The Effects of Pre and Post Exercise Low-Level Laser Therapy on Biochemical Markers of Skeletal Muscle Fatigue in Equines

Our objective was to determine whether administering low-level laser therapy before or after exercise had the greatest effect on biochemical markers of skeletal muscle fatigue in equines such as cortisol and blood lactate. Twelve quarter horses were divided into three groups: Group A received no laser therapy, Group B received laser therapy before exercise, and Group C received laser therapy after exercise. A Class II ERCHONIA ® PL500 handheld low-level laser was utilized for treatment with a wavelength of 635nm. Exercise was utilized using a horse walker system for 30 minutes five days a week for three weeks. Blood was collected via jugular venipuncture at time zero and then once a week for the remainder of the study. According to the results of this study, there is no evidence to suggest that laser therapy had a significant effect on equine cortisol or lactate, regardless if it was performed before or after exercise. However, there was an interaction between group and time for both lactate and cortisol. The results also showed that lactate increased as time increased as a result of lactic acid build up due to exercise, and cortisol decreased over time, which could be due to several possible variables such as weather. Several factors could have altered the results of this study, such as age, gender, weather, and diet of the equine subjects

Chronic fatigue syndrome; an approach combining self-management with graded exercise to avoid exacerbations.

Controversy regarding the aetiology and treatment of patients with chronic fatigue syndrome (CFS) continues to affect the medical professions. The Cochrane collaboration advises practitioners to implement graded exercise therapy for CFS sufferers using cognitive behavioural principles. In contrast there is evidence that exercise can induce symptom exacerbations in CFS where too vigorous exercise/activity promotes immune dysfunction, which in turn increases symptoms in patients with CFS. When designing and implementing an exercise programme it is important to be aware of both these seemingly opposing view points in order to deliver a programme without any detrimental effects on CFS pathophysiology. Using evidence from both the biological and clinical sciences, the present manuscript explains that graded exercise therapy for people with CFS can be safely undertaken without detrimental effects to the immune system. Exercise programs should be designed to cater for individual physical capabilities and should also account for the fluctuating nature of symptoms commonly reported by people with CFS. In line with cognitive behaviourally and graded exercise-based strategies, self-management for people with CFS involves encouraging the patients to pace their activities and respect their physical and mental limitations with the ultimate aim of improving their everyday function

A Pilot Study: The Beneficial Effects of Combined Statin-exercise Therapy on Cognitive Function in Patients with Coronary Artery Disease and Mild Cognitive Decline.

Objective Hypercholesterolemia, a risk factor in cognitive impairment, can be treated with statins. However, cognitive decline associated with "statins" (HMG-CoA reductase inhibitors) is a clinical concern. This pilot study investigated the effects of combining statins and regular exercise on cognitive function in coronary artery disease (CAD) patients with prior mild cognitive decline. Methods We recruited 43 consecutive CAD patients with mild cognitive decline. These patients were treated with a statin and weekly in-hospital aerobic exercise for 5 months. We measured serum lipids, exercise capacity, and cognitive function using the mini mental state examination (MMSE). Results Low-density lipoprotein cholesterol levels were significantly decreased, and maximum exercise capacity (workload) was significantly increased in patients with CAD and mild cognitive decline after treatment compared with before. Combined statin-exercise therapy significantly increased the median (range) MMSE score from 24 (22-25) to 25 (23-27) across the cohort (p<0.01). Changes in body mass index (BMI) were significantly and negatively correlated with changes in the MMSE. After treatment, MMSE scores in the subgroup of patients that showed a decrease in BMI were significantly improved, but not in the BMI-increased subgroup. Furthermore, the patients already on a statin at the beginning of the trial displayed a more significant improvement in MMSE score than statin-naïve patients, implying that exercise might be the beneficial aspect of this intervention as regards cognition. In a multivariate logistic regression analysis adjusted for age >65 years, sex, and presence of diabetes mellitus, a decrease in BMI during statin-exercise therapy was significantly correlated with an increase in the MMSE score (odds ratio: 4.57, 95% confidence interval: 1.05-20.0; p<0.05). Conclusion Statin-exercise therapy may help improve cognitive dysfunction in patients with CAD and pre-existing mild cognitive decline

