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Verdicchio C, Freene N, Hollings M, Maiorana A, Briffa T, Gallagher R, Hendriks JM, Abell B, Brown A, Colquhoun D, Howden E, Hansen D, Reading S, Redfern J. A Clinical Guide for Assessment and Prescription of Exercise and Physical Activity in Cardiac Rehabilitation. A CSANZ Position Statement. Heart Lung Circ 2023; 32:1035-1048. [PMID: 37516652 DOI: 10.1016/j.hlc.2023.06.854] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 06/27/2023] [Indexed: 07/31/2023]
Abstract
Patients with cardiovascular disease benefit from cardiac rehabilitation, which includes structured exercise and physical activity as core components. This position statement provides pragmatic, evidence-based guidance for the assessment and prescription of exercise and physical activity for cardiac rehabilitation clinicians, recognising the latest international guidelines, scientific evidence and the increasing use of technology and virtual delivery methods. The patient-centred assessment and prescription of aerobic exercise, resistance exercise and physical activity have been addressed, including progression and safety considerations.
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Affiliation(s)
- Christian Verdicchio
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Centre for Heart Rhythm Disorders, University of Adelaide, SAHMRI and Royal Adelaide Hospital, Adelaide, SA, Australia.
| | - Nicole Freene
- Physiotherapy, Faculty of Health, University of Canberra, Canberra, ACT, Australia; Health Research Institute, University of Canberra, Canberra, ACT, Australia
| | - Matthew Hollings
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Andrew Maiorana
- Allied Health Department, Fiona Stanley Hospital, Perth, WA, Australia; Curtin School of Allied Health, Curtin University, Perth, WA, Australia
| | - Tom Briffa
- School of Population and Global Health, University of Western Australia, Perth, WA, Australia
| | - Robyn Gallagher
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Jeroen M Hendriks
- Centre for Heart Rhythm Disorders, University of Adelaide, SAHMRI and Royal Adelaide Hospital, Adelaide, SA, Australia; Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Bridget Abell
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Qld, Australia
| | - Alex Brown
- Telethon Kids Institute, Australian National University, Canberra, ACT, Australia
| | - David Colquhoun
- Faculty of Medicine, University of Queensland, Brisbane, Qld, Australia; Faculty of Medicine, Wesley Medical Centre, Brisbane, Qld, Australia
| | - Erin Howden
- Baker Heart and Diabetes Institute, Melbourne, Vic, Australia; Baker Department of Cardiometabolic Health, University of Melbourne, Melbourne, Vic, Australia
| | - Dominique Hansen
- UHasselt, REVAL/BIOMED (Rehabilitation Research Centre), Hasselt University, Hasselt, Belgium
| | - Stacey Reading
- Department of Exercise Sciences, University of Auckland, Auckland, New Zealand
| | - Julie Redfern
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
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Dor-Haim H, Horowitz M, Yaakobi E, Katzburg S, Barak S. Intermittent aerobic-resistance interval training versus continues aerobic training: Improvement in cardiac electrophysiologic and anthropometric measures in male patients post myocadiac infarction, a randomized control trial. PLoS One 2022; 17:e0267888. [PMID: 35503787 PMCID: PMC9064084 DOI: 10.1371/journal.pone.0267888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 04/14/2022] [Indexed: 11/18/2022] Open
Abstract
Purpose Exercise is a valuable intervention modality for patients post-myocardial infarction (MI). Aerobic and resistance training are both commonly used separately in cardiac rehabilitation. However, the effect of aerobic interval exercise combined with alternating sets of resistance training (super-circuit training, SCT) on cardiac electrophysiologic and anthropometric measures had not been thoroughly investigated. Aim The primary objective of this study was to compare the effectiveness of moderate-intensity continuous-aerobic training (CAT) vs. SCT on cardiac electrical measures (resting electrocardiographic, ECG; a nd heart rate variability, HRV) in patients’ post-MI presenting reduced left ventricular function. Second, to examine its effect on anthropometric measures. Material and methods Twenty-nine men post-MI with reduced left ventricular function were assigned randomly to either 12 weeks of CAT (n = 15) or SCT (n = 14). CAT group performed moderate-intensity activity. SCT group performed high-intensity exercise, alternating between resistance and aerobic training. Differences between CAT and SCT groups were done using independent t-tests, paired t-tests and effect size (ES). Results Participants in both groups improved their HRV measures (increase in HFnu; p < 0.05; ES > 0.51) and ECG (reduction in QT-dispersion; p < 0.05; ES > 0.51). Only the SCT group had significant improvements in waist circumference (p < 0.05). Conclusion Exercise improves cardiac electrical measures post-MI. However, in comparison to CAT, SCT may yield greater anthropometric changes. In order to have improvements in cardiac electrical stability, clinicians working with post-MI patients may use both CAT and SCT. However, SCT might result in greater improvements.
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Affiliation(s)
- Horesh Dor-Haim
- O2 Health Promotion and Sports Medicine Department, Givat Ram, Jerusalem, Israel
| | - Michal Horowitz
- The laboratory of Environmental Physiology Department of Physiology, Faculty of Dentistry Hebrew University of Jerusalem, Hadassah Ein Kerem Campus Jerusalem, Jerusalem, Israel
| | - Eldad Yaakobi
- The Sagol Center for Hyperbaric Medicine and Research, Yitzhak Shamir Medical Center, Be’er Ya’akov, Israel
| | - Sara Katzburg
- O2 Health Promotion and Sports Medicine Department, Givat Ram, Jerusalem, Israel
- Department of Developmental Biology and Cancer Research, Israel-Canada Medical Research Institute, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Sharon Barak
- Department of Pediatric Rehabilitation, The Edmond and Lily Safra Children’s Hospital, The Chaim Sheba Medical Center, Ramat Gan, Israel
- Kaye Academic College of Education, Beer-Sheba, Israel
- * E-mail:
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Rosenberger F, Schneider J, Schlueter K, Paratte JL, Wiskemann J. Vertebral fracture during one repetition maximum testing in a breast cancer survivor: A case report. Medicine (Baltimore) 2021; 100:e25705. [PMID: 34011028 PMCID: PMC8137013 DOI: 10.1097/md.0000000000025705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/01/2021] [Accepted: 04/08/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE One repetition maximum (1-RM) testing is a standard strength assessment procedure in clinical exercise intervention trials. Because no adverse events (AEs) are published, expert panels usually consider it safe for patient populations. However, we here report a vertebral fracture during 1-RM testing. PATIENT CONCERNS A 69-year-old breast cancer survivor (body-mass-index 31.6 kg/m2), 3 months after primary therapy, underwent 1-RM testing within an exercise intervention trial. At the leg press, she experienced pain accompanied by a soft crackling. DIAGNOSIS Imaging revealed a partially unstable cover plate compression fracture of the fourth lumbar vertebra (L4) with a vertical fracture line to the base plate, an extended bone marrow edema and a relative stenosis of the spinal canal. INTERVENTIONS It was treated with an orthosis and vitamin D supplementation. Another imaging to exclude bone metastases revealed previously unknown osteoporosis. OUTCOMES The patient was symptom-free 6.5 weeks after the event but did not return to exercise. CONCLUSION This case challenges safety of 1-RM testing in elderly clinical populations. LESSONS Pre-exercise osteoporosis risk assessment might help reducing fracture risk. However, changing the standard procedure from 1-RM to multiple repetition maximum (x-RM) testing in studies with elderly or clinical populations would be the safest solution.
