A 2-km walking test for assessing the cardiorespiratory fitness of healthy adults

Physical rehabilitation program for cardiorespiratory health and quality of life among breast cancer survivors in UAE: a randomized control trial

BACKGROUND

Breast cancer treatment has improved significantly, contributing to a 5-year relative survival rate of 99% for localized cases. However, post-treatment survivors are reported to have significantly poor cardiovascular fitness which affects their health-related quality of life (HRQoL). In the United Arab Emirates (UAE), evidence for practice addressing post-treatment concerns is scarce.

OBJECTIVE

To analyse the changes in cardiorespiratory fitness and HRQoL domains for breast cancer survivors in the UAE using a 2-month physical rehabilitation program.

METHODOLOGY

DESIGN: Parallel-group, randomized controlled trial PARTICIPANTS AND SETTING: The study included breast cancer survivors who were treated with chemotherapy and/or radiotherapy, aged 18-65 years, and able to provide informed consent. Participants were recruited by referral from Al Tawam Hospital, a national referral center for oncology, and Dubai Hospital.

INTERVENTIONS

The intervention group (IG) received a 2-month supervised physical rehabilitation program focusing on aerobic training with 2 supervised sessions and 3 at-home sessions per week. The sessions were held at Thumbay Physical Therapy and Rehabilitation Hospital. The control group (CG) received standard care at their treatment facility. Randomization for subject allocation was double-blinded (conducted by a third party not involved in the research).

OUTCOME

The changes in cardiorespiratory fitness were assessed by measuring peak oxygen uptake (VO2peak) during a 2 km walk test using Cosmed fitmate Pro and Peak Expiratory Flow Rate (PEFR) was assessed using a peak flow meter. The HRQoL was measured by the QLQ-C30 questionnaire. Outcomes were measured at baseline, post-intervention, and 3 months post-intervention. Allocation of intervention was not blinded due to the nature of the intervention; however, the outcome accessors were blinded.

RESULTS

A total of 62 breast cancer survivors were randomly allocated to the intervention group (n = 31) and the control group (n = 31). Data from all participants who completed the 5-month trial was analyzed. The intervention group showed a significant improvement from baseline to follow-up in terms of cardiorespiratory fitness: VO2peak increased by 8.3 ± 4.6 ml/kg/min and PEFR by 81 ± 2.73 L/min, while the control group demonstrated a decrease of 1.1 ± 2.1 ml/kg/min and 4 ± 2.48 L/min, respectively (between-group difference, p < 0.001 for both measures). The intervention program was also significantly effective in improving HRQoL in all functional domains except cognitive and social, and there was a notable reduction in the symptoms of fatigue, dyspnea, pain, and sleep disturbances (p < 0.05).

CONCLUSIONS

The intervention group showed significant improvement in cardiorespiratory fitness and multiple domains of HRQoL among breast cancer survivors in the UAE, which were sustained at 3 months.

CLINICAL TRIALS REGISTRATION NUMBER

Clinical Trials.gov NCT06013527. Registered on 28 August 2023.

Feasibility and Safety of Field-Based Physical Fitness Tests: A Systematic Review

BACKGROUND

While there is evidence on the validity and reliability of field-based physical fitness tests in children, adolescents and adults, there is limited evidence to provide feasibility and safety data on the application and performance of the existing field-based physical fitness tests.

OBJECTIVES

(i) To examine the feasibility and safety of existing field-based physical fitness tests used in people of all ages and (ii) to establish a comprehensive view of criterion-related validity, reliability, feasibility and safety based on scientific evidence for the existing field-based physical fitness tests in adults.

METHODS

The search was conducted through the electronic databases MEDLINE (via PubMed) and Web of Science (all databases) for published studies from inception to 31 January 2023. This systematic review was developed according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Studies were classified as very low quality, low quality or high quality, based on the criteria of appropriate number of participants, appropriate description of the study population, and appropriate number of items reported to assess feasibility/safety. Three evidence levels were constructed (strong, moderate and limited or inconclusive evidence) according to the number of studies and the consistency of the findings.

RESULTS

We identified a total of 19 (14 of high quality) and 13 (11 high quality) original studies examining the feasibility and safety of field-based physical fitness tests, respectively. Strong evidence indicated that (a) the 2-km walk and 20-m shuttle run tests were feasible in adults and, children and adolescents, respectively; (b) the handgrip strength test was feasible in children and adolescents; and (c) the standing long jump test was feasible in children and adolescents. Only the 2-km walk test has shown strong evidence on safety in adults. Finally, combining the levels of evidence of criterion-related validity, reliability, feasibility and safety in adults, all the field-based physical fitness tests show limited evidence.

CONCLUSION

There is a need for more studies and consensus to establish homogeneous methodological criteria to assess the feasibility and safety of field-based fitness tests. The combined evidence on criterion-related validity, reliability, feasibility and safety of field-based tests was found to be limited in adults. PROSPERO reference number CRD42022298276.

Physical rehabilitation program for cardiorespiratory health and quality of life among breast cancer survivors in UAE: protocol for a randomized control trial

BACKGROUND

Cancer is a medical condition where some cells of the body reproduce uncontrollably and metastasize to other parts of the body. The burden of the disease is significantly high both at the global and national levels. In UAE, cancer was found to be the third leading cause of death. Breast cancer has been ranked first due to its prevalence, incidence, and mortality in UAE. Breast cancer survivors have significantly poor cardiovascular tolerance which affects their quality of life (QoL), even after the carcinoma has been treated or removed. Thus, the protocol aims to analyze the changes in cardiovascular endurance and QoL domains for breast cancer survivors in the United Arab Emirates using a long-term 2-month physical rehabilitation.

METHODS

A total of 60 breast cancer survivors would be included in the study using a randomized controlled allocation of a 2-month physical rehabilitation intervention program with 3 months of follow-up. The intervention would target the cardiovascular endurance component of the participants to improve their physical well-being and quality of life ultimately.

DISCUSSION

The findings of the study would have high clinical significance among breast cancer survivors in the UAE. The proposed physical rehabilitation program could be beneficial in improving cardiovascular endurance and thereby reduce the risk of mortality among breast cancer survivors. In addition, the physiological benefits of the exercise program could improve their quality-of-life domains including physical, mental, and social well-being. On a larger view, it could also help to reduce the economic burden on the health system due to associated complications.

TRIAL REGISTRATION

ClinicalTrials.gov NCT06013527. Registered on 28 August 2023.

The Beneficial Effects of Nordic Walking Training Combined with Time-Restricted Eating 14/24 in Women with Abnormal Body Composition Depend on the Application Period

The aim of the study was to assess the impact of two lengths of Nordic walking (NW) training interventions combined with time-restricted eating (TRE) on improving body-composition parameters, lipid profiles, and levels of selected adipokines in women with elevated body mass. Overweight and obese women (n = 55, age: 21-85) were recruited. Four groups were selected: 6 weeks (SG6, n = 13) and 12 weeks intervention (SG12, n = 13); and two control groups: CON6 (n = 13) and CON12 (n = 13). The training sessions took place three times a week (60 min each) and were conducted outdoors under the supervision of a professional coach. The training intensity was determined individually. The extended NW program combined with TRE induced a significant weight reduction in SG12 by 1.96 kg (p = 0.010) and fat tissue by 1.64 kg (p = 0.05). The proposed interventions did not affect LBM, TBW [kg], VFA, and lipid profile. The LDL/HDL ratio changed with a small size effect. The leptin concentration differed between groups (p = 0.006), but not over time. For resistin, the differentiating factor was time (p = 0.019), with lower results observed after the intervention. The change in leptin concentration was negatively correlated with its baseline concentration (p = 0.025). Extended to 12 weeks, this intervention allows for an improvement in body composition. Neither 6 nor 12 weeks of training and fasting affected the lipoprotein profile. It is, therefore, indicated to recommend prolonged training protocols and to inform patients that beneficial effects will be seen only after prolonged use of training and time-restricted eating.

Weight loss and lifestyle intervention for cardiorespiratory fitness in obstructive sleep apnea: The INTERAPNEA trial

INTRODUCTION

Although recent trials have shown benefits of weight loss and lifestyle interventions on obstructive sleep apnea (OSA) severity and comorbidities, the effect of these interventions on cardiorespiratory fitness (CRF) remains unknown. This study aimed to investigate the effects of an interdisciplinary weight loss and lifestyle intervention on CRF and self-reported physical fitness in adults with OSA.

METHODS

Eighty-nine men aged 18-65 years with moderate-to-severe OSA and a body mass index ≥25 kg/m2 were randomly assigned to a usual-care group or an 8-week interdisciplinary weight loss and lifestyle intervention. CRF was assessed through the 2-km walking test, and the International Fitness Scale (IFIS) was used to assess self-reported physical fitness.