Prescribing Exercise for Chronic Pain Management

In light of the opioid crisis, practitioners are looking for alternative ways to effectively treat pain. Utilizing exercise modalities as a method of pain management is becoming increasingly popular and more research is being done in this area than ever before. This article analyzes different research regarding exercise therapy for pain management, as well as what type of exercise has been found to be most beneficial for patients in pain

Influence of a six month endurance exercise program on the immune function of prostate cancer patients undergoing Antiandrogen or Chemotherapy: design and rationale of the ProImmun study

Background: Exercise seems to minimize prostate cancer specific mortality risk and treatment related side effects like fatigue and incontinence. However the influence of physical activity on the immunological level remains uncertain. Even prostate cancer patients undergoing palliative treatment often have a relatively long life span compared to other cancer entities. To optimize exercise programs and their outcomes it is essential to investigate the underlying mechanisms. Further, it is important to discriminate between different exercise protocols and therapy regimes. Methods/Design: The ProImmun study is a prospective multicenter patient preference randomized controlled trial investigating the influence of a 24 week endurance exercise program in 80–100 prostate cancer patients by comparing patients undergoing Antiandrogen therapy combined with exercise (AE), Antiandrogen therapy without exercise (A), Chemotherapy with exercise(CE) or Chemotherapy without exercise (C). The primary outcome of the study is a change in prostate cancer relevant cytokines and hormones (IL-6, MIF, IGF-1, Testosterone). Secondary endpoints are immune cell ratios, oxidative stress and antioxidative capacity levels, VO2 peak, fatigue and quality of life. Patients of the intervention group exercise five times per week, while two sessions are supervised. During the supervised sessions patients (AE and CE) exercise for 33 minutes on a bicycle ergometer at 70-75% of their VO2 peak. To assess long term effects and sustainability of the intervention two follow-up assessments are arranged 12 and 18 month after the intervention. Discussion: The ProImmun study is the first trial which primarily investigates immunological effects of a six month endurance exercise program in prostate cancer patients during palliative care. Separating patients treated with Antiandrogen therapy from those who are additionally treated with Chemotherapy might allow a more specific view on the influence of endurance training interventions and the impact of different therapy protocols on the immune function. Trial registration: German Clinical Trials Register: DRKS0000473

Exercise and progressive supranuclear palsy : the need for explicit exercise reporting

Background Progressive Supranuclear Palsy (PSP) is the most frequent form of atypical Parkinsonism. Although there is preliminary evidence for the benefits of gait rehabilitation, balance training and oculomotor exercises in PSP, the quality of reporting of exercise therapies appears mixed. The current investigation aims to evaluate the comprehensiveness of reporting of exercise and physical activity interventions in the PSP literature. Methods Two independent reviewers used the Consensus on Exercise Reporting Template (CERT) to extract all exercise intervention data from 11 studies included in a systematic review. CERT items covered: ‘what’ (materials), ‘who’ (instructor qualifications), ‘how’ (delivery), ‘where’ (location), ‘when’, ‘how much’ (dosage), ‘tailoring’ (what, how), and ‘how well’ (fidelity) exercise delivery complied with the protocol. Each exercise item was scored ‘1’ (adequately reported) or ‘0’ (not adequately reported or unclear). The CERT score was calculated, as well as the percentage of studies that reported each CERT item. Results The CERT scores ranged from 3 to 12 out of 19. No PSP studies adequately described exercise elements that would allow exact replication of the interventions. Well-described items included exercise equipment, exercise settings, exercise therapy scheduling, frequency and duration. Poorly described items included decision rules for exercise progression, instructor qualifications, exercise adherence, motivation strategies, safety and adverse events associated with exercise therapies. Discussion The results revealed variability in the reporting of physical therapies for people living with PSP. Future exercise trials need to more comprehensively describe equipment, instructor qualifications, exercise and physical activity type, dosage, setting, individual tailoring of exercises, supervision, adherence, motivation strategies, progression decisions, safety and adverse events. Conclusion Although beneficial for people living with PSP, exercise and physical therapy interventions have been inadequately reported. It is recommended that evidence-based reporting templates be utilised to comprehensively document therapeutic exercise design, delivery and evaluation

