Adaptaciones cardiacas hemodinámicas, estructurales y funcionales a un programa de ejercicio físico supervisado durante el embarazo: ensayo clínico aleatorizado = Hemodynamic, structural and functional cardiac adaptations in a supervised physical exercise program during pregnancy: a randomized controlled trial

Introducción: Diversos cambios ocurren en el sistema cardiovascular materno durante el embarazo, lo que genera un gran estrés sobre este sistema especialmente durante el tercer trimestre, pudiendo acentuarse en presencia de determinados factores de riesgo. Los objetivos de este estudio fueron, valorar las adaptaciones cardiovasculares producidas por un programa específico de ejercicio físico; su seguridad sobre el sistema cardiovascular materno y los resultados del embarazo; y su eficacia en el control de los factores de riesgo cardiovascular. Material y métodos: El diseño del estudio fue un ensayo clínico aleatorizado. 151 gestantes sanas fueron evaluadas mediante un ecocardiograma y un electrocardiograma en la semana 20 y 34 de gestación. Un total de 89 gestantes participaron en un programa de ejercicio físico (GE) desde el primer hasta el tercer trimestre de embarazo, constituido principalmente por 25-30 minutos de trabajo aeróbico (55-60% de la frecuencia cardiaca de reserva), trabajo de fortalecimiento general y específico, y un trabajo de tonificación del suelo pélvico; desarrollado 3 días a la semana con una duración de 55-60 minutos cada sesión. Las gestantes aleatoriamente asignadas al grupo de control (GC; n=62) permanecieron sedentarias durante el embarazo. El estudio fue aprobado por el Comité Ético de investigación clínica del Hospital Universitario de Fuenlabrada. Resultados: Las características basales fueron similares entre ambos grupos. A diferencia del GC, las gestantes del GE evitaron el descenso significativo del gasto cardiaco indexado, entre el 2º y 3ºT de embarazo, y conservaron el patrón geométrico normal del ventrículo izquierdo; mientras que en el GC cambió hacia un patrón de remodelado concéntrico. En la semana 20, las gestantes del GE presentaron valores significativamente menores de frecuencia cardiaca (GC: 79,56±10,76 vs. GE: 76,05±9,34; p=0,04), tensión arterial sistólica (GC: 110,19±10,23 vs. GE: 106,04±12,06; p=0,03); tensión arterial diastólica (GC: 64,56±7,88 vs. GE: 61,81±7,15; p=0,03); tiempo de relajación isovolumétrica (GC: 72,94±14,71 vs. GE: 67,05±16,48; p=0,04); y un mayor tiempo de deceleración de la onda E (GC: 142,09±39,11 vs. GE: 162,10±48,59; p=0,01). En la semana 34, el GE presentó valores significativamente superiores de volumen sistólico (GC: 51,13±11,85 vs. GE: 56,21±12,79 p=0,04), de llenado temprano del ventrículo izquierdo (E) (GC: 78,38±14,07 vs. GE: 85,30±16,62; p=0,02) y de tiempo de deceleración de la onda E (GC: 130,35±37,11 vs. GE: 146,61±43,40; p=0,04). Conclusión: La práctica regular de ejercicio físico durante el embarazo puede producir adaptaciones positivas sobre el sistema cardiovascular materno durante el tercer trimestre de embarazo, además de ayudar en el control de sus factores de riesgo, sin alterar la salud materno-fetal. ABSTRACT Background: Several changes occur in the maternal cardiovascular system during pregnancy. These changes produce a considerable stress in this system, especially during the third trimester, which can be increased in presence of some risk factors. The aims of this study were, to assess the maternal cardiac adaptations in a specific exercise program; its safety on the maternal cardiovascular system and pregnancy outcomes; and its effectiveness in the control of cardiovascular risk factors. Material and methods: A randomized controlled trial was designed. 151 healthy pregnant women were assessed by an echocardiography and electrocardiography at 20 and 34 weeks of gestation. A total of 89 pregnant women participated in a physical exercise program (EG) from the first to the third trimester of pregnancy. It consisted of 25-30 minutes of aerobic conditioning (55-60% of their heart rate reserve), general and specific strength exercises, and a pelvic floor muscles training; 3 times per weeks during 55-60 minutes per session. Pregnant women randomized allocated to the control group (CG) remained sedentary during pregnancy. The study was approved by the Research Ethics Committee of Hospital Universitario de Fuenlabrada. Results: Baseline characteristics were similar between groups. Difference from the CG, pregnant women from the EG prevented the significant decrease of the cardiac output index, between the 2nd and 3rd trimester of pregnancy, and preserved the normal left ventricular pattern; whereas in the CG shifted to concentric remodeling pattern. At 20 weeks, women in the EG had significant lower heart rate (CG: 79,56±10,76 vs. EG: 76,05±9,34; p=0,04), systolic blood pressure (CG: 110,19±10,23 vs. EG: 106,04±12,06; p=0,03); diastolic blood pressure (CG: 64,56±7,88 vs. EG: 61,81±7,15; p=0,03); isovolumetric relaxation time (GC: 72,94±14,71 vs. GE: 67,05±16,48; p=0,04); and a higher deceleration time of E Wave (GC: 142,09±39,11 vs. GE: 162,10±48,59; p=0,01). At 34 weeks, the EG had a significant higher stroke volume (CG: 51,13±11,85 vs. EG: 56,21±12,79 p=0,04), early filling of left ventricular (E) (CG: 78,38±14,07 vs. EG: 85,30±16,62; p=0,02) and deceleration time of E wave (CG: 130,35±37,11 vs. EG:146,61±43,40; p=0,04). Conclusion: Physical regular exercise program during pregnancy may produce positive maternal cardiovascular adaptations during the third trimester of pregnancy. In addition, it helps to control the cardiovascular risk factors without altering maternal and fetus health.

