Unsupervised Exercise Program Research Articles

Synchronous and asynchronous remote core stability exercises in patients with axial spondyloarthritis: a randomized-controlled clinical trial.

Exercise is a key component of axial spondyloarthritis (axSpA) management. As telerehabilitation has become a viable solution for delivering remote care, the effectiveness of core stability exercises via this method remains under-researched. To compare the effects of telerehabilitation-based synchronous versus asynchronous core stability exercises on core muscle endurance, spinal mobility, disease activity, physical function, and quality of life in patients with axSpA. Forty-four patients with axSpA were randomly assigned to a synchronous exercise group (n = 22, 14 females) performing real-time exercises supervised by a physiotherapist, or an asynchronous group (n = 22, 10 females) following pre-recorded exercise videos. Core endurance tests, Bath Ankylosing Spondylitis Disease Activity (BASDAI), Bath Ankylosing Spondylitis Functional (BASFI), Bath Ankylosing Spondylitis Metrology Index (BASMI), Ankylosing Spondylitis Quality of Life Scale (ASQoL), and functional mobility tests (timed-up-and-go and chair stand tests) were used to assess outcomes. Perceived change was evaluated at post-treatment using the 5-point Global Rating of Change (GRoC) scale. The synchronous group demonstrated greater changes in core endurance, BASMI, BASDAI, ASQoL, BASFI, and functional mobility tests (p < 0.05) compared to asynchronous group. Asynchronous group displayed improvement only in core endurance, ASQoL, chair stand test, and some BASMI parameters (p < 0.05). Notably, 100% of participants in the synchronous group reported their condition as improved, compared to 50% in the asynchronous group shown by GRoC. Supervised core stability exercises delivered by using a synchronous telerehabilitation program may provide better outcomes compared to unsupervised video-based exercise program. This study is prospectively registered at Clinicaltrials.gov (NCT06000072).

Effect of interdisciplinary obesity care on metabolic markers and body weight in people with type 2 diabetes in a rural setting: A randomised controlled trial.

Management of type 2 diabetes includes medications that can unintentionally increase obesity and insulin resistance. This unblinded, single-centre, randomised controlled trial focused on rural Australian adults with type 2 diabetes (aged 18-75 and body mass index [BMI] >30 kg/m2), measuring the effectiveness of a tailored interdisciplinary obesity care approach compared with usual diabetes care. Led by a nurse practitioner with allied health support (dietitian ± psychologist and physiotherapist), the bariatric treatment involved reducing weight-gaining medications, a 500-calories/day deficit, an unsupervised exercise program emphasising movement/strength and psychotherapy, 3-monthly to 24-months with support phone calls at weeks 2, 4, 8 and 10. Outcomes from the 224 (113 intervention/111 control) participants were differences in biomedical and physical markers within- and between-groups estimated using multivariate mixed-effects linear regression between recruitment and 6-monthly follow-ups. Greater change occurred in intervention compared with control groups at 12 and 24 months in mean: body weight (-5.9 kg [95% confidence interval, CI: -8.53, -3.23] and -9.0 kg [95% CI: -13.2, -4.77]); BMI (-2.03 kg/m2 [95% CI: -2.92, -1.15] and -3.51 kg/m2 [95% CI: -4.93, -2.08]); and glycated haemoglobin (-0.26% [95% CI: -0.69%, 0.18%] and -0.63% [95% CI: -1.17%, 0.08%]). The control group showed a significant increase in mean leptin level, resulting in a between-group difference (-27.1 [95% CI: -42.7, -11.5]). Lipids and blood pressure differences were inconclusive, while exploratory analysis showed greater decline in estimated glomerular filtration rate in the control group. The interdisciplinary obesity approach, compared with usual diabetes care, resulted in sustained weight loss and improved diabetes control over 2 years. Trial registration number: ACTRN12622000240741.

Adherence to Supervised and Unsupervised Exercise Programmes in Ageing Population with Intermittent Claudication: A Randomized Controlled Trial.