Natural Killer cells responsiveness to physical esercise: a brief review

Natural killer cells (NK) are a group of peripheral blood lymphocytes which display cytotoxic ac- tivity against a wide range of tumour cells. They are a consistent part of the inflammatory re- sponse that is activated when either internal or external injuries occur as they are able to syn- thesize perforins. An important role is played by NK cells in the host defence against tumours without expressing any antigen-binding recap- tor in their membrane which, however, distin- guish T and B lymphocytes. NK activity appears early in the immune response, thus providing immediate protection during the time required for the activation and proliferation of cytotoxic T lymphocytes and for their differentiation into functional cells. Even though much research regarding the effects of aerobic training exercise on NK cell numbers and function, there appears to be much controversy regarding its effect. NK cells are rapidly mobilized into circulation in response to acute exercise, most likely by in- creased shear stress and catecholamine-in- duced down-regulation of adhesion molecule expression. However, tissue injury and inflam- mation which often accompanies strenuous ex- ercise have been associated to post-exercise NK cell suppression. Scientific evidence indicates exercise-induced changes in NK cell redistribu- tion and function should be strongly influenced by stress hormones including catecholamines, cortisol and prolactin as well as by soluble me- diators such as cytokines and prostaglandins. The role of exercise therapy in cancer patients and survivors rehabilitation is becoming increasingly important as it is thought to modulate immunity and inflammation. However, more knowledge about the effects of exercise on im-mune function in these patients is needed

Therapy-based exercise from the perspective of adult patients: a qualitative systematic review conducted using an ethnographic approach

© The Author(s) 2019.Objectives: Many patients do not meet recommended levels of therapy-based exercise. This review aims to explore how adult patients view being prescribed therapy-based exercise, the information/education they are given and receive and if/how they independently practise and adhere. Design: A qualitative systematic review conducted using an ethnographic approach and in accordance with the PRISMA statement. Sources: PubMed, CINAHL, SCOPUS and EMBASE databases (01 January 2000–31 December 2018). Methods: Qualitative studies with a focus on engagement/adherence with therapy-based exercise were included. Data extraction and quality appraisal were undertaken by two reviewers. Results were discussed and data synthesized. Results: A total of 20,294 titles were screened, with data extracted from 39 full texts and data from 18 papers used to construct three themes. ‘The Guidance received’ suggests that the type of delivery desired to support and sustain engagement was context-dependent and individually situated. ‘The Therapist as teacher’ advocates that patients see independent therapy-based exercise as a shared activity and value caring, kind and professional qualities in their therapist. ‘The Person as learner’ proposes that when having to engage with and practise therapy-based exercise because of ill-health, patients often see themselves as new learners who experience fear and uncertainty about what to do. Patients may have unacknowledged ambivalences about learning that impact on engagement and persistence. Conclusion: The quality of the interaction between therapists and patients appears integral to patients engaging with, and sustaining practice of, rehabilitation programmes. Programmes need to be individualized, and health care professionals need to take patients’ previous experiences and ambivalences in motivation and empowerment into account.Peer reviewe

Therapeutic role of dietary nitrates on cardiorespiratory function in cancer survivors

