Search

This case describes the clinical decision-making behind the conservative clinical management of an individual presenting with chronic neck pain with myriad neuromuscular comorbidities. The focus of this case report is to support the safe utilization of manual therapy and describe the tolerable prescription of strength and endurance exercise in a patient with numerous complications to improve self-efficacy. A 22-year-old female college student presented with a chief complaint of chronic, non-specific neck pain with comorbid Chiari malformation, migraines, upper cervical spinal fusion, Ehlers-Danlos syndrome (EDS), and postural orthostatic tachycardia syndrome (POTS) to an outpatient physical therapy clinic for evaluation and treatment. Following four sessions of physical therapy treatment, no clinically significant improvement in the individual's symptoms and daily function was achieved. Despite the lack of measurable change, the patient reported the program's value on her ability to self-manage her complex condition. The patient responded well to manual therapy, specifically thrust manipulations. In addition, both endurance and strengthening exercises were well tolerated and provided a measure of self-management that may not have been achieved before physical therapy management. This case report highlights the need for exercise and pain-modulating interventions in highly complex individuals to reduce medical intervention by advancing the patient's self-efficacy. There is a need for further research about the utility of standardized outcome measures, joint manipulations, and the addition of cervico-ocular exercises for those who present with neck pain and pertinent neuromuscular comorbidities.

The integration of resistance training for cardiac patients leads to important health outcomes that are not optimally obtained with aerobic exercise; these include an increase in muscle mass, maintenance of bone mineral density, and improvements in muscular fitness parameters. Despite the proliferation of evidence supporting resistance exercise in recent decades, the implementation of resistance training is underutilised, and prescription is often sub-optimal in cardiac patients. This is frequently associated with safety concerns and inadequate methods of practical exercise prescription. This review discusses the potential application of cluster sets to prescribe interval resistance training in cardiac populations. The addition of planned, regular passive intra-set rest periods (cluster sets) in resistance training (i.e., interval resistance training) may be a practical solution for reducing the magnitude of haemodynamic responses observed with traditional resistance training. This interval resistance training approach may be a more suitable option for cardiac patients. Additionally, many cardiac patients present with impaired exercise tolerance; this model of interval resistance training may be a more suitable option to reduce fatigue, increase patient tolerance and enhance performance to these workloads. Practical strategies to implement interval resistance training for cardiac patients are also discussed. Preliminary evidence suggests that interval resistance training may lead to safer acute haemodynamic responses in cardiac patients. Future research is needed to determine the efficacy and feasibility of interval resistance training for health outcomes in this population.

Skeletal muscle is crucial for maintaining human health and overall quality of life. Acute exercise introduces a multifaceted intracellular stress, with numerous post-translational modifications believed to underpin the health benefits of sustained exercise training. Reactive oxygen species (ROS) are posited to serve as second messengers, triggering cytoprotective adaptations such as the upregulation of enzymatic scavenger systems. However, a significant knowledge gap exists between the generation of oxidants in muscle and the exact mechanisms driving muscle adaptations. This review delves into the current research on subcellular redox biochemistry and its role in the physiological adaptations to exercise. We propose that the subcellular regulation of specific redox modifications is key to ensuring specificity in the intracellular response.

Worldwide, less than 30% of the workforce in research and development are women (1). Within the field of healthcare, however, female representation (74%) has made substantial gains (2). This is in line with data (2021) from the European Respiratory Society (ERS), showing a higher number of female members (69%) in comparison to male members within the “Allied Respiratory Professionals” Assembly, including amongst others lung function technologist, physiotherapists, nurses and psychologists. This is also visible in the Assembly's early career member category (less than 40 years of age), where women (68%) are also more represented. This increasing representativeness of the female gender is also seen in leadership roles, as five out of 10 (50%) most influenceable researchers (based on the number of publications in the last decade) in the field of pulmonary rehabilitation (PR) are female (3). The current topic on “Women in Science: Pulmonary Rehabilitation” celebrates the increasing representativeness and leadership of females in this research area. It intends to provide a stage for researchers who identify as a woman to present their research within the field of PR. In this topic collection, published research is clustered in two areas that can be considered hot topics in the latest years, namely regarding the settings where PR can be delivered and its role in the treatment of symptoms and extrapulmonary features.

Worldwide, less than 30% of the workforce in research and development are women (1). Within the field of healthcare, however, female representation (74%) has made substantial gains (2). This is in line with data (2021) from the European Respiratory Society (ERS), showing a higher number of female members (69%) in comparison to male members within the “Allied Respiratory Professionals” Assembly, including amongst others lung function technologist, physiotherapists, nurses and psychologists. This is also visible in the Assembly's early career member category (less than 40 years of age), where women (68%) are also more represented. This increasing representativeness of the female gender is also seen in leadership roles, as five out of 10 (50%) most influenceable researchers (based on the number of publications in the last decade) in the field of pulmonary rehabilitation (PR) are female (3). The current topic on “Women in Science: Pulmonary Rehabilitation” celebrates the increasing representativeness and leadership of females in this research area. It intends to provide a stage for researchers who identify as a woman to present their research within the field of PR. In this topic collection, published research is clustered in two areas that can be considered hot topics in the latest years, namely regarding the settings where PR can be delivered and its role in the treatment of symptoms and extrapulmonary features.

Worldwide, less than 30% of the workforce in research and development are women (1). Within the field of healthcare, however, female representation (74%) has made substantial gains (2). This is in line with data (2021) from the European Respiratory Society (ERS), showing a higher number of female members (69%) in comparison to male members within the “Allied Respiratory Professionals” Assembly, including amongst others lung function technologist, physiotherapists, nurses and psychologists. This is also visible in the Assembly's early career member category (less than 40 years of age), where women (68%) are also more represented. This increasing representativeness of the female gender is also seen in leadership roles, as five out of 10 (50%) most influenceable researchers (based on the number of publications in the last decade) in the field of pulmonary rehabilitation (PR) are female (3). The current topic on “Women in Science: Pulmonary Rehabilitation” celebrates the increasing representativeness and leadership of females in this research area. It intends to provide a stage for researchers who identify as a woman to present their research within the field of PR. In this topic collection, published research is clustered in two areas that can be considered hot topics in the latest years, namely regarding the settings where PR can be delivered and its role in the treatment of symptoms and extrapulmonary features.

