Unsupervised Exercise Research Articles

Feasibility and safety of physical exercise in men with prostate cancer receiving androgen deprivation therapy and radiotherapy: a study protocol

IntroductionAndrogen deprivation therapy (ADT) and radiotherapy (RT) increase survival in selected patients with prostate cancer. Nevertheless, the side effects of these therapies are associated with an increased risk of accidental...

Effects of non-supervised exercise interventions on bone mineral density in adult women: a systematic review and meta‑analysis.

Mini abstractOsteoporosis is a major health issue worldwide. This study analyzes the effects of non-supervised osteoporosis prevention programs on bone mineral density. Non-supervised exercise increases femoral neck and lumbar spine bone mineral density in adult women. Thus, it might be effective for preventing or treating osteoporosis or osteopenia in this population.IntroductionOsteoporosis is a major health issue worldwide. Social distancing measures due to COVID-19 have hindered the chances to take part in supervised osteoporosis prevention exercise programs. The purpose of the present study is to systematically review and meta-analyze the effects of non-supervised osteoporosis prevention exercise programs on bone mineral density (BMD) in adult women.MethodsA comprehensive search of electronic databases (n = 7) was conducted including (a) prospective randomized controlled trials (RCTs) comparing at least one exercise group vs. a control group with sedentary lifestyle or sham exercises; (b) baseline and follow-up BMD values, or BMD changes from baseline, at any skeletal site; (c) women over 30 years old; and (d) non-supervised exercise programs only. Subgroup analyses were performed for menopausal status, intervention duration, type of exercise, and osteopenia/osteoporosis status.ResultsTen studies were included (n = 668). Random effect analyses showed that unsupervised exercise had beneficial effects on lumbar spine (LS) BMD with standardized mean difference (SMD) = 0.40 (95% confidence interval (CI): 0.03–0.77), and femoral neck (FN) BMD with SMD = 0.51 (95% CI: 0.16–0.85). Unsupervised exercise increased LS (SMD = 0.73 (95% CI: 0.13–1.33)) and FN BMD (SMD = 0.85 (95% CI: 0.33–1.37)) in women with osteopenia/osteoporosis, but not in healthy counterparts.ConclusionNon-supervised exercise improves FN and LS BMD in adult women. Beneficial effects of exercise on FN and LS BMD might be more pronounced in those with poor bone health compared with healthy counterparts. More RCTs prescribing non-supervised, osteogenic exercise are required in this population. It is necessary to investigate the efficacy of remote/assistive technologies for delivering and monitoring non-supervised exercise interventions.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00198-022-06357-3.

Unsupervised Home-based Exercise for Rural Frail Elderly: An Evidence-based Case-report

ABSTRACT To summarize the literature investigating the efficacy of unsupervised home-based exercise (UHBE) in managing rural community-dwelling pre-frail and frail elders, we searched, appraised, and ranked eligible studies published until February 18, 2021 according to the level of evidence (LOE). From six randomized trials, we discovered that UHBE yielded favorable effects on frailty by improving strength (LOE II), quality-of-life (LOE II), and flexibility (LOE I–II). Furthermore, UHBE was generally non-inferior to supervised exercise, except in terms of strength (LOE II–III), balance (LOE IV), and physical function (LOE III–IV). As no trials were conducted in rural underdeveloped settings, future studies are warranted.

Effects of Supervised Exercise on the Development of Hypertensive Disorders of Pregnancy: A Systematic Review and Meta-Analysis.