(1)H-NMR analysis of the human urinary metabolome in response to an 18-month multi-component exercise program and calcium-vitamin-D3 supplementation in older men

The musculoskeletal benefits of calcium and vitamin-D3 supplementation and exercise have been extensively studied, but the effect on metabolism remains contentious. Urine samples were analyzed by (1)H-NMR spectroscopy from participants recruited for an 18-month, randomized controlled trial of a multi-component exercise program and calcium and vitamin-D3 fortified milk consumption. It was shown previously that no increase in musculoskeletal composition was observed for participants assigned to the calcium and vitamin-D3 intervention, but exercise resulted in increased bone mineral density, total lean body mass, and muscle strength. Retrospective metabolomics analysis of urine samples from patients involved in this study revealed no distinct changes in the urinary metabolome in response to the calcium and vitamin-D3 intervention, but significant changes followed the exercise intervention, notably a reduction in creatinine and an increase in choline, guanidinoacetate, and hypoxanthine (p < 0.001, fold change > 1.5). These metabolites are intrinsically involved in anaerobic ATP synthesis, intracellular buffering, and methyl-balance regulation. The exercise intervention had a marked effect on the urine metabolome and markers of muscle turnover but none of these metabolites were obvious markers of bone turnover. Measurement of specific urinary exercise biomarkers may provide a basis for monitoring performance and metabolic response to exercise regimes.

Predictors of adherence to a 12-week exercise program among men treated for prostate cancer: ENGAGE study