Previous studies found a lower prevalence of sarcopenia in older adults engaged in regular aerobic training (AT) or with greater adherence to a Mediterranean (MED) diet. However, the effect of their combination on sarcopenia indices is unknown. The present study tested the association between AT plus a MED diet and the presence of sarcopenia and its defining elements in a sample of Italian older adults enrolled in the Longevity Check-up 7+ (Lookup 7+) project. Analyses were conducted in participants 65+ years, with a body mass index of at least 18.5 kg/m2, engaged in regular AT, and without missing information for the variables of interest. MED diet adherence was evaluated via a modified version of the MEDI-LITE score and categorized as low, moderate, or high. The presence of sarcopenia was established by handgrip strength and appendicular skeletal muscle mass (ASM) values below sex-specific cut-points recommended by the European Working Group on Sarcopenia in Older People 2. Data from 491 older adults were analyzed for the present study. The mean age was 72.7 ± 5.7 years, and 185 (37.7%) were women. MED diet adherence was low in 59 (12.0%) participants, moderate in 283 (57.6%), and high in 149 (30.3%). Sarcopenia was identified in 26 participants (5.3%), with no differences across MED diet adherence groups. The results of binary logistic regression showed no significant associations between AT plus adherence to a MED diet and dynapenia, low ASM, or sarcopenia. The findings of the present study indicate that the combination of AT with a MED diet is not associated with a lower probability of sarcopenia or its defining elements in Italian older adults enrolled in Lookup 7+. Further research is warranted to establish whether exercise frequency, volume, intensity, and length of engagement in AT impact the association between MED diet and sarcopenia.

Skeletal muscle is a tissue integral to general health. Due to its high abundance and oxidative capacity, its metabolism is intimately linked to whole-body physiology. In the elderly population, mobility correlates positively with life expectancy and survival. Furthermore, regular physical activity is one of the most effective health-promoting interventions that delay the onset of aging-associated chronic diseases. Data from preclinical studies show that aging of various tissues is accompanied by a decrease in the concentration of nicotinamide adenine dinucleotide (NAD), which plays a central role in energy homeostasis. Thus, a hypothesis has emerged that normalization of its content would ameliorate the age-related decline in tissue function and therefore improve health of the elderly. This idea, along with the documented safety and high tolerability of NAD precursor supplementation, makes NAD metabolism a prospective target for anti-aging interventions. Interestingly, muscle NAD biosynthesis pathways are stimulated by exercise training, which suggests that training-induced adaptations rely on tissue NAD levels. However, while the relationship between muscle fitness and regular physical activity is well-characterized, the proposed synergy between muscle NAD replenishment and exercise training has not been established. Here, we review the published data on the role of NAD metabolism in exercise in the context of young and aged skeletal muscle and discuss the current challenges relevant to the field.

Background: This study tested the hypothesis that training reduces resting sympathetic activity and improves baroreflex control in both hypertensive and normotensive men but reduces blood pressure only in hypertensive men.Methods: Middle-aged/older un-medicated stage-1 hypertensive males (mean age 55±3 yrs; n=13) and normotensive controls (mean age 60±5 yrs; n=12) participated in 8 weeks of supervised high-intensity interval spinning training. Before and after training, muscle sympathetic nerve activity (MSNA) and blood pressure were measured at rest and during a sympatho-excitatory cold pressor test (CPT). Based on the measurements, baroreceptor sensitivity and baroreceptor threshold were calculated.Results: Resting MSNA and baroreceptor sensitivity were similar for the hypertensive and the normotensive groups. Training lowered MSNA (p<0.05), expressed as burst frequency (burst/min), overall, and to a similar extent, in both groups (17 and 27%, respectively in hypertensive and normotensive group), whereas blood pressure was only significantly (p<0.05) lowered (by 4 mmHg in both systolic and diastolic pressure) in the hypertensive group. Training did not (p>0.05) alter the MSNA or blood pressure response to CPT or increase baroreceptor sensitivity but reduced (p<0.05) the baroreceptor threshold with a main effect for both groups. Training adherence and intensity was similar in both groups yet absolute maximal oxygen uptake increased by 15% in the normotensive group only.Conclusion: The dissociation between the training induced changes in resting MSNA, lack of change in baroreflex sensitivity and the change in blood pressure, suggests that MSNA is not a main cause of the blood pressure reduction with exercise training in un-medicated middle-aged/older men.

Skeletal muscle is a tissue integral to general health. Due to its high abundance and oxidative capacity, its metabolism is intimately linked to whole-body physiology. In the elderly population, mobility correlates positively with life expectancy and survival. Furthermore, regular physical activity is one of the most effective health-promoting interventions that delay the onset of aging-associated chronic diseases. Data from preclinical studies show that aging of various tissues is accompanied by a decrease in the concentration of nicotinamide adenine dinucleotide (NAD), which plays a central role in energy homeostasis. Thus, a hypothesis has emerged that normalization of its content would ameliorate the age-related decline in tissue function and therefore improve health of the elderly. This idea, along with the documented safety and high tolerability of NAD precursor supplementation, makes NAD metabolism a prospective target for anti-aging interventions. Interestingly, muscle NAD biosynthesis pathways are stimulated by exercise training, which suggests that training-induced adaptations rely on tissue NAD levels. However, while the relationship between muscle fitness and regular physical activity is well-characterized, the proposed synergy between muscle NAD replenishment and exercise training has not been established. Here, we review the published data on the role of NAD metabolism in exercise in the context of young and aged skeletal muscle and discuss the current challenges relevant to the field.

