Maintaining physical activity in cardiac rehabilitation

This chapter describes an intervention that has been used to encourage individuals to remain regularly physically active in exercise-based CR in phases III and IV.The principles of this intervention are also appropriate for allphases of CR.This intervention, called the exercise consultation (EC), is based on the Transtheoretical Model of behaviour change and Relapse Prevention Model (pp.197-205), and uses cognitive and behavioural strategies to increaseand maintain physical activity (Loughlan and Mutrie,1995,1997). The strategies used in this EC include: assessing stage of change, decisional balance, overcoming barriers to activity, social support, goal setting, self-monitoring and relapse prevention. It involves a client-centred, one-to-one counselling approach and encourages individuals to develop an activity plan, tailored to their needs, readiness to change and lifestyle. The EC aims to encourage accumulated physical activity accumulating at least 30 minutes ofmoderate intensity activity on five days per week (Pate, et al., 1995, stage one, as discussed in Chapter 4). In addition, this level of physical activity may be easier for cardiac patients to incorporate into their daily routine and to sustainin the long term. Thus, the exercise consultation encourages individuals to integrate moderate intensity activity into their daily lives. In addition, EC can help maintain involvement in structured exercise in phases III and IV (SIGN, 2002)

Physical Activity and Obesity Indicators: National Cross Sectional Study on Lebanese Adults

Association between higher levels of physical activity and lower rates of obesity has been shown. The aim is to assess the relation between the prevalence of physical activity and the Physical Activity Index (PAI) of 300 Lebanese healthy adults, with age, gender, occupation, body mass indices and waist circumferences (WC). The cutoff points of WC for both genders were determined using the values of Body Mass Index (BMI). A cross-sectional study using self-reported valid questionnaire was conducted randomly on 150 men and 150 women, between 18 and 74 years, from Beirut region. Association between variables was performed using chi2, T-Test and ANOVA. Linear regression determined the WC cutoffs based on BMI. 22% of the population was obese with WC mean level of 92.47±14.4cm (87.71±14.4 cm for women and 97.24±12.96 cm for men). The prevalence of physical activity was 34% in overall population (27% in women and 40% in men).There was no significant association between BMI values and PAI (p< 0.085 for men and p< 0.300 for women). However there was an inverse association between WC values and PAI in both genders (p<0.043 in men and p< 0.036 in women). Linear regression showed WC cut-off point in Lebanese women with BMI ≥25 kg/m2 and ≥30 kg/m2 of 86 cm and 100 cm respectively, whereas for men it was 92.12 cm and 105 cm respectively. The prevalence of physical activity in Beirut is low with differences among genders. The highest physical activity index is associated with the decreased values of waist circumference

Relationships between exercise and three components of mental well-being in corporate employees

Objectives: The main purpose of the present study was to examine the relationships between exercise participation and three components of mental well-being (physical self, work-related, and global) in a sample of corporate employees. As a subsidiary and exploratory question, we also examined whether these well-being components are more strongly related to structured exercise participation scores compared to total levels of physical activity. Design: Cross-sectional survey. Method: The participants were 312 employees from an information technology company (nZ204 males and nZ108 females). Structural equation modelling was used to examine links between exercise participation and the three well-being components within a hierarchical framework, featuring global well-being constructs at the apex and specific elements of well-being at lower levels. Results: Support was found for the a priori model in that there were direct paths from exercise to physical self and enthusiasm at work. Furthermore, there were indirect paths between exercise and global well-being components through measures of the physical self and enthusiasm at work. The results of an alternative model using physical activity as opposed to exercise were generally similar. Conclusion: The support found for the exercise and well-being model indicates that exercise is associated directly and indirectly with high well-being in various facets of employees’ lives. Thus, this study extends previous research that has examined associations between exercise and isolated indicators of employee well-being. Finally, the results pertaining to physical activity suggest that workplace exercise promotion programmes should incorporate and promote lifestyle physical activity

The association of physical function and physical activity with all-cause mortality and adverse clinical outcomes in non-dialysis chronic kidney disease : a systematic review

