Supervised Exercise Training Program Research Articles

The Effect of Early Cardiac Rehabilitation on Health-Related Quality of Life among Heart Transplant Recipients and Patients with Coronary Artery Bypass Graft Surgery

Purpose To investigate the effect of an early postoperative outpatient cardiac rehabilitation program to health-related quality of life among heart transplantation recipients (HTR) and patients with coronary artery bypass graft (CABG) surgery. Methods The study included 45 clinically stable HTR (age: 47 ± 14 years; 36 men, 9 women) and 34 patients with CABG (age: 57.2 ± 12.5 years; 27 men, 7 women). HTR started rehabilitation 70 ± 33 days after transplantation; patients with CABG started training 36 ± 18 days after surgery. Patients participated in a 12-week supervised exercise training program three times per week. Each training session comprised 10 minutes of warm-up, 25 to 30 minutes of cycling or treadmill walking, and 10 minutes of cooldown. The exercise intensity was set at 50% to 80% of peak oxygen uptake (V̇O 2peak) according to the patient's condition. The health-related quality of life of subjects was evaluated by the Medical Outcomes Trust 36-item health survey (SF-36) at baseline and upon the completion of rehabilitation. Results At baseline, the HTR group showed lower V̇O 2peak than the CABG group, but the health-related quality of life was similar between the two groups. After training, both groups exhibited an increase of 3.6 mL · kg −1 · min −1 in V̇O 2peak and improvement of physical component in health-related quality of life. The HTR group showed a significant increase of SF-36 scores in physical functioning (59.7 ± 18.9 to 77.0 ± 14.0), physical role (21.1 ± 34.1 to 38.3 ± 37.9), bodily pain (57.4 ± 24.3 to 73.6 ± 21.5), social functioning (63.6 ± 23.4 to 72.8 ± 22.1), emotional role (59.2 ± 43.7 to 76.3 ± 37.4), and mental health (67.1 ± 17.9 to 73.4 ± 14.6). The CABG group only exhibited increased scores in physical functioning (60.0 ± 22.9 to 73.4 ± 18.0), physical role (19.1 ± 24.9 to 27.9 ± 38.3), bodily pain (57.1 ± 20.0 to 70.3 ± 16.1), and social functioning (54.0 ± 21.3 to 69.9 ± 21.1). Conclusions Early postoperative cardiac rehabilitation significantly improved physical capacity and quality of life among heart transplant recipients and patients with CABG. Additionally, HTR showed greater improvement in health-related quality of life than patients with CABG regardless of lower physical capacity.

Supervised Exercise Training Reduces Plasma Levels of the Endothelial Inflammatory Markers E-Selectin and ICAM-1 in Patients With Peripheral Arterial Disease

Elevated plasma levels of vascular inflammatory markers have been reported in patients with peripheral arterial disease (PAD). We assessed the effect of supervised exercise training (ET) on vascular inflammation, hypothesizing that ET reduces plasma levels of the endothelial adhesion molecules E-selectin, intercellular adhesion molecule-1 (ICAM-1), and vascular cell adhesion molecule-I (VCAM-I). Twenty-nine patients with PAD underwent a supervised ET program for 8 weeks. Before and after ET, walking distances (pain-free, PWD; maximal, MWD) were determined by a standard treadmill test. Plasma levels of E-selectin and ICAM-I were significantly reduced (E-selectin: 45.5-40.4 ng/mL, P = .013); ICAM-I: 342.0-298.0 ng/mL, P = .016). VCAM-1 levels were unchanged. Walking distances increased significantly (PWD: median 77-150 m, P < .001; MWD: median 306-535 m, P < .001). In conclusion, 8 weeks of ET in patients with PAD reduces plasma levels of the specific endothelium-derived inflammatory markers E-selectin and ICAM-I.

