Exploration of the methodological quality and clinical usefulness of a cross-sectional sample of published guidance about exercise training and physical activity for the secondary prevention of coronary heart disease

Background Clinicians are encouraged to use guidelines to assist in providing evidence-based secondary prevention to patients with coronary heart disease. However, the expanding number of publications providing guidance about exercise training may confuse cardiac rehabilitation clinicians. We therefore sought to explore the number, scope, publication characteristics, methodological quality, and clinical usefulness of published exercise-based cardiac rehabilitation guidance. Methods We included publications recommending physical activity, exercise or cardiac rehabilitation for patients with coronary heart disease. These included systematically developed clinical practice guidelines, as well as other publications intended to support clinician decision making, such as position papers or consensus statements. Publications were obtained via electronic searches of preventive cardiology societies, guideline databases and PubMed, to November 2016. Publication characteristics were extracted, and two independent assessors evaluated quality using the 23-item Appraisal of Guidelines Research and Evaluation II (AGREE) tool. Results Fifty-four international publications from 1994 to 2016 were identified. Most were found on preventive cardiology association websites (n = 35; 65%) and were freely accessible (n = 50; 93%). Thirty (56%) publications contained only broad recommendations for physical activity and cardiac rehabilitation referral, while 24 (44%) contained the necessary detailed exercise training recommendations. Many were labelled as “guidelines”, however publications with other titles (e.g. scientific statements) were common (n = 24; 44%). This latter group of publications contained a significantly greater proportion of detailed exercise training recommendations than clinical guidelines (p = 0.017). Wide variation in quality also existed, with ‘applicability’ the worst scoring AGREE II domain for clinical guidelines (mean score 53%) and ‘rigour of development’ rated lowest for other guidance types (mean score 33%). Conclusions While a large number of guidance documents provide recommendations for exercise-based cardiac rehabilitation, most have limitations in either methodological quality or clinical usefulness. The lack of rigorously developed guidelines which also contain necessary detail about exercise training remains a substantial problem for clinicians

Synergistic Activities of Near-Earth Object Exploration

U.S. President Obama stated on April 15, 2010 that the next goal for human spaceflight will be to send human beings to near-Earth asteroids by 2025. Missions to NEOs would undoubtedly provide a great deal of technical and engineering data on spacecraft operations for future human space exploration while conducting in-depth scientific examinations of these primitive objects. Information obtained from a human investigation of a NEO, together with ground-based observations and prior spacecraft investigations of asteroids and comets, will also provide a real measure of ground truth to data obtained from terrestrial meteorite collections. Major advances in the areas of geochemistry, impact history, thermal history, isotope analyses, mineralogy, space weathering, formation ages, thermal inertias, volatile content, source regions, solar system formation, etc. can be expected from human NEO missions. Samples directly returned from a primitive body would lead to the same kind of breakthroughs for understanding NEOs that the Apollo samples provided for understanding the Earth-Moon system and its formation history. In addition, robotic precursor and human exploration missions to NEOs would allow the NASA and its international partners to gain operational experience in performing complex tasks (e.g., sample collection, deployment of payloads, retrieval of payloads, etc.) with crew, robots, and spacecraft under microgravity conditions at or near the surface of a small body. This would provide an important synergy between the worldwide Science and Exploration communities, which will be crucial for development of future international deep space exploration architectures and has potential benefits for future exploration of other destinations beyond low-Earth orbit

Robotic and Human Exploration of Near-Earth Objects

U.S. President Obama stated on April 15, 2010 that the next goal for human spaceflight will be to send human beings to a near-Earth asteroid by 2025. Given this direction from the White House, NASA has been involved in studying various strategies for near-Earth object (NEO) exploration in order to follow U.S. space exploration policy. This mission would be the first human expedition to an interplanetary body beyond the Earth-Moon system and would prove useful for testing technologies required for human missions to Mars and other Solar System destinations. Missions to NEOs would undoubtedly provide a great deal of technical and engineering data on spacecraft operations for future human space exploration while conducting in-depth scientific investigations of these primitive objects. In addition, the resulting scientific investigations would refine designs for future extraterrestrial resource extraction and utilization, and assist in the development of hazard mitigation techniques for planetary defense

Precursor Asteroid Missions and Synergies to Human Exploration of Phobos and Deimos