RESULTS

As compared with usual-care, the intervention group had greater improvements at intervention endpoint in objective CRF (6% reduction in 2-km walking test total time, mean between-group difference, -1.7 min; 95% confidence interval, -2.3 to -1.1), and self-reported overall physical fitness (18% increase in IFIS total score, mean between-group difference, 2.3; 95% CI 1.2 to 3.3). At 6 months after intervention, the intervention group also had greater improvements in both 2-km walking test total time (10% reduction) and IFIS total score (22% increase), with mean between-group differences of -2.5 (CI 95%, -3.1 to -1.8) and 3.0 (CI 95%, 1.8 to 4.1), respectively.

CONCLUSIONS

An 8-week interdisciplinary weight loss and lifestyle intervention resulted in significant and sustainable improvements in CRF and self-reported physical fitness in men with overweight/obesity and moderate-to-severe OSA.

STUDY REGISTRATION

ClinicalTrials.gov registration (NCT03851653).

Iron status determined changes in health measures induced by nordic walking with time-restricted eating in older adults- a randomised trial

BACKGROUND AND AIMS

This study evaluated whether stored iron determines the adaptive response induced by Nordic walking (NW) training combined with 10 hours' time-restricted eating (TRE) in older adults.

TRIAL DESIGN AND METHODS

Twenty-four participants underwent 12-week NW training supported by 10 h of TRE. The group was divided due to baseline ferritin concentration low < 75 ng/ml (LF) and high level ≥ 75 ng/ml (HF). Body composition, physical fitness and blood collection were assessed at baseline and post-intervention.

RESULTS

NW + TRE induced a statistically significant decrease in ferritin levels in all participants (p = 0.01). Additionally, statistically significant intergroup differences in the LF vs. HF in the reduction of serum ferritin levels (p = 0.04) were observed. The procedure NW + TRE diminished HbA1c levels (p < 0.01) and glucose in all participants (p = 0.05). The range of HbA1c drop was more pronounced among those participants who experienced a greater decrease in the stored iron (p = 0.04, [Formula: see text]=0.17, F=4.59). Greater changes in body weight and percent of body fat were recorded in the HF group (for both p<0.01).

CONCLUSION

Body iron stores determine the effects of a 12-week NW + TRE intervention on serum ferritin. The changes in HbA1c are more pronounced in subjects with a higher decrease in serum ferritin.

TRIAL REGISTRATION

All experimental protocols were approved by the Bioethical Committee of the Regional Medical Society in Gdansk, Poland (NKBBN/330/2021) according to the Declaration of Helsinki. We confirm that all methods were carried out in accordance with relevant guidelines and regulations. The trial was registered as a clinical trial (NCT05229835, date of first registration: 14/01/2022, direct link: https://classic.

CLINICALTRIALS

gov/ct2/show/NCT05229835 ). Informed consent was obtained from all subjects.

Change in Peak Oxygen Uptake Predicted by the Moderate 1-km Treadmill Walking Test After Walking Training in Outpatients With Cardiovascular Disease

PURPOSE

The purpose of this study was to determine the ability of the moderate 1-km treadmill walking test (1km-TWT) to predict changes in peak oxygen uptake (V˙O 2peak ) in patients with stable cardiovascular disease (CVD) during an exercise-based secondary prevention program.

METHODS

Sixty-four male outpatients with stable CVD (age 64 [41-85] yr) performed the 1km-TWT before and after an 8-wk walking training program. Patient V˙O 2peak was estimated using a sex-specific equation including age, body mass index, 1km-TWT performance time, and heart rate (V˙O 2peakEST ). Forty-one patients completed a maximal cardiopulmonary treadmill test (CPX) for direct V˙O 2peak determination (V˙O 2peakMEAS ). The training prescription consisted of moderate-to-high intensity supervised walking for 30-40 min/session, and an additional 2-4 times/wk of unsupervised home moderate walking sessions between 20-60 min at the end of the program. The walking intensity was based on the results of the 1km-TWT.

RESULTS

Patients participated in an average of 14 of the 16 supervised sessions. An overall significant improvement in V˙O 2peakMEAS and weekly recreational physical activity levels were observed. No differences were observed between V˙O 2peakMEAS and V˙O 2peakEST . Compared with CPX results, the 1km-TWT underestimated the V˙O 2peak increase after the exercise intervention (mean difference -0.3 mL/kg/min, P > .05).

CONCLUSIONS

The 1km-TWT provides a reasonably accurate and simple tool to predict changes in V˙O 2peak due to moderate walking training in male outpatients with CVD. These findings contribute to the growing body of evidence supporting the use of the 1km-TWT for exercise testing and training purposes in the context of cardiac rehabilitation/secondary prevention programs.

Health-related physical fitness parameters in women with breast cancer-related lymphedema: a case-control study

PURPOSE

This study aimed to compare health-related physical fitness parameters of women with breast cancer-related lymphedema (BCRL) to a matched control group.

METHODS

Thirty women with unilateral BCRL (lymphedema group, age = 55.00 (40.00-65.00) years) and 32 healthy women (control group, age = 49.00 (44.00-64.00) years) were included. Cardiorespiratory fitness with the UKK 2-km walk test, grip strength with a hand dynamometer, trunk muscle endurance with the McGill trunk muscle endurance tests, flexibility with the sit and reach test, body composition with a body composition analyzer, and waist-to-hip ratio were assessed.

RESULTS

In the lymphedema group, 36.7% of women had mild lymphedema, 36.7% had moderate, and 26.7% had severe lymphedema. It was found that maximal oxygen consumption, physical fitness index, grip strength, trunk extensor and lateral flexor muscle endurance, and flexibility scores were higher in the control group than in the lymphedema group (p < 0.05). In addition, body mass index, body fat percentage, and waist-to-hip ratio were found to be lower in the control group compared to the lymphedema group (p < 0.05). There was no significant difference between the trunk flexor muscle endurance scores (p > 0.05).

CONCLUSIONS

It was found that the health-related physical fitness parameters were adversely affected in women with BCRL compared to healthy women. The changes of physical fitness may be important for the assessment and the treatment of BCRL.

Associations between physical activity, physical fitness, and body composition in adults living in Germany: A cross-sectional study

BACKGROUND & AIMS

Body composition (BC) changes with age and is associated with morbidity and mortality. A physically active lifestyle influences BC and represents an important predictor of successful aging. To emphasize this, the World Health Organization established activity recommendations for all age groups. We describe BC during adulthood using a cross-sectional sample from a German community and investigate the associations between physical activity (PA), physical fitness (PF), and BC.

METHODS

Data from 329 men and women aged 35 to 86 years were analyzed. PA was measured by questionnaire and classified into sport activity and habitual activity. PF was measured through physical performance tests and BC by bioelectrical impedance analysis. Fat mass index (FMI) and fat-free mass index (FFMI) were calculated to represent height-adjusted BC. Associations between PA, PF, and BC were analyzed using linear regression models.

RESULTS

For both sexes, strength was positively associated with FFMI (♂: ß = 0.313; ♀: ß = 0.213) and phase angle (♂: ß = 0.357; ♀: ß = 0.409). For FMI, a significant negative association with strength was found only in women (ß = -0.189). Cardiorespiratory fitness showed a negative association with FMI (ß = -0.312) and FFMI (ß = -0.201) for men, while in women a positive association was found for FFMI (ß = 0.186). For coordination, a significant association with FMI was observed only in women (ß = -0.190). Regarding PA only one significant relationship between sport activity and FMI among women (ß = -0.170) was found.

CONCLUSIONS

In our sample, PF was closer related to BC than PA. Strength and cardiorespiratory fitness were the strongest predictors for BC. This supports the World Health Organization's activity recommendations to include both resistance and endurance training in the weekly sports program to maintain a healthy BC.

Criterion-related validity and reliability of the 2-km walk test and the 20-m shuttle run test in adults: the role of sex, age and physical activity level

OBJECTIVES

To analyze the criterion-related validity and the reliability of fitness field tests for evaluating cardiorespiratory fitness in adults, by sex, age, and physical activity level.

DESIGN

Cross-sectional.

METHODS

During 3 weeks, sociodemographic, anthropometric measurements, a treadmill maximal test, the 2-km walk test, and the 20-m SRT were performed in 410 adults aged 18-64 years. Measured and estimated VO_2max (by Oja's and Leger's equations) were analyzed.

