Sustainable Exercise Programs Research Articles

EXERCISE AND CANCER PROGRAM: A PRESCRIPTIVE EXERCISE PROGRAM IN A NON-CLINICAL SETTING

INTRODUCTION & AIMS This study aimed to establish a low-cost, sustainable exercise program for cancer patients in Gippsland, Australia, where access to such programs was previously limited. By developing and implementing a collaborative program, the program aimed to improve the physical and psycho-social well-being of cancer patients while reducing burden on healthcare services. METHODS Collaboration between Latrobe Community Health Service, Morwell Leisure Centre, and Gippsland Integrated Cancer Service led to the development of a prescriptive exercise program to provide cancer survivors a sustainable cost-effective exercise and cancer program in a community leisure centre. Exercise physiologists provided initial assessments, in which clients allocated to group-based, one-on-one, or home-based exercise sessions. RESULTS After 12 weeks in the program, 100% of participants that had a reassessment improved on at least one physical test and all improved on a subjective measure like fatigue, depression, or self-worth. On average, they saw a 14.88% increase in leg strength, a 12.70% increase in grip strength, and a 16.65% increase in aerobic fitness. Additionally, they reported an average decrease in anxiety (10.96%), depression (1.59%), fatigue (6.09%), and reported illness symptoms (5.24%). Overall, participant feedback was overwhelmingly positive, highlighting the benefits of the program’s psycho-social support and the opportunity to exercise outside a healthcare setting. CONCLUSION Collaboration between healthcare and leisure centres can provide sustainable and cost-effective exercise programs for cancer patients, improving physical and psycho-social well-being while reducing healthcare burden. Participants valued the support, social interaction, and sense of belonging provided by the program.

EXERCISE & CANCER PROGRAM: A COLLABORATIVE APPROACH TO PROVIDE PRESCRIPTIVE EXERCISE OUTSIDE OF THE CLINICAL HEALTHCARE SETTING

CASE SETTING This study implemented a standardized exercise program for oncology patients in the Latrobe Valley region of Gippsland, Australia, aiming to assess its potential transferability to other regions. This was undertaken due to a lack of structured services available in Gippsland, limiting patient access to these programs, in which patients having to travel up to 2 hours for treatment in Melbourne. TREATMENT Implementation of a standardized exercise program for oncology patients, developed by a multidisciplinary team of exercise physiologists, oncology health professionals, and leisure centre fitness professionals. Exercise Physiologists conducted initial assessments and patients were placed in either individual, group exercise sessions and/or home-based programs. RESULTS The program demonstrated significant improvements in both physical and psychological well-being. The program has received 73 referrals, of which 48 participants completed initial assessments with an Exercise Physiologist. Of the remaining 25 participants, 2 were discharged to other services due to their location outside the program’s jurisdiction, 18 withdrew or did not attend their appointments, and 5 are currently on the waitlist for assessment. At the time of data collection, 17 participants had completed their reassessments.100% of participants improved on at least one physical test, and all participants improved on one of their subjective measures (fatigue, depression, anxiety, self-worth). Additionally, participant feedback was overwhelmingly positive, highlighting the program’s psycho-social support and the benefits of exercising outside a healthcare setting. REFLECTIONS/LEARNINGS This program successfully demonstrated the effectiveness of collaboration between healthcare services and leisure centres in delivering sustainable exercise programs for oncology patients outside of the healthcare setting. It also highlighted the value of providing both physical and psycho-social support, with the inclusion of care coordinators significantly reducing burdens on health services. The program’s success suggests strong potential for transferability to other regions.

Determinants of exercise adherence and maintenance for cancer survivors: Implementation of a community-based group exercise program. A qualitative feasibility study.

Despite verified knowledge that physical exercise plays an important part in recovery after cancer treatment, multiple studies have shown that maintaining a physically active lifestyle after cancer is challenging. There is a need for qualitative studies to increase understanding into patient experiences and perspectives, and facilitate the design of more sustainable exercise program. This qualitative descriptive feasibility study explores experiences from the implementation of a novel four-month community-based group exercise program for cancer survivors within municipality health service after completion of rehabilitation in the specialist health care service. Fourteen cancer survivors participated in focus group interviews after completing Rehabilitation: Physical activity and Coping - feasibility study. Data were analyzed using the systematic text condensation method. We identified a main category, Determinants for exercise adherence and maintenance and four subcategories: peer-support, environment, structure and knowledge. A social and supportive exercise environment promotes exercise adherence and maintenance among cancer survivors. This knowledge can be useful for further efforts to implement high quality community-based group exercise programs for cancer survivors. This study adds knowledge of survivors' experience of a novel community-based group exercise program in clinical practice and can promote the implementation of sustainable community-based exercise programs for cancer survivors.