U.S. President Obama stated on April 15, 2010 that the next goal for human spaceflight will be to send human beings to a near-Earth asteroid by 2025 and then on to the Martian system in the 2030s. Given this direction from the White House, NASA has been involved in studying various strategies for near-Earth object (NEO) exploration in order to follow U.S. space exploration policy. These missions would be the first human expeditions to interplanetary bodies beyond the Earth-Moon system and would prove useful for testing technologies required for human missions to Mars and its moons, as well as other Solar System destinations. Robotic precursor missions to NEOs would undoubtedly provide a great deal of technical and engineering data on spacecraft operations for future human space exploration while conducting in-depth scientific investigations of these primitive objects. In addition, the resulting scientific investigations would refine designs for future extraterrestrial resource extraction and utilization, which may play a vital role in leveraging potential resources from the Martian moons that in turn could enable robotic and human exploration of Mars

Exercise training characteristics in cardiac rehabilitation programmes: A cross-sectional survey of Australian practice

Introduction Exercise training is a core component of cardiac rehabilitation (CR), however, little information exists regarding the specific exercise interventions currently provided for coronary heart disease in Australian practice. We aimed to analyse the current status of exercise-based CR services across Australia. Design Cross-sectional survey. Methods Australian sites offering exercise-based CR were identified from publically available directories. All sites were invited by email to participate in an online Survey Monkey questionnaire between October 2014 and March 2015, with reminders via email and phone follow-up. Questions investigated the demographics and format of individual programmes, as well as specific exercise training characteristics. Results 297 eligible programmes were identified, with an 82% response rate. Most sites (82%) were based at hospital or outpatient centres, with home (15%), community (18%) or gym-based options (5%) less common. While CR was most often offered in a comprehensive format (72% of sites), the level of exercise intervention varied greatly among programmes. Most frequently, exercise was prescribed 1–2 times per week for 60 min over 7 weeks. Almost one-quarter (24%) had a sole practitioner supervising exercise, although the majority used a nurse/physiotherapist combination. Low to moderate exercise intensities were used in 60% of programmes, however, higher intensity prescriptions were not uncommon. Few sites (Conclusions While advances have been made towards providing flexible and accessible exercise-based CR, much of Australia's service remains within traditional models of care. A continuing focus on service improvement and evidence-based care should, therefore, be considered a core aim of those providing exercise for CR in order to improve health service delivery and optimise outcomes for patients

Near-Earth Object Exploration and Marco Polo-R

A major goal for NASA's human spaceflight program is to send astronauts to near-Earth asteroids (NEAs) in the coming decades. Missions to NEAs would undoubtedly provide a great deal of technical and engineering data on spacecraft operations for future human space exploration while conducting in-depth scientific examinations of these primitive objects. However, prior to sending human explorers to NEAs, robotic investigations of these bodies would be required in order to maximize operational efficiency and reduce mission risk. These precursor missions to NEAs would fill crucial strategic knowledge gaps concerning their physical characteristics that are relevant for human exploration of these relatively unknown destinations. Therefore robotic investigations of NEAs, such as ESA's Marco Polo-R sample return mission to 2008 EV5, would allow NASA and its international partners to gain critical operational experience in performing complex tasks (e.g., close proximity operations, surface sample collection, etc.) under microgravity conditions at or near the surface of a potential human destination. This would provide an important synergy between the worldwide Science and Exploration communities, which will be crucial for development of future international deep space exploration architectures and has potential benefits for future exploration of other destinations beyond low-Earth orbit

Near-Earth Objects: Targets for Future Human Exploration, Solar System Science, Resource Utilization, and Planetary Defense

U.S. President Obama stated on April 15, 2010 that the next goal for human spaceflight will be to send human beings to a near-Earth asteroid by 2025. Given this direction from the White House, NASA has been involved in studying various strategies for near-Earth object (NEO) exploration in order to follow U.S. Space Exploration Policy. This mission would be the first human expedition to an interplanetary body beyond the Earth-Moon system and would prove useful for testing technologies required for human missions to Mars and other Solar System destinations. Missions to NEOs would undoubtedly provide a great deal of technical and engineering data on spacecraft operations for future human space exploration while conducting in-depth scientific investigations of these primitive objects. In addition, the resulting scientific investigations would refine designs for future extraterrestrial resource extraction and utilization, and assist in the development of hazard mitigation techniques for planetary defense. This presentation will discuss some of the physical characteristics of NEOs and review some of the current plans for NEO research and exploration from both a human and robotic mission perspective