Master of ScienceDepartment of KinesiologyCarl J. AdeIntroduction: The acute and chronic adverse physiological consequences of anticancer therapy include direct injury to the entire cardiovascular-skeletal muscle axis. As such, these patients are at an increased risk of both cancer therapy-related and age-related pathological outcomes; primary cardiovascular disease, exercise intolerance, and cancer-related fatigue. To date, however, therapeutic strategies that mitigate these negative effects within the human body have yet to be established. Previous work has demonstrated that dietary nitrate (NO₃⁻) supplementation can improve cardiac, vascular and cardiorespiratory exercise parameters, highlighting its potential therapeutic use in clinical populations. Therefore, we hypothesized that NO₃⁻ supplementation would improve both cardiac performance and exercise capacity. Methods: To date, 6 cancer survivors (57 ± 11 years) with a history of anticancer therapy completed a randomized, double-blind, crossover study with a single, acute-dose administration of NO₃⁻ or placebo (PL) [140 ml]. Transthoracic echocardiographic measures at rest were made to obtain left ventricular stroke volume. Patients performed a supine-cycling steady-state exercise test (30W) with measurements of arterial blood pressure, stroke volume, cardiac output, and a maximal-effort cardiopulmonary exercise test. Results: As intended, there was a statistically significant increase in plasma nitrite during the NO₃⁻ condition compared to PL (NO₃⁻ 1300 ± 963 µM vs. PL 111 ± 49 µM, respectively; P = 0.02). Additionally, we observed a decrease in relative oxygen uptake (VO₂) during steady-state exercise with NO₃⁻ compared to PL (NO₃⁻ 8.46 ± 2.2 vs. PL 8.98 ± 2.4 ml/kg/min; p = 0.01; Absolute VO₂: BRJ 0.64 ± 0.10 vs. PL: 0.68 ± 0.11 L/min; p = 0.01) indicating an improved exercise efficiency. Resting and steady-state arterial blood pressure, stroke volume, and cardiac output were not different between conditions. Furthermore, we did not observe any differences between conditions for peak relative VO₂ (NO₃⁻ 22.42 ± 3.86 vs. PL 23.14 ± 4.01 ml/kg/min; p = 0.23), total work done (NO₃⁻ 70.64 ± 29.5 vs PL 70.67 ± 30.71 kJ; p = 0.49), or for gross exercise efficiency (NO₃⁻ 5.23 ± 1.48 vs. PL 4.97 ± 1.41 kJ/L O₂; p = 0.14) during the maximal-effort cardiopulmonary exercise test. Conclusions: A single, acute-dose of inorganic nitrate supplementation in cancer survivors with a history of anticancer therapy enhanced steady-state exercise efficiency, but had no effect on exercise cardiac performance or peak exercise capacity

Supervised exercise training as an adjunct therapy for venous leg ulcers: a randomised controlled feasibility trial

Background Venous leg ulcers (VLUs) are typically painful and heal slowly. Compression therapy offers high healing rates; however, improvements are not usually sustained. Exercise is a low‐cost, low‐risk and effective strategy for improving physical and mental health. Little is known about the feasibility and efficacy of supervised exercise training used in combination with compression therapy patients with VLUs. Objectives To assess the feasibility of a 12‐week supervised exercise programme as an adjunct therapy to compression in patients with VLUs. Methods This was a two‐centre, two‐arm, parallel‐group, randomized feasibility trial. Thirty‐nine patients with venous ulcers were recruited and randomized 1 : 1 either to exercise (three sessions weekly) plus compression therapy or compression only. Progress/success criteria included exercise attendance rate, loss to follow‐up and patient preference. Baseline assessments were repeated at 12 weeks, 6 months and 1 year, with healing rate and time, ulcer recurrence and infection incidents documented. Intervention and healthcare utilization costs were calculated. Qualitative data were collected to assess participants’ experiences. Results Seventy‐two per cent of the exercise group participants attended all scheduled exercise sessions. No serious adverse events and only two exercise‐related adverse events (both increased ulcer discharge) were reported. Loss to follow‐up was 5%. At 12 months, median ulcer healing time was lower in the exercise group (13 vs. 34·7 weeks). Mean National Health Service costs were £813·27 for the exercise and £2298·57 for the control group. Conclusions The feasibility and acceptability of both the supervised exercise programme in conjunction with compression therapy and the study procedures is supported