Background: This study tested the hypothesis that training reduces resting sympathetic activity and improves baroreflex control in both hypertensive and normotensive men but reduces blood pressure only in hypertensive men.Methods: Middle-aged/older un-medicated stage-1 hypertensive males (mean age 55±3 yrs; n=13) and normotensive controls (mean age 60±5 yrs; n=12) participated in 8 weeks of supervised high-intensity interval spinning training. Before and after training, muscle sympathetic nerve activity (MSNA) and blood pressure were measured at rest and during a sympatho-excitatory cold pressor test (CPT). Based on the measurements, baroreceptor sensitivity and baroreceptor threshold were calculated.Results: Resting MSNA and baroreceptor sensitivity were similar for the hypertensive and the normotensive groups. Training lowered MSNA (p<0.05), expressed as burst frequency (burst/min), overall, and to a similar extent, in both groups (17 and 27%, respectively in hypertensive and normotensive group), whereas blood pressure was only significantly (p<0.05) lowered (by 4 mmHg in both systolic and diastolic pressure) in the hypertensive group. Training did not (p>0.05) alter the MSNA or blood pressure response to CPT or increase baroreceptor sensitivity but reduced (p<0.05) the baroreceptor threshold with a main effect for both groups. Training adherence and intensity was similar in both groups yet absolute maximal oxygen uptake increased by 15% in the normotensive group only.Conclusion: The dissociation between the training induced changes in resting MSNA, lack of change in baroreflex sensitivity and the change in blood pressure, suggests that MSNA is not a main cause of the blood pressure reduction with exercise training in un-medicated middle-aged/older men.

Worldwide, less than 30% of the workforce in research and development are women (1). Within the field of healthcare, however, female representation (74%) has made substantial gains (2). This is in line with data (2021) from the European Respiratory Society (ERS), showing a higher number of female members (69%) in comparison to male members within the “Allied Respiratory Professionals” Assembly, including amongst others lung function technologist, physiotherapists, nurses and psychologists. This is also visible in the Assembly's early career member category (less than 40 years of age), where women (68%) are also more represented. This increasing representativeness of the female gender is also seen in leadership roles, as five out of 10 (50%) most influenceable researchers (based on the number of publications in the last decade) in the field of pulmonary rehabilitation (PR) are female (3). The current topic on “Women in Science: Pulmonary Rehabilitation” celebrates the increasing representativeness and leadership of females in this research area. It intends to provide a stage for researchers who identify as a woman to present their research within the field of PR. In this topic collection, published research is clustered in two areas that can be considered hot topics in the latest years, namely regarding the settings where PR can be delivered and its role in the treatment of symptoms and extrapulmonary features.

Worldwide, less than 30% of the workforce in research and development are women (1). Within the field of healthcare, however, female representation (74%) has made substantial gains (2). This is in line with data (2021) from the European Respiratory Society (ERS), showing a higher number of female members (69%) in comparison to male members within the “Allied Respiratory Professionals” Assembly, including amongst others lung function technologist, physiotherapists, nurses and psychologists. This is also visible in the Assembly's early career member category (less than 40 years of age), where women (68%) are also more represented. This increasing representativeness of the female gender is also seen in leadership roles, as five out of 10 (50%) most influenceable researchers (based on the number of publications in the last decade) in the field of pulmonary rehabilitation (PR) are female (3). The current topic on “Women in Science: Pulmonary Rehabilitation” celebrates the increasing representativeness and leadership of females in this research area. It intends to provide a stage for researchers who identify as a woman to present their research within the field of PR. In this topic collection, published research is clustered in two areas that can be considered hot topics in the latest years, namely regarding the settings where PR can be delivered and its role in the treatment of symptoms and extrapulmonary features.

Background: Implementation of exercise training in people with kidney failure may be affected by clinicians' attitudes. Objectives: To investigate Danish nephrology nurses' and medical doctors' attitudes towards: exercise for people undergoing dialysis; use of physical activity interventions in chronic kidney disease; and to compare Danish and previously reported Australian nurse attitudes. Design: Cross-sectional survey. Participants: Nurses and medical doctors from the nephrology field in Denmark. Measurements: The questionnaire attitudes towards exercise in dialysis, and questions about exercise advice, counselling and interventions. Results: Nephrology nurses (n = 167) and 17 medical doctors (women 92%, age 47 ± 11 years) from 19 dialysis units participated. There were no differences between nurses' and medical doctors attitudes about training. Ninety-five % and 88% of nurses and medical doctors, respectively, agreed that most people undergoing dialysis could benefit from exercise. Exercise training was offered to people undergoing haemodialyses in 88% of 17 departments. Danish nurses reported more positive attitudes than Australian towards exercise (p < 0.05). Ninety-five % and 86% of the Danish and Australian nurses, respectively, agreed/strongly agreed that most people undergoing dialysis could benefit from exercise. Six % and 35% of the Danish and Australian nurses, respectively, agreed/strongly agreed that most people with dialysis were too sick to exercise. Conclusion: Danish nephrology nurses and medical doctors had mostly positive attitudes to exercise training to people undergoing dialysis, and exercise to people with dialysis was offered frequently. Danish and Australian nurses had positive attitudes to exercise to people undergoing dialysis, it was however more positive in Danish nurses.