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Affiliation(s)
- Friederike Rosenberger
- Working Group Exercise Oncology, Department of Medical Oncology, National Center for Tumor Diseases (NCT) Heidelberg, Heidelberg University Hospital
- Division of Health Sciences, German University of Applied Sciences for Prevention and Health Management, Saarbrucken
| | - Justine Schneider
- Working Group Exercise Oncology, Department of Medical Oncology, National Center for Tumor Diseases (NCT) Heidelberg, Heidelberg University Hospital
- Institute of Sports and Sport Science, Heidelberg University, Germany
| | - Kathrin Schlueter
- Working Group Exercise Oncology, Department of Medical Oncology, National Center for Tumor Diseases (NCT) Heidelberg, Heidelberg University Hospital
- Institute of Sports and Sport Science, Heidelberg University, Germany
| | - Jean-Luc Paratte
- Working Group Exercise Oncology, Department of Medical Oncology, National Center for Tumor Diseases (NCT) Heidelberg, Heidelberg University Hospital
| | - Joachim Wiskemann
- Working Group Exercise Oncology, Department of Medical Oncology, National Center for Tumor Diseases (NCT) Heidelberg, Heidelberg University Hospital
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Kemmler W, Kohl M, Fröhlich M, Jakob F, Engelke K, von Stengel S, Schoene D. Effects of High-Intensity Resistance Training on Osteopenia and Sarcopenia Parameters in Older Men with Osteosarcopenia-One-Year Results of the Randomized Controlled Franconian Osteopenia and Sarcopenia Trial (FrOST). J Bone Miner Res 2020; 35:1634-1644. [PMID: 32270891 DOI: 10.1002/jbmr.4027] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 03/19/2020] [Accepted: 03/31/2020] [Indexed: 02/06/2023]
Abstract
Dynamic resistance exercise (DRT) might be the most promising agent for fighting sarcopenia in older people. However, the positive effect of DRT on osteopenia/osteoporosis in men has still to be confirmed. To evaluate the effect of low-volume/high-intensity (HIT)-DRT on bone mineral density (BMD) and skeletal muscle mass index (SMI) in men with osteosarcopenia, we initiated the Franconian Osteopenia and Sarcopenia Trial (FrOST). Forty-three sedentary community-dwelling older men (aged 73 to 91 years) with osteopenia/osteoporosis and SMI-based sarcopenia were randomly assigned to a HIT-RT exercise group (EG; n = 21) or a control group (CG; n = 22). HIT-RT provided a progressive, periodized single-set DRT on machines with high intensity, effort, and velocity twice a week, while CG maintained their lifestyle. Both groups were adequately supplemented with whey protein, vitamin D, and calcium. Primary study endpoint was integral lumbar spine (LS) BMD as determined by quantitative computed tomography. Core secondary study endpoint was SMI as determined by dual-energy X-ray absorptiometry. Additional study endpoints were BMD at the total hip and maximum isokinetic hip-/leg-extensor strength (leg press). After 12 months of exercise, LS-BMD was maintained in the EG and decreased significantly in the CG, resulting in significant between-group differences (p < 0.001; standardized mean difference [SMD] = 0.90). In parallel, SMI increased significantly in the EG and decreased significantly in the CG (p < 0.001; SMD = 1.95). Total hip BMD changes did not differ significantly between the groups (p = 0.064; SMD = 0.65), whereas changes in maximum hip-/leg-extensor strength were much more prominent (p < 0.001; SMD = 1.92) in the EG. Considering dropout (n = 2), attendance rate (95%), and unintended side effects/injuries (n = 0), we believe our HIT-RT protocol to be feasible, attractive, and safe. In summary, we conclude that our combined low-threshold HIT-RT/protein/vitamin D/calcium intervention was feasible, safe, and effective for tackling sarcopenia and osteopenia/osteoporosis in older men with osteosarcopenia. © 2020 The Authors. Journal of Bone and Mineral Research published by American Society for Bone and Mineral Research.
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Affiliation(s)
- Wolfgang Kemmler
- Institute of Medical Physics, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany
| | - Matthias Kohl
- Faculty Medical and Life Sciences, University of Furtwangen, Villingen-Schwenningen, Germany
| | - Michael Fröhlich
- Department of Sports Science, University of Kaiserslautern, Kaiserslautern, Germany
| | - Franz Jakob
- Bernhard-Heine-Center for Locomotion Research, Würzburg, Germany
| | - Klaus Engelke
- Institute of Medical Physics, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany.,Department of Medicine III, Friedrich-Alexander University of Erlangen-Nürnberg, University Hospital Erlangen, Erlangen, Germany
| | - Simon von Stengel
- Institute of Medical Physics, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany
| | - Daniel Schoene
- Institute of Medical Physics, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany
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Tan AEL, Grisbrook TL, Minaee N, Williams SA. Predicting 1 Repetition Maximum Using Handheld Dynamometry. PM R 2018. [DOI: 10.1016/j.pmrj.2018.02.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Casillas JM, Gudjoncik A, Gremeaux V, Aulagne J, Besson D, Laroche D. Assessment tools for personalizing training intensity during cardiac rehabilitation: Literature review and practical proposals. Ann Phys Rehabil Med 2017; 60:43-49. [DOI: 10.1016/j.rehab.2016.01.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 01/25/2016] [Accepted: 01/25/2016] [Indexed: 10/22/2022]
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Association Between Maximal Bench Press Strength and Isometric Handgrip Strength Among Breast Cancer Survivors. Arch Phys Med Rehabil 2016; 98:264-269. [PMID: 27543047 DOI: 10.1016/j.apmr.2016.07.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 06/28/2016] [Accepted: 07/13/2016] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To characterize the relationship between 1-repetition maximum (1-RM) bench press strength and isometric handgrip strength among breast cancer survivors. DESIGN Cross-sectional study. SETTING Laboratory. PARTICIPANTS Community-dwelling breast cancer survivors (N=295). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE 1-RM bench press strength was measured with a barbell and exercise bench. Isometric handgrip strength was measured using an isometric dynamometer, with 3 maximal contractions of the left and right hands. All measures were conducted by staff with training in clinical exercise testing. RESULTS Among 295 breast cancer survivors, 1-RM bench press strength was 18.2±6.1kg (range, 2.2-43.0kg), and isometric handgrip strength was 23.5±5.8kg (range, 9.0-43.0kg). The strongest correlate of 1-RM bench press strength was the average isometric handgrip strength of both hands (r=.399; P<.0001). Mean difference analysis suggested that the average isometric handgrip strength of both hands overestimated 1-RM bench press strength by 4.7kg (95% limits of agreement, -8.2 to 17.6kg). In a multivariable linear regression model, the average isometric handgrip strength of both hands (β=.31; P<.0001) and age (β=-.20; P<.0001) were positively correlated with 1-RM bench press strength (R2=.23). CONCLUSIONS Isometric handgrip strength is a poor surrogate for 1-RM bench press strength among breast cancer survivors. 1-RM bench press strength and isometric handgrip strength quantify distinct components of muscular strength.