Feasibility, safety and efficacy of an early aerobic rehabilitation program for patients after minor ischemic stroke: A pilot randomized controlled trial

To examine the feasibility, safety and effectiveness of an early aerobic rehabilitation program for patients after minor ischemic stroke. Randomized control trial. Twenty-eight patients, 1-3 weeks post minor ischemic stroke (modified Rankin scale; mRS ≤ 2), were randomly assigned to intervention or control groups. Measures were taken at weeks 1 and 6. All participants were instructed in home practice to achieve strength and flexibility, and were asked to continue their normal community routine. Intervention group participants performed a supervised exercise training program twice a week for 6 weeks. Exercise capacity was evaluated by the 6-minute walk distance test (6MWD), and the modified Bruce treadmill test. Eight subjects out of 14 participated in all 12 training sessions, one at less than 50% of the sessions, while five reached the highest stage of the program. No adverse events were noted during the intervention period. In the intention to treat analysis a significant improvement over time was seen for the functional parameters only. No interaction (group*time) was found. According to the per protocol analysis a significant interaction effect was found; only the intervention group participants showed a significant clinical change in the 6MWD test (412 ± 178 meters to 472 ± 196 meters, vs the control group 459 ± 116 meters to 484 ± 122 meters, p< 0.01). An early supervised aerobic training after minor ischemic stroke is feasible and well tolerated and, in a per-protocol analysis, was associated with improved walking endurance. Further studies with a larger sample size are needed to assess the effect of such a program on functional abilities, prevention of risk factors, and recurrent stroke.

The Effect of a Structured Exercise Program on Nutrition and Fitness Outcomes in Human Immunodeficiency Virus-Infected Children

The feasibility and effectiveness of a hospital-based exercise-training program followed by a home-based program for improving fitness, strength, and changes in body composition in children and adolescents with HIV were evaluated. Subjects participated in nonrandomized 24-session, hospital supervised exercise training program followed by an 314 unsupervised home-based maintenance program. Outcome measurements included muscular strength/endurance, flexibility, relative peak VO(2), body composition, and lipids. Seventeen subjects (eight females) with a median age of 15.0 years (range: 6.0-22.6) and BMI z-score of 0.61 (range: -1.70-2.57) at entry completed the intervention. After 24 training sessions, the median increases in muscular strength were between 8% and 50%, depending on muscle group. The median increases in muscle endurance, relative peak VO(2), and lean body mass were 38.7% (95% CI: 12.5-94.7; p = 0.006), 3.0 ml/kg/min (95% CI: 1.5-6.0; p < 0.001), and 4.5% (95% CI: 2.4-6.6; p < 0.001), respectively. Twelve children completed the home-based maintenance program. Median changes in these outcomes between completion of the hospital-based intervention and a follow-up after completion of the home-based program were near zero. No adverse events occurred during the intervention. A supervised hospital-based fitness program is feasible, safe, and effective for improving general fitness and strength as well as lean body mass in children with HIV.

Post-polio syndrome: Pathophysiological hypotheses, diagnosis criteria, medication therapeutics

Post-polio syndrome (PPS) refers to a clinical disorder affecting polio survivors with sequelae years after the initial polio attack. These patients report new musculoskeletal symptoms, loss of muscular strength or endurance. PPS patients are tired, in pain and experience new and unusual muscular deficits, on healthy muscles as well as deficient muscles initially affected by the Poliovirus. Once a clinical diagnosis is established, the therapeutic options can be discussed. Some pathophysiological mechanisms have been validated by research studies on PPS (inflammatory process in cerebrospinal fluid [CSF] and cytokines of the immune system). Several studies have been conducted to validate medications (pyridostigmine, immunoglobulin, coenzyme Q10) or physical exercises protocols. This article focuses on the relevance and efficacy that can be expected from these therapeutics. Very few studies reported some improvements. Medications combined to individual and supervised exercise training programs are promising therapeutic strategies for PPS patients care management.

Endurance Exercise Training in Older Patients with Heart Failure: Results from a Randomized, Controlled, Single‐Blind Trial