Objective: People with nondialysis-dependent chronic kidney disease (CKD) and renal transplant recipients (RTRs) have compromised physical function and reduced physical activity (PA) levels. Whilst established in healthy older adults and other chronic diseases, this association remains underexplored in CKD. We aimed to review the existing research investigating poor physical function and PA with clinical outcome in nondialysis CKD. Data sources: Electronic databases (PubMed, MEDLINE, EMBASE, Web of Science, Cochrane Central Register of Controlled Trials) were searched until December 2017 for cohort studies reporting objective or subjective measures of PA and physical function and the associations with adverse clinical outcomes and all-cause mortality in patients with nondialysis CKD stages 1–5 and RTRs. The protocol was registered on the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42016039060). Review methods: Study quality was assessed using the Newcastle-Ottawa Scale and the Agency for Healthcare and Research Quality (AHRQ) standards. Results: A total of 29 studies were included; 12 reporting on physical function and 17 on PA. Only eight studies were conducted with RTRs. The majority were classified as ‘good’ according to the AHRQ standards. Although not appropriate for meta-analysis due to variance in the outcome measures reported, a coherent pattern was seen with higher mortality rates or prevalence of adverse clinical events associated with lower PA and physical function levels, irrespective of the measurement tool used. Sources of bias included incomplete description of participant flow through the study and over reliance on self-report measures. Conclusions: In nondialysis CKD, survival rates correlate with greater PA and physical function levels. Further trials are required to investigate causality and the effectiveness of physical function and PA interventions in improving outcomes. Future work should identify standard assessment protocols for PA and physical function

Fit Into College: A Program to Improve Physical Activity and Dietary Intake Lifestyles Among College Students

The purpose of this study was to determine whether a 10-week program could improve physical activity, physical fitness, body weight, dietary intake, and perceptions of exercise and diet among college 30 healthy college freshmen. Outcomes were measured at baseline, and following the 10-week program. The weekly sessions incorporated constructs of the Transtheoretical Model of Health Behavior Change and were administered by fitness interns who were junior or senior college students enrolled in health-related majors. The participants presented with low physical activity, physical fitness, and poor dietary intake, and 50% were overweight/obese (BMI \u3e 25). Participants demonstrated gains in their physical fitness and their perceived benefits to engaging in exercise and decreased their perceived barriers to engaging in exercise and a healthy diet. College freshmen presented with low levels of physical activity, poor dietary intake, and excess body weight. A peer-administered program can improve these measures and favorably change perceptions of exercise and diet

A methodological framework for capturing relative eyetracking coordinate data to determine gaze patterns and fixations from two or more observers

While physical activity during cancer treatment is found beneficial for breast cancer patients, evidence indicates ambiguous findings concerning effects of scheduled exercise programs on treatment-related symptoms. This study investigated effects of a scheduled home-based exercise intervention in breast cancer patients during adjuvant chemotherapy, on cancer-related fatigue, physical fitness, and activity level. Sixty-seven women were randomized to an exercise intervention group (n=33, performed strength training 3x/week and 30 minutes brisk walking/day) and a control group (n=34, performed their regular physical activity level). Data collection was performed at baseline, at completion of chemotherapy (Post1), and 6-month postchemotherapy (Post2). Exercise levels were slightly higher in the scheduled exercise group than in the control group. In both groups, cancer-related fatigue increased at Post1 but returned to baseline at Post2. Physical fitness and activity levels decreased at Post1 but were significantly improved at Post2. Significant differences between intervention and control groups were not found. The findings suggest that generally recommended physical activity levels are enough to relief cancer-related fatigue and restore physical capacity in breast cancer patients during adjuvant chemotherapy, although one cannot rule out that results reflect diminishing treatment side effects over time

The association of physical function and physical activity with all-cause mortality and adverse clinical outcomes in non-dialysis chronic kidney disease : a systematic review

Objective: People with nondialysis-dependent chronic kidney disease (CKD) and renal transplant recipients (RTRs) have compromised physical function and reduced physical activity (PA) levels. Whilst established in healthy older adults and other chronic diseases, this association remains underexplored in CKD. We aimed to review the existing research investigating poor physical function and PA with clinical outcome in nondialysis CKD. Data sources: Electronic databases (PubMed, MEDLINE, EMBASE, Web of Science, Cochrane Central Register of Controlled Trials) were searched until December 2017 for cohort studies reporting objective or subjective measures of PA and physical function and the associations with adverse clinical outcomes and all-cause mortality in patients with nondialysis CKD stages 1–5 and RTRs. The protocol was registered on the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42016039060). Review methods: Study quality was assessed using the Newcastle-Ottawa Scale and the Agency for Healthcare and Research Quality (AHRQ) standards. Results: A total of 29 studies were included; 12 reporting on physical function and 17 on PA. Only eight studies were conducted with RTRs. The majority were classified as ‘good’ according to the AHRQ standards. Although not appropriate for meta-analysis due to variance in the outcome measures reported, a coherent pattern was seen with higher mortality rates or prevalence of adverse clinical events associated with lower PA and physical function levels, irrespective of the measurement tool used. Sources of bias included incomplete description of participant flow through the study and over reliance on self-report measures. Conclusions: In nondialysis CKD, survival rates correlate with greater PA and physical function levels. Further trials are required to investigate causality and the effectiveness of physical function and PA interventions in improving outcomes. Future work should identify standard assessment protocols for PA and physical function