Hypertensive disorders of pregnancy (HDP) are the most common medical complication in pregnancy, affecting approximately 10–15% of pregnancies worldwide. HDP are a major cause of maternal and perinatal morbidity and mortality, and each year, worldwide, around 70,000 mothers and 500,000 babies die because of HDP. Up-to-date high-quality systematic reviews quantifying the role of exercise and the risks of developing HDP are currently lacking. Physical exercise is considered to be safe and beneficial to pregnant women. Supervised exercise has been shown to be safe and to be more beneficial than unsupervised exercise in the general population, as well as during pregnancy in women with obesity and diabetes. Therefore, we undertook a systematic review and meta-analysis to investigate the effects of women performing supervised exercise during pregnancy compared to a control group (standard antenatal care or unsupervised exercise) on the development of HDP. We searched Medline, Embase, CINHAL, and the Cochrane Library, which were searched from inception to December 2021. We included only randomized controlled trials (RCTs) investigating the development of HDP compared to a control group (standard antenatal care or unsupervised exercise) in pregnant women performing supervised exercise. Two independent reviewers selected eligible trials for meta-analysis. Data collection and analyses were performed by two independent reviewers. The PROSPERO registration number is CRD42020176814. Of 6332 articles retrieved, 16 RCTs met the eligibility criteria, comparing a total of 5939 pregnant women (2904 pregnant women in the intervention group and 3035 controls). The risk for pregnant women to develop HDP was significantly reduced in the intervention compared to the control groups, with an estimated pooled cumulative incidence of developing HDP of 3% in the intervention groups (95% CI: 3 to 4) and of 5% in the control groups (95% CI: 5 to 6), and a pooled odds ratio (OR) comparing intervention to control of 0.54 (95% CI:0.40 to 0.72, p < 0.001). A combination of aerobic and anaerobic exercise, or yoga alone, had a greater beneficial effect compared to performing aerobic exercise only (mixed-OR = 0.50, 95% CI:0.33 to 0.75, p = 0.001; yoga-OR = 0.28, 95% CI:0.13 to 0.58, p = 0.001); aerobic exercise only-OR = 0.87, 95% CI:0.55 to 1.37, p = 0.539). Pregnancy is an opportunity for healthcare providers to promote positive health activities, thus optimizing the health of pregnant women with potential short- and long-term benefits for both mother and child. This systematic review and meta-analysis support a beneficial effect of either structured exercise (combination of aerobic, strength, and flexibility workouts) or yoga for preventing the onset of HDP. Yoga, considered a low-impact physical activity, could be more acceptable and safer for women in pregnancy in reducing the risk of developing HDP.

Exercise and Quality-of-Life Outcomes of Two Versus Three Weekly Sessions of Pulmonary Rehabilitation

This study aimed to assess whether there are differences in exercise or health-related quality-of-life (HRQoL) outcomes following twice-weekly supervised sessions of pulmonary rehabilitation (PR) compared with three times weekly over an 8-wk program in patients with chronic obstructive pulmonary disease (COPD). We conducted a quasi-experimental, single-center observational study using 198 subjects who completed two supervised PR sessions (intervention group) compared with 208 historical controls who completed three weekly sessions. We assessed between-group differences in outcomes after balancing groups using inverse probability of treatment weighting (IPTW) of propensity scores, followed by regression adjustment. Both groups achieved clinically and statistically significant improvements in exercise and HRQoL following the PR program. After IPTW and regression adjustment, the intervention group had a lower post-PR 6-min walk time by 1.2: 95% CI, -12.9 to 10.5 m ( P = .84), compared with the control group. Although post-PR COPD Assessment Test (CAT) scores decreased in both groups, the intervention group had a higher post-PR CAT score by 1.5: 95% CI, 0.37 to 2.66 a.u. ( P = .01), compared with the control group. All other HRQoL measures failed to reach statistical significance. None of the between-group differences reached minimal clinically important differences for COPD. Our findings support current international guidelines for twice-weekly supervised PR sessions combined with unsupervised home exercise sessions. We conclude there is no disadvantage in running a PR program for patients with COPD using twice-weekly supervised sessions compared with three times weekly supervised sessions.

Paget-Schroetter syndrome in an active young female after unsupervised exercise.

Introduction and importanceThoracic outlet syndrome (TOS) is a rare syndrome caused by compression of one of the three neurovascular structures in their passage from the cervical area toward the axilla and proximal arm either at the interscalene triangle, the costoclavicular triangle, or the sub coracoid space. The mainstay of management is nonsurgical; however, surgery may be needed when patients persist with symptoms despite conservative management and when vascular structures are involved. Symptoms are non-specific and require high clinical awareness since this pathology tends to affect otherwise healthy young patients.Case presentationWe present the case of a 45-year-old female without any past medical history. She was active and did plenty of exercises. After a high-intensity routine without any guidance, she presented with acute upper limb swelling with pain. After further examination, a venous thoracic outlet syndrome was identified and treated without complications.Clinical discussion & conclusionVenous TOS is a rare pathology associated with high long-term morbidity and disability if left untreated; heightened clinical awareness of the possibility of acute thrombosis obstructing venous return and producing these rare symptoms should lead the medical team to assess the patient further and lead to the appropriate medical and surgical intervention.

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.