IntroductionThe COPD Biomarkers Qualification Consortium (CBQC) was formed under COPD Foundation management, with the goal of qualifying biomarkers and clinical outcome assessments through established regulatory processes for chronic obstructive pulmonary disease (COPD). Within CBQC, a working group evaluated opportunities for qualification of an exercise endurance measure. In a recent publication (Chronic Obstr Pulm Dis. 2022; 9[2]:252-265), we described a conceptual framework establishing exercise endurance's direct relationship to an individual with COPD's experience of physical functioning in daily life, and that increase in exercise endurance is a patient-centered, meaningful treatment benefit. We further proposed endurance time during constant work rate cycle ergometery (CWRCE) as a useful efficacy endpoint in clinical therapeutic intervention trials. In this current publication, we describe the process of assembling an integrated database of endurance time responses to interventions in COPD.MethodsWe sought participant-level data from published studies incorporating CWRCE as an outcome measure. A literature search screened 2993 publications and identified 553 studies for assessment. Two interventions had sufficient data across studies to warrant data extraction: bronchodilators and rehabilitative exercise training. Investigators were contacted and requested to provide participant-by-participant data from their published studies.ResultsThe final dataset included data from 8 bronchodilator studies (2166) participants and 15 exercise training studies (3488 participants). The database includes 71 variables per participant, comprising demographic, pulmonary function, and detailed physiologic response data. This paper provides a detailed description of the analysis population, while analysis supporting the validation/qualification process and addressing other scientific questions will be described in subsequent publications.

Objectives This pilot study tested the use of an exercise offer to hospital employees during working hours and changes in work and health parameters. Methods Employees (n = 214) from a medical department on a Danish hospital were invited to 30 minutes' exercise training twice weekly for 12 weeks. Outcomes included health- and work-related parameters. Results Eighty employees (mean age, 44.4 [SD, 10.7] years; 81.3% women) completed the study. Intervention adherence was 36.3% (SD, 25.1%). Aerobic capacity increased from 34.6 (95% confidence interval [CI], 32.3 to 36.9) to 36.7 (95% CI, 34.1 to 39.4) mL O2/min per kilogram, P = 0.004. Blood pressure decreased from 120 (95% CI, 117 to 123)/79 (95% CI, 76 to 81) to 116 (95% CI, 112 to 120)/76 (95% CI, 74 to 79) mm Hg, P = 0.003. Waist circumference and musculoskeletal pain decreased. Well-being, social capital, and quality of life increased. Conclusions Despite low training adherence, completers improved outcomes related to metabolic and self-rated health.

BACKGROUND: Although exercise and daily physical activity (PA) have long been known to benefit patients with chronic disorders, knowledge is limited regarding asthma. OBJECTIVE: In a Danish setting, our aim was to measure physical activity, sedentary behavior, and physical capacity among patients with asthma. We hypothesized that people with severe asthma would be less active and more sedentary than their mild-moderate counterparts. METHODS: Adults with asthma were recruited through respiratory outpatient clinics and subsequently examined twice, 4 weeks apart. At each visit, participants underwent a series of lung function tests, questionnaires, and maximum oxygen uptake testing (VO2max). Between the visits, participants wore an accelerometer continuously for 4 weeks, measuring sedentary time and daily steps. Sixty patients, 27 with mild-moderate asthma (GINA 1–3) and 33 with severe asthma (GINA 4–5), completed both visits and had valid accelerometer measurements. RESULTS: No significant differences between the two groups were found in sedentary time, number of steps or VO2max. VO2max was significantly correlated with FeNO (r = −0.30, p < 0.05), Short Form-12 Mental Health (r = 0.37, p < 0.05), Asthma Control Questionnaire (r = −0.35, p < 0.05), and Mini Asthma Quality of Life Questionnaire (r = 0.36, p < 0.05). CONCLUSION: No differences were observed between patients with mild-moderate and severe asthma regarding sedentary behavior, daily steps or level of cardiopulmonary fitness. Furthermore, patients with the highest VO2max had the higher quality of life scores. Abbreviations: VO2max: Maximal Oxygen Uptake; CPET: Cardiopulmonary Exercise Testing; BMI: Body Mass Index; FEV1: Forced Expired Volume in the First Second; FVC: Forced Vital Capacity; PEF: Peak Expiratory Flow; EIB: Exercise-Induced Bronchoconstriction; COPD: Chronic Obstructive Pulmonary Disease; ACQ: Asthma Control Questionnaire

Exercise is a cornerstone in diabetes care; however, adherence is low and sustaining physical activity remains a challenge. Patient-centered diabetes self-management education and support are recommended; however, sparse literature exists on how to design exercise interventions that improve self-management in individuals with complications of type 2 diabetes mellitus (T2D). We aimed to gain insights into needs, barriers, and motivation based on experiences with exercise participation among individuals with T2D and complications to adjust and develop new types of tailored, supervised exercise classes in specialized care at three hospitals in Denmark. In keeping with a constructivist research paradigm, a qualitative hermeneutic approach using focus group interviews was applied to explore perspectives among different participants in terms of disease severity. Seven interviews with 30 participants (aged 49–88) representing seven different exercise classes, were conducted over three years. Reflective thematic analysis was used. Four themes were generated: People like us, Getting started with exercise, Game changers, and Moving forward. An overarching theme ‘The transformation of motivation when exercising in a safe and kind environment’ links the themes together, resembling the participants’ development of physical literacy encompassing motivation, confidence, physical competence as well as an ability to value physical activity. Supportive patient-centered exercise classes promoted a transformation of motivation grounded in the development of physical literacy among participants in specialized diabetes care. However, participants were concerned with continuing to exercise on their own after the intervention, as they experienced a lack of continuous, supervised exercise opportunities in local communities.