To test the hypothesis that exercise training (ET) improves exercise capacity and other clinical outcomes in older persons with heart failure with reduced ejection fraction (HfrEF). Randomized, controlled, single-blind trial. Outpatient cardiac rehabilitation program. Fifty-nine patients aged 60 and older with HFrEF recruited from hospital records and referring physicians were randomly assigned to a 16-week supervised ET program (n=30) or an attention-control, nonexercise, usual care control group (n=29). Sixteen-week supervised ET program of endurance exercise (walking and stationary cycling) three times per week for 30 to 40 minutes at moderate intensity regulated according to heart rate and perceived exertion. Individuals blinded to group assignment assessed four domains pivotal to HFrEF pathophysiology: exercise performance, left ventricular (LV) function, neuroendocrine activation, and health-related quality of life (QOL). At follow-up, the ET group had significantly greater exercise time and workload than the control group, but there were no significant differences between the groups for the primary outcomes: peak exercise oxygen consumption (VO(2) peak), ventilatory anaerobic threshold (VAT), 6-minute walk distance, QOL, LV volumes, EF, or diastolic filling. Other than serum aldosterone, there were no significant differences after ET in other neuroendocrine measurements. Despite a lack of a group "training" effect, a subset (26%) of individuals increased VO(2) peak by 10% or more and improved other clinical variables as well. In older patients with HFrEF, ET failed to produce consistent benefits in any of the four pivotal domains of HF that were examined, although the heterogeneous response of older patients with HFrEF to ET requires further investigation to better determine which patients with HFrEF will respond favorably to ET.

Effects of exercise training in patients with idiopathic pulmonary arterial hypertension

We determined the physiological effects of exercise training on exercise capacity and quadriceps muscle function in patients with idiopathic pulmonary arterial hypertension (iPAH). In total, 19 clinically stable iPAH patients (New York Heart Association II-III) underwent a supervised exercise training programme for the duration of 12 weeks. Maximal capacity, endurance capacity and quadriceps function were assessed at baseline and after 12 weeks. In 12 patients, serial quadriceps muscle biopsies were obtained. 6-min walk distance and peak exercise capacity did not change after training. However, endurance capacity improved significantly after training, demonstrated by a shift of the anaerobic threshold to a higher workload (from 32+/-5 to 46+/-6 W; p = 0.003) together with an increase in exercise endurance time (p<0.001). Moreover, exercise training increased quadriceps strength by 13% (p = 0.005) and quadriceps endurance by 34% (p = 0.001). Training enhanced aerobic capacity of the quadriceps, by increasing capillarisation (1.36+/-0.10 to 1.78+/-0.13 capillaries per muscle fibre; p<0.001) and oxidative enzyme activity, especially of the type-I (slow) muscle fibres. No changes were found in cross-sectional area and fibre type distribution. Exercise training in iPAH improves exercise endurance and quadriceps muscle function, which is also reflected by structural changes of the quadriceps.

Effects of Exercise Training on Noninvasive Cardiac Measures in Patients Undergoing Long-term Hemodialysis: A Randomized Controlled Trial

Noninvasive screening studies may identify hemodialysis (HD) patients at increased risk of sudden cardiac death. Interventions that improve the findings of such screening studies may reduce sudden cardiac death. Randomized and controlled clinical trial. 59 HD patients were randomly assigned to an exercise training group (group A; 30 patients) or control group (group B; 29 patients). Group A participated in a 10-month supervised exercise training program during the HD sessions (3 times weekly). Each risk factor separately and the composite risk score. Patients were considered high risk according to the criteria (aerobic capacity: peak oxygen consumption [Vo(2)peak] < or = 14 mL/kg/min, left ventricular ejection fraction < or = 30%, SD of normal RR intervals [SDNN] < or = 70 milliseconds, positive T-wave alternans, or positive late potentials). Statistical analysis included a 2-group comparison of change scores and analysis of covariance adjusting for baseline. At entry and end of the study, Vo(2)peak and left ventricular ejection fraction were estimated, heart rate variability was calculated (measurement of SDNN, mean RR intervals), and the ratio between low- (LF) to high-frequency (HF) components (LF/HF) and late potentials and T-wave alternans were detected. Baseline measurements were similar between the 2 groups. At follow-up, 9 patients from group A and 20 from group B (P = 0.003) were considered high risk. The change in number of risk markers over time was significantly different between groups (-0.5 +/- 0.7 in group A versus 0.07 +/- 0.3 in group B; P < 0.001). Additionally, the change in Vo(2)peak over time was 3.5 +/- 3.2 in group A and -0.2 +/- 3.5 mL/kg/min in group B (P < 0.001), left ventricular ejection fractions were 3.4% +/- 3.9% and 0.2% +/- 7.7% (P < 0.05), SDNNs were 12.6 +/- 16.3 and -1.1 +/- 10.2 milliseconds (P < 0.001), and LF/HF ratios were 0.3 +/- 0.4 and -0.1 +/- 0.3 (P < 0.001), respectively. Change in numerical score of the signal-averaged electrocardiogram also was found to be statistically different (P < 0.05) between groups. Clinical outcomes, including survival, were not assessed. Exercise training improves aerobic capacity and ameliorates some indicators of risk of sudden cardiac death in HD patients.

