and core stabilization program on pain, symptoms, physical performance, peak muscle torques, and quality of life in persons with PFJ OA.MethodsTen females with PFJ OA and ten age- and sex-matched controls participated in baseline tests. PFJ OA participants attended ten twice-a-week hip strengthening and core stabilization exercise sessions. Outcome measures included questionnaires, the Timed-Up-and-Go, and peak isometric torque of hip and quadriceps muscles. Data were tested for normality; parametric and non-parametric tests were used as appropriate.ResultsAt baseline, the PFJ OA group had significantly worse symptoms, slower Timed-Up-and-Go performance, and lower muscle torques than control participants. PFJ OA group adherence to supervised exercise sessions was adequate. All PFJ OA participants attended at least nine exercise sessions. Five PFJ OA participants returned 6-month follow-up questionnaires, which was considered fair retention. The PFJ OA participants’ self-reported pain, symptoms, function in daily living, function in sport, and quality of life all improved at 6 weeks (P < 0.05). Timed-Up-and-Go time score improved at 6 weeks (P = 0.005). Peak hip external rotator torque increased (P = 0.01). Improvements in pain and self-reported function were no longer significant 6 months following completion of the intervention.ConclusionsPFJ OA participants were adherent to the supervised sessions of the intervention. Improvement in symptoms, physical performance, and muscle torque were found after 6 weeks. Participant retention at 6 months was fair, and significant changes were no longer present. Our findings suggest that a hip strengthening and core stabilization program may be beneficial to improve symptoms, function, and physical performance in persons with PFJ OA. Future studies are needed, and additional measures should be taken to improve long-term adherence to exercise.Trial registrationClinicalTrials.gov NCT02825238. Registered 6 July 2016 (retrospectively registered).

Abstract 202: Outcomes of Region-Wide Cardiac Rehabilitation

Background: Cardiac rehabilitation (CR) is recommended for patients with cardiovascular disease, however the impact of a region-wide, centrally managed CR model with local non-medical community-based delivery of CR is unknown in a universal health care system setting. Objectives: To determine the impact of a regional 6-month, once per week supervised exercise session CR model on mortality and re-hospitalization compared to a matched control within a regional health care system. Methods: The regional CR service comprised: a standardized regional referral strategy for patients with established cardiac disease including stable heart failure, local (within a 30-minute drive time from place of residence) CR service delivery by trained CR professionals. Patient data that was prospectively entered into a regional CR database for patients referred to CR from 2012 through 2014, was linked to government mandated administrative databases and all-cause mortality and hospitalization rates were compared between patients who were referred to CR vs. a matched cohort who were not. Matching included age, sex, year of referral, socioeconomic status, and cardiac condition at hospital discharge. Mortality and re-hospitalization were assessed at 1-yr post index cardiac event excluding the initial 6-month period to account for immortal time bias. Results: Fewer patients who completed CR compared to matched controls died (14/1,318 or 1.1% vs. 31/1,318 or 2.4%, p=0.011), or were readmitted to hospital (128 or 9.7% vs. 190 or 14.4%, p&lt;0.001). Fewer patients who started but did not complete CR (CR non-completers) died compared to matched controls (10/639 or 1.6% vs. 21/639 or 3.3%, p=0.045), however there was no difference in hospital readmission rates between CR non-completers compared to matched controls (18.0% vs. 14.9%, p=0.13). More patients who were referred to CR but did not enroll in CR, died compared to matched controls (241/3,933 or 6.1% vs. 196/3,933 or 5.0%, p=0.027), or were readmitted to hospital (932 or 23.7% vs. 643 or 16.3%, p&lt;0.001). Conclusions: In a universal health-care system, patients who completed a regionally coordinated, locally delivered, standardized CR program close to home, experienced lower mortality or re-hospitalization rates compared to matched patients not referred to CR. This association was not likely due to a referral bias as patients who were referred to CR but did not enroll in CR faired worse, not better, compared to matched non-CR referred patients. Health care system decision makers (e.g. provincial governments in Canada) should strongly consider funding regional CR strategies.

Metabolic and Psychological Impact of a Pragmatic Exercise Intervention Program in Adolescent and Young Adult Survivors of Pediatric Cancer-Related Cerebral Insult.