A community-based exercise program for ambulant adolescents with cerebral palsy, a feasibility study

The aim of this study was to investigate the feasibility of an 18-week exercise program for adolescents with cerebral palsy (CP). Fourteen individuals aged 16-25 (GMFCS I-III) performed aerobic and strength exercises at their community leisure center up to three times a week. A physiotherapist provided instruction at the first session and between 2-4 times thereafter. The fitness instructor on duty provided supervision when required. Feasibility of the exercise program was explored through an exercise logbook and participant feedback questionnaire. Gross motor function, muscle strength, aerobic capacity and the Timed Up and Go test were assessed at baseline, 6, 12 and 18 weeks. Quality of life and self-esteem were measured at baseline and 12 and 18 weeks. Participants completed a mean 14.8 (range 5-23) weeks of the exercise program and a mean of 31 (range 10-52) sessions. The results of the feedback questionnaire suggested that the exercise program was mostly well accepted. Adverse effects (muscle soreness and fatigue) were reported by three participants. Results indicated the feasibility of a community exercise program for adolescents with CP and recommendations for sustainable exercise programs for this group were provided.

Sustained exercise programs for hemodialysis patients: The characteristics of successful approaches in Portugal, Canada, Mexico, and Germany.

Despite having good intentions, hemodialysis (HD) clinics often fail to sustain exercise programs that they initiate. There are many reasons for this, including a lack of funding, inadequate training of the clinic staff, a lack of exercise professionals to manage the program or train the staff, and the many challenges inherent to exercising a patient population with multiple comorbid diseases. Despite these barriers, there are several outstanding examples of successful exercise programs in HD clinics throughout the world. The aim of this manuscript is to review the characteristics of four successfully sustained HD exercise programs in Portugal, Canada, Mexico, and Germany. We describe the unique approaches they have used to fund and manage their programs, the varied exercise prescriptions they incorporate, the unique challenges they face, and discuss the benefits they have seen. While the programs differ in many regards, a consistent theme is that they each have substantial and committed support from the entire clinic staff, including the nephrologists, administration, nurses, dietitians, and technicians. This suggests that exercise programs in HD clinics can be successfully implemented and sustained provided significant effort is made to foster a culture of physical activity throughout the clinic.

Effects of physiotherapy in patients treated with chronic hemodialysis

<p>Although physical activity is an important factor in prevention of many chronic, non-infectious diseases, it is rarely used as a regular procedure in dialysis patients. Despite the guidelines on good clinical practice, recommended physical exercise as a part of routine activities is implemented in a very small number of centers. Factors that contribute to sustainable exercise programs are the professional commitment of a multidisciplinary team consisting of physiotherapist, nephrologist, geriatrist, social worker, nurse, the incentive and encouragement of the entire dialysis staff for carrying out active exercise, as well as adequate physical space and equipment, with individualization for each patient in turn. Patients with end-stage kidney disease who are in the physical treatment program show significant functional improvements, especially those associated with the cardiovascular, respiratory and muscular system, as well as with the quality of life. There are no reports on serious injuries as a result of participation in the exercise program. This indicates that it is time for physical therapy to be included in the regular routine care procedure in hemodialysis patients. However, it is necessary to identify an optimal training regimen in accordance with the individual characteristics of each patient, in order to make it easier to apply the exercise program.</p>

Searching for maintenance in exercise interventions for cancer survivors.

Translating evidence-based exercise interventions into practice is important for expanding the capacity to support cancer survivors. Using the reach, efficacy/effectiveness, adoption, implementation, and maintenance (RE-AIM) framework and scoping study methodology, we addressed the research question, "What is known about the maintenance of exercise interventions for cancer survivors that would inform translation from research to practice and community settings?" Maintenance was investigated at the individual and setting level. Literature searches were performed in the PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Sport Discus databases for articles published from January 2009 to June 2012. Abstracts were judged using a priori criteria for the survivor population, exercise intervention, and maintenance on the individual or setting level. We included completed and planned randomized controlled trials (RCTs) and other study designs. Publications meeting the criteria were reviewed and coded. Of the 211 abstracts meeting patient and exercise criteria, 24 (19 RCTs) met the maintenance criteria. Nine of the 12 completed RCTs demonstrated maintenance of intervention outcomes after 3 to 14 months of follow-up. The planned RCTs described interventions lasting 2 to 4.5 months and maintenance intervals lasting 3 to 12 months following the active intervention. Maintenance at the setting level was reported in one publication. On the individual level, intervention outcomes were maintained in most studies, in a variety of settings and survivor subpopulations. Maintenance on the setting level was scarcely addressed. This scoping study suggests several strategies that could be taken by agencies, clinicians, and researchers to develop more effective and sustainable exercise programs for cancer survivors. Many benefits of exercise training are maintained for months after cancer survivors complete controlled research studies but relatively little is known about how to translate research to sustainable community-based exercise programs. A better understanding of how programs can be sustained in practice beyond short-term research or grant funding is needed to support a growing number of survivors.