Purpose: This study aimed to investigate the effect of intensity and duration of continuous and interval exercise training on capillarization in skeletal muscle of healthy adults. Methods: PubMed and Web of Science were searched from inception to June 2021. Eligibility criteria for studies were endurance exercise training >2 wk in healthy adults, and the capillary to fiber ratio (C:F) and/or capillary density (CD) reported. Meta-analyses were performed, and subsequent subgroup analyses were conducted by the characteristics of participants and training scheme. Results: Fifty-seven trials from 38 studies were included (10%/90%, athletic/sedentary). C:F was measured in 391 subjects from 47 trials, whereas CD was measured in 428 subjects from 50 trials. Exercise training increased C:F (mean difference, 0.33 (95% confidence interval, 0.30–0.37)) with low heterogeneity (I2 = 45.08%) and CD (mean difference, 49.8 (36.9–62.6) capillaries per millimeter squared) with moderate heterogeneity (I2 = 68.82%). Compared with low-intensity training (<50% of maximal oxygen consumption (VO˙2max)), 21% higher relative change in C:F was observed after continuous moderate-intensity training (50%–80% of VO˙2max) and 54% higher change after interval training with high intensity (80%–100% of VO˙2max) in sedentary subjects. The magnitude of capillary growth was not dependent on training intervention duration. In already trained subjects, no additional increase in capillarization was observed with various types of training. Conclusions: In sedentary subjects, continuous moderate-intensity training and interval training with high intensity lead to increases in capillarization, whereas low-intensity training has less effect. Within the time frame studied, no effect on capillarization was established regarding training duration in sedentary subjects. The meta-analysis highlights th

Growing old is patently among the most prominent risk factors for lifestyle related diseases and deterioration in physical performance. Aging in particular affects mitochondrial homeostasis and maintaining a well-functioning mitochondrial pool is imperative in order to avoid age-associated metabolic decline. White adipose tissue (WAT) is a key organ in energy balance and impaired mitochondrial function in adipocytes has been associated with increased low-grade inflammation, altered metabolism, excessive ROS production and an accelerated aging phenotype. Exercise training improves mitochondrial health but whether lifelong exercise training can sufficiently maintain WAT mitochondrial function is currently unknown. Therefore, to dissect the role and dose-dependence of lifelong exercise training on aging WAT metabolic parameters and mitochondrial function, young and older untrained, as well as moderately and highly exercise trained older male subjects were recruited and abdominal subcutaneous (s)WAT biopsies and venous blood samples were obtained to measure mitochondrial function and key metabolic factors in WAT and plasma. Mitochondrial intrinsic respiratory capacity was lower in sWAT from older than in young subjects. In spite of this, maximal mitochondrial respiration per wet weight, markers of oxidative capacity, and mitophagic capacity were increased in sWAT from lifelong highly exercise trained than all other groups. Furthermore, ROS emission was generally lower in sWAT from lifelong highly exercise trained than older untrained subjects. Taken together, aging reduces intrinsic mitochondrial respiration in human sWAT, but lifelong high volume exercise training increases oxidative capacity by increasing mitochondrial volume likely contributing to healthy aging.

Athletic performance is determined by many factors, such as cardiorespiratory fitness, muscular strength and psychological features, which all interact simultaneously. The large Italian National Olympic Committee database of Olympic athletes offers a unique healthy population to verify the strength of the interplay among a number of major elements of training, including autonomic nervous system (ANS) modulation, biochemical indicators and body composition, in a system medicine approach. This observational, retrospective study involved 583 individuals. As part of the yearly precompetitive examination, cardiac autonomic (heart rate variability), psychological, physical (cycloergometer stress test), biochemical and body composition (BOD POD) evaluations were performed. In subsequent analysis, we first considered the relationship between body composition and single individual variables in a simple correlation matrix, including a multitude of variables; then, Exploratory Factor Analysis (EFA) restricted the information to six latent domains, each combining congruent information in relation to body composition. Finally, we employed a multiple quantile regression model to evaluate possible relationships between ANSIs (index capable of synthetizing ANS regulation) and the latent domains indicated by EFA reflecting body composition. We observed a clear relationship between ANS and body mass composition parameters, as indicated by both bivariate correlations and the quantile regression result of ANSIs versus the latent domain aggregating mainly body composition data expressed in % (p = 0.002). In conclusion, these results suggest that specific training may elicit parallel adaptation of ANS control and body composition. The analysis of Olympic athletes’ data allowed us to obtain a better understanding of the complex, multidimensional factors involved in determining sport performance. The latter appears to be determined by the simultaneous interaction not only of cardiorespirat

BACKGROUND: Although exercise and daily physical activity (PA) have long been known to benefit patients with chronic disorders, knowledge is limited regarding asthma. OBJECTIVE: In a Danish setting, our aim was to measure physical activity, sedentary behavior, and physical capacity among patients with asthma. We hypothesized that people with severe asthma would be less active and more sedentary than their mild-moderate counterparts. METHODS: Adults with asthma were recruited through respiratory outpatient clinics and subsequently examined twice, 4 weeks apart. At each visit, participants underwent a series of lung function tests, questionnaires, and maximum oxygen uptake testing (VO2max). Between the visits, participants wore an accelerometer continuously for 4 weeks, measuring sedentary time and daily steps. Sixty patients, 27 with mild-moderate asthma (GINA 1–3) and 33 with severe asthma (GINA 4–5), completed both visits and had valid accelerometer measurements. RESULTS: No significant differences between the two groups were found in sedentary time, number of steps or VO2max. VO2max was significantly correlated with FeNO (r = −0.30, p < 0.05), Short Form-12 Mental Health (r = 0.37, p < 0.05), Asthma Control Questionnaire (r = −0.35, p < 0.05), and Mini Asthma Quality of Life Questionnaire (r = 0.36, p < 0.05). CONCLUSION: No differences were observed between patients with mild-moderate and severe asthma regarding sedentary behavior, daily steps or level of cardiopulmonary fitness. Furthermore, patients with the highest VO2max had the higher quality of life scores. Abbreviations: VO2max: Maximal Oxygen Uptake; CPET: Cardiopulmonary Exercise Testing; BMI: Body Mass Index; FEV1: Forced Expired Volume in the First Second; FVC: Forced Vital Capacity; PEF: Peak Expiratory Flow; EIB: Exercise-Induced Bronchoconstriction; COPD: Chronic Obstructive Pulmonary Disease; ACQ: Asthma Control Questionnaire