Understanding the factors that influence adherence to exercise programs is necessary to develop effective interventions for people with cancer. We examined the predictors of adherence to a supervised exercise program for participants in the ENGAGE study - a cluster randomized controlled trial that assessed the efficacy of a clinician-referred 12-week exercise program among men treated for prostate cancer. Demographic, clinical, behavioral, and psychosocial data from 52 participants in the intervention group were collected at baseline through self-report and medical records. Adherence to the supervised exercise program was assessed through objective attendance records. Adherence to the supervised exercise program was 80.3%. In the univariate analyses, cancer-specific quality of life subscales (role functioning r = 0.37, P = 0.01; sexual activity r = 0.26, P = 0.06; fatigue r = -0.26, P = 0.06, and hormonal symptoms r = -0.31, P = 0.03) and education (d = -0.60, P = 0.011) were associated with adherence. In the subsequent multivariate analysis, role functioning (B = 0.309, P = 0.019) and hormonal symptoms (B = -0.483, P = 0.054) independently predicted adherence. Men who experienced more severe hormonal symptoms had lower levels of adherence to the exercise program. Those who experienced more positive perceptions of their ability to perform daily tasks and leisure activities had higher levels of adherence to the exercise program. Hormonal symptoms and role functioning need to be considered when conducting exercise programs for men who have been treated for prostate cancer.

A path analysis of an after-school health and exercise program for elementary school children in El Paso, Texas

As schools are pressured to perform on academics and standardized examinations, schools are reluctant to dedicate increased time to physical activity. After-school exercise and health programs may provide an opportunity to engage in more physical activity without taking time away from coursework during the day. The current study is a secondary data analysis of data from a randomized trial of a 10-week after-school program (six schools, n = 903) that implemented an exercise component based on the CATCH physical activity component and health modules based on the culturally-tailored Bienestar health education program. Outcome variables included BMI and aerobic capacity, health knowledge and healthy food intentions as assessed through path analysis techniques. Both the baseline model (χ2 (df = 8) = 16.90, p = .031; RMSEA = .035 (90% CI of .010–.058), NNFI = 0.983 and the CFI = 0.995) and the model incorporating intervention participation proved to be a good fit to the data (χ2 (df = 10) = 11.59, p = .314. RMSEA = .013 (90% CI of .010–.039); NNFI = 0.996 and CFI = 0.999). Experimental group participation was not predictive of changes in health knowledge, intentions to eat healthy foods or changes in Body Mass Index, but it was associated with increased aerobic capacity, β = .067, p < .05. School characteristics including SES and Language proficiency proved to be significantly associated with changes in knowledge and physical indicators. Further effects of school level variables on intervention outcomes are recommended so that tailored interventions can be developed aimed at the specific characteristics of each participating school. ^

A pilot study assessing the feasibility of a home-based progressive resistance exercise program and trend toward healing rates for patients with venous leg ulcers

Venous leg ulceration is a serious condition affecting 1 – 3% of the population. Decline in the function of the calf muscle pump is correlated with venous ulceration. Many previous studies have reported an improvement in the function of the calf muscle pump, endurance of the calf muscle and increased range of ankle motion after structured exercise programs. However, there is a paucity of published research that assesses if these improvements result in an improvement in the healing rates of venous ulcers. The primary purpose of this pilot study was to establish the feasibility of a homebased progressive resistance exercise program and examine if there was any clinical significance or trend toward healing. The secondary aims were to examine the benefit of a home-based progressive resistance exercise program on calf muscle pump function and physical parameters. The methodology used was a randomised controlled trial where eleven participants were randomised into an intervention (n = 6) or control group (n = 5). Participants who were randomised to receive a 12-week home-based progressive resistance exercise program were instructed through weekly face-to-face consultations during their wound clinic appointment by the author. Control group participants received standard wound care and compression therapy. Changes in ulcer parameters were measured fortnightly at the clinic (number healed at 12 weeks, percentage change in area and pressure ulcer score healing score). An air plethysmography test was performed at baseline and following the 12 weeks of training to determine changes in calf muscle pump function. Functional measures included maximum number of heel raises (endurance), maximal isometric plantar flexion (strength) and range of ankle motion (ROAM); these tests were conducted at baseline, week 6 and week 12. The sample for the study was drawn from the Princess Alexandra Hospital in Brisbane, Australia. Participants with venous leg ulceration who met the inclusion criteria were recruited. The participants were screened via duplex scanning and ankle brachial pressure index (ABPI) to ensure they did not have any arterial complications. Participants were excluded if there was evidence of cellulitis. Demographic data were obtained from each participant and details regarding medical history, quality of life and geriatric depression scores were collected at baseline. Both the intervention and control group were required to complete a weekly exercise diary to monitor activity levels between groups. To test for the effect of the intervention over time, a repeated measures analysis of variance was conducted on the major outcome variables. Group (intervention versus control) was the between subject factor and time (baseline, week 6, week 12) was the within subject or repeated measures factor. Due to the small sample size, further tests were conducted to check the assumptions of the statistical test to be used. The results showed that Mauchly.s Test, the Sphericity assumptions of repeated measures for ANOVA were met. Further tests of homogeneity of variance assumptions also confirmed that this assumption was met. Data analysis was conducted using the software package SPSS for Windows Release 17.0. The pilot study proved feasible with all of the intervention (n=6) participants continuing with the resistance program for the 12 week duration and no deleterious effects noted. Clinical significance was observed in the intervention group with a 32% greater change in ulcer size (p= 0.26) than the control group, and a 10% (p = 0.74) greater difference between the numbers healed compared to the control group. Statistical significance was observed for the ejection fraction (p = 0.05), residual volume fraction (p = 0.04) and ROAM (p = 0.01), which all improved significantly in the intervention group over time. These results are encouraging, nevertheless, further investigations seem warranted to examine the effect exercise has on the healing rates of venous leg ulcers, with a multistudy site, larger sample size and longer follow up period.