Reduced oxidant stress, increased NO‐dependent vasodilatation, and improved endothelial function with voluntary exercise in old mice: another excuse for long walks on the beach

The study by Durrant and coworkers (2009) in this issue of The Journal of Physiology investigates the effect of aerobic exercise on endothelium-dependent (vaso)dilatation (EDD) in B6D2F1 mice, a model of age-associated endothelial dysfunction (Lesniewski et al. 2009). The authors note that increasing age is a major risk factor for cardiovascular disease (Lakatta & Levy, 2003) that is likely to be mediated via increased oxidative stress and reduced NO levels (Cai & Harrison, 2000; Taddei et al. 2001). Current evidence indicates that habitual aerobic exercise improves EDD in older humans by reducing oxidative stress and increasing NO availability (Seals et al. 2008). The multiple beneficial effects of exercise that the authors report in the older mice are consistent with existing studies in humans, but provide more detailed insight into the potential mechanisms by which habitual aerobic exercise may improve EDD with age and potentially reduce age-associated risks of cardiovascular disease. The study evaluates multiple indices of EDD from the whole animal level to the vascular and enzymatic level in young and old mice with and without access to an exercise wheel for voluntary running. The authors report that voluntary exercise ameliorates the decreased whole body sensitivity to systemic infusion of acetylcholine in conscious older mice. The improvement in whole body acetylcholine sensitivity in older mice was accompanied by a restoration of both the maximum capacity for EDD and the NO-dependent component of EDD in the carotid artery, increased eNOS expression and activation (Ser1177 phosphorylation) in the aorta, and reduced nitrotyrosine levels in the aorta. The beneficial effects of voluntary exercise in the older mice are mediated via effects on both pro-oxidant and antioxidant mechanisms. For example, exercise not only increased total SOD activity, MnSOD activity, and Cu/Zn SOD + ecSOD activity in aortas of the older mice, but also ameliorated the increased expression of the p67 subunit of NADPH oxidase and the increased NADPH oxidase activity in aortas of the older mice. An important and striking observation in this study was that the beneficial effects of voluntary exercise in the older mice occurred even though their exercise levels were only about 10% of those in the younger mice. The importance of endothelial dysfunction and vascular oxidant stress in contributing to cardiovascular morbidity and mortality in humans was strongly emphasized in a recent review (Widlansky et al. 2003) citing 10 different studies showing that the presence of endothelial dysfunction is predictive of future adverse cardiovascular events (including death), and suggesting that evaluation of endothelial function in peripheral arteries may be beneficial in guiding the diagnosis and treatment of cardiovascular disease. In this regard, the results of the present study raise the possibility that voluntary exercise might not only reduce the risk of cardiovascular disease in older asymptomatic humans (see Lakatta and Levy, 2003), but also be beneficial in ameliorating more serious conditions such as peripheral artery disease, which increases with age and is associated with increased cardiovascular morbidity and mortality (McDermott et al. 2008; Sakamoto et al. 2009). The latter possibility is supported by studies showing that antioxidant treatment with glutathione infusion increases pain free walking distance and improves several indicators of microcirculatory and whole bed blood flow in humans with peripheral artery disease (Arosio et al. 2002) and that peripheral artery disease patients completing a supervised exercise training programme show reduced cardiovascular morbidity and mortality (Sakamoto et al. 2009).