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Beidas RS, Paciotti B, Barg F, Branas AR, Brown JC, Glanz K, DeMichele A, DiGiovanni L, Salvatore D, Schmitz KH. A hybrid effectiveness-implementation trial of an evidence-based exercise intervention for breast cancer survivors. J Natl Cancer Inst Monogr 2015; 2014:338-45. [PMID: 25749601 DOI: 10.1093/jncimonographs/lgu033] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The primary aims of this hybrid Type 1 effectiveness-implementation trial were to quantitatively assess whether an evidence-based exercise intervention for breast cancer survivors, Strength After Breast Cancer, was safe and effective in a new setting and to qualitatively assess barriers to implementation. METHODS A cohort of 84 survivors completed measurements related to limb volume, muscle strength, and body image at baseline, 67 survivors completed measurements 12 months later. Qualitative methods were used to understand barriers to implementation experienced by referring oncology clinicians and physical therapists who delivered the program. RESULTS Similar to the efficacy trial, the revised intervention demonstrated safety with regard to lymphedema, and led to improvements in lymphedema symptoms, muscular strength, and body image. Comparison of effects in the effectiveness trial to effects in the efficacy trial revealed larger strength increases in the efficacy trial than in the effectiveness trial (P < .04), but few other differences were found. Qualitative implementation data suggested significant barriers around intervention characteristics, payment, eligibility criteria, the referral process, the need for champions (ie, advocates), and the need to adapt during implementation of the intervention, which should be considered in future dissemination and implementation efforts. CONCLUSIONS This trial successfully demonstrated that a physical therapy led strength training program for breast cancer survivors can be implemented in a community setting while retaining the effectiveness and safety of the clinical trial. However, during the translation process, strategies to reduce barriers to implementation are required. This new program can inform larger scale dissemination and implementation efforts.
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Affiliation(s)
- Rinad S Beidas
- Department of Psychiatry (RSB), Department of Family Medicine and Community Health (BP, FB, KHS), Abramson Cancer Center (AB, KG, AD, LD, DS, KHS), and Center for Clinical Epidemiology (JCB, KG, AD, LD, DS, KHS), University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Good Shepherd Penn Partners, Philadelphia, PA (AB); Biobehavioral Health Science Department, School of Nursing, University of Pennsylvania, Philadelphia, PA (KG)
| | - Breah Paciotti
- Department of Psychiatry (RSB), Department of Family Medicine and Community Health (BP, FB, KHS), Abramson Cancer Center (AB, KG, AD, LD, DS, KHS), and Center for Clinical Epidemiology (JCB, KG, AD, LD, DS, KHS), University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Good Shepherd Penn Partners, Philadelphia, PA (AB); Biobehavioral Health Science Department, School of Nursing, University of Pennsylvania, Philadelphia, PA (KG)
| | - Fran Barg
- Department of Psychiatry (RSB), Department of Family Medicine and Community Health (BP, FB, KHS), Abramson Cancer Center (AB, KG, AD, LD, DS, KHS), and Center for Clinical Epidemiology (JCB, KG, AD, LD, DS, KHS), University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Good Shepherd Penn Partners, Philadelphia, PA (AB); Biobehavioral Health Science Department, School of Nursing, University of Pennsylvania, Philadelphia, PA (KG)
| | - Andrea R Branas
- Department of Psychiatry (RSB), Department of Family Medicine and Community Health (BP, FB, KHS), Abramson Cancer Center (AB, KG, AD, LD, DS, KHS), and Center for Clinical Epidemiology (JCB, KG, AD, LD, DS, KHS), University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Good Shepherd Penn Partners, Philadelphia, PA (AB); Biobehavioral Health Science Department, School of Nursing, University of Pennsylvania, Philadelphia, PA (KG)
| | - Justin C Brown
- Department of Psychiatry (RSB), Department of Family Medicine and Community Health (BP, FB, KHS), Abramson Cancer Center (AB, KG, AD, LD, DS, KHS), and Center for Clinical Epidemiology (JCB, KG, AD, LD, DS, KHS), University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Good Shepherd Penn Partners, Philadelphia, PA (AB); Biobehavioral Health Science Department, School of Nursing, University of Pennsylvania, Philadelphia, PA (KG)
| | - Karen Glanz
- Department of Psychiatry (RSB), Department of Family Medicine and Community Health (BP, FB, KHS), Abramson Cancer Center (AB, KG, AD, LD, DS, KHS), and Center for Clinical Epidemiology (JCB, KG, AD, LD, DS, KHS), University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Good Shepherd Penn Partners, Philadelphia, PA (AB); Biobehavioral Health Science Department, School of Nursing, University of Pennsylvania, Philadelphia, PA (KG)
| | - Angela DeMichele
- Department of Psychiatry (RSB), Department of Family Medicine and Community Health (BP, FB, KHS), Abramson Cancer Center (AB, KG, AD, LD, DS, KHS), and Center for Clinical Epidemiology (JCB, KG, AD, LD, DS, KHS), University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Good Shepherd Penn Partners, Philadelphia, PA (AB); Biobehavioral Health Science Department, School of Nursing, University of Pennsylvania, Philadelphia, PA (KG)
| | - Laura DiGiovanni
- Department of Psychiatry (RSB), Department of Family Medicine and Community Health (BP, FB, KHS), Abramson Cancer Center (AB, KG, AD, LD, DS, KHS), and Center for Clinical Epidemiology (JCB, KG, AD, LD, DS, KHS), University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Good Shepherd Penn Partners, Philadelphia, PA (AB); Biobehavioral Health Science Department, School of Nursing, University of Pennsylvania, Philadelphia, PA (KG)
| | - Domenick Salvatore
- Department of Psychiatry (RSB), Department of Family Medicine and Community Health (BP, FB, KHS), Abramson Cancer Center (AB, KG, AD, LD, DS, KHS), and Center for Clinical Epidemiology (JCB, KG, AD, LD, DS, KHS), University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Good Shepherd Penn Partners, Philadelphia, PA (AB); Biobehavioral Health Science Department, School of Nursing, University of Pennsylvania, Philadelphia, PA (KG)
| | - Kathryn H Schmitz
- Department of Psychiatry (RSB), Department of Family Medicine and Community Health (BP, FB, KHS), Abramson Cancer Center (AB, KG, AD, LD, DS, KHS), and Center for Clinical Epidemiology (JCB, KG, AD, LD, DS, KHS), University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Good Shepherd Penn Partners, Philadelphia, PA (AB); Biobehavioral Health Science Department, School of Nursing, University of Pennsylvania, Philadelphia, PA (KG).