RESULTS

Measured VO_2max was associated with estimated VO_2max by the 2-km walk test and 20-m SRT (r = 0.784 and r = 0.875, respectively; both p < 0.01). Bland-Altman analysis showed a mean difference of -0.30 ml* kg^-1 * min^-1 (p < 0.001, d = -0.141) in the 2-km walk test, and 0.86 ml* kg^-1 * min^-1 (p = 0.051) in the 20-m SRT. Significant mean differences between test and retest were found in the time to complete the 2-km walk test (-1.48 ± 0.51 s, p = 0.004, d = -0.014) and in the final stage reached in the 20-m SRT (0.04 ± 0.01, p = 0.002, d = 0.015). Non-significant differences were found between test and retest in the estimated VO_2max by Oja's (-0.29 ± 0.20 ml* kg^-1 * min^-1, p > 0.05) and Leger's eqs. (0.03 ± 0.04 ml* kg^-1 * min^-1, p > 0.05). Moreover, both test results and estimated VO_2max equations showed a high test-retest reliability.

CONCLUSIONS

Both tests were valid and reliable for evaluating cardiorespiratory fitness in adults aged 18-64 years, regardless of sex, age, and physical activity level.

The Effect of Submaximal Exercise on Jugular Venous Pulse Assessed by a Wearable Cervical Plethysmography System

The jugular venous pulse (JVP) is a one of the crucial parameters of efficient cardiovascular function. Nowadays, limited data are available regarding the response of JVP to exercise because of its complex and/or invasive assessment procedure. The aim of the present work is to test the feasibility of a non-invasive JVP plethysmography system to monitor different submaximal exercise condition. Twenty (20) healthy subjects (13M/7F mean age 25 ± 3, BMI 21 ± 2) underwent cervical strain-gauge plethysmography, acquired synchronously with the electrocardiogram, while they were carrying out different activities: stand supine, upright, and during the execution of aerobic exercise (2 km walking test) and leg-press machine exercise (submaximal 6 RM test). Peaks a and x of the JVP waveform were investigated since they reflect the volume of cardiac filling. To this aim, the Δax parameter was introduced, representing the amplitude differences between a and x peaks. Significant differences in the values of a, x, and Δax were found between static and exercise conditions (p < 0.0001, p < 0.0001, p < 0.0001), respectively. Particularly, the Δax value for the leg press was approximately three times higher than the supine, and during walking was even nine times higher. The exercise monitoring by means of the novel JVP plethysmography system is feasible during submaximal exercise, and it provides additional parameters on cardiac filling and cerebral venous drainage to the widely used heartbeat rate value.

COX7A2L genetic variants determine cardiorespiratory fitness in mice and human

Mitochondrial respiratory complexes form superassembled structures called supercomplexes. COX7A2L is a supercomplex-specific assembly factor in mammals, although its implication for supercomplex formation and cellular metabolism remains controversial. Here we identify a role for COX7A2L for mitochondrial supercomplex formation in humans. By using human cis-expression quantitative trait loci data, we highlight genetic variants in the COX7A2L gene that affect its skeletal muscle expression specifically. The most significant cis-expression quantitative trait locus is a 10-bp insertion in the COX7A2L 3' untranslated region that increases messenger RNA stability and expression. Human myotubes harboring this insertion have more supercomplexes and increased respiration. Notably, increased COX7A2L expression in the muscle is associated with lower body fat and improved cardiorespiratory fitness in humans. Accordingly, specific reconstitution of Cox7a2l expression in C57BL/6J mice leads to higher maximal oxygen consumption, increased lean mass and increased energy expenditure. Furthermore, Cox7a2l expression in mice is induced specifically in the muscle upon exercise. These findings elucidate the genetic basis of mitochondrial supercomplex formation and function in humans and show that COX7A2L plays an important role in cardiorespiratory fitness, which could have broad therapeutic implications in reducing cardiovascular mortality.

Factors predicting long-term physical activity of breast cancer survivors. 5-year-follow-up of the BREX exercise intervention study

BACKGROUND

The benefits of exercise training are well documented among breast cancer (BC) survivors. Patients decrease their physical activity during treatment, and many fail to regain their previous exercise levels. There is therefore a need to define factors supporting long-term physical activity behavior in this patient group, to target supporting interventions aimed at preventing the decline in physical activity (PA).

AIM

The aim of this study was to determine physical and psychosocial factors explaining long-term physical activity after the adjuvant treatments in BC survivors.

METHODS

Four-hundred forty-six BC survivors followed for 5-years within a randomized exercise trial participated. Factors explaining (1) physical activity after the adjuvant treatments and (2) changes in physical activity in long-term were analyzed using linear regression models and general estimating equation models. Pretreatment leisure-time physical activity (LTPA), demographic, and treatment factors, physical fitness, and quality of life (Qol) at baseline were independent factors.

RESULTS

Exercise levels increased during the first year, and thereafter remained mostly stable. Higher LTPA, higher fitness level, better Qol and older age at baseline were associated with higher physical activity level after adjuvant treatments (p < .001) in multivariate analysis. Higher levels of fatigue (p < .008) and better emotional functioning (p = .017) at baseline were the main factors associated with increased physical activity during the follow-up.

CONCLUSION

Previous exercise habits and Qol after adjuvant chemo-, and radiotherapy were the strongest determinants of long-term physical activity levels in breast cancer survivors. Patients with better emotional functioning increased their exercise activity most as did those patients with higher fatigue levels at baseline. Patients suffering from fatigue after adjuvant treatment managed to increase their exercise levels, in contrast to patients with low emotional functioning, and may benefit from physical exercise interventions. Emotionally deprived patients may benefit from psychosocial support to regain their previous exercise levels.

Effects of worksite exercise intervention (PRODET®) on well-being at work and capability in performing work-related sedentary tasks: A pilot study

BACKGROUND: Companies have tried to carry out interventions in order to mitigate the risks associated with losses in productivity and the health of employees. OBJECTIVE: This intervention trial evaluated the effect of a supervised exercise intervention based on aerobic capacity and strength on well-being at work and capability in performing work tasks. METHODOLOGY: The sample was composed of 67 participants (N = 67, mean age 34.31 years) and investigated a 12-week group physical exercise program in the workplace, two days per week for 50 minutes, which was supervised and based on aerobic endurance and strength. The 67 subjects were working-age office workers, deemed sedentary and randomized into an intervention (N = 40) or control (N = 27) group. Among them, 33 were men (N = 33; 49.25%) and 34 were women (N = 34, 50.75%). Outcomes were assessed pre- and post-test in both groups. The Mann-Whitney U and Chi-Square tests were performed to compare the characteristics of the intervention and control group. η2 = z/(n-1) was calculated as effect size rates. RESULTS: The program showed statistically significant effects on strength endurance (P = 0.020, η2 = 0.08), the loss of fat percentage (P = 0.015, η2 = 0.09), lower limb power (P = 0.020, η2 = 0.08) and QoL (P = 0.0001, η2 = 0.39 for the physical health outcome, and P = 0.0001, η2 = 0.35 for the outcome of total scores of mental health). CONCLUSIONS: The intervention had an impact on the endurance, fat percentage loss and QoL of the workers whose occupations were based on sedentary tasks.

Valorization of natural cardio trekking trails through open innovation for promotion of sustainable cross-generational, health-oriented tourism during the Connect2Move project: study design (Preprint)

Background

Hiking is one of the most popular forms of exercise in the alpine region. However, besides its health benefits, hiking is the alpine activity with the highest incidence of cardiac events. Most incidents occur due to overexertion or underestimation of the physiological strain of hiking.

Objective

This project will establish a standardized cardio trekking test trail to evaluate the exercise capacity of tourists within hiking areas and deliver a tool for the prevention of hiking-associated cardiac incidents. Further, individual exercise intensity for a hiking tour will be predicted and visualized in digital maps.

Methods

This cooperation study between Austria and Germany will first validate a 1-km outdoor cardio trekking test trail at 2 different study sites. Then, exercise intensity measures on 8-km hiking trails will be evaluated during hiking to estimate overall hiking intensity. A total of 144 healthy adults (aged >45 years) will perform a treadmill test in the laboratory and a 1-km hiking test outdoors. They will wear a portable spirometry device that measures gas exchange, as well as heart rate, walking speed, ventilation, GPS location, and altitude throughout the tests. Estimation models for exercise capacity based on measured parameters will be calculated.

Results

The project “Connect2Move” was funded in December 2019 by the European Regional Development Fund (INTERREG V-A Programme Austria-Bavaria – 2014-2020; Project Number AB296). “Connect2Move” started in January 2020 and runs until the end of June 2022. By the end of April 2022, 162 participants were tested in the laboratory, and of these, 144 were tested outdoors. The data analysis will be completed by the end of June 2022, and results are expected to be published by the end of 2022.