Patients With Peripheral Artery Disease Who Complete 12-Week Supervised Exercise Training Program Show Reduced Cardiovascular Mortality and Morbidity

Exercise training improves walking ability in patients with peripheral arterial disease (PAD), but whether exercise training improves the long-term outcome of these patients remains unknown. Participants were 118 PAD patients who were enrolled in a 12-week supervised exercise program. The long-term outcomes of 64 patients who completed the training were compared with the outcomes of 54 patients who did not. The primary endpoint was cardiovascular mortality, and the secondary endpoint was cardiovascular morbidity. Mean follow-up was 5.7+/-3.9 years. The cardiovascular death-free rate was higher in patients who completed the training program than in those who did not (P=0.022). Multivariate analysis showed independent predictors of cardiovascular death were age over 70 years, diabetes mellitus, maximum walking distance, history of coronary revascularization, and completion of training program. The cardiovascular event-free rate was also higher in patients who completed the training program (P=0.048). Supervised exercise training improved cardiovascular mortality and morbidity in patients with PAD, which suggests that exercise training should be considered as a secondary prevention strategy for these patients.

Aerobic exercise training reduces epicardial fat in obese men

The purpose of this study was to determine the effects of exercise training on ventricular epicardial fat thickness in obese men and to investigate the relationship of the change in epicardial fat thickness to changes in abdominal fat tissue following exercise training. Twenty-four obese middle-aged men [age, 49.4 +/- 9.6 yr; weight, 87.7 +/- 11.2 kg; body mass index (BMI), 30.7 +/- 3.3 kg/m(2); peak oxygen consumption, 28.4 +/- 7.2 ml.kg(-1).min(-1); means +/- SD] participated in this study. Each participant completed a 12-wk supervised exercise training program (60-70% of the maximal heart rate; 60 min/day, 3 days/wk) and underwent a transthoracic echocardiography. The epicardial fat thickness on the free wall of the right ventricle was measured from both parasternal long- and short-axis views. The visceral adipose tissue (VAT) and subcutaneous adipose tissues were measured by computed tomography. Following exercise training, the epicardial fat thickness was significantly decreased (P < 0.001). The percentage change of epicardial fat thickness was twice as high compared with those of waist, BMI, and body weight of original values (P <0.05). There was a significant relationship (r = 0.525, P = 0.008) between changes in the epicardial fat thickness and VAT with exercise training. Stepwise multiple regression analysis revealed that the change in VAT, change in systolic blood pressure, and change in quantitative insulin sensitivity check index were independently related to the change epicardial fat thickness (P < 0.05). The ventricular epicardial fat thickness is reduced significantly after aerobic exercise training and is associated with a decrease in VAT. These results suggest that aerobic exercise training may be an effective nonpharmacological strategy for decreasing the ventricular epicardial fat thickness and visceral fat area in obese middle-aged men.

Health‐related fitness and trainability in children with cystic fibrosis

The objective of this study was to examine the effects of a supervised exercise training program performed during an in patient rehabilitation course on various attributes of health-related fitness, e.g., flexibility, balance and coordination. 286 patients with CF, age range 6-18 years (11.8 +/- 3.4 years), mean forced expiratory volume in 1 sec (FEV1 82.7 +/- 22.3% predicted) were included. Patients performed the modified Munich fitness test (mMFT) to assess flexibility, balance, strength and coordination. To assess aerobic capacity a 6-min walk-test (6MWT) was performed. In addition, some of the patients performed an incremental exercise test on a bicycle ergometer using the Godfrey protocol before and after the exercise training program. The supervised training program consisted of 4-6 weeks of different sports activities 5 times per week. After training, pulmonary function showed a significant (P < 0.05) increase. All test items of the mMFT improved significantly (P < 0.05). Compared to healthy children test scores achieved from children with CF in the mMFT were lower but within a normal range. Our children with CF had a lower walk distance in 6MWT (P < 0.05) compared to healthy. Our findings clearly demonstrated benefits of a systematic exercise training program on components of physical fitness in patients with CF, with improvements of test-tasks to predicted normal in some cases. The results from our study suggested that an exercise training program in CF should be focused on several aspects of physical fitness including all components of physical fitness, e.g. aerobic endurance, flexibility, balance and motor skills.