Background: Intermittent Claudication symptomatic peripheral arterial disease (ICSPAD) is associated with reduced mobility, functional capacity, and quality of life. Physical exercise is an effective non-pharmacological intervention for the management of ICSPAD. Adherence to exercise programs is challenging, due to the nature of the disease and the complex comorbidities associated with it. This study aimed to determine adherence to three supervised physical exercise programs (a walking intervention, strength intervention, and concurrent intervention) and an unsupervised exercise program (standard advice) in individuals with ICSPAD. Methods: In this clinical trial, 122 patients were divided into four groups based on the type of exercise program they followed: standard advice, walking intervention, strength intervention, and concurrent intervention. Results: The results revealed that while the demographic characteristics were similar, the strength intervention group had a younger mean age, and the walking group had a higher prevalence of hypertension and increased usage of anti-hypertensive drugs. Adherence to physical exercise and pedometer wearing was highest in the standard advice group. Logistic regression analysis showed lower odds of adherence to exercise and pedometer wearing in the intervention groups compared to the standard advice group. Adherence did not significantly vary across ankle-brachial index categories. Furthermore, there was no significant difference in adherence between the severity levels of intermittent claudication, though mild cases tended to exhibit higher adherence. Conclusions: The results show that the standard advice from healthcare professionals positively influences treatment adherence.

Comparing the efficacy of a multi-dimensional breast cancer rehabilitation programme versus a home-based exercise programme during adjuvant cancer treatment

BackgroundBreast cancer is the most common female malignancy worldwide and a major cause of morbidity and mortality. Exercise during adjuvant treatment improves function and relieves symptoms in breast cancer survivors. However, it is unclear if an unsupervised exercise programme may be as effective as a supervised multimodal group. We investigated the feasibility and efficacy of a centre-based multidimensional rehabilitation (MDR) programme for breast cancer survivors undergoing adjuvant treatment and compared it to an unsupervised home-based exercise (HE) programme.MethodsParticipants were self-allocated to either MDR or HE group. MDR participants underwent 24 supervised exercise classes and 10 education classes over 12 weeks. HE participants were instructed on a home exercise regime. Outcome measures, including the 6-min walk test (6MWT) and Frenchay Activities Index (FAI), FACT-Cognitive Function scale, and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30, were conducted at baseline (W0), post-intervention (W12) and 6-months post-intervention (M6). Variance between time points and the 2 groups were analysed using a linear mixed model (unstructured covariance matrix) and adjusted with Bonferroni.ResultTwenty-five participants attended at least half of the MDR interventions, while 21 completed the HE interventions. The former showed significant improvement in 6MWT, from 406.88 m (W0) to 443.34 m (W12) to 452.81 m (M6), while the improvement in the HE group was not significant (407.67 m (W0) to 433.14 m (W12) to 430.96 m (M6)). Both groups showed a significant improvement in FAI, with earlier significant improvement noted at W12 in the MDR group (22.71 (W0) to 27.65 (W12) to 28.81 (M6)) compared to the HE group (23.16 (W0) to 26.47 (W12) to 29.85 (M6)). Dropout rate was 16% in the MDR group and 34% in HE group. Overall satisfaction with the MDR programme was high.ConclusionBoth MDR and HE programmes were feasible. MDR was superior in improving endurance and earlier return to instrumental activities for those who completed at least half of the sessions. Future studies could explore use of technology to improve adherence to exercise.Trial registrationThe study was registered with ClinicalTrial.gov on 01/04/2022 with the registration number NCT05306808.