Sustaining a Hemodialysis Exercise Program: A Review

This article reviews the literature addressing exercise programs for dialysis patients to identify elements necessary for sustaining exercise programs in this population. Literature searches for publications (January 1980-February 2009) in Medline (OVID), PubMed, CINAHL (EBSCO), EBSCOhost EJS, ProQuest Central, Web of Science, Cochrane Library, Google Scholar, ScienceDirect, SpringerLink (Kluwer), and Wiley Interscience (Blackwell) were performed. Reference lists from relevant articles were hand-searched for further publications. Criteria for inclusion included full-text primary research and review articles focused on exercise for adult hemodialysis patients. One hundred and seventy one publications were found with a primary focus on exercise in hemodialysis. Of these, 28 primary research and 14 review articles addressed one or more aspects of sustainability of hemodialysis exercise programs. Factors contributing to sustainable exercise programs included: dedicated exercise professionals; encouragement to exercise intradialytically; dialysis and medical staff commitment; adequate physical requirements of equipment and space; interesting and stimulating; cost implications need to be addressed; exercise is not for everyone; requires individual prescription; and there is no age barrier to exercise on hemodialysis.

Exercise intervention to prevent falls and enhance mobility in community dwellers after stroke: a protocol for a randomised controlled trial

BackgroundStroke is the most common disabling neurological condition in adults. Falls and poor mobility are major contributors to stroke-related disability. Falls are more frequent and more likely to result in injury among stroke survivors than among the general older population. Currently there is good evidence that exercise can enhance mobility after stroke, yet ongoing exercise programs for general community-based stroke survivors are not routinely available. This randomised controlled trial will investigate whether exercise can reduce fall rates and increase mobility and physical activity levels in stroke survivors.Methods and designThree hundred and fifty community dwelling stroke survivors will be recruited. Participants will have no medical contradictions to exercise and be cognitively and physically able to complete the assessments and exercise program. After the completion of the pre-test assessment, participants will be randomly allocated to one of two intervention groups. Both intervention groups will participate in weekly group-based exercises and a home program for twelve months. In the lower limb intervention group, individualised programs of weight-bearing balance and strengthening exercises will be prescribed. The upper limb/cognition group will receive exercises aimed at management and improvement of function of the affected upper limb and cognition carried out in the seated position. The primary outcome measures will be falls (measured with 12 month calendars) and mobility. Secondary outcome measures will be risk of falling, physical activity levels, community participation, quality of life, health service utilisation, upper limb function and cognition.DiscussionThis study aims to establish and evaluate community-based sustainable exercise programs for stroke survivors. We will determine the effects of the exercise programs in preventing falls and enhancing mobility among people following stroke. This program, if found to be effective, has the potential to be implemented within existing community services.Trial registrationThe protocol for this study is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12606000479505).

Thiazolidinediones for the Treatment in NASH

Although of unproven benefit for nonalcoholic steatohepatitis (NASH), thiazolidinediones (TZDs) have emerged as a promising therapy. Little evidence exists, however, regarding sustained effects of TZDs in NASH after drug discontinuation. A recent clinical study suggests that relapse of NASH pathophysiology is inevitable and that lifelong therapy may be needed to maintain histologic response. We reviewed extended follow-up data of NASH patients previously treated with troglitazone to evaluate the influence of weight and physical activity on clinical and histologic parameters related to NASH recurrence. After medical record review, 9 of 10 patients had complete data for follow-up and 5 had an extended follow-up biopsy 3 years or more after discontinuing troglitazone therapy. In contrast to recent work showing relapse of NASH to be nearly universal after discontinuation of TZD therapy, 2 of our patients had 1-stage improvement in fibrosis, normal aminotransferases, and absence of diabetes after median follow-up of 37 months after discontinuation of troglitazone. Both patients had sustained exercise programs and interval body mass index reduction. In contrast, active steatohepatitis, progression of fibrosis, and requirement of antidiabetic medications were seen in patients unable to achieve lifestyle modifications. We conclude that sustained histologic response after short-term TZD therapy for NASH is not invariably lost after medication discontinuation but rather is intimately related to sustained changes in lifestyle, particularly physical activity. Activity and diet in the setting of thiazolidinedione or other drug therapy of NASH is an essential consideration that warrants careful incorporation into future drug trials.