Supervised and home-based exercise training for patients with intermittent claudication

Home-based exercise training, applied as the primary treatment in patients with intermittent claudication, has produced inconsistent effects on walking capacity in previous published studies. The aim of the present study was to evaluate whether a home-based exercise training program could maintain improved walking capacity and other functional variables achieved through a supervised exercise training program. The present design was a 48-week self-controlled study. The first 12-week period was a control stage in which no prescribed exercise program was provided, the second 12-week period was a supervised treadmill-walking training program and the following 24-week period was a home-based exercise program. Twenty-two subjects with intermittent claudication were recruited initially; 15 of them (14 men and one woman) completed the whole program. Walking capacity, peak oxygen uptake, walking economy and ankle-brachial index were measured at baseline and at 12, 24 and 48 weeks. There was no significant change in the measured variables after the control stage. The 12-week supervised treadmill-walking training program significantly increased pain-free walking time, maximal walking time and peak oxygen uptake. Walking economy was also significantly improved. These improvements were successfully maintained after 24 weeks of home-based training. The results indicated that 12 weeks of supervised treadmill-walking training followed by a home-based training program is an effective model of exercise rehabilitation for patients with intermittent claudication.

Long-term effects of supervised exercise training on walking capacity and quality of life in patients with intermittent claudication

Supervised exercise training has been shown to improve walking capacity in several studies of patients with intermittent claudication. However, data on long-term outcome are quite limited. The aim of this prospective study was to evaluate long-term effects of supervised exercise training on walking capacity and quality of life in patients with intermittent claudication. Sixty-seven consecutive patients with intermittent claudication who completed a supervised 12-week exercise training program were asked for follow up evaluation 39 +/- 20 months after program completion. Pain-free walking distance (PWD) and maximum walking distances (MWD) were assessed by treadmill test and several questionnaires. Forty (60%) patients agreed to participate, 22 (33%) refused participation, and 5 (7%) died during follow-up. PWD and MWD significantly improved at completion of 12-weeks supervised exercise training as compared to baseline (PWD 114 +/- 100 vs. 235 +/- 248, p = 0.002; MWD 297 +/- 273 vs. 474 +/- 359, p = 0.001). Improvement of PWD and MWD could be maintained at follow up (197 +/- 254, p = 0.014; 390 +/- 324, p = 0.035, respectively) with non-smokers showing significantly better sustained PWD and MWD improvement as compared to baseline. Overall, walking capacity correlated with functional status of quality of life. Major findings of this investigation were that improvement in walking capacity is sustained after completion of supervised exercise training program with best results in patients who quitted or never smoked. Improved walking capacity is associated with increased functional status of quality of life.

Aerobic Exercise Training May Decrease Epicardial Fat and Improve Postexercise Heart Rate Recovery in Obese Men

BACKGROUND: Epicardial fat has been recently recognized as being indicative of insulin resistance as well as a reliable marker of intraabdominal visceral fat. However, the effect of exercise training on epicardial fat and its association with postexercise heart rate recovery (HRR) have yet to be studied. PURPOSE: To determine the effects of exercise training on epicardial fat and its association with HRR in obese men. METHODS: Twenty-six obese middle-aged men (age 49.4 ± 9.6 yrs; weight 87.3 ± 10.9 kg; body mass index 30.4 ± 3.4; peak oxygen consumption 29.2 ± 6.2 ml/kg/ min; mean ± SD) participated in this study. Each participant completed a 12-week supervised exercise training program (60-70% of maximal heart rate; 60 min per day; 3 days per week), underwent a transthoracic echocardiogram to evaluate epicardial fat thickness on the free wall of the right ventricle from both parasternal long- and short- axis views. HRR was calculated from a graded maximal exercise test as maximal heart rate attained during the test minus heart rate at 2 min post exercise. RESULTS: There was an inverse correlation between epicardial fat thickness and HRR (r = -0.58, p < 0.01) at baseline. Epicardial fat thickness decreased from 8.11 ± 1.64 to 7.29 ± 1.35 mm (p < 0.001) and HRR improved from 46.7 ± 11.5 to 52.2 ± 14.1 beats/min (p < 0.01) after exercise training. CONCLUSION: These results suggest that aerobic exercise training may be an effective nonpharmacologic strategy for decreasing epicardial fat thickness and improving HRR in obese middle-aged men.