Vigorous vs. moderate exercise to improve glucose metabolism in inactive women with polycystic ovary syndrome and insulin resistance: a pilot randomized controlled trial of two home-based exercise routines

To study the impact of vigorous vs. moderate exercise on metabolic parameters in polycystic ovary syndrome (PCOS). Randomized controlled trial. Unsupervised home-based exercise program. Patients with PCOS on the basis of the Rotterdam criteria with insulin resistance. Participants were block randomized to a home-based exercise program of 75 minutes of vigorous exercise or 150 minutes of moderate exercise per week, for 8 weeks total. Changes in glucose, insulin, and insulin resistance. In total, 36 participants were randomized, of whom 20 completed the study. The percentage changes from baseline at 4 and 8weeks for fasting glucose, insulin, and homeostatic model assessment for insulin resistance did not significantly differ between the groups, except for the change in the 8-week glucose level, which was more favorable in the moderate arm (8.06% [standard deviation, 6.44%] in the vigorous group compared with -0.32% [standard deviation, 4.91%] in the moderate group). The absolute values of the main outcomes (fasting glucose, insulin, and homeostatic model assessment for insulin resistance) at baseline and 4 and 8 weeks did not significantly differ between trial arms. When assessing the change from baseline at 4 and 8 weeks, overall and within each trial arm, only the 8-week fasting glucose level was significantly greater than the baseline value in the vigorous arm (93.5 [95% confidence interval, 88.7-98.3] vs. 86.8 [95% confidence interval, 81.1-92.4]). Unsupervised short-term exercise programs may not achieve significant metabolic improvements in patients with PCOS, regardless of vigorous vs. moderate intensity. Future studies should investigate this question in larger sample sizes and longer or structured exercise programs. ClinicalTrials.gov identifier, NCT02303470.

Cost and outcomes of Hospital-based Usual cAre versus Tele-monitor self-directed Rehabilitation (HUATR) in patients with total knee arthroplasty: A randomized, controlled, non-inferiority trial

To evaluate the clinical efficacy and cost-effectiveness of telemonitored self-directed rehabilitation (TR) compared with hospital-based rehabilitation (HBR) for patients with total knee arthroplasty (TKA). In this randomized, non-inferiority clinical trial, 114 patients with primary TKA who were able to walk independently preoperatively were randomized to receive HBR (n=58) or TR (n=56). HBR comprised at least five physical therapy sessions over 10weeks. TR comprised a therapist-led onboarding session, followed by a 10-week unsupervised home-based exercise program, with asynchronous monitoring of rehabilitation outcomes using a telemonitoring system. The primary outcome was fast-paced gait speed at 12weeks, with a non-inferiority margin of 0.10m/s. For economic analysis, quality-adjusted-life-years (QALY) was the primary economic outcome (non-inferiority margin, 0.027 points). In Bayesian analyses, TR had >95% posterior probability of being non-inferior to HBR in gait speed (week-12 adjusted TR-HBR difference, 0.02m/s; 95%CrI, -0.05 to 0.10m/s; week-24 difference, 0.01m/s; 95%CrI, -0.07 to 0.10m/s) and QALY (0.006 points; 95%CrI, -0.006 to 0.018 points). When evaluated from a societal perspective, TR was associated with lower mean intervention cost (adjusted TR-HBR difference, -S$227; 95%CrI, -112 to -330) after 24weeks, with 82% probability of being cost-effective compared with HBR at a willingness to pay of S$0/unit of effect for the QALYs. In patients with uncomplicated TKAs and relatively good preoperative physical function, home-based, self-directed TR was non-inferior to and more cost-effective than HBR over a 24-week follow-up period. TR should be considered for this patient subgroup.

Effect of Supervised and Unsupervised Exercise Training in Outdoor Gym on the Lifestyle of Elderly People.

physically independent elderly people were randomly distributed into three groups: supervised training (n: 20; ST), unsupervised training (n: 20; UT) and control (n: 20; C). The ST and UT groups completed a 12-week program, with exercises performed three times a week. The ST group underwent weekly 30 min sessions consisting of a 5 min warm-up (walking at 60% of HRmax), followed by 20 sets of 30, "monitored by a metronome with 30" of passive recovery between sets and a five-minute cool-down. The following equipment was used: elliptical, rowing, surfing and leg press. The UT group was instructed to freely attend the gym and train spontaneously using the same equipment used by ST. Lifestyle changes were evaluated using a questionnaire containing specific domains. no significant differences were identified in the domains for family, physical activity, nutrition, smoking, sleep, behavior, introspection, work and overall score; however, the values corresponding to the alcohol domain for the ST and UT groups were lower (p < 0.05) than the C group, remaining even lower after the 12 weeks of intervention. Time effect (p < 0.05) was found only in the ST group for the physical domains, sleep, behavior and overall score. elderly people submitted to supervised and unsupervised physical exercise programs using outdoor gym equipment present positive changes in lifestyle parameters compared to physical inactive elderly people.