Supervised Physical Therapy Versus Unsupervised Exercise for Patients with Lumbar Spinal Stenosis: One Year Follow-up of a Randomized Controlled Trial -Japanese Translation Version-

Supervised Physical Therapy Versus Unsupervised Exercise for Patients with Lumbar Spinal Stenosis: One Year Follow-up of a Randomized Controlled Trial -Japanese Translation Version-

Necessity of Structured Exercise Training Program and Its Feasability on Physical Capacity and Health Statuswith Post COVID-19 Syndrome Patients

Abstract: Corona virus Disease 2019 (COVID-19) has spread worldwide and has become a global public health emergency. The World Health Organization declared the outbreak a pandemic. Pulmonary Rehabilitation has shown good impact on Quality of life , Functional capacity and health status of patients with Chronic Respiratory Disease Recently there are various guidelines and consensus available for Pulmonary Rehabilitation in Post – COVID patients that has been extrapolated from other respiratory condition. There is paucity of literature that has shown the effect of Exercise training program on Physical capacity and Health status of patient with Post COVID 19 syndrome. So the present study uses the available evidence on COVID 19 patients to prepare the exercise program and implement it on post COVID syndrome patients.Thus, the aim of this study is to evaluate the effect of supervised Exercise Training Program on Post COVID-19 syndrome patients&#x0D; Methodology: In this experimental study total 70 patients with Post Covid Syndrome will be included and they will be equally divided into two groups. Group A will receive supervised exercise training, while Group B will receive unsupervised exercise training. Participant will be evaluated at the beginning of therapy or after 6 weeks.&#x0D; Discussion: This study is conducted to evaluate effectiveness of structured exercise training program and its feasibility on physical capacity and health status of patients with Post COVID19 syndrome.&#x0D; Conclusion: Its effectiveness of a structured exercise program and its feasibility on physical capacity and health status of patients with Post COVID19 syndrome will be evaluated.

Exercise and carbohydrate‐restricted diet associates with improved cerebral blood flow

AbstractBackgroundInsulin resistance (IR) is linked to decreased cerebral blood flow (CBF), an Alzheimer’s disease risk factor. Previous findings of the Blood Flow Improvement Trial (BFiT, clinicaltrials.gov NCT03117829) demonstrate that reversing midlife IR associated with improved cognition, but it is unknown whether this also improves CBF. BFiT tested an exercise and carbohydrate‐restricted diet (CRD) to determine whether improving IR resulted in higher CBF.MethodTwenty‐nine pre‐diabetic, cognitively unimpaired participants from the Wisconsin Alzheimer’s Disease Research Center were recruited in four phases (ns = 9, 7, 5, 8) into a stepped wedge cluster randomized trial. Participants engaged in 12 weeks of supervised aerobic exercise three times weekly, unsupervised exercise twice weekly, and behavioral classes once weekly for program adherence. Post‐intervention, participants were instructed to maintain the regimen for six additional months. At baseline (T1), 12 weeks (T2), and six months post‐intervention (T3), arterial spin labeling (ASL) images were obtained. CBF was calculated globally and in frontal and temporal regions of interest.Intervention effects on regional CBF were tested through pairwise comparison of the three visits using random intercept three‐level mixed models, with visits nested within participants, and participants nested within groups. Age and sex were adjusted as covariates for each region, and models were tested with and without influential outliers. Tukey‐Kramer adjustment was applied to control for the inflation of type I error rate associated with multiple comparison.ResultOf the 29 participants (Table 1) enrolled in the study, 23 completed the intervention, and 21 completed all measurements. Between T1 and T3, CBF showed significant bilateral increases in the middle temporal gyri and temporal poles (superior and middle areas), middle frontal gyri (orbital), superior frontal gyri (medial orbital), and precentral gyri (Figures 1, 2). No regions showed significant CBF increases (p&lt;.05) between T1 and T2, or T2 and T3.ConclusionIn a cognitively unimpaired cohort, an exercise and carbohydrate‐restricting intervention significantly improved CBF over the trial duration. This suggests that sustaining a CRD and exercise may improve CBF in people with impaired glucose regulation. Ongoing analysis of trial data will assess whether improved cerebral blood flow and cardiorespiratory fitness mediate observed enhancements in cognitive performance.