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Bowser B, O'Rourke S, Brown CN, White L, Simpson KJ. Sit-to-stand biomechanics of individuals with multiple sclerosis. Clin Biomech (Bristol, Avon) 2015; 30:788-94. [PMID: 26144661 DOI: 10.1016/j.clinbiomech.2015.06.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 06/19/2015] [Accepted: 06/21/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND It is unclear how people with multiple sclerosis, who often have compromised strength and balance, compare to healthy controls during sit-to-stand movements. The purpose of this study was to compare sit-to-stand biomechanics among three groups: people with multiple sclerosis who exhibit leg weakness, people with multiple sclerosis who have comparable strength to controls, and healthy controls. METHODS Twenty-one individuals with multiple sclerosis (n=10 exhibiting leg weakness: n=11 exhibiting comparable strength to controls), and 12 controls performed five sit-to-stand trials while kinematic data and ground reaction forces were captured. ANOVAs followed by Tukey's post-hoc tests (α=0.05) were used to determine group and limb differences for leg strength, movement time, and sagittal-plane joint kinematics and kinetics. FINDINGS Persons with multiple sclerosis exhibiting leg weakness displayed decreased leg strength, greater trunk flexion, faster trunk flexion velocity and decreased knee extensor power compared to the other two groups (p<0.05; d≥0.87), and slower rise times compared to controls(p<0.03; d≥1.17). No differences were found between controls and the multiple sclerosis-comparable strength group. Across all 3 groups, leg strength was moderately correlated with trunk kinematics and knee extensor velocities, moments and powers of the sit-to-stand (p≤0.05). INTERPRETATION Participants with multiple sclerosis exhibiting leg weakness took longer to stand and appeared to use a trunk-flexion movement strategy when performing the sit-to-stand. The majority of group differences appear to be a result of leg extension weakness. Treatment that includes leg strengthening may be necessary to improve sit-to-stand performance for people with multiple sclerosis.
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Affiliation(s)
- Bradley Bowser
- Department of Health and Nutritional Sciences, South Dakota State University, Brookings, SD, USA.
| | | | - Cathleen N Brown
- Department of Kinesiology, University of Georgia, Athens, GA, USA.
| | - Lesley White
- Department of Kinesiology, University of Georgia, Athens, GA, USA.
| | - Kathy J Simpson
- Department of Kinesiology, University of Georgia, Athens, GA, USA.
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Brown JC, Schmitz KH. Weight Lifting and Physical Function Among Survivors of Breast Cancer: A Post Hoc Analysis of a Randomized Controlled Trial. J Clin Oncol 2015; 33:2184-9. [PMID: 25964257 DOI: 10.1200/jco.2014.57.7395] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Survivors of breast cancer may experience deterioration of physical function. This is important because poor physical function may be associated with premature mortality, injurious falls, bone fracture, and disability. We conducted a post hoc analysis to explore the potential efficacy of slowly progressive weight lifting to reduce the incidence of physical function deterioration among survivors of breast cancer. METHODS Between October 2005 and August 2008, we conducted a single-blind, 12-month, randomized controlled trial of twice-per-week slowly progressive weight lifting or standard care among 295 survivors of nonmetastatic breast cancer. In this post hoc analysis of data from the Physical Activity and Lymphedema Trial, we examined incident deterioration of physical function after 12 months, defined as a ≥ 10-point decrease in the physical function subscale of the Medical Outcomes Short-Form 36-item questionnaire. RESULTS The proportion of participants who experienced incident physical function deterioration after 12 months was 16.3% (24/147) in the control group and 8.1% (12/148) in the weight lifting group (relative risk, 0.49; 95% CI, 0.25 to 0.96; P = .04). No serious or unexpected adverse events occurred that were related to weight lifting. CONCLUSION Slowly progressive weight lifting compared with standard care reduced the incidence of physical function deterioration among survivors of breast cancer. These data are hypothesis generating. Future studies should directly compare the efficacy of weight lifting with other modalities of exercise, such as brisk walking, to appropriately inform the development of a confirmatory study designed to preserve physical function among survivors of breast cancer.
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Affiliation(s)
- Justin C Brown
- All authors: Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Kathryn H Schmitz
- All authors: Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
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Florian J, Rubin A, Mattiello R, Fontoura FFD, Camargo JDJP, Teixeira PJZ. Impact of pulmonary rehabilitation on quality of life and functional capacity in patients on waiting lists for lung transplantation. J Bras Pneumol 2014; 39:349-56. [PMID: 23857680 PMCID: PMC4075851 DOI: 10.1590/s1806-37132013000300012] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2012] [Accepted: 04/25/2013] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVE: To investigate the impact of a pulmonary rehabilitation program on the functional capacity and on the quality of life of patients on waiting lists for lung transplantation. METHODS: Patients on lung transplant waiting lists were referred to a pulmonary rehabilitation program consisting of 36 sessions. Before and after the program, participating patients were evaluated with the six-minute walk test and the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36). The pulmonary rehabilitation program involved muscle strengthening exercises, aerobic training, clinical evaluation, psychiatric evaluation, nutritional counseling, social assistance, and educational lectures. RESULTS: Of the 112 patients initially referred to the program, 58 completed it. The mean age of the participants was 46 ± 14 years, and females accounted for 52%. Of those 58 patients, 37 (47%) had pulmonary fibrosis, 13 (22%) had pulmonary emphysema, and 18 (31%) had other types of advanced lung disease. The six-minute walk distance was significantly greater after the program than before (439 ± 114 m vs. 367 ± 136 m, p = 0.001), the mean increase being 72 m. There were significant point increases in the scores on the following SF-36 domains: physical functioning, up 22 (p = 0.001), role-physical, up 10 (p = 0.045); vitality, up 10 (p < 0.001); social functioning, up 15 (p = 0.001); and mental health, up 8 (p = 0.001). CONCLUSIONS: Pulmonary rehabilitation had a positive impact on exercise capacity and quality of life in patients on lung transplant waiting lists.
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Affiliation(s)
- Juliessa Florian
- Santa Casa Sisters of Mercy Hospital Complex, Department of Pulmonary Rehabilitation and Physical Therapy, Porto Alegre, Brazil.