Effects of Home-Based Exercise Programs on Mobility, Muscle Strength, Balance, and Gait in Community-Dwelling Older Adults: A Systematic Review and Meta-Analysis.

Individual unsupervised home-based exercise programs can enhance muscle strength, physical function, gait, and balance in older adults. However, the effectiveness of such programs may be limited by the lack of supervision. This study aims to verify the effectiveness of individual unsupervised home-based programs, compare the effects of individual unsupervised home-based to supervised programs, and verify the influence of supervision over individual unsupervised home-based programs on the physical function of older adults. A systematic literature search was performed in four electronic databases, and the trials involved randomized controlled comparing the home-based programs to supervised, control groups, or home-based + supervised evaluating the muscle strength, physical function, gait, and balance in older adults. Eleven studies met the inclusion criteria. The meta-analysis revealed no differences between home-based program versus supervised program in gait, mobility, and balance, revealing a trend of significance to supervised program on strength (standardized mean difference [SMD] = 0.27, p = .05). The analysis revealed effects in mobility (SMD = 0.40, p = .003), balance (SMD = 0.58, p = .0002), and muscle strength (SMD = 0.36, p = .02) favoring home-based program versus control group. Significant effects between home-based program versus home-based + supervised program were observed in balance (SMD = 0.74, p = .002) and muscle strength (SMD = 0.58, p = .01) in favor of home-based + supervised program. Home-based programs effectively improve older adults' physical function compared with control groups. However, supervised programs were more effective for muscle strength.

The Golfer's Fore, Fore +, and Advanced Fore + Exercise Program: An Exercise Series and Injury Prevention Program for the Golfer.

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The effectiveness of “Dijital Steps” web based telerehabilitation system for patient with hindfoot pain: A randomised controlled trial

ObjectiveThe aim of the study was to evaluate and compare effective therapeutic options for hindfoot pain, develop and investigate the effectiveness of tele-rehabilitation systems, and ensure patients perform their exercises and preventive measures regularly and accurately, while monitoring results. MethodsHindfoot pain (HP) patients (N = 77 with 120 feet) were admitted to this study and divided into two pathologies; Plantar Fasciitis and Achilles Tendinopathy. Patients in each pathology were randomized into three different rehabilitation programs-web-based telerehabilitation (PF-T & AT-T), -hands-on healing techniques combined with exercise (PF-C & AT-C)-unsupervised home exercise (PF-H & AT-H) program. Disability, activity restrictions, first-step pain, dorsiflexion-plantar flexion range of motion and kinesiophobia scores were recorded. The outcomes of the study groups were collected pre-post intervention (8thweek). Telerehabilitation system was developed via user-driven innovation and tested before using formally. ResultsEach group had significant improvements in pain, disability, functional status and kinesiophobia (p < 0.001). In terms of functional status, PF-C had a statistically significant difference from others (p < 0.001). There was no difference between the groups for the pain scores in both pathologies. (p > 0.001). However, web-based telerehabilitation (PF-T & AT-T) were found to be more effective on kinesiophobia compared to the other groups (p < 0.001). ConclusionsThe presented web-based telerehabilitation system for management of hindfoot pain is an effective way and might be preferred instead of unsupervised home exercise specially for kinesiophobia. Additionally, Foot and ankle stretching and strengthening exercises protocols, myofascial releasing and mulligan concept manual therapy are effective modalities in terms of ROM, VISA-A, FAAM, FFI, TSK and VAS scores for hindfoot pain. The results indicated that three promised different rehabilitation protocols could be an effective strategy for HP.