Examination of the Monoamine Oxidase a Gene Promoter on Motivation to Exercise and Levels of Voluntary Physical Activity

Purpose: Monoamine oxidase A (MAO-A) is an enzyme that causes inactivation of monoamine neurotransmitters, such as dopamine. Polymorphisms in the promoter region of the MAO-A gene can change transcriptional activity and the amount of MAO-A produced, leading to alterations in available dopamine levels. MAO-A polymorphisms have been associated with physical activity level. This study examined whether motivation to exercise, and levels of voluntary physical activity are associated with MAO-A gene polymorphisms. Methods: Seventy-one participants (18-24 years, 13 males & 58 females) completed the Behavioral Regulation in Exercise Questionaire-2 (BREQ-2) to assess their motivation to exercise and the International Physical Activity Questionnaire (IPAQ) to assess their level of physical activity. DNA was isolated from a cheek cell sample. MAO-A 3/3 and 4/4 genotype individuals were used for analysis. Results: External motivation to exercise was significantly higher (p \u3c 0.01) in the high transcription 4/4 genotype (ave 1.17 ± 0.7) compared to the low transcription 3/3 genotype (ave 0.42 ± 0.5). Internal motivation to exercise, body mass index, and weekly MET minutes were comparable between genotypes. Conclusion: The results suggest a polymorphism in this monoamine pathway may play a role in increasing sensitivity to external factors that motivate individuals to exercise

Can a Home-based Cardiac Physical Activity Program Improve the Physical Function Quality of Life in Children with Fontan Circulation?

Objective Patients after Fontan operation for complex congenital heart disease (CHD) have decreased exercise capacity and report reduced health-related quality of life (HRQOL). Studies suggest hospital-based cardiac physical activity programs can improve HRQOL and exercise capacity in patients with CHD; however, these programs have variable adherence rates. The impact of a home-based cardiac physical activity program in Fontan survivors is unclear. This pilot study evaluated the safety, feasibility, and benefits of an innovative home-based physical activity program on HRQOL in Fontan patients. Methods A total of 14 children, 8–12 years, with Fontan circulation enrolled in a 12-week moderate/high intensity home-based cardiac physical activity program, which included a home exercise routine and 3 formalized in-person exercise sessions at 0, 6, and 12 weeks. Subjects and parents completed validated questionnaires to assess HRQOL. The Shuttle Test Run was used to measure exercise capacity. A Fitbit Flex Activity Monitor was used to assess adherence to the home activity program. Results Of the 14 patients, 57% were male and 36% had a dominant left ventricle. Overall, 93% completed the program. There were no adverse events. Parents reported significant improvement in their child\u27s overall HRQOL (P \u3c .01), physical function (P \u3c .01), school function (P = .01), and psychosocial function (P  \u3c .01). Patients reported no improvement in HRQOL. Exercise capacity, measured by total shuttles and exercise time in the Shuttle Test Run and calculated VO2max, improved progressively from baseline to the 6 and 12 week follow up sessions. Monthly Fitbit data suggested adherence to the program. Conclusion This 12-week home-based cardiac physical activity program is safe and feasible in preteen Fontan patients. Parent proxy-reported HRQOL and objective measures of exercise capacity significantly improved. A 6-month follow up session is scheduled to assess sustainability. A larger study is needed to determine the applicability and reproducibility of these findings in other age groups and forms of complex CHD

Special Article: Physical Activity, Physical Fitness, and Cardiovascular Risk Factors in Childhood

In adults, physical activity and exercise training are associated with reduced cardiovascular morbidity and mortality, a reduced likelihood of developing adverse cardiovascular risk factors, and improved insulin sensitivity. In childhood, participation in appropriate physical activity may prevent the development of cardiovascular risk factors in the future and complement treatment of existing cardiovascular risk factors, including hypertension, dyslipidemia, and overweight. Exercise in children can also significantly improve insulin sensitivity independent of weight loss. These e fects are mediated in overweight children by increases in lean body mass relative to fat mass and associated improvements in inflammatory mediators, endothelial function, and the associated adverse hormonal milieu