Benefits of Intrahospital Exercise Training after Pediatric Bone Marrow Transplantation

The purpose of this study was to determine if an eight-week intrahospital supervised, conditioning program improves functional capacity and quality of life (QOL) in children (4 boys, 4 girls) (mean [SD] age: 10.9 [2.8] years [range: 8-16]) who have undergone bone marrow transplantation (BMT) for leukemia treatment within the last 12 months. A group of 8 age and gender-matched healthy children served as controls. The experimental group performed 3 weekly sessions of resistance and aerobic training inside an intra-hospital gymnasium. A significant combined effect of group and time (p < 0.05) was observed for muscle functional capacity (Timed Up and Down Stairs [TUDS] test) and peak oxygen uptake (V.O(2peak)), i.e., with BMT children showing greater improvements than controls (V.O(2peak) at pre- and post-training of 25.9 (8.2) and 31.1 (7.6) mL/kg/min in diseased children). Muscle strength (6 RM test for bench and leg press and seated row) also improved after training (p < 0.05) in the BMT group. Concerning QOL, a significant combined effect of group and time (p < 0.05) was also observed for children's self-report of comfort and resilience and for parents' report of their children's satisfaction and achievement. In summary, children who have received BMT experience physical and overall health benefits after a relatively short-term (8 weeks) supervised exercise training program.

Moderate exercise training improves functional capacity, quality of life, and endothelium-dependent vasodilation in chronic heart failure patients with implantable cardioverter defibrillators and cardiac resynchronization therapy

The objective of this study was to determine the effects of a moderate exercise training program on functional capacity, quality of life, and hospital readmission rate in chronic heart failure patients with implantable cardioverter defibrillators and cardiac resynchronization therapy. We studied 52 men (mean age 55+/-10 years, ejection fraction 31+/-7%) in chronic heart failure II (n=29) and III (n=23) NYHA functional class with ischemic cardiomyopathy who received implantable cardioverter defibrillators with or without cardiac resynchronization therapy. Patients were randomized into two groups. Group T (n=30 patients, 15 implantable cardioverter defibrillator, 15 implantable cardioverter defibrillator+cardiac resynchronization therapy) underwent a supervised exercise training program at 60% of peak VO2 three times a week for 8 weeks. Group C (n=22 patients, 12 implantable cardioverter defibrillator, 10 implantable cardioverter defibrillator+cardiac resynchronization therapy) avoided physical training. At 8 weeks, only trained patients had improvements in peak VO2 (P<0.01 versus C), endothelium-dependent dilatation of the brachial artery (P<0.001 versus C) and quality of life (P<0.001 versus C). Among trained patients, those with cardiac resynchronization therapy had greater improvements in peak VO2 and quality of life. During the follow-up (24+/-6 months), eight controls had sustained ventricular tachycardia requiring hospital readmission, while no trained patients had adverse events (log rank 8.56; P<0.001). The improvement in peak VO2 was correlated with the improvement in endothelium-dependent dilatation (r=0.65). Moderate exercise training is safe and has beneficial effects after implantable cardioverter defibrillator implantation, especially when cardiac resynchronization therapy is present. These effects are associated with improvement in quality of life and outcome.

Long-term versus intermediate-term supervised exercise training in advanced heart failure: Effects on exercise tolerance and mortality

Aim To date there have been no studies exploring the effects of long-term versus intermediate-term and short-term supervised exercise training program in patients with severe chronic heart failure (CHF) on optimal medical therapy. We assessed exercise tolerance and mortality in CHF patients undergoing long- versus intermediate-term exercise training (ET). Methods Forty-two consecutive severe CHF patients (New York Heart Association functional class III) were referred for a supervised exercise and cardiac rehabilitation program and were followed-up for 3 years: 20/42 (48%) patients discontinued ET after intermediate-term period of 1.6 ± 0.8 years (Group A, intermediate-term ET), and 22/42 (52%) remained on the ET program for 3.0 ± 0.3 years (Group B, long-term ET). Exercise duration, 6-min walked distance and metabolic equivalents (METs) assessed by modified Bruce protocol were recorded before, 4.5 months after, and 3 years after initiation of ET. Results Both groups were comparable regarding age, gender, prevalence of ischemic etiology, mean ejection fraction and medications. Risk factors for ischemic heart disease were similar, except for the prevalence of diabetes, which was higher in Group A compared to Group B (11/20 versus 5/22, p = 0.03). Significantly more Group A patients died after ET discontinuation (4/20 versus 0/22, p = 0.01). At the end of follow-up a significant improvement could be seen in Group B patients compared to A in exercise duration, 6-min walked distance and metabolic equivalents ( p < 0.01 for all). Conclusions Higher survival rate was observed in severe CHF patients undergoing long-term versus intermediate-term exercise training. Long-term supervised exercise training is safe and improves exercise tolerance in these patients.