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Arazi H, Asadi A. One repetition maximum test increases serum indices of muscle damage and soreness in trained and untrained males. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.apunts.2012.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Dias RMR, Avelar A, Menêses AL, Salvador EP, Silva DRPD, Cyrino ES. Segurança, reprodutibilidade, fatores intervenientes e aplicabilidade de testes de 1-RM. MOTRIZ: REVISTA DE EDUCACAO FISICA 2013. [DOI: 10.1590/s1980-65742013000100024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Um dos métodos mais utilizados para mensuração da força muscular é o teste de uma repetição máxima (1-RM), tendo em vista a sua versatilidade para aplicação em diferentes exercícios, a especificidade do movimento e o baixo custo operacional. Neste trabalho discutimos as evidências disponíveis a respeito da segurança, da reprodutibilidade, dos fatores intervenientes e da aplicabilidade prática do teste de 1-RM. Com base nas informações disponíveis até o presente momento, o teste de 1-RM parece ser um método seguro do ponto de vista ortopédico e cardiovascular e a sua reprodutibilidade depende, fundamentalmente, da realização de procedimentos de testagem adequados para a estabilização da carga, assim como do controle dos fatores intervenientes os quais podem influenciar no desempenho do teste. Embora a aplicabilidade para o diagnóstico e acompanhamento da força muscular seja ampla, a utilização de testes de 1-RM para a prescrição de treinamento com pesos ainda é bastante discutível.
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Rajotte EJ, Yi JC, Baker KS, Gregerson L, Leiserowitz A, Syrjala KL. Community-based exercise program effectiveness and safety for cancer survivors. J Cancer Surviv 2012; 6:219-28. [PMID: 22246463 DOI: 10.1007/s11764-011-0213-7] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Accepted: 12/16/2011] [Indexed: 12/27/2022]
Abstract
PURPOSE Clinical trials have demonstrated the benefits of exercise for cancer survivors. This investigation determined the effectiveness and safety of a disseminated community-based exercise program for cancer survivors who had completed treatment. METHODS Personal trainers from regional YMCAs received training in cancer rehabilitation and supervised twice-a-week, 12-week group exercise sessions for survivors. At baseline and post-program, validated measures assessed patient-reported outcomes (PRO) and physiologic measurements. RESULTS Data were collected from 221 survivors from 13 YMCA sites and 36 separate classes. All participants had data available at one time point, while matched baseline and post-program PRO and physiologic data were available for 85% (N = 187). Participants with matched data were largely female (82%), with mean age of 58 (range, 28-91 years). Time since diagnosis ranged from 1 to 48 (mean, 5.6 years), and mean time since last treatment was 3.0 (range, 1-33 years). Physiological improvements were significant in systolic (P < 0.001) and diastolic (P = 0.035) blood pressure, upper and lower body strength, the 6-min walk test (P = 0.004), and flexibility (P < 0.001). Participants reported improvements in overall health-related quality of life (P < 0.001), social support (P = 0.019), body pain (P = 0.016), fatigue (P < 0.001), insomnia (P < 0.001), and overall musculoskeletal symptoms (P = <0.001). Few injuries or lymphedema events occurred during classes. CONCLUSIONS Community-based exercise groups for cancer survivors of mixed diagnoses and ages, who have completed active treatment, have physiologic and psychosocial benefits, and are safe. IMPLICATIONS FOR CANCER SURVIVORS Survivors may expect significant benefit from participating in a community-based exercise program tailored to meet their individual needs as a survivor.
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Affiliation(s)
- Emily Jo Rajotte
- Clinical Research Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, D5-220, P.O. Box 19024, Seattle, WA 98109, USA
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15
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Reliability of the 8-repetition maximum test in men and women. J Sci Med Sport 2012; 15:69-73. [DOI: 10.1016/j.jsams.2011.07.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2011] [Revised: 06/08/2011] [Accepted: 07/11/2011] [Indexed: 11/23/2022]
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Reliability in one-repetition maximum performance in people with Parkinson's disease. PARKINSONS DISEASE 2011; 2012:928736. [PMID: 22135765 PMCID: PMC3205703 DOI: 10.1155/2012/928736] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/30/2011] [Revised: 08/05/2011] [Accepted: 09/01/2011] [Indexed: 11/17/2022]
Abstract
Strength training is
an effective modality to improve muscular
strength and functional performance in people
with Parkinson's disease (PWP). One-repetition maximum (1-RM) is the gold standard
assessment of strength; however, PWP suffer from
day-to-day variations in symptom severity and
performance characteristics, potentially
adversely affecting the reliability of 1-RM
performance. Herein, we assessed the reliability
of 1-RM in PWP. Forty-six participants completed
two sessions of 1-RM testing of knee extension,
knee flexion, chest press, and biceps curl at
least 72 hours apart. Significantly differences
between testing sessions were identified for
knee extension (P < 0.001), knee flexion (P = 0.042), and biceps curl (P = 0.001); however, high reliability (ICC > 0.90)
was also identified between sessions. Interestingly, almost third of subjects failed to perform better on the second testing session. These findings suggest that 1-RM testing can be safely performed in PWP and that disease-related daily variability may influence 1-RM performance.
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Machado HG, Simões RP, Mendes RG, Castello V, Di Thommazo L, Almeida LB, Lopes SLB, Catai AM, Borghi-Silva A. Cardiac autonomic modulation during progressive upper limb exercise by patients with coronary artery disease. Braz J Med Biol Res 2011; 44:1276-84. [PMID: 22002089 DOI: 10.1590/s0100-879x2011007500134] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Accepted: 09/27/2011] [Indexed: 11/21/2022] Open
Abstract
The purpose of this study was to investigate the behavior of heart rate (HR) and HR variability (HRV) during different loads of resistance exercise (incline bench press) in patients with coronary artery disease (CAD) and healthy sedentary controls. Ten healthy men (65 ± 1.2 years, control group, CG) and 10 men with clinically stable CAD (66 ± 2.4 years, CADG) were recruited. A discontinuous progressive protocol was applied with an initial load of 10% of the maximum load achieved in the 1RM (1 repetition maximum) with increases of 10% until 30% 1RM was reached, which was followed by subsequent increases of 5% 1RM until exhaustion. HRV was analyzed by linear and non-linear methods. There was a significant reduction in rMSSD (CG: 20 ± 2 to 11 ± 3 ms; CADG: 19 ± 3 to 9 ± 1 ms) and SD1 indexes (CG: 14 ± 2 to 8 ± 1 ms; CADG: 14 ± 2 to 7 ± 1 ms). An increase in HR (CG: 69 ± 5 to 90 ± 5 bpm; CADG: 62 ± 4 to 75 ± 4 bpm) and in systolic blood pressure (CG: 124 ± 3 to 138 ± 3 mmHg; CADG: 122 ± 6 to 126 ± 9 bpm) were observed (P < 0.05) when comparing pre-effort rest and 40% 1RM in both groups. Furthermore, an increase in RMSM index was also observed (CG: 28 ± 3 to 45 ± 9 ms; CADG: 22 ± 2 to 79 ± 33 ms), with higher values in CADG. We conclude that loads up to 30% 1RM during incline bench press result in depressed vagal modulation in both groups, although only stable CAD patients presented sympathetic overactivity at 20% 1RM upper limb exercise.