Conclusions

Individual prediction of exercise capacity in healthy individuals with interest in hiking aims at the prevention of hiking-associated cardiovascular events caused by overexertion. Integration of a mathematical equation into existing hiking apps will allow individual hiking route recommendations derived from individual performance on a standardized cardio trekking test trail.

Trial Registration

ClinicalTrails.gov NCT05226806; https://clinicaltrials.gov/ct2/show/NCT05226806

International Registered Report Identifier (IRRID)

DERR1-10.2196/39038

Criterion-Related Validity of Field-Based Fitness Tests in Adults: A Systematic Review

We comprehensively assessed the criterion-related validity of existing field-based fitness tests used to indicate adult health (19–64 years, with no known pathologies). The medical electronic databases MEDLINE (via PubMed) and Web of Science (all databases) were screened for studies published up to July 2020. Each original study’s methodological quality was classified as high, low and very low, according to the number of participants, the description of the study population, statistical analysis and systematic reviews which were appraised via the AMSTAR rating scale. Three evidence levels were constructed (strong, moderate and limited evidence) according to the number of studies and the consistency of the findings. We identified 101 original studies (50 of high quality) and five systematic reviews examining the criterion-related validity of field-based fitness tests in adults. Strong evidence indicated that the 20 m shuttle run, 1.5-mile, 12 min run/walk, YMCA step, 2 km walk and 6 min walk test are valid for estimating cardiorespiratory fitness; the handgrip strength test is valid for assessing hand maximal isometric strength; and the Biering–Sørensen test to evaluate the endurance strength of hip and back muscles; however, the sit-and reach test, and its different versions, and the toe-to-touch test are not valid for assessing hamstring and lower back flexibility. We found moderate evidence supporting that the 20 m square shuttle run test is a valid test for estimating cardiorespiratory fitness. Other field-based fitness tests presented limited evidence, mainly due to few studies. We developed an evidence-based proposal of the most valid field-based fitness tests in healthy adults aged 19–64 years old.

Smartphone-recorded physical activity for estimating cardiorespiratory fitness

While cardiorespiratory fitness is strongly associated with mortality and diverse outcomes, routine measurement is limited. We used smartphone-derived physical activity data to estimate fitness among 50 older adults. We recruited iPhone owners undergoing cardiac stress testing and collected recent iPhone physical activity data. Cardiorespiratory fitness was measured as peak metabolic equivalents of task (METs) achieved on cardiac stress test. We then estimated peak METs using multivariable regression models incorporating iPhone physical activity data, and validated with bootstrapping. Individual smartphone variables most significantly correlated with peak METs (p-values both < 0.001) included daily peak gait speed averaged over the preceding 30 days (r = 0.63) and root mean square of the successive differences of daily distance averaged over 365 days (r = 0.57). The best-performing multivariable regression model included the latter variable, as well as age and body mass index. This model explained 68% of variability in observed METs (95% CI 46%, 81%), and estimated peak METs with a bootstrapped mean absolute error of 1.28 METs (95% CI 0.98, 1.60). Our model using smartphone physical activity estimated cardiorespiratory fitness with high performance. Our results suggest larger, independent samples might yield estimates accurate and precise for risk stratification and disease prognostication.

Prediction of Exercise Capacity and Training Prescription from the 6-Minute Walk Test and Rating of Perceived Exertion

Walking tests, such as the 6-min walk test (6MWT), are popular methods of estimating peak oxygen uptake (VO₂peak) in clinical populations. However, the strength of the distance vs. VO₂peak relationship is not strong, and there are no equations for estimating ventilatory threshold (VT), which is important for training prescription and prognosis. Since the 6MWT is often limited by walking mechanics, prediction equations that include simple additional predictors, such as the terminal rating of perceived exertion (RPE), hold the potential for improving the prediction of VO₂max and VT. Therefore, this study was designed to develop equations for predicting VO₂peak and VT from performance during the 6MWT, on the basis of walking performance and terminal RPE. Clinically stable patients in a cardiac rehabilitation program (N = 63) performed the 6MWT according to the American Thoracic Society guidelines. At the end of each walk, the subject provided their terminal RPE on a 6-20 Borg scale. Each patient also performed a maximal incremental treadmill test with respiratory gas exchange to measure VO₂peak and VT. There was a good correlation between VO₂peak and 6MWT distance (r = 0.80) which was improved by adding the terminal RPE in a multiple regression formula (6MWT + RPE, R² = 0.71, standard error of estimate, SEE = 1.3 Metabolic Equivalents (METs). The VT was also well correlated with walking performance, 6MWT distance (r = 0.80), and was improved by the addition of terminal RPE (6MWT + RPE, R² = 0.69, SEE = 0.95 METs). The addition of terminal RPE to 6MWT distance improved the prediction of maximal METs and METs at VT, which may have practical applications for exercise prescription.

Validation of a Modified Submaximal Balke Protocol to Assess Cardiorespiratory Fitness in Individuals at High Risk of or With Chronic Health Conditions-A Pilot Study

Objectives: This study aims to validate a submaximal treadmill walking test for estimation of maximal oxygen consumption (VO_2max) in individuals at high risk of or with chronic health conditions. Method: Eighteen participants (age 62 ± 16 years; VO_2max 31.2 ± 5.9 ml kg^-1 min^-1) at high risk of getting or with established chronic diseases performed two valid modified Balke treadmill walking protocols, one submaximal protocol, and one maximal protocol. Test duration, heart rate (HR), and rate of perceived exertion (RPE) were measured during both tests. VO_2max was measured during the maximal test. VO_2max was estimated from the submaximal test by multiple regression using time to RPE ≥ 17, gender, age, and body mass as independent variables. Model fit was reported as explained variance (R ²) and standard error of the estimate (SEE). Results: The model fit for estimation of VO_2max from time to RPE ≥ 17 at the submaximal test, body mass, age, and gender was R ² = 0.78 (SEE = 3.1 ml kg^-1 min^-1, p ≤ 0.001). Including heart rate measurement did not improve the model fit. Conclusions: The submaximal walking test is feasible and valid for assessing cardiorespiratory fitness in individuals with high risk of or chronic health conditions.

Physical capacities and leisure activities are related with cognitive functions in older adults

OBJECTIVE

This study aimed to evaluate the relationship between physical activity habits, physical performance and cognitive capacity in older adults' population of Italy and Slovenia.

METHODS

Anthropometric characteristics and body composition bioelectrical impedance analysis (BIA) were evaluated in 892 older adults (60-80 y). Aerobic capacity was measured using the 2km walking test and handgrip and flexibility tests were performed. Physical activity habits and cognitive functions were evaluated by the Global-Physical-Activity-Questionnaires (GPAQ) and by Montreal-Cognitive-Assessment (MoCA) questionnaires, respectively.

RESULTS

GPAQ scores were associated with lower BMI (r=-0.096; p=0.005), lower percentage of fat-mass (r=-0.138; p=0.001), better results in the 2km-walk test (r=-0.175; p=0.001) and a higher percentage of fat-free mass (r=0.138; p=0.001). We also evaluated that, a higher MoCA score correlates with age (r=-0.208; p=0.001), 2km-walk test (r=-0.166; p=0.001), waist-hip ratio (r=-0.200; p=0.001), resting heart-rate (r=-0.087; p=0.025) and heart-rate at the end of 2km-walk test (r=0.189; p=0.001).

CONCLUSIONS

Older adults with a higher level of daily physical activity showed reduction in fat mass and BMI, and higher aerobic fitness; these characteristics have a protection effect on cognitive function.

Five-year follow-up results of aerobic and impact training on bone mineral density in early breast cancer patients

A 12-month exercise program reversibly prevented hip bone loss in premenopausal women with early breast cancer. The bone-protective effect was maintained for 2 years after the end of the program but was lost thereafter.

PURPOSE

Breast cancer survivors are at an increased risk for osteoporosis and fracture. This 5-year follow-up of a randomized impact exercise intervention trial evaluated the maintenance of training effects on bone among breast cancer patients.

METHODS

Five hundred seventy-three early breast cancer patients aged 35-68 years and treated with adjuvant therapy were allocated into a 12-month exercise program or a control group. Four hundred forty-four patients (77%) were included in the 5-year analysis. The exercise intervention comprised weekly supervised step aerobics, circuit exercises, and home training. Areal bone mineral density (aBMD) was measured by dual-energy X-ray absorptiometry. Physical activity was estimated in metabolic equivalent (MET) hours per week and physical performance assessed by 2-km walking and figure-8 running tests.