To assess metabolic function among adolescent and young adult (AYA) survivors of childhood cancer-related brain surgery or cranial irradiation (CRT) and to determine feasibility, safety, and metabolic as well as psychological impact of a 6-month exercise program in this cohort. Twenty AYAs aged 15-23 years were recruited. All had completed cancer treatment by age 15.5 and were more than 1 year after end of treatment. Metabolic function was assessed at baseline (T1), after a 6-month non-intervention period (T2), and after the 6-month intervention (T3). Psychological assessments were performed at T1 and T3. Eight to 12 months after the program (T4), its lasting impact was assessed by questionnaire. The 6-month intervention consisted of small group-based, tailored, supervised exercise sessions combining resistance and aerobic exercise. Sessions were offered up to thrice per week and adherence defined as participation in ≥24 sessions. Flexibility was built into the design with an alternative home-based program offered to those who could not attend the gymnasium. Thirteen of the 20 recruited participants were adherent to the program. There was one fall during exercise, but no injury was sustained. Higher rates of metabolic impairment than would be expected in a healthy cohort were found at baseline both among brain tumor survivors and survivors of total body irradiation. Central adiposity reduced post-intervention (p = 0.014) and improvements in adaptive function were seen. Participants enjoyed the program, but work and study commitments limited attendance. AYA survivors of childhood brain tumors and CRT should be screened for metabolic and psychological well-being. Small group-based exercise is safe, feasible, and enjoyable for this cohort and may benefit them both metabolically and psychologically. ACTRN12614000796684. Retrospectively registered July 28, 2014.

Exercise Rehabilitation for Peripheral Artery Disease: A REVIEW.

To summarize evidence regarding exercise therapy for people with lower extremity peripheral artery disease (PAD). Literature was reviewed regarding optimal strategies for delivering exercise interventions for people with PAD. Randomized trial evidence and recent studies were emphasized. Randomized clinical trial evidence consistently demonstrates that supervised treadmill exercise improves treadmill walking performance in people with PAD. A meta-analysis of 25 randomized trials (1054 participants) concluded that supervised treadmill exercise was associated with 180 m of improvement in maximal treadmill walking distance and 128 m of improvement in pain-free walking distance compared with a control group. Three randomized trials of 493 patients with PAD demonstrated that home-based walking exercise interventions that incorporate behavioral change techniques improve walking ability in patients with PAD. Furthermore, evidence suggests that home-based walking exercise improves the 6-min walk more than supervised treadmill exercise. Upper and lower extremity ergometry also significantly improved walking endurance in PAD. The Centers for Medicare & Medicaid Services recently determined that Medicare would cover 12 wk (36 sessions) of supervised treadmill exercise for patients with PAD. Supervised treadmill exercise and home-based walking exercise each improve walking ability in patients with PAD. The availability of insurance coverage for supervised treadmill exercise for patients with PAD will make supervised treadmill exercise more widely available and accessible. Home-based exercise that incorporates behavioral change technique is an effective alternative for patients unwilling or unable to attend 3 supervised exercise sessions per week.

Maximizing patient adherence to prehabilitation: what do the patients say?

Multimodal prehabilitation programs (exercise, nutrition, and anxiety reduction) have been shown to be successful for enhancing patients' physical function prior to surgery, although adherence remains a challenge. Given the short pre-operative period, maintaining adherence is critical to maximize program effectiveness. This study was designed to better understand patients' perspectives of prehabilitation and to identify factors related to program adherence. A qualitative descriptive study was conducted based on 52 cancer patients enrolled in a prehabilitation program at the Montreal General Hospital, Montreal, Canada. Data was collected with a structured questionnaire designed to evaluate the program. Patients enjoyed their experience in prehabilitation, especially the exercise program and training sessions. The primary motivating factor for participation was to be physically prepared for the surgery. The most challenging exercise component was resistance training, while the most enjoyed was the aerobic training. Approximately 50% of patients were interested in group fitness classes as opposed to supervised individual training sessions for reasons related to social support. The preferred methods for exercise program delivery were home-based and one supervised exercise session per week. The biggest barrier to participation was related to transportation. These findings highlight the need to make prehabilitation programs more patient-centered. This is critical when designing more effective therapeutic strategies tailored to meet patients' specific needs while overcoming program non-adherence.