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Affiliation(s)
- H G Machado
- Programa de Pós-Graduação Interunidades em Bioengenharia, Escola de Engenharia de São Carlos, Universidade de São Paulo, São Carlos, SP, Brasil
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Ritti-Dias RM, Avelar A, Salvador EP, Cyrino ES. Influence of previous experience on resistance training on reliability of one-repetition maximum test. J Strength Cond Res 2011; 25:1418-22. [PMID: 21522076 DOI: 10.1519/jsc.0b013e3181d67c4b] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The 1-repetition maximum test (1RM) has been widely used to assess maximal strength. However, to improve accuracy in assessing maximal strength, several sessions of the 1RM test are recommended. The aim of this study was to analyze the influence of previous resistance training experience on the reliability of 1RM test. Thirty men were assigned to the following 2 groups according to their previous resistance training experience: no previous resistance training experience (NOEXP) and more than 24 months of resistance training experience (EXP). All subjects performed the 1RM tests in bench press and squat in 4 sessions on distinct days. There was a significant session × group effect in bench press (F = 3.09; p < 0.03) and squat (F = 2.76; p < 0.05) showing that only the NOEXP increased maximal strength between the sessions. Significant increases (p < 0.05) in maximal strength occurred in the NOEXP between session 1 and the other sessions in bench press (session 1 vs. 2 = +3.8%; session 1 vs. 3 = +7.4%; session 1 vs. 4 = +10.1%), and squat (session 1 vs. 2 = +7.6%; session 1 vs. 3 = +10.1%; session 1 vs. 4 = +11.2%). Moreover, in bench press, maximal strength in sessions 3 and 4 were significantly higher than in session 2. The results of the present study suggest that the reliability of the 1RM test is influenced by the subject's previous experience in resistance training. Subjects without experience in resistance training require more practice and familiarization and show greater increases in maximal strength between sessions than subjects with previous experience in resistance training.
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Weight lifting in patients with lower-extremity lymphedema secondary to cancer: a pilot and feasibility study. Arch Phys Med Rehabil 2010; 91:1070-6. [PMID: 20599045 DOI: 10.1016/j.apmr.2010.03.021] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2009] [Revised: 03/17/2010] [Accepted: 03/30/2010] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess the feasibility of recruiting and retaining cancer survivors with lower-limb lymphedema into an exercise intervention study. To develop preliminary estimates regarding the safety and efficacy of this intervention. We hypothesized that progressive weight training would not exacerbate leg swelling and that the intervention would improve functional mobility and quality of life. DESIGN Before-after pilot study with a duration of 5 months. SETTING University of Pennsylvania. PARTICIPANTS Cancer survivors with a known diagnosis of lower-limb lymphedema (N=10) were directly referred by University of Pennsylvania clinicians. All 10 participants completed the study. INTERVENTION Twice weekly slowly progressive weight lifting, supervised for 2 months, unsupervised for 3 months. MAIN OUTCOME MEASURES The primary outcome was interlimb volume differences as measured by optoelectronic perometry. Additional outcome measures included safety (adverse events), muscle strength, objective physical function, and quality of life. RESULTS Interlimb volume differences were 44.4% and 45.3% at baseline and 5 months, respectively (pre-post comparison, P=.70). There were 2 unexpected incident cases of cellulitis within the first 2 months. Both resolved with oral antibiotics and complete decongestive therapy by 5 months. Bench and leg press strength increased by 47% and 27% over 5 months (P=.001 and P=.07, respectively). Distance walked in 6 minutes increased by 7% in 5 months (P=.01). No improvement was noted in self-reported quality of life. CONCLUSIONS Recruitment of patients with lower-limb-lymphedema into an exercise program is feasible. Despite some indications that the intervention may be safe (eg, a lack of clinically significant interlimb volume increases over 5 mo), the unexpected finding of 2 cellulitic infections among the 10 participants suggests additional study is required before concluding that patients with lower-extremity lymphedema can safely perform weight lifting.
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Schmitz KH, Speck RM. Risks and benefits of physical activity among breast cancer survivors who have completed treatment. ACTA ACUST UNITED AC 2010; 6:221-38. [PMID: 20187728 DOI: 10.2217/whe.10.1] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Worldwide, over 1 million cases of breast cancer are diagnosed each year. In the USA, approximately 185,000 women are newly diagnosed annually. Nearly 90% of newly diagnosed cancer patients in the USA will live for 5 years beyond diagnosis and there are estimated to be 2.4 million breast cancer survivors currently living in the USA. There are unique challenges in meeting the medical needs of these survivors. Persistent impairment and increased medical risks can occur as a result of treatment, including changes to the cardiovascular, pulmonary, endocrine, immune, musculoskeletal, neurological and lymphatic systems. Physical activity can cause positive changes in each of these body systems. However, physiologic impairments and altered risks for cardiopulmonary, bone health, neurosensory and other outcomes among breast cancer survivors can cause confusion regarding the safety of returning to exercise after treatment. In this article, we review the adverse effects of cancer treatments on the body systems affected by and used to perform exercise, the risks of exercise among breast cancer survivors, the effects of exercise on persistent treatment toxicities, whether exercise may prevent recurrence or mortality, as well as providing guidance for exercise testing and prescription among breast cancer survivors.
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Affiliation(s)
- Kathryn H Schmitz
- University of Pennsylvania School of Medicine, Division of Clinical Epidemiology, Philadelphia, PA 19104-6021, USA.