Development and validation of a sport-specific exercise protocol for elite youth soccer players

Thatcher, Rhys, and Alan Batterham, 'Development and validation of a sport-specific exercise protocol for elite youth soccer players', Journal of Sports Medicine and Physical Fitness, (2004) 44(1) pp.15-22 RAE2008

Effects of microcurrents and physical exercise on the abdominal fat in patients with coronary artery disease

Introduction Coronary artery disease is associated with decreased levels of physical activity, contributing to increases in abdominal fat and consequently increasing metabolic risk. The innovative use of microcurrents may be an effective method to increase the lipolytic rate of abdominal adipocytes. This study aimed to investigate the effects of utilizing microcurrents in a home-based exercise program in subjects with coronary artery disease to assess changes in total, subcutaneous and visceral abdominal adipose tissue. Methods This controlled trial included 44 subjects with myocardial infarction, randomly divided into Intervention Group 1 (IG1; n = 16), Intervention Group 2 (IG2; n = 12) and Control Group (CG; n = 16). IG1 performed a specific exercise program at home during 8 weeks, and IG2 additionally used microcurrents on the abdominal region before the exercise program. All groups were given health education sessions. Computed tomography was used to evaluate abdominal, subcutaneous and visceral fat, accelerometers to measure habitual physical activity and the semi-quantitative food frequency questionnaire for dietary intake. Results After 8 weeks, IG2 showed a significantly decrease in subcutaneous fat (p ≤ 0.05) when compared to CG. Concerning visceral fat, both intervention groups showed a significant decrease in comparison to the CG (p ≤ 0.05). No significant changes were found between groups on dietary intake and habitual physical activity, except for sedentary activity that decreased significantly for IG2 in comparison with CG (p ≤ 0.05). Conclusion This specific home-based exercise program using microcurrent therapy for individuals with coronary artery disease showed improvements in visceral and subcutaneous abdominal fat.

The Relationship between Participation in an Exercise Program and Body Image in Post-Menopausal Women Self-Reporting Osteoporosis

The current study investigated body image differences in post-menopausal women who self-reported having (SRO) or not having (SRN) osteoporosis and the impact of a 16-week exercise program on body image in these groups. Participants completed a measure of body image, and were randomly assigned to a 16-week exercise program or control group, stratified by self-reported osteoporosis status. After 16 weeks, they completed the same body image measure. There were no differences in body image between the two osteoporosis groups. The exercise intervention had a positive impact on body image for both the SRO and SRN groups. The exercise groups showed increases in fitness and health orientation and body areas satisfaction from baseline to 16-weeks, while the non-exercise group showed decreases in appearance and health evaluation, health orientation and body areas satisfaction. The results suggest an exercise program for post-menopausal women can lead to improvements in body image, regardless of osteoporosis status.