Exercise is a cornerstone in diabetes care; however, adherence is low and sustaining physical activity remains a challenge. Patient-centered diabetes self-management education and support are recommended; however, sparse literature exists on how to design exercise interventions that improve self-management in individuals with complications of type 2 diabetes mellitus (T2D). We aimed to gain insights into needs, barriers, and motivation based on experiences with exercise participation among individuals with T2D and complications to adjust and develop new types of tailored, supervised exercise classes in specialized care at three hospitals in Denmark. In keeping with a constructivist research paradigm, a qualitative hermeneutic approach using focus group interviews was applied to explore perspectives among different participants in terms of disease severity. Seven interviews with 30 participants (aged 49–88) representing seven different exercise classes, were conducted over three years. Reflective thematic analysis was used. Four themes were generated: People like us, Getting started with exercise, Game changers, and Moving forward. An overarching theme ‘The transformation of motivation when exercising in a safe and kind environment’ links the themes together, resembling the participants’ development of physical literacy encompassing motivation, confidence, physical competence as well as an ability to value physical activity. Supportive patient-centered exercise classes promoted a transformation of motivation grounded in the development of physical literacy among participants in specialized diabetes care. However, participants were concerned with continuing to exercise on their own after the intervention, as they experienced a lack of continuous, supervised exercise opportunities in local communities.

Growing old is patently among the most prominent risk factors for lifestyle related diseases and deterioration in physical performance. Aging in particular affects mitochondrial homeostasis and maintaining a well-functioning mitochondrial pool is imperative in order to avoid age-associated metabolic decline. White adipose tissue (WAT) is a key organ in energy balance and impaired mitochondrial function in adipocytes has been associated with increased low-grade inflammation, altered metabolism, excessive ROS production and an accelerated aging phenotype. Exercise training improves mitochondrial health but whether lifelong exercise training can sufficiently maintain WAT mitochondrial function is currently unknown. Therefore, to dissect the role and dose-dependence of lifelong exercise training on aging WAT metabolic parameters and mitochondrial function, young and older untrained, as well as moderately and highly exercise trained older male subjects were recruited and abdominal subcutaneous (s)WAT biopsies and venous blood samples were obtained to measure mitochondrial function and key metabolic factors in WAT and plasma. Mitochondrial intrinsic respiratory capacity was lower in sWAT from older than in young subjects. In spite of this, maximal mitochondrial respiration per wet weight, markers of oxidative capacity, and mitophagic capacity were increased in sWAT from lifelong highly exercise trained than all other groups. Furthermore, ROS emission was generally lower in sWAT from lifelong highly exercise trained than older untrained subjects. Taken together, aging reduces intrinsic mitochondrial respiration in human sWAT, but lifelong high volume exercise training increases oxidative capacity by increasing mitochondrial volume likely contributing to healthy aging.

OBJECTIVE: To evaluate the effectiveness of motor control training (MCT) compared with other physical therapist-led interventions, minimal/no intervention or surgery in patients with symptomatic lumbar disc herniation (LDH).DESIGN: Systematic review and meta-analysis.DATA SOURCES: Eight databases and the ClinicalTrials.gov were searched from inception to April 2021.ELIGIBILITY CRITERIA: We included clinical trial studies with concurrent comparison groups which examined the effectiveness of MCT in patients with symptomatic LDH. Primary outcomes were pain intensity and functional status which were expressed as mean difference (MD) and standardised mean difference (SMD), respectively.RESULTS: We screened 6695 articles, of which 16 clinical trials (861 participants) were eligible. Fourteen studies were judged to have high risk of bias and two studies had some risk of bias. In patients who did not undergo surgery, MCT resulted in clinically meaningful pain reduction compared with other physical therapist-led interventions (ie, transcutaneous electrical nerve stimulation (TENS)) at short-term (MD -28.85, -40.04 to -17.66, n=69, studies=2). However, the robustness of the finding was poor. For functional status, a large and statistically significant treatment effect was found in favour of MCT compared with traditional/classic general exercises at long-term (SMD -0.83 to -1.35 to -0.31, n=63, studies=1) and other physical therapist-led interventions (ie, TENS) at short-term (SMD -1.43 to -2.41 to -0.46, n=69, studies=2). No studies compared MCT with surgery. In patients who had undergone surgery, large SMDs were seen. In favour of MCT compared with traditional/classic general exercises (SMD -0.95 to -1.32 to -0.58, n=124, studies=3), other physical therapist-led interventions (ie, conventional treatments; SMD -2.30 to -2.96 to -1.64, n=60, studies=1), and minimal intervention (SMD -1.34 to -1.87 to -0.81, n=68, studies=2) for functional improve

Background: Dialysis treatments weigh heavily on patients' physical and psychosocial health. Multiple studies have assessed the potential for exercise training to improve outcomes in adults undergoing dialysis. However, uncertainties exist in its relevance and sustainable benefits for patient-important outcomes. This is an update of a review first published in 2011. Objectives: To assess the benefits and safety of regular structured exercise training in adults undergoing dialysis on patient-important outcomes including death, cardiovascular events, fatigue, functional capacity, pain, and depression. We also aimed to define the optimal prescription of exercise in adults undergoing dialysis. Search methods: In this update, we conducted a systematic search of the Cochrane Kidney and Transplant Register of Studies up to 23 December 2020. The Register includes studies identified from CENTRAL, MEDLINE, EMBASE, the International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov as well as kidney-related journals and the proceedings of major kidney conferences. Selection criteria: Randomised controlled trials (RCTs) and quasi-RCTs of any structured exercise programs of eight weeks or more in adults undergoing maintenance dialysis compared to no exercise or sham exercise. Data collection and analysis: Two authors independently assessed the search results for eligibility, extracted the data and assessed the risk of bias using the Cochrane risk of bias tool. Whenever appropriate, we performed random-effects meta-analyses of the mean difference in outcomes. The primary outcomes were death (any cause), cardiovascular events and fatigue. Secondary outcomes were health-related quality of life (HRQoL), depression, pain, functional capacity, blood pressure, adherence to the exercise program, and intervention-related adverse events. Main results: We identified 89 studies involving 4291 randomised participants, of which 77 studies (3846 participants) contributed to