Human Exploration of Near-Earth Asteroids and Sample Collection Considerations

In 2009 the Augustine Commission identified near-Earth asteroids (NEAs) as high profile destinations for human exploration missions beyond the Earth-Moon system as part of the Flexible Path. Subsequently, the U.S. presidential administration directed NASA on April 15, 2010 to include NEAs as destinations for future human exploration with the goal of sending astronauts to a NEA in the mid to late 2020s. This directive became part of the official National Space Policy of the United States of America as of June 28, 2010. Human Exploration Considerations: These missions would be the first human expeditions to interplanetary bodies beyond the Earth-Moon system and would prove useful for testing technologies required for human missions to Mars, Phobos and Deimos, and other Solar System destinations. Missions to NEAs would undoubtedly provide a great deal of technical and engineering data on spacecraft operations for future human space exploration while conducting in-depth scientific examinations of these primitive objects. However, prior to sending human explorers to NEAs, robotic investigations of these bodies would be required in order to maximize operational efficiency and reduce mission risk. These precursor missions to NEAs would fill crucial strategic knowledge gaps concerning their physical characteristics that are relevant for human exploration of these relatively unknown destinations. Sample Science Benefits: Information obtained from a human investigation of a NEA, together with ground-based observations and prior spacecraft investigations of asteroids and comets, will also provide a real measure of ground truth to data obtained from terrestrial meteorite collections. Major advances in the areas of geochemistry, impact history, thermal history, isotope analyses, mineralogy, space weathering, formation ages, thermal inertias, volatile content, source regions, solar system formation, etc. can be expected from human NEA missions. Samples directly returned from a primitive body would lead to the same kind of breakthroughs for understanding NEAs that the Apollo samples provided for understanding the Earth-Moon system and its formation history. International Participation: In addition, robotic precursor and human exploration missions to NEAs would allow the NASA and its international partners to gain operational experience in performing complex tasks (e.g., sample collection, deployment of payloads, retrieval of payloads, etc.) with crew, robots, and spacecraft under microgravity conditions at or near the surface of a small body. This would provide an important synergy between the worldwide Science and Exploration communities, which will be crucial for development of future international deep space exploration architectures and has potential benefits for future exploration of other destinations beyond low-Earth orbit

The Hayabusa Spacecraft Sample Return Mission

The Hayabusa (originally known as MUSES-C) engineering spacecraft was launched by the 5th Mu V launch vehicle on May 9, 2003 by the Japan Aerospace Exploration Agency (JAXA). It was designed to acquire samples from the surface of near-Earth asteroid 25143 Itokawa (1998 SF36) and return them to Earth. The main objectives of the mission were to demonstrate the performance of various technologies such as ion engine performance, autonomous navigation and control, asteroid surface sampling, and recovery of the return capsule after high speed re-entry. Hayabusa successfully returned a small capsule to Earth in June 2010 with a parachute assisted landing in Woomera, Australia. Details of the Hayabusa mission and the recovery operation will be presented for discussion

Exploration of Near-Earth Asteroids

A major goal for NASA's human spaceflight program is to send astronauts to near-Earth asteroids (NEAs) in the coming decades. Missions to NEAs would undoubtedly provide a great deal of technical and engineering data on spacecraft operations for future human space exploration while conducting in-depth scientific examinations of these primitive objects. However, prior to sending human explorers to NEAs, robotic investigations of these bodies would be required in order to maximize operational efficiency and reduce mission risk. These precursor missions to NEAs would fill crucial strategic knowledge gaps concerning their physical characteristics that are relevant for human exploration of these relatively unknown destinations. Information obtained from a human investigation of a NEA, together with ground-based observations and prior spacecraft investigations of asteroids and comets, will also provide a real measure of ground truth to data obtained from terrestrial meteorite collections. Major advances in the areas of geochemistry, impact history, thermal history, isotope analyses, mineralogy, space weathering, formation ages, thermal inertias, volatile content, source regions, solar system formation, etc. can be expected from human NEA missions. Samples directly returned from a primitive body would lead to the same kind of breakthroughs for understanding NEAs that the Apollo samples provided for understanding the Earth-Moon system and its formation history. In addition, robotic precursor and human exploration missions to NEAs would allow the NASA and its international partners to gain operational experience in performing complex tasks (e.g., sample collection, deployment of payloads, retrieval of payloads, etc.) with crew, robots, and spacecraft under microgravity conditions at or near the surface of a small body. This would provide an important synergy between the worldwide Science and Exploration communities, which will be crucial for development of future international deep space exploration architectures and has potential benefits for future exploration of other destinations beyond low-Earth orbit