RESULTS

In premenopausal patients, the 12-month exercise program maintained femoral neck (FN) and total hip (TH) aBMD for 3 years, but the protective effect was lost thereafter. The mean FN aBMD change in the exercise and control groups was - 0.2% and - 1.5% 1 year, - 1.1% and - 2.1% 3 years and - 3.3% versus - 2.4% 5 years after the beginning of the intervention, respectively. Lumbar spine (LS) bone loss was not prevented in premenopausal women and no training effects on aBMD were seen in postmenopausal women. The main confounding element of the study was the unexpected rise in physical activity among patients in the control group. The physical performance improved among premenopausal women in the exercise group compared with the controls.

CONCLUSION

The 12-month exercise program prevented FN and TH bone loss in premenopausal breast cancer patients for 3 years. The bone-protective effect was reversible and lost thereafter.

Smartphone App (2kmFIT-App) for Measuring Cardiorespiratory Fitness: Validity and Reliability Study

BACKGROUND

There is strong evidence suggesting that higher levels of cardiorespiratory fitness (CRF) are associated with a healthier metabolic profile, and that CRF can serve as a powerful predictor of morbidity and mortality. In this context, a smartphone app based on the 2-km walk test (UKK test) would provide the possibility to assess CRF remotely in individuals geographically distributed around a country or continent, and even between continents, with minimal equipment and low costs.

OBJECTIVE

The overall aim of this study was to evaluate the validity and reliability of 2kmFIT-App developed for Android and iOS mobile operating systems to estimate maximum oxygen consumption (VO2max) as an indicator of CRF. The specific aims of the study were to determine the validity of 2kmFIT-App to track distance and calculate heart rate (HR).

METHODS

Twenty participants were included for field-testing validation and reliability analysis. The participants completed the UKK test twice using 2kmFIT-App. Distance and HR were measured with the app as well as with accurate methods, and VO2max was estimated using the UKK test equation.

RESULTS

The validity results showed the following mean differences (app minus criterion): distance (-70.40, SD 51.47 meters), time (-0.59, SD 0.45 minutes), HR (-16.75, SD 9.96 beats/minute), and VO2max (3.59, SD 2.01 ml/kg/min). There was moderate validity found for HR (intraclass correlation coefficient [ICC] 0.731, 95% CI -0.211 to 0.942) and good validity found for VO2max (ICC 0.878, 95% CI -0.125 to 0.972). The reliability results showed the following mean differences (retest minus test): app distance (25.99, SD 43.21 meters), app time (-0.15, SD 0.94 seconds), pace (-0.18, SD 0.33 min/km), app HR (-4.5, 13.44 beats/minute), and app VO2max (0.92, SD 3.04 ml/kg/min). There was good reliability for app HR (ICC 0.897, 95% CI 0.742-0.959) and excellent validity for app VO2max (ICC 0.932, 95% CI 0.830-0.973). All of these findings were observed when using the app with an Android operating system, whereas validity was poor when the app was used with iOS.

CONCLUSIONS

This study shows that 2kmFIT-App is a new, scientifically valid and reliable tool able to objectively and remotely estimate CRF, HR, and distance with an Android but not iOS mobile operating system. However, certain limitations such as the time required by 2kmFIT-App to calculate HR or the temperature environment should be considered when using the app.

Low-cost exercise interventions improve long-term cardiometabolic health independently of a family history of type 2 diabetes: a randomized parallel group trial

INTRODUCTION

To investigate the effect of an exercise prescription and a 1-year supervised exercise intervention, and the modifying effect of the family history of type 2 diabetes (FH), on long-term cardiometabolic health.

RESEARCH DESIGN AND METHODS

For this prospective randomized trial, we recruited non-diabetic participants with poor fitness (n=1072, 30-70 years). Participants were randomly assigned with stratification for FH either in the exercise prescription group (PG, n=144) or the supervised exercise group (EG, n=146) group and compared with a matched control group from the same population study (CON, n=782). The PG and EG received exercise prescriptions. In addition, the EG attended supervised exercise sessions two times a week for 60 min for 12 months. Cardiometabolic risk factors were measured at baseline, 1 year, 5 years, and 6 years. The CON group received no intervention and was measured at baseline and 6 years.

RESULTS

The EG reduced their body weight, waist circumference, diastolic blood pressure, and low-density lipoprotein-cholesterol (LDL-C) but not physical fitness (p=0.074) or insulin or glucose regulation (p>0.1) compared with the PG at 1 year and 5 years (p≤0.011). The observed differences were attenuated at 6 years; however, participants in the both intervention groups significantly improved their blood pressure, high-density lipoprotein-cholesterol, and insulin sensitivity compared with the population controls (p≤0.003). FH modified LDL-C and waist circumference responses to exercise at 1 year and 5 years.

CONCLUSIONS

Low-cost physical activity programs have long-term beneficial effects on cardiometabolic health regardless of the FH of diabetes. Given the feasibility and low cost of these programs, they should be advocated to promote cardiometabolic health.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov identifier NCT02131701.

A moderate 200-m walk test estimates peak oxygen uptake in elderly outpatients with cardiovascular disease

BACKGROUND

A moderate 1-km treadmill walk test (1k-TWT) has been demonstrated to be a valid tool for estimating peak oxygen uptake (VO2peak) in outpatients with cardiovascular disease (CVD). The results obtained by the 1k-TWT predict survival and hospitalization in men and women with CVD. We aimed to examine whether shorter versions of the full 1k-TWT equally assess VO2peak in outpatients with CVD.

METHODS

One hundred eighteen outpatients with CVD, aged 70±9 years, referred to an exercise-based secondary prevention program, performed a moderate and perceptually-regulated (11-13/20 on the Borg Scale) 1k-TWT. Age, height, weight, heart rate, time to walk 100-m, 200-m, 300-m, and 400-m, and the full 1000-m, were entered into equations to estimate VO2peak.

RESULTS

The minimal distance providing similar VO2peak results of the full 1k-TWT was 200-m: 23.0±5.3 mL/kg/min and 23.0±5.5 mL/kg/min, respectively. The concordance correlation coefficient between the two was 0.97 (95%CI 0.96 to 0.98, P<0.0001). The slope and the intercept of the relationship between the values obtained by the 200-m and the full 1k-TWT were not different from the line of identity. Bland-Altman analysis did not show systematic or proportional error.

CONCLUSIONS

A moderate 200-m treadmill-walk is a reliable method for estimating VO2peak in elderly outpatients with CVD. A 200-m walk enables quick and easy cardiorespiratory fitness assessment, with low costs and low burden for health professionals and patients. These findings have practical implications for the transition of patients from clinically-based programs to fitness facilities or self-guided exercise programs.

Internet of Things (IoT) System and Field Sensors for Exercise Intensity Measurements

Although exercise training according to individual peak aerobic capacity ( V ˙ o_2peak ) has been recommended at all ages, sensors available in the field are limited. The most popular sensors in the field are pedometers, but they cannot be used to monitor exercise intensity. Instead, although heart rate (HR) monitors are broadly available in the field to estimate exercise intensity, HR responses to exercise vary by individual according to physical fitness and environmental conditions, which hinders the precise measurement of energy expenditure. These issues make it difficult for exercise physiologists to collaborate with geneticists, nutritionists, and clinicians using the internet of things (IoT). To conquer these problems, we have developed a device that is equipped with a triaxial accelerometer and a barometer to measure energy expenditure during interval walking training (IWT) in the field with inclines. IWT is a training regimen to repeat fast and slow walking for 3 min each, equivalent to greater than 70% and approximately 40% of individual V ˙ o_2peak , respectively. Additionally, we developed an IoT system that enables users to receive instructions from trainers according to their walking records even if they live far away. Since the system is available at low cost with minimum personnel, we can investigate any factors affecting the adherence to and effects of IWT in a large population for a long period. This system was also used to verify any effects of nutritional supplements during IWT and to examine the value of applying IWT to clinical medicine. © 2020 American Physiological Society. Compr Physiol 10:1207-1240, 2020.

