Exploring the feasibility of an exercise programme including aerobic and resistance training in people with limited cutaneous systemic sclerosis.

OBJECTIVES: It is suggested that exercise can improve the vascular function and quality of life (QoL) in people with systemic sclerosis (SSc), potentially offering clinical benefits to this population. Yet the feasibility of such an intervention remains untested. Therefore, the purpose of this study is to examine the feasibility of a combined exercise protocol (aerobic and resistance training) in people with limited cutaneous SSc (lcSSc). METHODS: Thirty-two lcSSc patients (66.5 ± 12 years old) were randomly allocated in two groups (exercise and control group). The exercise group underwent a 12-week exercise programme, twice per week. All patients performed the baseline, three- and six-month follow-up measurements where functional ability, body composition and QoL were assessed. Participants' experiences were explored through interviews. RESULTS: Compliance was 92.6% with no dropouts. The individuals' confidence to participate in the study's exercise protocol for twice per week was 95%. The average value for the physical activity enjoyment scale was 103 ± 10 out of 119 (highest score). The mean values for the intention to engage in exercise twice per week were 6.4 ± 1 (likely) out of 7 (very likely). QoL for the exercise group showed to have a better life satisfaction, less anxiety and Raynaud's phenomenon-accompanied pain. CONCLUSIONS: Our results suggest that a combined exercise protocol was feasible for people with lcSSc, with no adverse events, resulting in high adherence and low attrition rates, high enjoyment levels and intentions for future engagement to this exercise. Thus, the specific protocol is a safe adjunct therapy for people with lcSSc. TRIAL REGISTRATION: ClinicalTrials.gov (NCT number): NCT03058887, February 23, 2017, https://clinicaltrials.gov/ct2/show/NCT03058887?term=NCT03058887&rank=1Key Points• High-intensity interval training in combination with resistance training constitutes a feasible exercise protocol for people with lcSSc.• Overall, the exercise programme demonstrated high adherence and enjoyment levels and low attrition rates.• The exercise protocol was proved to be safe with no adverse events for people with lcSSc

Comparison of laser speckle contrast imaging with laser Doppler for assessing microvascular function

Objective: To compare the inter-day reproducibility of post-occlusive reactive hyperaemia (PORH) and sympathetic vasomotor reflexes assessed by single-point laser Doppler flowmetry (SP-LDF), integrating-probe LDF (IP-LDF) and laser speckle contrast imaging (LSCI), and the spatial variability of PORH assessed by IP-LDF and LSCI. We also evaluated the relationship between IP-LDF and LSCI perfusion values across a broad range of skin blood flows. Methods: Eighteen healthy adults (50% male, age 27 ± 4 years) participated in this study. Using SP-LDF, IP-LDF and LSCI, an index of skin blood flow was measured on the forearm during PORH (1-, 5- and 10-min occlusions) and on the finger pad during inspiratory gasp and cold pressor tests. These tests were repeated 3-7 days later. Data were converted to cutaneous vascular conductance (CVC; laser Doppler flow/mean arterial pressure) and expressed as absolute and relative changes from pre-stimulus CVC (ΔCVCABS and ΔCVCREL, respectively), as well as normalised to peak CVC for the PORH tests. Reproducibility was expressed as within-subjects coefficients of variation (CV, in %) and intraclass correlation coefficients. Results: The reproducibility of PORH on the forearm was poorer when assessed with SP-LDF and IP-LDF compared to LSCI (e.g., CV for 5-min PORH ΔCVCABS = 35, 27 and 19%, respectively), with no superior method of data expression. In contrast, the reproducibility of the inspiratory gasp and cold pressor test responses on the finger pad were better with SP-LDF and IP-LDF compared to LSCI (e.g., CV for inspiratory gasp ΔCVCREL = 13, 7 and 19%, respectively). The spatial variability of PORH responses was poorer with IP-LDF compared to LSCI (e.g., CV ranging 11-35% versus 3-16%, respectively). The association between simultaneous LSCI and IP-LDF perfusion values was non-linear. Conclusion: The reproducibility of cutaneous PORH was better when assessed with LSCI compared to SP-LDF and IP-LDF; probably due to measuring larger skin areas (lower inter-site variability). However, when measuring sympathetic vasomotor reflexes on the finger pad, reproducibility was better with SP-LDF and IP-LDF, perhaps due to the high sensitivity of LSCI to changes in skin blood flow at low levels

Validation of an arm crank ergometer test for use in sedentary adults

The maximal oxygen uptake (V̇O2peak) test is an approved pre-operative examination tool, in a clinical setting: Both V̇O2peak and anaerobic threshold indicate a patient's physiological tolerance for major surgery and post-operative mortality, with cycle ergometry being routinely used for V̇O2peak tests in clinical settings, in many European countries. Nevertheless, the opportunities to assess populations with restricted mobility of the lower limbs are limited, as alternative methods (such as an arm-crank test protocol) to assess V̇O2peak are yet to be established. Twelve sedentary middle-aged adults (55.1 ± 5.0 years) performed two incremental protocols on an arm crank and cycle ergometer on separate occasions. During exercise, gas exchange was collected and analysed by an online breath-by-breath analysis system. Regression analysis showed that the model with dependent variable cycle ergometer V̇O2peak (CEV̇O2peak) in ml·kg-1·min-1 and independent variables arm crank V̇O2peak (ACEV̇O2peak) in ml·kg-1·min-1, lean body mass lower limbs (LBMLL) and total lean body mass (TLBM) fitted the population the best, with r2 = 0.87, adj. r2 = 0.82 and SEE = 3.14. The equation estimated with this model is: CE V̇O2peak = 11.776 + 1.418 X ACE V̇O2peak(ml·kg-1·min-) – 1.454 x TLBM + 3.967 X LLLBM. Our study suggests that arm cranking could be an alternative mode of exercise for sedentary middle-aged adults (and potentially in clinical settings) to assess the cardiorespiratory fitness of people with restricted lower-limb mobility. Key words: Cardiopulmonary test, arm exercise, physiological responses, upper limbs