[EU] Sarrera: Esklerosi anizkoitza (EA) kausa ezezaguneko hanturazko gaixotasun autoimmune desmielinizatzaile bezala definitzen da. Bere garapena kronikoa da, etiologia ezezaguna eta sintomatologia ugaria. Gaixotasunaren tratamendua nagusiki sintomatologia honi aurre egitera, progresioa moteltzera eta bizi kalitatea mantentzera bideratuta dago; ariketa fisikoak terapian paper garrantzitsua betetzen duelarik. Nahiz eta ez den existitzen gaixotasunaren progresioa moteltzen duenaren frogarik, pazienteak sintometariko asko murriztera eta bizi kalitatea hobetzera eraman ahal dituela frogatu izan da Helburua: Ariketa fisikoa esklerosi anizkoizdun pazienteen bizi kalitatea hobetzeko estrategia eraginkorra den aztertzea. Metodologia: Entsegu klinikoen bilaketa bibliografiko bat gauzatu zen PubMed eta Scopus datu baseetan argitaraturikoen artean. Artikulu desberdinen aukeraketarako, barne- eta kanpo-irizpide jakin batzuk ezarri ziren, baita zenbait filtro gehigarri ere. __ Emaitzak: Hamaika artikulu aukeratu ziren soilik batean ez zirelarik eskuratu emaitza estatistikoki esanguratsuak. Hala eta guztiz ere, guztiek ematen zuten aditzera ariketa fisikoa intentsitate moderatu-ertainean onuragarria dela EA-dun pazienteen bizi kalitaterako. __ Ondorioak: Ariketa aerobikoa eta-edo indar ariketak intentsitatea moderatu-ertainean burutzea, 2-3 saiorekin astean eta ordu bat inguruko entrenamenduekin praktika onuragarria da EA duten pertsonen bizi kalitatearentzat. Haatik, mugapen metodologikoak eta azterturiko entsegu klinikoen heterogeneotasuna kontutan hartuz eskuraturiko emaitzak kontuz hartu behar dira.

Background: This exploratory observational case–control study investigated the rate of referral to cardiac rehabilitation (CR) among patients hospitalised with heart failure (HF) and identified factors associated with referral. Methods: Patients hospitalised with HF as identified by the Victorian Cardiac Outcomes Registry HF study were included. Factors found to be univariately associated with referral were selected for multivariate logistic regression. Results: Among 1281 patients (mean age: 76.9 years; 32.8% HFrEF and 33.9% HfpEF), 125 (9.8%) were referred to CR. Patients referred were younger (73.6 (2.7, 81.5) vs. 80.2 (71.1, 86.5) p < 0.001) and were more likely to be men (72%, p < 0.001). Factors associated with referral included inpatient percutaneous coronary intervention (OR, 3.31; 95% CI, 1.04–10.48; p = 0.04), an aetiology of ischaemic or rhythm-related cardiomyopathy, and anticoagulants prescribed on discharge. Factors that lowered the likelihood of referral included older age, female, receiving inpatient oxygen therapy, and the presence of chronic obstructive pulmonary disease (COPD) or anaemia. Conclusions: The rate of referral to CR following hospitalisation with HF is low. Shortfalls are particularly evident among females, older patients, and in those with COPD or anaemia. Future studies should focus on improving referral processes and translating proven strategies that increase referrals to CR into practice.

BACKGROUND: The relative role of skeletal muscle mechano-transduction in comparison with systemic hormones, such as testosterone (T), in regulating hypertrophic responses to exercise is contentious. We investigated the mechanistic effects of chemical endogenous T depletion adjuvant to 6 weeks of resistance exercise training (RET) on muscle mass, function, myogenic regulatory factors, and muscle anabolic signalling in younger men. METHODS: Non-hypogonadal men (n = 16; 18-30 years) were randomized in a double-blinded fashion to receive placebo (P, saline n = 8) or the GnRH analogue, Goserelin [Zoladex (Z), 3.6 mg, n = 8], injections, before 6 weeks of supervised whole-body RET. Participants underwent dual-energy X-ray absorptiometry (DXA), ultrasound of m. vastus lateralis (VL), and VL biopsies for assessment of cumulative muscle protein synthesis (MPS), myogenic gene expression, and anabolic signalling pathway responses. RESULTS: Zoladex suppressed endogenous T to within the hypogonadal range and was well tolerated; suppression was associated with blunted fat free mass [Z: 55.4 ± 2.8 to 55.8 ± 3.1 kg, P = 0.61 vs. P: 55.9 ± 1.7 to 57.4 ± 1.7 kg, P = 0.006, effect size (ES) = 0.31], composite strength (Z: 40 ± 2.3% vs. P: 49.8 ± 3.3%, P = 0.03, ES = 1.4), and muscle thickness (Z: 2.7 ± 0.4 to 2.69 ± 0.36 cm, P > 0.99 vs. P: 2.74 ± 0.32 to 2.91 ± 0.32 cm, P < 0.0001, ES = 0.48) gains. Hypogonadism attenuated molecular transducers of muscle growth related to T metabolism (e.g. androgen receptor: Z: 1.2 fold, P > 0.99 vs. P: 1.9 fold, P < 0.0001, ES = 0.85), anabolism/myogenesis (e.g. IGF-1Ea: Z: 1.9 fold, P = 0.5 vs. P: 3.3 fold, P = 0.0005, ES = 0.72; IGF-1Ec: Z: 2 fold, P > 0.99 vs. P: 4.7 fold, P = 0.0005, ES = 0.68; myogenin: Z: 1.3 fold, P > 0.99 vs. P: 2.7 fold, P = 0.002, ES = 0.72), RNA/DNA (Z: 0.47 ± 0.03 to 0.53 ± 0.03, P = 0.31 vs. P: 0.50 ± 0.01 to 0.64 ± 0.04, P = 0.003, ES = 0.72), and RNA/ASP (Z: 5.8 ± 0.4 to 6.8 ± 0.5, P > 0.99 vs. P, Funding agency:Medical Research Council as part of the MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research MR/R502364/1 MR/P021220/1