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Changes in the Body Image and Relationship Scale following a one-year strength training trial for breast cancer survivors with or at risk for lymphedema. Breast Cancer Res Treat 2009; 121:421-30. [DOI: 10.1007/s10549-009-0550-7] [Citation(s) in RCA: 108] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2009] [Accepted: 09/09/2009] [Indexed: 10/20/2022]
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Schmitz KH, Ahmed RL, Troxel A, Cheville A, Smith R, Lewis-Grant L, Bryan CJ, Williams-Smith CT, Greene QP. Weight lifting in women with breast-cancer-related lymphedema. N Engl J Med 2009; 361:664-73. [PMID: 19675330 DOI: 10.1056/nejmoa0810118] [Citation(s) in RCA: 362] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Weight lifting has generally been proscribed for women with breast-cancer-related lymphedema, preventing them from obtaining the well-established health benefits of weight lifting, including increases in bone density. METHODS We performed a randomized, controlled trial of twice-weekly progressive weight lifting involving 141 breast-cancer survivors with stable lymphedema of the arm. The primary outcome was the change in arm and hand swelling at 1 year, as measured through displaced water volume of the affected and unaffected limbs. Secondary outcomes included the incidence of exacerbations of lymphedema, number and severity of lymphedema symptoms, and muscle strength. Participants were required to wear a well-fitted compression garment while weight lifting. RESULTS The proportion of women who had an increase of 5% or more in limb swelling was similar in the weight-lifting group (11%) and the control group (12%) (cumulative incidence ratio, 1.00; 95% confidence interval, 0.88 to 1.13). As compared with the control group, the weight-lifting group had greater improvements in self-reported severity of lymphedema symptoms (P=0.03) and upper- and lower-body strength (P<0.001 for both comparisons) and a lower incidence of lymphedema exacerbations as assessed by a certified lymphedema specialist (14% vs. 29%, P=0.04). There were no serious adverse events related to the intervention. CONCLUSIONS In breast-cancer survivors with lymphedema, slowly progressive weight lifting had no significant effect on limb swelling and resulted in a decreased incidence of exacerbations of lymphedema, reduced symptoms, and increased strength. (ClinicalTrials.gov number, NCT00194363.)
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Affiliation(s)
- Kathryn H Schmitz
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA.
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Schmitz KH, Troxel AB, Cheville A, Grant LL, Bryan CJ, Gross CR, Lytle LA, Ahmed RL. Physical Activity and Lymphedema (the PAL trial): assessing the safety of progressive strength training in breast cancer survivors. Contemp Clin Trials 2009; 30:233-45. [PMID: 19171204 DOI: 10.1016/j.cct.2009.01.001] [Citation(s) in RCA: 98] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2008] [Revised: 12/15/2008] [Accepted: 01/04/2009] [Indexed: 01/02/2023]
Abstract
Lymphedema is a chronic and progressive long-term adverse effect of breast cancer treatment commonly defined by swelling of the affected arm. Current clinical guidelines indicate that women with and at risk for lymphedema should protect the affected arm from overuse. In clinical practice, this often translates into risk aversive guidance to avoid using the arm. This could lead to a disuse pattern that may increase the likelihood of injury from common activities of daily living. Further, such guidance poses an additional barrier to staying physically active, potentially translating to weight gain, which has been shown to be associated with worse clinical course for women with lymphedema. We hypothesize that a program of slowly progressive strength training with no upper limit on the amount of weight that may be lifted would gradually increase the physiologic capacity of the arm so that common activities represent a decreasing percentage of maximal capacity. Theoretically, this increased capacity should decrease the risk that daily activities put stress on the lymphatic system of the affected side. The Physical Activity and Lymphedema (PAL) Trial is a recently completed randomized controlled exercise intervention trial that recruited 295 breast cancer survivors (141 with lymphedema at study entry, 154 at risk for lymphedema at study entry). The purpose of this report is to provide detail regarding the study design, statistical design, and protocol of the PAL trial.
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Affiliation(s)
- Kathryn H Schmitz
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA 19104-6021, USA.
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de Vos NJ, Singh NA, Ross DA, Stavrinos TM, Orr R, Fiatarone Singh MA. Continuous Hemodynamic Response to Maximal Dynamic Strength Testing in Older Adults. Arch Phys Med Rehabil 2008; 89:343-50. [DOI: 10.1016/j.apmr.2007.08.130] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2007] [Revised: 08/07/2007] [Accepted: 08/07/2007] [Indexed: 11/26/2022]
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Puthoff ML, Nielsen DH. Relationships among impairments in lower-extremity strength and power, functional limitations, and disability in older adults. Phys Ther 2007; 87:1334-47. [PMID: 17684086 DOI: 10.2522/ptj.20060176] [Citation(s) in RCA: 147] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND PURPOSE During the aging process, older adults may experience a loss of strength and power, which then may lead to functional limitations and disability. The purpose of this study was to examine how impairments in lower-extremity strength and power are related to functional limitations and disability in community-dwelling older adults. SUBJECTS Thirty older adults (age [X+/-SD], 77.3+/-7.0 years; 25 women and 5 men) with mild to moderate functional limitations participated in this study. METHODS Lower-extremity strength, peak power, power at a low relative intensity, and power at a high relative intensity were measured with a pneumatic resistance leg press. Functional limitations and disability were assessed with the Short Physical Performance Battery (SPPB), the Six-Minute Walk Test (SMWT), and the Late Life Function and Disability Instrument (LLFDI). RESULTS All measures of strength and power were related to functional limitations. Peak power demonstrated the strongest relationships with SMWT, the SPPB gait speed subscale, and the LLFDI functional limitation component. Power at a high relative intensity demonstrated the strongest relationships to the SPPB total score and the SPPB sit-to-stand subscale score. All measures of strength and power were indirectly related to the LLFDI disability component. DISCUSSION AND CONCLUSION Older adults should focus on increasing and maintaining lower-extremity strength and power across a range of intensities in order to decrease functional limitations and disability.
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Affiliation(s)
- Michael L Puthoff
- Physical Therapy Department, St Ambrose University, 518 W Locust St, Davenport, IA 52803, USA.
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26
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DiFrancisco-Donoghue J, Werner W, Douris PC. Comparison of once-weekly and twice-weekly strength training in older adults. Br J Sports Med 2006; 41:19-22. [PMID: 17062657 PMCID: PMC2465144 DOI: 10.1136/bjsm.2006.029330] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Strength training has been shown to benefit the health and function of older adults. OBJECTIVE To investigate whether one set of exercises performed once a week was as effective in increasing muscle strength as training twice a week. METHODS 18 subjects (7 women and 11 men) aged 65-79 years were randomly assigned to two groups. Both groups performed one set of exercises to muscular fatigue; group 1 trained 1 day/week and group 2 trained 2 days/week on three lower and three upper body exercises for 9 weeks. The data were analysed using a mixed model 2 x 2 analysis of variance. RESULTS A significant main effect of time (p<0.001), but not group, on one-repetition maximum scores was observed. No significant interaction was observed between time and group and therefore no difference in strength changes between training once a week versus twice a week after 9 weeks. CONCLUSIONS One set of exercises performed once weekly to muscle fatigue improved strength as well as twice a week in the older adult. Our results provide information that will assist in designing strength-training programmes that are more time and cost efficient in producing health and fitness benefits for older adults.