Motivational profiles and change in physical activity during a weight loss intervention: a secondary data analysis

BackgroundHigh levels of moderate-to-vigorous intensity physical activity (MVPA) are strongly associated with sustained weight loss, however the majority of adults are unsuccessful in maintaining high levels of MVPA long-term. Our goal was to identify profiles based on exercise motives, and examine the association between motivational profile and longitudinal changes in MVPA during a weight loss intervention.MethodsAdults with overweight or obesity (n = 169, mean ± SE; age 39 ± 0.7 years, BMI 34.4 ± 0.3 kg/m2, 83% female) underwent an 18-month behavioral weight loss program, including 6 months of supervised exercise, followed by 6 months of unsupervised exercise. Participants self-reported behavioral regulations for exercise at baseline (BREQ-2). Latent profile analysis identified subgroups from external, introjected, identified, and intrinsic regulations measured at baseline. Mean differences in device-measured total MVPA were compared across motivational profiles at baseline, after 6 months of supervised exercise and after a subsequent 6 months of unsupervised exercise.ResultsThree motivational profiles emerged: high autonomous (high identified and intrinsic, low external regulations; n = 52), high combined (high scores on all exercise regulations; n = 25), and moderate combined (moderate scores on all exercise regulations; n = 92). Motivational profile was not associated with baseline level of MVPA or the increase in MVPA over the 6-month supervised exercise intervention (high autonomous: 21 ± 6 min/d; high combined: 20 ± 9 min/d; moderate combined: 33 ± 5 min/d; overall P > 0.05). However, during the transition from supervised to unsupervised exercise, MVPA decreased, on average, within all three profiles, but the high autonomous profile demonstrated the least attenuation in MVPA (− 3 ± 6 min/d) compared to the moderate combined profile (− 20 ± 5 min/d; P = 0.043).ConclusionsResults were in alignment with the Self-Determination Theory. Adults motivated by autonomous reasons (value benefits of exercise, intrinsic enjoyment) may be more likely to sustain increases in MVPA once support is removed, whereas participants with moderate-to-high scores on all types of exercise regulations may need additional long-term support in order to sustain initial increases in MVPA.Clinical trial registrationNCT01985568. Registered 24 October 2013.

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.

Yoga and Pilates compared to pelvic floor muscle training for urinary incontinence in elderly women: A randomised controlled pilot trial

Backgroundand purpose: There is limited evidence from randomised controlled trials (RCTs) regarding the use of yoga and Pilates for the management of urinary incontinence (UI) in women. This study aims to investigate the preliminary effects of using Pilates and yoga to manage UI. Materials and methodsAn assessor-blinded, prospective, three-arm parallel-group randomised controlled pilot trial was conducted in three elderly care centres in Hong Kong. Thirty women aged 60 years or above were included in the study. Study centres were randomly assigned to each of the three interventions (yoga, Pilates and pelvic floor muscle training [PFMT; standard care control]). Study interventions were provided once a week for four weeks, followed by unsupervised CD-guided home exercises for eight weeks. Outcomes included the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), 1-h pad test, and feasibility measures such as adherence to the intervention programme, recruitment and retention rates and safety. Outcomes were assessed at baseline, 4 and 12 weeks. Statistical analysis was performed using two-way repeated measures analysis of covariance. ResultsAll three interventions demonstrated a statistically significant effect on ICIQ-SF scores from baseline to weeks 4 and 12. Significant effects in UI were reported for yoga compared with Pilates (mean: −2.93, 95% CI −5.35, −0.51; p = 0.02). ConclusionYoga poses intended to address the pelvic floor and core muscles were found to have superior benefits over Pilates exercises in terms of improved continence measured with the ICIQ-SF.

Postnatal exercise interventions: a systematic review of adherence and effect

ObjectiveTo evaluate adherence to and effect of postnatal physical activity (PA) interventions.DesignSystematic review of PA intervention randomised controlled trials in postnatal women. The initial search was carried out in September...

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

A randomized-controlled trial comparing supervised aerobic training to resistance training followed by unsupervised exercise on physical functioning in older breast cancer survivors

IntroductionThis study compared the relative efficacy of aerobic training to resistance training on physical functioning in older breast cancer survivors and determined whether benefits could be maintained by transitioning to unsupervised home-based training. Materials and methodsEarly-stage, post-treatment, older (≥65 years) breast cancer survivors (n = 114; mean age 72 years) were randomized to 12 months of supervised aerobic (n = 37), resistance (n = 39) or stretching (active control; n = 38) training followed by 6 months of unsupervised home-based training. Outcomes included aerobic capacity by 6-min walk distance (6MWD; m), maximal upper and lower body strength (1-repetition maximum; kg); physical function by short physical performance battery (SPPB), SF-36 and Late Life Function and Disability Instruments. ResultsOver 12-months of supervised exercise, all groups improved in muscle strength and SPPB scores, but resistance trained women also improved 6MWD. Improvements in upper and lower body strength in the resistance group were significantly greater than those in the stretching control (+2.5 kg vs. +1.8 kg; p = 0.05) and aerobic groups (+8.3 kg vs +2.7 kg; p = 0.047), respectively, with trends for greater improvements in 6MWD (+57.9 m vs. +22.5 m; p = 0.057) and self-report physical function (+4.8 vs. -4.4; 0.066) in resistance trained women versus controls. Compared to values at 12 months, there were no changes during unsupervised training in any measure within or between groups, except for self-reported advanced lower extremity function which improved in the resistance group and fell in the aerobic group (+1.3 vs. -3.1; p = 0.043). DiscussionSupervised exercise can improve strength and physical functioning among older breast cancer survivors. Resistance training may lead to better improvements compared to aerobic or flexibility training, whether in a supervised or unsupervised setting.Clinicaltrials.govNCT00662103