Effectiveness of supervised and functional level-based exercise program in elderly inpatients: Randomised controlled trial

Objective The aim of this study was to compare the effectiveness of supervised and unsupervised functional level-based exercises program for elderly inpatients on physical activity, mobility, health-related quality of life and depression status. Design A single-blinded randomised controlled trial. Setting Internal medicine service. Subjects Patients aged 65 years or older. Interventions A supervised functional level-based exercise program was applied to the intervention group by a physiotherapist, for 40 min 5 times a week during their hospitalisation. Patients in the control group were asked to perform an unsupervised functional level-based exercise program which was described by the physiotherapist during the first visit. Main measures Mobility, physical activity level and health-related quality of life were assessed at admission and discharge in both groups. Depression status was evaluated at admission and 3 months after discharge. Results Sociodemographic features between intervention group (n = 62) and control group (n = 62) were similar. The intervention group showed a higher increment in mobility, physical activity level and quality of life scores than the control group (d = 0.62, p < 0.05; d = 0.57, p < 0.05; d = 1.12, p < 0.05 respectively). Inpatients in the intervention group, depression scores were lower 3 months after discharge (d = 0.42, p < 0.05). The length of stay in the hospital was not different between the groups. Conclusions A supervised functional level-based exercise program is more effective than an unsupervised functional level-based exercise program for mobility, physical activity, depression and quality of life in elderly inpatients. These positive contributions are seen within a short period like a 5 to 10 days stay in hospital. Trial Registration ClinicalTrials.gov(NCT03516032).

Evaluation of two electronic-rehabilitation programmes for persistent knee pain: protocol for a randomised feasibility trial

IntroductionPersistent, knee pain is a common cause of disability. Education and exercise treatment are advocated in all clinical guidelines; however, the increasing prevalence of persistent knee pain presents challenges for...

UNSUPERVISED EXERCISE ADHERENCE RATES IN CLINICAL TRIALS FOR KNEE OSTEOARTHRITIS: A SYSTEMATIC REVIEW

Purpose: Exercise is a beneficial intervention for knee osteoarthritis, and unsupervised exercise programs are a common and recommended adjunct to most clinical interventions. However, it is unknown how adherence with unsupervised programs affects outcomes, and it is unclear if current clinical trials are capturing information regarding adherence. The purpose of this systematic review was to identify the extent and quality of reporting adherence to unsupervised exercise programs in clinical trials for knee osteoarthritis.

Effects of an App-Based Physical Exercise Program on Selected Parameters of Physical Fitness of Females in Retirement: A Randomized Controlled Trial.

Modern technologies enable new options in the delivery of physical exercise programs. Specially designed app-based programs can be used to help older people in particular to integrate physical exercise into their daily lives. This study examines the influence of an app-based physical exercise program on selected parameters of physical fitness, such as muscular strength, balance, and flexibility. The women (n = 110) were on average 65.3 (± 1.5) years old and, compared to age-specific norm values, healthy. The 14-week intervention consisted of an app-based, unsupervised physical exercise program, in which the exercise frequency and duration of sessions were self-selected. The physical exercise program consisted of simple, functional exercises such as arm circles, squats, lateral raises. The participants were provided with an elastic resistance band and an exercise ball allowing them to increase exercise intensity if needed. Participants were randomly assigned to intervention group (IG) and control group (CG). 71% of the IG used the physical exercise program at least 1.2 times per week, whereas 25% of the IG showed usage rates above four times per week. Significant effects were found in the domains of muscular strength and flexibility. While IG could maintain their performance in isometric muscular strength tests and increased their flexibility, CG faced a decrease in those parameters. Thus, this app-based physical exercise program had positively influenced muscular strength and flexibility in women over 60 years of age.

Tai Chi for Dynamic Balance Training Among Individuals with Cerebellar Ataxia: An Assessor-Blinded Randomized-Controlled Trial.