Physical Exercise Program for Elderly Subjects in the “Club Nueva Vida”, in Tunja City

A descriptive, case series intervention study was performed to identify changes in physical qualities, aerobic power, flexibility, strength and body composition amongst 20 elderly subjects belonging to the “Club Nueva Vida” in Tunja City, during the second period of 2005. A PRE and POST assessment of their physical qualities was applied after a 16 week physical exercise program.Results showed an increase in the average of the static muscle streneth from 0.27 to 0.30 Newtons. Standard deviation diminished in 0.1. The dynamic strength measure by the push up test improved in 10% a 35% improved in 10% a 35% improved their. Cardiovascular capability until to high levels of 80% there were not significant changes in the body weight between measures taken before and after the program application. The results obtained with the sit and reach test did not show statistically significant differences. Hower in other flexibility tests the results changed from bad ranges to middle and good ones. The enrolled population was stable during the development of the exercise program. This study concludes that elderly adults acquire changes in their physical quality features after exercise intervention. Physical exercise programs in elderly adults must involve strength activities for upper limbs, trunk and aerobic power activities. The “Beliefs Health Model” is a adherence to reach compliance and maintenance in physical exercise.

Effects of a multi-component exercise program and calcium–vitamin-D3-fortified milk on bone mineral density in older men : a randomised controlled trial

Summary We examined the independent and combined effects of a multi-component exercise program and calcium–vitamin-D3-fortified milk on bone mineral density (BMD) in older men. Exercise resulted in a 1.8% net gain in femoral neck BMD, but additional calcium–vitamin D3 did not enhance the response in this group of older well-nourished men.

Introduction This 12-month randomised controlled trial assessed whether calcium–vitamin-D3-fortified milk could enhance the effects of a multi-component exercise program on BMD in older men.

Methods Men (n  = 180) aged 50–79 years were randomised into: (1) exercise + fortified milk; (2) exercise; (3) fortified milk; or (4) controls. Exercise consisted of high intensity progressive resistance training with weight-bearing impact exercise. Men assigned to fortified milk consumed 400 mL/day of low fat milk providing an additional 1,000 mg/day calcium and 800 IU/day vitamin D3. Femoral neck (FN), total hip, lumbar spine and trochanter BMD and body composition (DXA), muscle strength 25-hydroxyvitamin D and parathyroid hormone (PTH) were assessed.

Results There were no exercise-by-fortified milk interactions at any skeletal site. Exercise resulted in a 1.8% net gain in FN BMD relative to no-exercise (p < 0.001); lean mass (0.6 kg, p < 0.05) and muscle strength (20–52%, p < 0.001) also increased in response to exercise. For lumbar spine BMD, there was a net 1.4–1.5% increase in all treatment groups relative to controls (all p < 0.01). There were no main effects of fortified milk at any skeletal site.

Conclusion A multi-component community-based exercise program was effective for increasing FN BMD in older men, but additional calcium–vitamin D3 did not enhance the osteogenic response.

The effects of a simplified tai-chi exercise program (STEP) on the physical health of older adults living in long-term care facilities : a single group design with multiple time points