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Affiliation(s)
- J DiFrancisco-Donoghue
- Academic Health Care Center of The New York College of Osteopathic Medicine, Old Westbury, New York, USA
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Schmitz KH, Ahmed RL, Hannan PJ, Yee D. Safety and efficacy of weight training in recent breast cancer survivors to alter body composition, insulin, and insulin-like growth factor axis proteins. Cancer Epidemiol Biomarkers Prev 2005; 14:1672-80. [PMID: 16030100 DOI: 10.1158/1055-9965.epi-04-0736] [Citation(s) in RCA: 226] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND This randomized controlled trial assessed the safety and effects of twice-weekly weight training among recent breast cancer survivors. Outcomes included body size and biomarkers hypothesized to link exercise and breast cancer risk. METHODS A convenience sample of 85 recent survivors was randomized into immediate and delayed treatment groups. The immediate group trained from months 0 to 12; the delayed treatment group served as a no exercise parallel comparison group from months 0 to 6 and trained from months 7 to 12. Measures at baseline, 6 and 12 months included body weight, height, body fat, lean mass, body fat %, and waist circumference, as well as fasting glucose, insulin, insulin resistance, insulin-like growth factor-I (IGF-I), IGF-II, and IGF-binding protein-1, IGFBP-2, and IGFBP-3. Injury reporting was standardized. RESULTS The intervention resulted in significant increases in lean mass (0.88 versus 0.02 kg, P < 0.01), as well as significant decreases in body fat % (-1.15% versus 0.23%, P = 0.03) and IGF-II (-6.23 versus 28.28 ng/mL, P = 0.02) comparing immediate with delayed treatment from baseline to 6 months. Within-person changes experienced by delayed treatment group participants during training versus no training were similar. Only one participant experienced a study related injury that prevented continued participation. CONCLUSION Twice-weekly weight training is a safe exercise program for recent breast cancer survivors that may result in increased muscle mass, as well as decreased body fat % and IGF-II. The implications of these results on cancer recurrence or survival may become more evident with longer exercise intervention trials among breast cancer survivors.
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Affiliation(s)
- Kathryn H Schmitz
- Division of Clinical Epidemiology University of Pennsylvania 423 Guardian Drive, 9th floor Blockley Drive, Philadelphia, PA 19072 215-898-0901
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Measuring Lower Extremity Strength in Older Adults: The Stability of Isokinetic versus 1RM Measures. J Aging Phys Act 2002. [DOI: 10.1123/japa.10.4.489] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In order to obtain joint-specific baseline strength characteristics in older adults, clinicians and researchers must have knowledge regarding the relative stability of the various strength tests (the strength difference between repeated measures) and the number of prebaseline practice sessions required to obtain consistent data. To address these needs, the relative multiple-test stability and reliability associated with lower extremity isokinetic and 1-repetition-maximum (1RM) strength measures were assessed in a sample of older adults (N= 30, 65.2 ± 6.3 years), over 4 weeks (T1-T4). Isokinetic ankle plantar-flexion (30°/s) strength and 1RM ankle plantar-flexion, leg-press, and knee-flexion strength exhibited poor stability between Weeks T1 and T2 but stabilized between Weeks T2 and T3 and Weeks T3 and T4. The measures exhibited low incidence of injury and induced low levels of residual muscle soreness. Findings suggest that the 1RM measures require at least 1 prebaseline training session in order to establish consistent baseline performance and are more reliable than isokinetic ankle plantar-flexion tests.
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Kaelin ME, Swank AM, Adams KJ, Barnard KL, Berning JM, Green A. Cardiopulmonary responses, muscle soreness, and injury during the one repetition maximum assessment in pulmonary rehabilitation patients. JOURNAL OF CARDIOPULMONARY REHABILITATION 1999; 19:366-72. [PMID: 10609187 DOI: 10.1097/00008483-199911000-00008] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE The safety of one repetition maximum (1RM) testing for patients with chronic obstructive pulmonary disease (COPD) has not been determined. Therefore, this study was conducted to determine the prevalence of abnormal cardiopulmonary responses, muscle soreness, and muscle injury of patients with moderate to severe COPD in response to 1RM testing. METHODS Twenty pulmonary rehabilitation patients (11 women and 9 men) with moderate or severe COPD participated in this investigation. The 1RM testing was performed using the parallel squat and incline press. Blood pressure, heart rate dyspnea ratings, and oxygen saturation responses were measured immediately following the 1RM procedure. Ratings of muscle soreness and injury were measured immediately after 1RM testing and on days 2 and 7. RESULTS No injury, significant muscle soreness, or abnormal cardiopulmonary responses occurred as a result of 1RM testing. No gender differences were found for any variable measured in response to 1RM testing. CONCLUSIONS A properly supervised and screened pulmonary rehabilitation population can be 1RM tested without significant muscle soreness, injury, or abnormal cardiopulmonary responses.
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Affiliation(s)
- M E Kaelin
- Southern Indiana Rehabilitation Hospital, New Albany, Indiana, USA
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30
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Adams KJ, Barnard KL, Swank AM, Mann E, Kushnick MR, Denny DM. Combined high-intensity strength and aerobic training in diverse phase II cardiac rehabilitation patients. JOURNAL OF CARDIOPULMONARY REHABILITATION 1999; 19:209-15. [PMID: 10453427 DOI: 10.1097/00008483-199907000-00001] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Developing adequate levels of muscular strength in the cardiac rehabilitation (CR) patient helps return the patient to an active lifestyle. This study evaluated the effects and safety of an 8-week high-intensity strength training (ST) program combined with a traditional aerobic-based CR program on the muscular strength of a diverse phase II CR population. METHODS Sixty-one phase II CR patients (age = 60.5 +/- 10.6 years) stratified by risk (high risk: n = 18, ejection fraction = 23.6 +/- 7.8%; intermediate risk: n = 19, ejection fraction = 40.0 +/- 4.6%; low risk: n = 24, ejection fraction = 58.0 +/- 7.7%) and gender (males = 46, females = 15) participated. One repetition maximum (1RM) testing was performed on the horizontal squat, shoulder press, leg extension, lat pulldown, and biceps curl. Patients performed two sets of each exercise 2 days per week at an intensity that started at 60% 1RM and progressed to 80% 1RM by week 4. Weeks 4 to 8 intensity was adjusted individually to maintain 8RM per set. Blood pressure and heart rate/rhythm responses to 1RM testing were monitored in high-risk patients. Muscle soreness and injury were monitored for all patients immediately after 1RM testing and on days 2 and 7. RESULTS All patient groups made significant gains (P < 0.05) in muscle strength (mean increase: lower body = 15.3%, upper body = 16.7%). No injury or significant muscle soreness occurred due to 1RM testing. No abnormal heart rate/rhythm or blood pressure responses occurred in high-risk patients. CONCLUSIONS Diverse phase II CR patients can improve their strength significantly with a combination of high-intensity strength and aerobic training.
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Affiliation(s)
- K J Adams
- Exercise Physiology Lab, Crawford Gym, University of Louisville, KY 40292, USA
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