Objective: To evaluate the immediate and long-term effects of 12 weeks of Tai Chi training on dynamic balance and disease severity among individuals with cerebellar ataxia (CA).Design: An assessor-blinded, two-arm, parallel-group randomized-controlled trial was conducted among 24 participants with CA. Participants were randomized to receive either Tai Chi intervention (n = 12) or usual care (n = 12). Dynamic balance was assessed using the Berg Balance Scale (BBS), Scale for the Assessment and Rating of Ataxia (SARA) balance sub-component of the SARA (SARAbal), Sensory Organization Test, and Limits of Stability test. Disease severity was assessed using the SARA and health-related quality of life using the EuroQol visual analog scale. Assessments were completed at baseline (week 0: T1), postintervention (week 12: T2), and at the end of the 24-week (week 36: T3) follow-up period.Interventions: The 8-form Tai Chi exercise was delivered in 60-min sessions, three times a week for 12 weeks. Participants were asked to complete an unsupervised home Tai Chi exercise program over the next 24 weeks. Participants in the usual care control group completed all study measures but did not receive any intervention.Results: Compared with the usual care control group, after 12 weeks of Tai Chi training, the experimental group demonstrated beneficial effects for dynamic balance assessed using the BBS (mean difference [MD]: 4, 95% confidence interval [CI]: −1.06 to 8.71) and the SARAbal (MD: −1.33, 95% CI: −2.66 to 2.33). The effect size ranged from small to large. The benefits gained were not sustained after 24 weeks during the follow-up assessment. Tai Chi did not benefit disease severity and health-related quality of life in this population.Conclusion: Some evidence supports the immediate beneficial effects of 12 weeks of Tai Chi training on the dynamic balance among individuals with CA.Australia New Zealand Clinical Trials Registry (ACTRN12617000327381).

Effectiveness of Therapeutic Exercise and Patient Education on Cancer-Related Fatigue in Breast Cancer Survivors: A Randomised, Single-Blind, Controlled Trial with a 6-Month Follow-Up.

This study aimed to determine the effectiveness of therapeutic exercise plus patient therapeutic education on perceived fatigue, functional capacity and pain in breast cancer survivors with cancer-related fatigue. A randomised, single-blind, clinical trial was conducted with a total of 80 breast cancer survivors who presented cancer-related fatigue. Women were randomised into a supervised therapeutic exercise group (STE-G) (n = 40) or an unsupervised exercise group (UE-G) (n = 40). Both interventions included patient therapeutic education and were delivered in three sessions per week over eight weeks. The main outcome was perceived fatigue as assessed by the Spanish version of the Functional Assessment of Chronic Illness Therapy-Fatigue subscale (FACIT-F). Other evaluated outcomes were pain measured on a visual analogue scale, and distance measured using the 6-Minute Walk Test. Data were collected at baseline, immediately post-intervention, and at three and six months after baseline. Significantly greater improvements across all variables were observed in the STE-G throughout the entire follow-up period with the exception of pain. Conclusions: A supervised therapeutic exercise program plus patient therapeutic education significantly reduce perceived fatigue and increase functional capacity in breast cancer survivors suffering from cancer-related fatigue compared to an unsupervised physical exercise program based on individual preferences with patient therapeutic education.

The characteristics and effects of exercise interventions on improving physical fitness in adults with asthma: a systematic review and meta-analysis