Abstract P5-13-01: Effects of a 16-week combined aerobic and resistance exercise intervention on metabolic syndrome in overweight/Obese Hispanic breast cancer survivors

Abstract Purpose. Metabolic syndrome (MetS) is associated with increased risk of cardiovascular disease, type 2 diabetes, and possibly cancer recurrence, and is higher in breast cancer survivors than age-matched postmenopausal women. Further, MetS is 1.5 times more prevalent in Hispanic women (&amp;gt;40 years of age) than in non-Hispanic Whites and African Americans, thereby increasing the need to attenuate MetS in Hispanic breast cancer survivors (HBCS). This study examined the effects of a 16-week combined aerobic and resistance exercise intervention on MetS in overweight and obese HBCS. Methods. This pre-planned sub-analysis included 60 sedentary HBCS (BMI325 kg/m2) from our larger MetS trial. HBCS were randomized to the exercise intervention (EXE; n=30) or usual care (UC; n=30). The EXE group participated in 3 supervised exercise sessions per week for 16 weeks. Aerobic exercise was performed at 65-85% heart rate maximum for ˜30 minutes. Resistance exercise was performed in circuit-fashion with 3 sets of 10-15 repetitions including upper and lower body exercises at 65-85% 1-repetition maximum. The UC group was asked not to increase their current exercise levels during the study period. Participants were tested for MetS (blood pressure, waist circumference, fasting blood glucose, HDL-C, and triglycerides) at baseline, within one week following the 16-week study period, and at 12-week follow-up for the EXE group only. Fasting blood samples were used to measure glucose, HDL-C, and triglycerides. Waist circumference was measured at the midpoint between the lower margin of the last palpable rib and the top of the iliac crest using a fabric tape measure. Blood pressure was measured with an automated sphygmomanometer. Body composition was assessed via dual energy X-ray absorptiometry. Results. At baseline, 82% (overall and by group) of the HBCS met the criteria for MetS. There were no significant group differences in the MetS variables between the EXE and UC groups at baseline (p&amp;gt;0.01). Post-intervention, all MetS components were significantly lower in the EXE group than the UC group (p&amp;lt;0.01) and only 15% of participants in the EXE group met the criteria for MetS, representing a 67% absolute decrease. This is in comparison to 84% of participants in the UC group. Body fat mass decreased by 10% during the 16-week EXE period, compared to a 2% increase in the UC group (p&amp;lt;0.01). MetS changes remained significantly improved in the EXE group when fat mass was included as a covariate in the statistical model. At the follow-up assessment in the EXE group, all MetS variables remained significantly improved compared to baseline (p&amp;lt;0.01) and were not significantly different post-intervention (p&amp;gt;0.25) despite slight increases (&amp;lt;2%) in waist circumference and triglyceride levels. Conclusion. This is one of few exercise trials in minority BCS and the first study to target MetS with exercise in HBCS. This 16-week supervised combined aerobic and resistance exercise intervention reduced MetS in sedentary, overweight and obese HBCS. Reductions in MetS components were maintained after completion of the intervention, suggesting the benefits of the intervention on MetS were sustainable in the absence of a supervised intervention. Citation Format: Dieli-Conwright CM, Sami N, Lee K, Spicer D, Buchanan TA, Demark-Wahnefried W, Courneya K, Tripathy D, Mortimer J. Effects of a 16-week combined aerobic and resistance exercise intervention on metabolic syndrome in overweight/Obese Hispanic breast cancer survivors [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P5-13-01.

Abstract P6-12-11: Feasibility and biomarker modulation due to high levels of moderate to vigorous physical activity as part of a weight loss intervention in older, sedentary, obese breast cancer survivors