Improved Health And Wellbeing In Type 2 Diabetes Outpatients Involved In A Kinesiologist-directed Training Program

Exercise is important in the management of type 2 diabetes. Structured, supervised training sessions in a Diabetes Education Centre led by a kinesiologist could improve the physical health and psychological well-being of these patients. PURPOSE A pilot project to determine the feasibility and effectiveness of a kinesiologist-directed, supervised exercise training program on the health and health related quality of life of type 2 diabetes outpatients. METHODS Subjects (6 males and 9 females; 61.9±13.0 years, 92.4±33.1 kg body mass, means ± SD) were recruited from the Diabetes Education Center to participate in this project. All participants completed a stress test and were cleared for participation by their physician. Pre- and post-tests consisted of a physical assessment, questionnaires, and blood work. Participants exercised in a supervised hospital setting, twice a week for 10–12 weeks. The kinesiologistdirected exercise sessions consisted of 25 minutes of aerobic activity and 25 minutes of resistance training with 10 minutes of flexibility exercises during the warm up and cool down. Pre- to post-training values were compared using a dependent ttest. Significance was accepted at p < 0.05. RESULTS Body composition improved significantly (average weight decreased 1.55 kg, waist girth decreased by 5cm, sum of 2 and sum of 5 skinfolds decreased 10 and 9 % respectively) while physical functioning measures (push ups, curl ups, step test duration, sit to stand tests) improved significantly 15 to 474 %. Diastolic blood pressure did not change however, systolic blood pressure decreased significantly (average decrease of 9.2 mm Hg). Glucose control improved significantly (HbA1C; pre=7.15±1.06; post=6.91±1.06 %). Health related quality of life and physical activity participation assessed using the SF-36 Vitality and Reported Health Transition subscales and Total Score as well as the Total Score on the Healthy Physical Activity Participation Questionnaire were improved significantly (p=0.028, 0.047, 0.039 and 0.020 respectively) by the intervention. CONCLUSION There are clear benefits for type 2 diabetes outpatients to be involved in a kinesiologist-directed exercise training program within the health care system. Supported by the Eastern Kings Memorial Health Foundation, Thera-Band ® and the Nova Scotia Health Research Foundation.

Post Surgical Weight Loss In Bariatric Patients Who Self-Select Supervised Exercise

Bariatric surgery is an effective method for weight loss in those who are morbidly obese. However, little data exists regarding the effect of exercise following surgery with respect to the rate of weight loss. PURPOSE Describe the rate of weight loss after bariatric surgery in individuals who 1) self-selected participation in a clinicbased, supervised exercise (ClinicEx) program, or 2) self-reported regular exercise (NonClinicEx), or 3) self-reported not participating in regular exercise (NoEx). METHODS All patients were provided an individual exercise counseling session and group nutrition counseling prior to surgery. Each returned to the surgery clinic at three and six months post surgery. We queried an outcome database for patients and gathered 3 and 6 month post-surgery body weight and exercise data (N = 42) from a clinic chart review. Baseline body weight was not different between the groups: ClinicEx patients (n = 10; 6 males) baseline body weight = 162+ 37 kg; NonClinicEx patients (n = 20; 17 females) = 140+16 kg; and NoEx patients (n = 12; 10 females) = 139+23 kg. Statistical analysis was performed using ANOVA with Tukey post-hoc analysis. RESULTS At three and six months post-surgery each group lost weight (p<0.01). However, the ClinicEx group lost a significantly greater absolute amount of weight at both three and six months (table). There was no difference in weight loss at either time point between the NonClinicEx and NoEx groups (p >0.05).TableCONCLUSIONS Patients who are post-bariatric surgery and who self-select participation in a clinic-based, supervised exercise training program lose significantly more weight at three and six months post-surgery than those who either self-report regular exercise or those who do not exercise. This pilot data supports the benefits of a supervised exercise program as a method to accelerate the rate of weight loss following bariatric surgery.