Introduction: Physical activity and fitness is beneficial for asthma-related outcomes and overall health. Experts are calling for exercise training to be embedded within asthma care and for the development of asthma-specific physical activity guidelines. This systematic review aimed to identify the characteristics and determine the effects of exercise interventions on improving physical fitness in adults with asthma. Methods: A systematic search was completed in MEDLINE, CINAHL, EMBASE and SportsDISCUS for peer-reviewed publications of empirical studies that investigated the effects of an exercise training intervention on performance-based measures of physical fitness outcome(s) in adults with asthma. Two reviewers independently screened studies for inclusion according to predetermined criteria and performed data extraction and quality assessment of included studies. Results: Thirty-nine articles were included, in which results for 33 unique studies were reported. Subjects (n=1,726) were aged (mean ± SD) 22±4 to 71 ± 11 years with mild-severe asthma. Most exercise programs used aerobic exercise (97%), alone (39%) or in combination with resistance, stretching and/or breathing exercises (58%). Resistance exercise featured in 39% of studies, stretching exercise in 36% and breathing exercise in 24%. The most common exercise program characteristics were supervised moderate-to-vigorous intensity aerobic exercise performed for 31-45 minutes three days/week. Meta-analyses revealed significant improvements in cardiorespiratory (VO2peak: MD 3.46mL/kg/min, 95% CI 2.55, 4.38, p<0.00001) and functional (6MWD: MD 56.7m, 95% CI 34.5, 78.9, p<0.00001) fitness in favour of experimental exercise training interventions. Findings regarding muscular fitness were not able to be pooled quantitatively, and qualitative synthesis was inconclusive. The effects of unsupervised exercise programs are also unclear and understudied. Discussion: Supervised exercise training elicits improvements in cardiorespiratory and functional fitness in adults with asthma. Exercise training may have important clinical implications in addressing the increased risk of cardiovascular disease mortality amongst adults with asthma, as these improvements have previously been associated with 9% reduction in the risk of cardiovascular disease morbidity and 8-12% reduction in the risk of all-cause mortality in healthy and comorbid adults. Improvements in functional fitness also exceed minimum clinically important differences for healthy and comorbid adults including those with respiratory conditions. These findings complement previous review findings regarding effectiveness of aerobic exercise for asthma-related outcomes and should be considered collectively in the formation of asthma-specific physical activity guidelines to ensure they confer benefits to both asthma-related and overall health-related physical fitness outcomes. Further research on resistance exercise, as well as unsupervised and telehealth exercise programs, is required in this population. Conflict of interest statement: My co-authors and I acknowledge that we have no conflict of interest of relevance to the submission of this abstract.

Study protocol for the Exercising Together\xa9 trial: a randomized, controlled trial of partnered exercise for couples coping with cancer

BackgroundMost cancer survivors are married, and cancer strains the physical and mental health of each partner and their intimate relationship. We created a partnered strength training program, Exercising Together©, where the survivor and his/her partner exercise as a team in order to improve physical and mental health of both members of the couple as well as the quality of their relationship. We have not yet determined if Exercising Together© is similarly effective in couples coping with different types of cancer nor if training as a team has unique and added benefits over those derived from supervised group training and/or shared behavior change. The purpose of this study is to determine the unique benefits of Exercising Together© on physical, mental, and relational health in couples coping with breast, prostate, or colorectal cancer.MethodsSurvivors of prostate, breast and colorectal cancer (N = 294, 98 per cancer site) and their intimate, co-residing partners are recruited to participate in a single-blind, parallel group, randomized trial comparing three exercise groups that train twice per week for 6 months. Couples are randomized to one of three groups: (1) Exercising Together© where partners train as a team in a supervised group setting; (2) separate supervised group exercise classes for survivors or partners, respectively; (3) unsupervised home exercise program provided to each partner. The primary outcome is relationship quality (dyadic coping by the Dyadic Coping scale, emotional intimacy by the Dyadic Adjustment Scale, physical intimacy by the Physical Intimacy Behavior Scale, and symptom incongruence). Secondary outcomes are physical health (% body fat by DXA, serum fasting lipids (triglycerides, HDL, and LDL cholesterol), insulin resistance (HOMA-IR), resting blood pressure, C-reactive protein, TNF alpha, and physical functioning by the short Physical Performance Battery and SF-36) and mental health (depressive symptoms, anxiety, fear of recurrence) of each partner. Outcomes are collected at baseline, mid (3 months), post-intervention (6 months), and follow-up (12 months).DiscussionExercising Together© could shift the paradigm of survivorship care toward novel couple-based approaches that could optimize outcomes for each partner because their health is interdependent on each other and their relationship.Trial registrationClinicalTrials.govNCT03630354. Registered August 14, 2018