Validation of Maximal, Submaximal, and Nonexercise Indirect V ˙ O2max Estimations at 2600 m Altitude

Aim: To study the criterion validity of three indirect maximal oxygen uptake (V ˙ O2max) assessment equations at altitude. Methods: We studied 64 young adults (53% men) at Bogota, Colombia (2600 m altitude). DirectV ˙ O2max was measured by indirect calorimetry using a maximal incremental treadmill protocol. IndirectV ˙ O2max was estimated by two exercise field tests (the 20-m shuttle-run test [20-MST] and the 2-km walking test (UKK)) and one nonexercise method (the perceived functional ability-physical activity rating questionnaire [PFA-PAR]). Altitude-adjusted PFA-PAR was estimated as a 13% linear reduction in PFA-PAR. We calculated Lin concordance coefficients (LCC) and standard error of the estimates (SEEs), and we performed Bland-Altman analyses for each indirect method. Results: MeanV ˙ O2max was 41.2 ± 5.8 mL/kg/min in men and 32.2 ± 3.6 mL/kg/min in women. We found the highest agreement with directV ˙ O2max for the 20-MST (LCC = 0.79, SEE = 3.91 mL/kg/min), followed in order by the altitude-adjusted PFA-PAR (LCC = 0.71, SEE = 4.12 mL/kg/min), the UKK (LCC = 0.67, SEE = 5.48 mL/kg/min), and the unadjusted PFA-PAR (LCC = 0.57, SEE = 4.75 mL/kg/min). The unadjusted PFA-PAR tended to overestimateV ˙ O2max, but Bland-Altman analysis showed that this bias disappeared after altitude adjustment. Conclusion: Several maximal, submaximal, and nonexercise methods provide estimates ofV ˙ O2max with acceptable validity for use in epidemiological studies of populations living at moderate altitude.

Efficacy of a Multicomponent Intervention for Fibromyalgia Based on Pain Neuroscience Education, Exercise Therapy, Psychological Support, and Nature Exposure (NAT-FM): Study Protocol of a Randomized Controlled Trial

The study protocol of a prospective and randomized controlled trial for the assessment of the efficacy of nature activity therapy for people with Fibromyalgia (NAT-FM) is described. The primary outcome is the mean change from baseline in the Revised Fibromyalgia Impact Questionnaire (FIQR) score at post-treatment (12 weeks) and at 9 months of follow-up, and secondary outcomes are changes in the positive affect, negative affect, pain, fatigue, self-efficacy, catastrophising, and emotional regulation. A total of 160 patients with fibromyalgia will be divided into two arms: treatment-as-usual (TAU) and NAT-FM+TAU. Pre, during, post, +6, and +9 months assessments will be carried out, as well as an ecological momentary assessment (EMA) of intrasession and intersessions. Results will be subjected to a mixed group (NAT-FM+TAU vs. TAU) × phase (pre, post, +6 months, +9 months) general linear model. EMA intrasession measurements will be subjected to a 2 (pre vs. post) × 5 (type of activity) mixed-effects ANOVA. EMA between-session measurements obtained from both arms of the study will be analysed on both a time-domain and frequency-domain basis. Effect sizes and number needed to treat (NNT) will be computed. A mediation/moderation analysis will be conducted.

Outdoor circuit test: construction and validation of an instrument for the prediction of cardiorespiratory capacity for older adults

Abstract Objective: the present study aimed to construct, validate and verify the reliability of a protocol for assessing the cardiorespiratory capacity of older adults attending the Rio ao Ar Livre (Open Air Rio, or RAL) project entitled the “Outdoor Circuit Test” (OCT). Method: validity and reliability tests were carried out to assess the accuracy of the OCT, with 50 older adults (70.6 ± 6.3 years) of both sexes who regularly attended the RAL. Validity was tested by collecting VO2max data under maximal cardiopulmonary exercise test conditions, and the OCT variables: a) Circuit Execution Time; b) Heart Rate; c) Subjective Perception of Exertion; d) Average Heart Rate (HRméd). Reliability was tested through the reproducibility of the measurements of the OCT variables, expressed by the Intraclass Correlation Coefficient (ICC). The predictive capacity of VO2max was given by multiple linear regression and the final stability of the model by the analysis of the residues and the calculation of Cook’s distances, with a value of P≤ 0.05 adopted for statistical significance. Results: the predictive model based on age, sex, waist circumference, BMI and circuit execution time explained 41% of VO2max variance, with a standard error of estimate of 18.5%. Conclusion: the OCT exhibited satisfactory reproducibility (0.62 to 0.93), and proved to be valid, reliable, and specific for predicting the cardiorespiratory fitness of older adults attending RAL, demonstrating adequate reproducibility and a positive association with the physical fitness of older adults.

Interdisciplinary Weight Loss and Lifestyle Intervention for Obstructive Sleep Apnoea in Adults: Rationale, Design and Methodology of the INTERAPNEA Study

Obesity is a major risk factor for obstructive sleep apnoea (OSA), the most common sleep-disordered breathing related to neurocognitive and metabolic syndromes, type II diabetes, and cardiovascular diseases. Although strongly recommended for this condition, there are no studies on the effectiveness of an interdisciplinary weight loss and lifestyle intervention including nutrition, exercise, sleep hygiene, and smoking and alcohol cessation. INTERAPNEA is a randomised controlled trial with a two-arm parallel design aimed at determining the effects of an interdisciplinary tailored weight loss and lifestyle intervention on OSA outcomes. The study will include 84 males aged 18–65 with a body mass index of ≥25 kg/m² and severe to moderate OSA randomly assigned to usual care (i.e., continuous positive airway pressure), or interdisciplinary weight loss and lifestyle intervention combined with usual care. Outcomes will be measured at baseline, intervention end-point, and six-month post-intervention, including apnoea-hypopnoea index (primary outcome), other neurophysical and cardiorespiratory polysomnographic outcomes, sleep quality, daily functioning and mood, body weight and composition, physical fitness, blood biomarkers, health-related quality of life, and cost-effectiveness. INTERAPNEA may serve to establish a cost-effective treatment not only for the improvement of OSA and its vast and severe comorbidities, but also for a potential remission of this condition.

Effects of Hypobaric Hypoxia on Endothelial Function and Adiponectin Levels in Airforce Aviators

Background: Hypobaric hypoxia (HH) increases the risk of high altitude-related illnesses (HARI). The pathophysiological mechanism(s) involved are still partially unknown. Altered vascular reactivity as consequence of endothelial dysfunction during HH might play a role in this phenomenon. Adiponectin exerts protective effect on cardiovascular system since it modulates NO release, antagonizing endothelial dysfunction. Aims of this study, performed in a selected population of airforce aviators, were (1) to investigate whether exposure to acute HH might be associated with endothelial dysfunction and (2) to evaluate whether adiponectin might be involved in modulating this phenomenon. Methods: Twenty aviators were exposed to acute HH in a hypobaric chamber by simulating altitude of 8000 and then 6000 m for 2 hours. Vascular reactivity was evaluated by the EndoPAT test immediately before and after the HH; salivary and blood adiponectin levels were measured. Results: EndoPAT performed immediately after HH divided pilots in two groups: 12 pilots with preserved vascular reactivity and 8 pilots with reduction of vascular reactivity, indicating that HH exposure might cause endothelial dysfunction. Salivary and blood adiponectin levels increased post-HH in a time-dependent manner in all aviators, but the significant increase was observed only in those with preserved vascular reactivity suggesting that HH stimulated release of adiponectin that, in turn, by exerting a protective effect, might reduce endothelial dysfunction. Conclusions: Acute HH may cause endothelial dysfunction due, at least in part, to reduced release of adiponectin. This phenomenon might be involved in pathophysiology of HARI.

Effectiveness of a 12-month Exercise Intervention on Physical Activity and Quality of Life of Breast Cancer Survivors; Five-year Results of the BREX-study

BACKGROUND/AIM

This is a report of the 5-year quality of life (QoL) findings of the BREX-study (n=444).

PATIENTS AND METHODS

A 12-month exercise intervention was arranged shortly after adjuvant treatments. Physical activity (PA) was assessed by PA diary, physical performance by a 2- km walking test, QoL by the EORTC QLQC30 and BR-23 questionnaires, fatigue by the FACIT-Fatigue scale and depression by the Beck's 13-item depression scale (BDI).

RESULTS

Participants who improved their PA from baseline to 5-year follow-up were more likely to improve their global health score (RRR=1.02, p=0.016), physical (RRR=1.02, p=0.009), social (RRR=1.03, p=0.013), role functioning (RRR=1.03, p=0.005), and fatigue (RRR=1.02, p=0.002). An improved 2-km walking test was associated to improved global health, physical and role functioning, body image, future perspectives, and fatigue (p=0.011, p<0.001, p=0.001, p=0.021, p=0.012 and p=0.003). No significant difference between the groups was found.

CONCLUSION

Improvement in PA or physical performance yields a positive change in QoL of breast cancer patients.