Exercise therapy in women treated for breast cancer

Treatment for breast cancer can result in reduced quality of life (QoL), psychological and physical well-being. Evidence suggests that exercise may be of therapeutic benefit for breast cancer patients. To date, however, no randomised controlled trial in the UK has examined the effects of aerobic exercise therapy upon QoL and associated outcomes in women who have completed breast cancer treatment. Furthermore no trial has included an exercise-placebo and a usual care group to control for possible attention effects arising from instructor-patient interaction. Therefore, the purpose of this thesis was to examine the effects of a supervised one-to-one aerobic exercise-therapy intervention upon QoL and associated outcomes in women who had completed treatment for breast cancer 12-36 months previously. Additional aims of the thesis were to provide detailed information about participants' adherence to the trial interventions and to examine the most effective methods of recruitment into the trial. A qualitative study was also included to explore the personal exercise experiences of participants who took part in the exercise therapy and exercise-placebo interventions.The sample consisted of 108 sedentary women who had been treated for breast cancer 12-36 months previously. The mean age of the participants was 51 years (age range 32-65years). The primary route of recruitment was via clinician invitation letters. Participants were randomised to one of three groups: exercise therapy (n=34), exercise-placebo (n=36) or usual care (n=38). The exercise therapy and exercise-placebo groups attended one-to-one supervised sessions three times a week for a period of eight weeks (24 sessions in total). The exercise therapy group participated in moderate intensity aerobic exercise and received exercise counselling designed to promote exercise participation. The exercise-placebo group participated in light flexibility, mobility and body conditioning exercises and did not receive exercise counselling.Repeated measures mixed analyses of covariance (controlling for baseline scores) revealed a significant mean difference of 9.8 units in the primary outcome (QoL), Functional Assessment of Cancer Therapy (FACT-G)-General scale, favouring exercise therapy at eight week follow-up relative to usual care. The exercise placebo group did not report similar statistical significant benefits. Significant differences favouring exercise therapy relative to usual care were found for FACT-B (breast cancer specific QoL), social/family well-being, functional well-being and breast specific concerns subscales. Outcomes including depression, physical self-worth and aerobic fitness improved significantly in the exercise therapy group compared to usual care. Adherence to both exercise interventions was excellent. The estimated trial recruitment rate based on clinician invitation was 28.6%.Findings from the qualitative study revealed participants perceived the exercise interventions had accelerated their psychological and physical recovery from breast cancer. A patient-centred approach mediated exercise enjoyment and adherence.This pioneering study demonstrated that exercise therapy was a safe, tolerable intervention that elicited short-term, clinically important benefits upon QoL in women treated for breast cancer. Future research should focus on sustaining QoL benefits through longer-term exercise participation and the feasibility of integrating exercise rehabilitation into mainstream breast cancer care

Identification of research priorities in exercise oncology: a consensus study

The growth of research in the field of exercise oncology has resulted in a large evidence base for the role of physical activity in preventing and managing cancer outcomes. Nonetheless, there remain many unanswered questions across the multidisciplinary field. This study aimed to determine the priority research questions within exercise oncology using a systematic consensus method. Forty-seven exercise oncology experts engaged in the five-step process of the Nominal Group Technique to generate a list of research questions in small groups and rank the 10 most important. One hundred questions resulted from the process and fifteen received total scores (sum of ranks) of at least 50 from a maximum score of 470. The highest ranked question (score of 125) related to the identification of functional markers of recovery. The next five questions concerned minimum exercise parameters, health professional education, translation of behavioural interventions, effects of exercise on the tumour microenvironment and development of in vitro models to study the impact of exercise on cancer cell growth and metastasis. The study has demonstrated the importance of future research across all disciplinary areas of exercise oncology and identified the priority questions to which resources might be directed

Understanding the experience of initiating community-based group physical activity by people with serious mental illness: a systematic review using a meta-ethnographic approach

Background People living with serious mental illness (SMI) experience debilitating symptoms that worsen their physical health and quality of life. Regular physical activity (PA) may bring symptomatic improvements and enhance wellbeing. When undertaken in community-based group settings, PA may yield additional benefits such as reduced isolation. Initiating PA can be difficult for people with SMI and so PA engagement is commonly low. Designing acceptable and effective PA programmes requires a better understanding of the lived experiences of PA initiation among people with SMI. Methods This systematic review of qualitative studies used the meta-ethnography approach by Noblit and Hare (1988). Electronic databases were searched from inception to November 2017. Eligible studies used qualitative methodology; involved adults (≥18 years) with schizophrenia, bipolar affective disorder, major depressive disorder or psychosis; reported community-based group PA; and captured the experience of PA initiation, including key features of social support. Study selection and quality assessment was performed by four reviewers. Results Sixteen studies were included in the review. We identified a ‘journey' that depicted a long sequence of phases involved in initiating PA. The journey demonstrated the thought processes, expectations, barriers and support needs of people with SMI. In particular, social support from a trusted source played an important role in getting people to the activity, both physically and emotionally. Discussion The journey illustrated that initiation of PA for people with SMI is a long complex transition. This complex process needs to be understood before ongoing participation in PA can be addressed