Retention And Adherence Rates In Cancer Survivors And Partners To Virtual Exercise During Covid-19

PURPOSE: The EXERCISING TOGETHER© trial is studying a partnered exercise program to improve the physical, emotional, and relationship health of cancer survivors and their partners (NCT03630354). During COVID-19, the exercise program delivery format transitioned from supervised, facility-based group exercise to supervised, group exercise delivered by video conference. Here we will assess feasibility of remote supervised exercise by comparing exercise adherence and study retention rates between participants attending in-person and remote programs. METHODS: Data from 3 groups of couples coping with breast cancer were used for analyses: 1 in-person group (n = 46 participants), 1 hybrid group that transitioned to remote classes at week 8 (n = 64 participants), and 1 group recruited into remote classes (n = 66 participants). Couples exercise twice weekly for 6 months after randomization into 1 of 3 groups: partnered group exercise, separate survivor/spouse group exercise, or unsupervised home exercise. Adherence is defined by exercise session completion. Retention is defined by active participation through the intervention. Comparisons between study arms and delivery format were assessed using linear mixed-effects models with a group by training interaction. RESULTS: The home group showed significantly lower adherence during remote training compared to in-person (p < 0.01). The separate group showed a significant increase in attendance to remote classes compared to in-person (p < 0.01). The partnered group showed similar attendance rates in both delivery formats. Four couples from the hybrid wave (9.5% of wave) withdrew in the transition to remote classes. Attrition rates of in-person, hybrid, and remote waves were 19.5%, 15.6%, and 12.5% respectively, and did not differ across delivery formats. CONCLUSIONS: After transitioning to remote classes, home group adherence decreased while supervised remote class adherence remained similar (partnered group) or increased (separate group). Our preliminary data suggest that couples coping with breast cancer may adhere to remote exercise classes just as well, or better than in-person classes and that attrition is not impacted by delivery format. Remote delivery of supervised exercise could increase program accessibility but efficacy remains to be determined.

Unsupervised Exercise Training Was Not Found to Improve the Metabolic Health or Phenotype over a 6-Month Dietary Intervention: A Randomised Controlled Trial with an Embedded Economic Analysis.

Ectopic fat leads to metabolic health problems. This research aimed to assess the effectiveness of a hypocaloric diet intervention together with an unsupervised exercise training program in comparison with a hypocaloric diet alone to reduce ectopic fat deposition. Sixty-one premenopausal women with overweight or obesity participated in this controlled trial and were each randomised into either a usual care group (hypocaloric diet) or intervention group (hypocaloric diet + unsupervised exercise training). Ectopic fat deposition, metabolic parameters, incremental costs from a societal perspective and incremental quality-adjusted life years (QALYs) were assessed before, during and after the six-month intervention period. In the total sample, there was a significant decrease in visceral adipose tissue (VAT: −18.88 cm2, 95% CI −11.82 to −25.95), subcutaneous abdominal adipose tissue (SAT: −46.74 cm2, 95% CI −29.76 to −63.18), epicardial fat (ECF: −14.50 cm3, 95% CI −10.9 to −18.98) and intrahepatic lipid content (IHL: −3.53%, 95% CI −1.72 to −5.32). Consequently, an “adapted” economic analysis revealed a non-significant decrease in costs and an increase in QALYs after the intervention. No significant differences were found between groups. A multidisciplinary lifestyle approach seems successful in reducing ectopic fat deposition and improving the metabolic risk profile in women with overweight and obesity. The addition of unsupervised exercise training did not further improve the metabolic health or phenotype over the six months.

Efficacy of unsupervised exercise in adults with obstructive lung disease: a systematic review and meta-analysis

IntroductionThe benefits of unsupervised exercise programmes in obstructive lung disease are unclear. The aim of this systematic review was to synthesise evidence regarding the efficacy of unsupervised exercise versus non-exercise-based...