Association of Irisin Serum Concentration and Muscle Strength in Normal-Weight and Overweight Young Women

Background: Irisin is a muscle-contraction-induced myokine. In previous studies, it has been related to exercise type, fitness and physical activity; however, evidence is not consistent. Thus, the aim of this study was to research the association between health-related fitness and irisin in young women. Methods: The study was designed as a prospective cross-sectional one. Young, healthy, nonsmoking women were enlisted. The sample comprised 40 overweight (OW) and 40 normal-weight (NW) individuals. The average age was 18.63 ± 0.63 and 18.78 ± 0.73 years, respectively. Components of health-related fitness, metabolic parameters, serum irisin and body composition were analyzed. Results: Statistically significant differences were found in physical tests between NW and OW groups for one-leg standing, hand grip strength, vertical jump, modified push-up, fitness index and maximal oxygen uptake (VO_2MAX). There were no differences in concentrations of serum irisin between the groups. We found a positive correlation between irisin and hand grip strength (r = 0.374, p = 0.023). In a multivariate analysis adjusted by body fat, a significant association between irisin and hand grip strength was observed in OW group (β = 0.380, p = 0.026); as well, a positive association between irisin and one-leg standing test in NW group (β = 0.311, p = 0.044) was found. Conclusions: According to our findings, hand grip strength could be linked to irisin concentration in overweight young women.

Six-minute walk test: a tool for predicting maximal aerobic power (VO2 max) in healthy adults

BACKGROUND

The 6-min walk test (6MWT) is cost-effective and well-documented field test for assessing functional exercise capacity and response to medical interventions in diverse patient groups, and predicting cardiorespiratory fitness among healthy people.

OBJECTIVE

Assessments of cardiorespiratory fitness in terms of maximal aerobic power (VO2 max) have great potential in public health monitoring to predict future health, early retirement and ability to independent living. This study aimed to develop a prediction model for VO2 max based on 6MWT results among healthy adults.

DESIGN

The study comprised of pilot and validation studies. In validation study, seventy-five 19- to 75-year-old adults (39 men, 36 women) were equipped with portable gas analyser and heart rate monitor. Participants performed 6MWT on a 15-m indoor track and maximal graded exercise test (GXT) on a treadmill. We evaluated performance of the developed prediction model among 1583 Finnish adults.

RESULTS

Participant's mean walking distance was 652 m (SD ± 74). Their mean VO2 max in GXT and O2 uptake at the end of the 6MWT were 34·4 ml kg-1 min-1 (SD ± 7·6) and 27·2  ml kg-1 min-1 (SD ± 6·5), respectively. For men, the best predictors for VO2 max were walking distance, age, BMI, heart rate at the end of 6MWT and height, and for women, walking distance, age and weight. The predictors explained 82% and 79% of men's and women's measured VO2 max with the standard error of estimate of 3·6 ml kg-1 min-1 and 3·5 ml kg-1 min-1 , respectively.

CONCLUSION

The 6MWT performed along a 15-m track is a valid field test for predicting VO2 max of healthy adults with accuracy of about 1MET.

Validity of the 6-minute walk test and step test for evaluation of cardio respiratory fitness in patients with type 2 diabetes mellitus

PURPOSE

The purpose of this study was to evaluate the reliability, reproducibility, and validity of the 6-minute walk test and step test as substitutes for ergometer exercise in patients with type 2 diabetes mellitus.

METHODS

The study included 54 women aged 50-70 years who had type 2 diabetes mellitus. All the patients performed a cycle ergometer-graded exercise test for cardiorespiratory fitness (V̇O2max), followed by 6-minute walk and step tests.

RESULTS

The mean distance covered during the 6-minute walk test was 538 ± 54 m, and the mean recovery heart rate after the step test was 93 ± 11 beats/min. A significant correlation was found between the distances covered during the cardiorespiratory fitness test (V̇O2max) and those covered the 6-minute walk test (r = 0.542, p < 0.01) and step test (r = -0.490, p < 0.01) in the patients with type 2 diabetes mellitus. Regression equations for the prediction of V̇O2max were constructed from the distance covered, heart rate, age, weight, height, fasting blood glucose level, 2-hour postprandial glucose level, and glycated hemoglobin level during the 6-minute walk test and step test.

CONCLUSION

The 6-minute walk and step tests are simple to perform and reliable for the evaluation of cardiorespiratory fitness in patients with type 2 diabetes mellitus.

Reliability and Validity of a Twelve-Minute Walking Test for Coronary Heart Disease Patients

This study examined the reliability and validity of a 12-min. walking test for coronary heart disease patients. CHD patients (28 men, 18 women) were recruited out of 86 CHD patients of the Martini Hospital Groningen, The Netherlands. 46 CHD patients (age M = 66.0 yr., SD = 6.8) participated in the reliability study and 24 (age M = 62.0 yr., SD = 9.2) in the validity study. A test-retest analysis showed a satisfactory Bland-Altman plot and an intraclass coefficient of .98. The Pearson correlation between the score on the test and the VO2 peak was .77. This test gives a reliable and valid assessment of cardiorespiratory fitness of CHD patients.

Predicting VO2peak from Submaximal- and Peak Exercise Models: The HUNT 3 Fitness Study, Norway

Purpose

Peak oxygen uptake (VO_2peak) is seldom assessed in health care settings although being inversely linked to cardiovascular risk and all-cause mortality. The aim of this study was to develop VO_2peak prediction models for men and women based on directly measured VO_2peak from a large healthy population

Methods

VO_2peak prediction models based on submaximal- and peak performance treadmill work were derived from multiple regression analysis. 4637 healthy men and women aged 20–90 years were included. Data splitting was used to generate validation and cross-validation samples.

Results

The accuracy for the peak performance models were 10.5% (SEE = 4.63 mL⋅kg^-1⋅min^-1) and 11.5% (SEE = 4.11 mL⋅kg^-1⋅min^-1) for men and women, respectively, with 75% and 72% of the variance explained. For the submaximal performance models accuracy were 14.1% (SEE = 6.24 mL⋅kg^-1⋅min^-1) and 14.4% (SEE = 5.17 mL⋅kg^-1⋅min^-1) for men and women, respectively, with 55% and 56% of the variance explained. The validation and cross-validation samples displayed SEE and variance explained in agreement with the total sample. Cross-classification between measured and predicted VO_2peak accurately classified 91% of the participants within the correct or nearest quintile of measured VO_2peak.

Conclusion

Judicious use of the exercise prediction models presented in this study offers valuable information in providing a fairly accurate assessment of VO_2peak, which may be beneficial for risk stratification in health care settings.

Translation of lifestyle modification programs focused on physical activity and dietary habits delivered in community settings

BACKGROUND

Lifestyle modification programs (LMPs) can provide individuals with behavioral skills to sustain long-term changes to their physical activity (PA) levels and dietary habits. Yet, there is much work to be done in the translation of these programs to community settings.

PURPOSE

This review identified LMPs that focused on changing both PA and dietary behaviors and examined common features and barriers faced in their translation to community settings.

METHODS

A search of multiple online databases was conducted to identify LMPs that included participants over the age of 18 who enrolled in LMPs, offered in community settings, and had the goal of improving both PA and dietary behaviors. Data were extracted on participant demographics, study design characteristics, and study outcome variables including changes in PA, dietary habits, body weight, and clinical outcomes.

RESULTS

We identified 27 studies that met inclusion criteria. Despite high levels of retention and adherence to the interventions, varying levels of success were observed in increasing PA levels, improving dietary habits, reducing body weight, and improving clinic outcomes.

CONCLUSION

LMPs addressing issues of PA and dietary habits can be successfully implemented in a community setting. However, inconsistent reporting of key components in the translation of these studies (participant recruitment, utilization of behavioral strategies) may limit their replication and advancement of future programs. Future efforts should better address issues such as identifying barriers to participation and program implementation, utilization of community resources, and evaluating changes across multiple health behaviors.

Efficacy of an exercise intervention for employees with work-related fatigue: study protocol of a two-arm randomized controlled trial

Background

The aim of the current study is to evaluate the efficacy of an exercise intervention to reduce work-related fatigue. Exercise is a potentially effective intervention strategy to reduce work-related fatigue, since it may enhance employees’ ability to cope with work stress and it helps to detach from work. However, based on available research, no clear causal inferences regarding its efficacy can be made. This RCT therefore investigates whether exercise is effective in reducing work-related fatigue, and in improving other indicators of employees’ mental and physical well-being and performance.

Methods/design

A two-arm parallel trial will be conducted. Participants (N = 108) who experience high levels of work-related fatigue will be randomized at a 1:1 ratio to a 6-week exercise intervention or wait list (control). The exercise intervention consists of three one-hour low-intensity outdoor running sessions a week. Each week, two sessions take place in a group under supervision of a trainer, and one session is completed individually. The running sessions will be carried out during leisure time. The primary outcome is work-related fatigue. Secondary outcomes include work ability, self-efficacy, sleep quality, cognitive functioning, and aerobic fitness. These data will be collected at pre-intervention, post-intervention, and at 6 weeks and 12 weeks after the intervention. In addition, weekly measures of employees’ well-being, and exercise activities (i.e. type, frequency, and duration) and experiences (i.e. pleasure, effort, and detachment) will be collected during the intervention period.