Abstract We sought to demonstrate that older, sedentary, obese breast cancer survivors could achieve &amp;gt; 200 minutes per week of moderate to vigorous physical activity (MVI PA) as part of a weight loss intervention; and to assess modulation of risk biomarkers. This level of PA in combination with moderate calorie restriction is associated with weight losses of &amp;gt;10% in women without cancer, which in turn is associated with significant modulation of cancer risk biomarkers. Eleven participants with BMI &amp;gt; 30 kg/m2 enrolled in a 12-week program that consisted of moderate caloric restriction, weekly phone group behavioral sessions, and individualized exercise plans based on measured heart rate reserve. Women were provided an accelerometer with heart rate monitor linked to GarminConnect, membership to a YMCA, twice weekly supervised exercise sessions with a personal trainer, and weekly feedback regarding weight and physical activity progress. The goal was to increase MVI PA (≥45% heart rate reserve) gradually from &amp;lt;60 to &amp;gt;200 minutes per week. The median age was 61, 5/11 women had received prior chemotherapy, and 7/11 were currently taking aromatase inhibitors. Median values of baseline anthropomorphic measures acquired by dual energy x-ray absorptiometry (GE Lunar iDXA) included BMI, 37.3 kg/m2; total mass, 97.5 kg; fat mass, 47.6 kg; visceral fat, 1.7 kg (range 1.4-3.0); and fat mass index, 17.6 kg/m2. The majority had a baseline VO2 peak in the poor range for their age. All 11 participants completed the intervention, with no reported serious adverse events. Median MVI PA achieved over weeks 5-12 was 161 minutes/week (range 48-320). VO2 peak was increased in 10/11 with a median relative change of 12% from baseline. All but one lost weight with an overall median of 8% total mass loss, which was associated with 13% total fat mass loss and 21% visceral fat mass loss. For those with MVI PA above the median, values were 11%, 17%, and 40%, respectively. Visceral fat mass loss was linearly correlated with minutes per week of MVI PA (p=0.032); these parameters in turn were associated with changes in a number of serum biomarkers, including adiponectin-leptin ratio, TNF-alpha, as well as circulating adipose stromal cells, a potential marker for metastasis. Insulin and hs-CRP were favorably modulated in almost all participants but change was not linearly correlated with activity or mass loss parameters; thus these may not be ideal biomarkers to document a dose response to level of MVI PA. Conclusion: These results demonstrate that older, sedentary, obese breast cancer survivors can safely achieve a high level of MVI PA when provided a structured program that includes an exercise trainer. It is feasible to design a clinical trial for such breast cancer survivors to examine biomarker modulation as a function of level of physical activity. Citation Format: Fabian CJ, Klemp JR, Burns JM, Vidoni ED, Nydegger JL, Kreutzjans AL, Phillips TL, Baker HA, Hendry B, John C, Amin AL, Khan QJ, Mitchell MP, O'Dea AP, Sharma P, Wagner JL, Hursting SD, Kimler BF. Feasibility and biomarker modulation due to high levels of moderate to vigorous physical activity as part of a weight loss intervention in older, sedentary, obese breast cancer survivors [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-12-11.

Evaluation of supervised multimodal prehabilitation programme in cancer patients undergoing colorectal resection: a randomized control trial

Background: Prehabilitation has been previously shown to be more effective in enhancing postoperative functional capacity than rehabilitation alone. The purpose of this study was to determine whether a weekly supervised exercise session could provide further benefit to our current prehabilition program, when comparing to standard post-surgical rehabilitation.Methods: A parallel-arm single-blind randomized control trial was conducted in patients scheduled for non-metastatic colorectal cancer resection. Patients were assigned to either a once weekly supervised prehabilitation (PREHAB+, n = 41) or standard rehabilitation (REHAB, n = 39) program. Both multimodal programs were home-based program and consisted of moderate intensity aerobic and resistance exercise, nutrition counseling with daily whey protein supplementation and anxiety-reduction strategies. Perioperative care was standardized for both groups as per enhanced recovery after surgery (ERAS®) guidelines. Functional exercise capacity, as determined by the 6-minute walk test distance (6MWD), was the primary outcome. Exercise quantity, intensity and energy expenditure was determined by the CHAMPS questionnaire.Results: Both groups were comparable for baseline walking capacity (PREHAB+: 448 m [IQR 375–525] vs. REHAB: 461 m [419–556], p=.775) and included a similar proportion of patients who improved walking capacity (>20 m) during the preoperative period (PREHAB+: 54% vs. REHAB: 38%, p = .222). After surgery, changes in 6MWD were also similar in both groups. In PREHAB+, however, there was a significant association between physical activity energy expenditure and 6MWD (p < .01). Previously inactive patients were more likely to improve functional capacity due to PREHAB+ (OR 7.07 [95% CI 1.10–45.51]).Conclusions: The addition of a weekly supervised exercise session to our current prehabilitation program did not further enhance postoperative walking capacity when compared to standard REHAB care. Sedentary patients, however, seemed more likely to benefit from PREHAB+. An association was found between energy spent in physical activity and 6MWD. This information is important to consider when designing cost-effective prehabilitation programs.