Collaborative co‐design of an active and healthy ageing program using mobile technology to reduce dementia risk in older Aboriginal Australians

AbstractBackgroundHigh rates of dementia have been observed in Aboriginal Australians and dementia risk reduction is a priority in this population. The Koori Active and Healthy Ageing Project aimed to develop new, effective, culturally appropriate healthy brain ageing approaches in collaboration with older Aboriginal people and partner communities in regional and urban Australia.MethodInitially, 34 semi‐structured interviews and 2 yarning (focus) groups were conducted with older Aboriginal participants to understand perceptions regarding community health priorities, preferences for healthy ageing programs and acceptability of technology as a platform for program delivery. Following consultation and development, a pilot randomised control trial (RCT) was conducted over 16 weeks, to evaluate the feasibility of a new program versus a health education control condition in 30 Aboriginal people aged 45+ years. The primary outcome included dual‐task walking. Trial registration ID: ACTRN12619001130156.ResultQualitative interviews identified key health concerns including memory loss, mobility, depression, and access to healthcare services. Using self‐directed technology for healthy ageing was widely supported, however, the importance of maintaining social group connections was emphasised. StandingTall is an unsupervised balance exercise program delivered using mobile technology for older people and was the preferred option selected in yarning groups. With further consultation, this program was redeveloped to provide a culturally inclusive interface, and incorporate cognitive‐motor (dual‐task) activities to boost potential benefits for healthy brain ageing and maintaining functional independence. Eighteen participants were enrolled and completed the RCT (8 intervention, 10 control). Users rated the StandingTall program as easy and enjoyable to use. There was no significant effect of intervention observed on dual‐task walking in intention to treat analysis (F(1,16)=0.14, p=0.71). However, adherence was highly variable and likely affected outcomes; three participants did not engage with the program and five reached a median of 33.4 minutes per week (max=130.7).ConclusionBy implementing a technological platform, this program has strong potential to improve access to dementia prevention strategies, enable low‐cost individualised program tailoring and facilitate transferability across diverse community settings. Understanding the factors related to program adherence is critical and a larger trial is needed to examine the effectiveness of the program in this population.

A feasibility pragmatic clinical trial of a primary care network exercise and education program for people with COPD

BackgroundPulmonary rehabilitation is an important component of chronic disease management in chronic obstructive pulmonary disease (COPD) and has been shown to improve shortness of breath, exercise capacity, quality of life, and decrease hospitalizations. However, pulmonary rehabilitation capacity is low. Primary care may be an effective method for delivering disease management services to this population. The objective of this feasibility pragmatic clinical trial was to evaluate enrollment and completion of a primary care network exercise and education program for people with COPD.MethodsCOPD patients (N = 23; mean age = 65 ± 9 years; FEV1 = 68 ± 20% predicted) were recruited after referral to a primary care network exercise program in Edmonton, Alberta. Participants self-selected either an 8-week 16-session supervised exercise program or an 8-week unsupervised exercise program where they received three visits with an exercise specialist. Both groups self-selected education sessions with clinicians for disease management support. Referrals, completion, and program outcomes (physical activity, exercise capacity and health status) were measured before (T1), immediately after (T2), and 8 weeks following the program (T3).ResultsForty-three referrals were received in 10 months, where a minimum of 50 was required in order for the program to be considered feasible. Twenty-three participants provided baseline data, and twenty participants started the exercise program (10 in each exercise group), 16 of which completed the exercise program (80%). On average, 48% of the recommended education sessions were completed by participants.ConclusionsEnrollment into a COPD exercise and education program in a primary care network was low indicating the need for improved referral processes from physicians. Completion rates by participants were adequate for exercise but not education. The low referral rate and the lack of enrollment in COPD education by the patients indicate that a large-scale trial of the program as designed is not feasible.