Discussion

This study will compare an exercise intervention to a wait list. This enables us to examine the effect of exercise on work-related fatigue compared to the natural course of these symptoms. As such, this study contributes to a better understanding of the causal link between exercise and work-related fatigue. If the intervention is proven effective, the results could provide a basis for future ‘effectiveness’ trials in which the (implementation of the) intervention can be investigated among a broader defined population in a less standardized way, eventually leading to better evidence-based policies and practices to employees, employers, health practitioners, and policy makers concerning the effect of exercise on work-related fatigue.

Trial registration

NTR5034. Registered 10 March 2015.

Long-term effect of physical activity on health-related quality of life among menopausal women: a 4-year follow-up study to a randomised controlled trial

OBJECTIVES

The aim of the study was to explore the long-term effects of physical activity intervention on quality of life (QoL) 4 years after an original randomised controlled trial (RCT).

DESIGN

Cohort study after an RCT.

SETTING

95 of the 159 women from the original RCT participated in weight, height and waist circumference measurements, performed the UKK 2 km Walk Test and completed the SF-36 Health Survey questionnaire. Multilevel mixed regression models were performed in order to compare the original and current group in an RCT setting.

PARTICIPANTS

There were 159 participants in the original RCT; 2.5 years later, 102 of the women responded to a questionnaire and 4-year after the trial, there were 95 respondents. The inclusion criteria in the original RCT were: being symptomatic, experiencing daily hot flushes, age between 40 and 63 years, not using hormone therapy now or in the past 3 months, sedentary lifestyle and having last menstruated 3-36 months earlier.

MAIN OUTCOME MEASURE

Health-related QoL as measured with the SF-36 instrument.

RESULTS

Women in the intervention group had a significantly higher probability of improved physical functioning (OR 1.41; 95% CI 1.00 to 1.99) as compared with women in the control group. In addition, women in the intervention group had higher odds of good role functioning (OR 1.21; 95% CI 0.88 to 1.67), physical health (OR 1.33; 95% CI 0.96 to 1.84) and general health (OR 1.14; 95% CI 0.81 to 1.62), relative to women in the control group, although the differences did not reach statistical significance.

CONCLUSIONS

Women in the intervention group showed positive long-term effects on physical and mental dimensions of QoL after 4 years.

TRIAL REGISTRATION NUMBER

ISRCTN54690027.

Self-selected intensity exercise in the treatment of major depression: A pragmatic RCT

OBJECTIVE

The purpose of the study was to determine the therapeutic effect of physical exercise for patients with unipolar depression. Participants took part in an 8-week walking/running aerobic exercise program at a local sports club.

METHODS

Forty-six outpatients aged 18-65 years and diagnosed with mild to severe depression (ICD-10 criteria) were randomly assigned to an intervention group or wait list. Treatment as usual was continued. The Hamilton Rating Scale for Depression (HRSD-17) served as the main outcome measure. Secondary outcome measures were Beck Depression Inventory (BDI-II), Fitness Index (FI), and VO(2) max as estimated by Urho Kaleka Kekkonen or UKK 2-km Walk Test.

RESULTS

Out of forty-six participants, 24% dropped out. Participants attended 58% of exercise sessions. All randomized participants were included in intention-to-treat (ITT) analysis. Analysis of covariance or ANCOVA showed a large reduction of depressive symptoms in HRSD-17 scores (Cohen's d: 1.8; mean change 8.2, p < .0001). BDI-II (Cohen's d: 0.50; mean change: 4.7, p = 0.09), FI scores (Cohen's d: 0.27; mean change: 5.3, p = 0.08), and VO2 max did not change significantly.

CONCLUSIONS

We observed a large and clinically significant change in HRSD-17 scores. Moderate changes in BDI-II scores without clinical significance and small changes in physical fitness assessments were observed.

Aerobic capacity and upper limb strength are reduced in women diagnosed with breast cancer: a systematic review

QUESTION

What are typical values of physical function for women diagnosed with breast cancer and how do these compare to normative data?

DESIGN

Systematic review with meta-analysis.

PARTICIPANTS

Women diagnosed with breast cancer who were before, during or after treatment.

OUTCOME MEASURES

Physical function was divided into three categories: aerobic capacity, upper and lower extremity muscular fitness, and mobility. Measures of aerobic capacity included field tests (6-minute walk test, 12-minute walk tests, Rockport 1-mile test, and 2-km walk time) and submaximal/maximal exercise tests on a treadmill or cycle ergometer. Measures of upper and lower extremity muscular fitness included grip strength, one repetition maximum (bench, chest or leg press), muscle endurance tests, and chair stands. The only measure of mobility was the Timed Up and Go test.

RESULTS

Of the 1978 studies identified, 85 were eligible for inclusion. Wide ranges of values were reported, reflecting the range of ages, disease severity, treatment type and time since treatment of participants. Aerobic fitness values were generally below average, although 6-minute walk time was closer to population norms. Upper and lower extremity strength was lower than population norms for women who were currently receiving cancer treatment. Lower extremity strength was above population norms for women who had completed treatment.

CONCLUSION

Aerobic capacity and upper extremity strength in women diagnosed with breast cancer are generally lower than population norms. Assessment of values for lower extremity strength is less conclusive. As more research is published, expected values for sub-groups by age, treatment, and co-morbidities should be developed. [Neil-Sztramko SE, Kirkham AA, Hung SH, Niksirat N, Nishikawa K Campbell KL (2014) Aerobic capacity and upper limb strength are reduced in women diagnosed with breast cancer: a systematic review.Journal of Physiotherapy60: 189-200].

Short- and Long-term Effects of a Physical Exercise Intervention on Work Ability and Work Strain in Symptomatic Menopausal Women

BACKGROUND

Physical exercise during leisure time is known to increase physical capacity; however, the long-term effects on work ability and work strain are inconclusive. The aim of this study was to investigate the effects of a 6-month physical exercise program on work ability and work strain after 6 months and 30 months, among women with menopausal symptoms at baseline.

METHODS

A questionnaire including questions on work ability and work strain was mailed in the beginning, at 6 months and after 30 months after the intervention to occupationally active women participating in a randomized controlled study on physical exercise and quality of life. The intervention included aerobic exercise training 4 times per week, 50 minutes per session. Work ability was measured with the Work Ability Index (WAI) and with questions about physical and mental work strain.

RESULTS

Women aged 47-62 years (N = 89) who were occupationally active at baseline were included in the analyses. The increase in WAI from baseline to the end of the exercise intervention (6 months) was statistically significantly greater among the intervention group than among the control group (regression coefficient 2.08; 95% confidence interval 0.71-3.46). The difference between the groups persisted for 30 months. No significant short- or long-term effects on physical and mental work strain were found.

CONCLUSION

A 6-month physical exercise intervention among symptomatic menopausal women had positive short-term as well as long-term effects on work ability.

Effects of acute bouts of endurance exercise on retinal vessel diameters are age and intensity dependent

Alterations of retinal vessel diameters are associated with increased cardiovascular risk. We aimed to investigate changes in retinal vessel diameters in response to acute dynamic exercise of different intensities and whether these changes are age dependent. Seventeen healthy seniors (median (IQR) age 68 (65, 69) years) and 15 healthy young adults (median (IQR) age 26 (25, 28) years) first performed a maximal treadmill test (MTT) followed by a submaximal treadmill test (SMTT) and a resting control condition in randomised order. Central retinal arteriolar (CRAE) and central retinal venular (CRVE) diameter equivalents were measured before as well as 5 (t5) and 40 (t40) minutes after exercise cessation using a static retinal vessel analyser. Both exercise intensities induced a significant dilatation in CRAE and CRVE at t5 compared to the control condition (P < 0.001). At t40, the mean increase in CRAE and CRVE was greater for MTT compared to that for SMTT (CRAE 1.7 μm (95 % confidence interval (CI) -0.1, 3.6; P = 0.061); CRVE 2.2 μm (95 % CI 0.4, 4.1; P = 0.019)). However, the estimated difference at t5 between seniors and young adults in their response to MTT compared to SMTT was 5.3 μm (95 % CI 2.0, 8.5; P = 0.002) for CRAE and 4.1 μm (95 % CI -0.4, 8.6; P = 0.076) for CRVE. Wider arteries and veins after maximal versus submaximal exercise for seniors compared to young adults suggest that myogenic vasoconstriction in response to exhaustive exercise may be reduced in seniors. Age-related loss of vascular reactivity has clinical implications since the arteriolar vasoconstriction protects the retinal capillary bed from intraluminal pressure peaks.