Background
Studies support the positive effects that Tai Chi has on the physical health of older adults. However, many older adults residing in long-term care facilities feel too weak to practice traditional Tai Chi, and a more simplified style is preferred.
Objective
To test the effects of a newly-developed, Simplified Tai-Chi Exercise Program (STEP) on the physical health of older adults who resided in long-term care facilities.
Design
A single group design with multiple time points: three pre-tests, one month apart; four post-tests at one month, two months, three months, and six months after intervention started.
Settings
Two 300–400 bed veteran homes in Taiwan.
Participants
The 51 male older adults were recruited through convenience sampling, and 41 of them completed six-month study. Inclusion criteria included: (1) aged 65 and over; (2) no previous training in Tai Chi; (3) cognitively alert and had a score of at least eight on the Short Portable Mental Status Questionnaire; (4) able to walk without assistance; and (5) had a Barthel Index score of 61 or higher. Participants who had dementia, were wheel-chair bound, or had severe or acute cardiovascular, musculoskeletal, or pulmonary illnesses were excluded.
Methods
The STEP was implemented three times a week, 50 min per session for six months. The outcome measures included cardio-respiratory function, blood pressure, balance, hand-grip strength, lower body flexibility, and physical health actualization.
Results
A drop in systolic blood pressure (p=.017) and diastolic blood pressure (p<.001) was detected six months after intervention started. Increase in hand-grip strength from pre to post intervention was found (left hand: p<.001; right hand: p=.035). Participants also had better lower body flexibility after practicing STEP (p=.038).
Conclusions
Findings suggest that the STEP be incorporated as a floor activity in long-term care facilities to promote physical health of older adults.

Can a disease-specific education program augment self-management skills and improve Health-Related Quality of Life in people with hip or knee osteoarthritis?

Background: Patient education and self-management programs are offered in many countries to people with chronic conditions such as osteoarthritis (OA). The most well-known is the disease-specific Stanford Arthritis Self-Management Program (ASMP). While Australian and international clinical guidelines promote the concept of self-management for OA, there is currently little evidence to support the use of the ASMP. Several meta-analyses have reported that arthritis self-management programs had minimal or no effect on reducing pain and disability. However, previous studies have had methodological shortcomings including the use of outcome measures which do not accurately reflect program goals. Additionally, limited cost-effectiveness analyses have been undertaken and the cost-utility of the program has not been explored.

Methods/design: This study is a randomised controlled trial to determine the efficacy (in terms of Health-Related Quality of Life and self-management skills) and cost-utility of a 6-week group-based Stanford ASMP for people with hip or knee OA.

Six hundred participants referred to an orthopaedic surgeon or rheumatologist for hip or knee OA will be recruited from outpatient clinics at 2 public hospitals and community-based private practices within 2 private hospital settings in Victoria, Australia. Participants must be 18 years or over, fluent in English and able to attend ASMP sessions. Exclusion criteria include cognitive dysfunction, previous participation in self-management programs and placement on a waiting list for joint replacement surgery or scheduled joint replacement.

Eligible, consenting participants will be randomised to an intervention group (who receive the ASMP and an arthritis self-management book) or a control group (who receive the book only). Follow-up will be at 6 weeks, 3 months and 12 months using standardised self-report measures. The primary outcome is Health-Related Quality of Life at 12 months, measured using the Assessment of Quality of Life instrument. Secondary outcome measures include the Health Education Impact Questionnaire, Western Ontario and McMaster Universities Osteoarthritis Index (pain subscale and total scores), Kessler Psychological Distress Scale and the Hip and Knee Multi-Attribute Priority Tool. Cost-utility analyses will be undertaken using administrative records and self-report data. A subgroup of 100 participants will undergo qualitative interviews to explore the broader potential impacts of the ASMP.

Discussion: Using an innovative design combining both quantitative and qualitative components, this project will provide high quality data to facilitate evidence-based recommendations regarding the ASMP.

A haemodialysis exercise program using novel exercise equipment

This study explored whether an exercise programme for haemodialysis patients, including the use of a purpose built dialysis exercise machine, would improve quality of life (QoL), nutrition, physical function and biochemical indices. QoL, and biochemical indices were measured at 6 months and nutrition was measured at 12 months. Physical function was measured at 4, 8 and 12 months. Results showed improvement in physical function tests a decrease in serum phosphate. The QoL health and physical functioning domain improved also. Conclusions The development of a structured exercise programme can improve quality of life, physical functioning, PO4 levels and urea clearances of dialysis patients.

Sustaining a hemodialysis exercise program : a review

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