[EU] Sarrera: Esklerosi anizkoitza (EA) kausa ezezaguneko hanturazko gaixotasun autoimmune desmielinizatzaile bezala definitzen da. Bere garapena kronikoa da, etiologia ezezaguna eta sintomatologia ugaria. Gaixotasunaren tratamendua nagusiki sintomatologia honi aurre egitera, progresioa moteltzera eta bizi kalitatea mantentzera bideratuta dago; ariketa fisikoak terapian paper garrantzitsua betetzen duelarik. Nahiz eta ez den existitzen gaixotasunaren progresioa moteltzen duenaren frogarik, pazienteak sintometariko asko murriztera eta bizi kalitatea hobetzera eraman ahal dituela frogatu izan da Helburua: Ariketa fisikoa esklerosi anizkoizdun pazienteen bizi kalitatea hobetzeko estrategia eraginkorra den aztertzea. Metodologia: Entsegu klinikoen bilaketa bibliografiko bat gauzatu zen PubMed eta Scopus datu baseetan argitaraturikoen artean. Artikulu desberdinen aukeraketarako, barne- eta kanpo-irizpide jakin batzuk ezarri ziren, baita zenbait filtro gehigarri ere. __ Emaitzak: Hamaika artikulu aukeratu ziren soilik batean ez zirelarik eskuratu emaitza estatistikoki esanguratsuak. Hala eta guztiz ere, guztiek ematen zuten aditzera ariketa fisikoa intentsitate moderatu-ertainean onuragarria dela EA-dun pazienteen bizi kalitaterako. __ Ondorioak: Ariketa aerobikoa eta-edo indar ariketak intentsitatea moderatu-ertainean burutzea, 2-3 saiorekin astean eta ordu bat inguruko entrenamenduekin praktika onuragarria da EA duten pertsonen bizi kalitatearentzat. Haatik, mugapen metodologikoak eta azterturiko entsegu klinikoen heterogeneotasuna kontutan hartuz eskuraturiko emaitzak kontuz hartu behar dira.

Background: Dialysis treatments weigh heavily on patients' physical and psychosocial health. Multiple studies have assessed the potential for exercise training to improve outcomes in adults undergoing dialysis. However, uncertainties exist in its relevance and sustainable benefits for patient-important outcomes. This is an update of a review first published in 2011. Objectives: To assess the benefits and safety of regular structured exercise training in adults undergoing dialysis on patient-important outcomes including death, cardiovascular events, fatigue, functional capacity, pain, and depression. We also aimed to define the optimal prescription of exercise in adults undergoing dialysis. Search methods: In this update, we conducted a systematic search of the Cochrane Kidney and Transplant Register of Studies up to 23 December 2020. The Register includes studies identified from CENTRAL, MEDLINE, EMBASE, the International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov as well as kidney-related journals and the proceedings of major kidney conferences. Selection criteria: Randomised controlled trials (RCTs) and quasi-RCTs of any structured exercise programs of eight weeks or more in adults undergoing maintenance dialysis compared to no exercise or sham exercise. Data collection and analysis: Two authors independently assessed the search results for eligibility, extracted the data and assessed the risk of bias using the Cochrane risk of bias tool. Whenever appropriate, we performed random-effects meta-analyses of the mean difference in outcomes. The primary outcomes were death (any cause), cardiovascular events and fatigue. Secondary outcomes were health-related quality of life (HRQoL), depression, pain, functional capacity, blood pressure, adherence to the exercise program, and intervention-related adverse events. Main results: We identified 89 studies involving 4291 randomised participants, of which 77 studies (3846 participants) contributed to

[EU] Sarrera: Esklerosi anizkoitza (EA) kausa ezezaguneko hanturazko gaixotasun autoimmune desmielinizatzaile bezala definitzen da. Bere garapena kronikoa da, etiologia ezezaguna eta sintomatologia ugaria. Gaixotasunaren tratamendua nagusiki sintomatologia honi aurre egitera, progresioa moteltzera eta bizi kalitatea mantentzera bideratuta dago; ariketa fisikoak terapian paper garrantzitsua betetzen duelarik. Nahiz eta ez den existitzen gaixotasunaren progresioa moteltzen duenaren frogarik, pazienteak sintometariko asko murriztera eta bizi kalitatea hobetzera eraman ahal dituela frogatu izan da Helburua: Ariketa fisikoa esklerosi anizkoizdun pazienteen bizi kalitatea hobetzeko estrategia eraginkorra den aztertzea. Metodologia: Entsegu klinikoen bilaketa bibliografiko bat gauzatu zen PubMed eta Scopus datu baseetan argitaraturikoen artean. Artikulu desberdinen aukeraketarako, barne- eta kanpo-irizpide jakin batzuk ezarri ziren, baita zenbait filtro gehigarri ere. __ Emaitzak: Hamaika artikulu aukeratu ziren soilik batean ez zirelarik eskuratu emaitza estatistikoki esanguratsuak. Hala eta guztiz ere, guztiek ematen zuten aditzera ariketa fisikoa intentsitate moderatu-ertainean onuragarria dela EA-dun pazienteen bizi kalitaterako. __ Ondorioak: Ariketa aerobikoa eta-edo indar ariketak intentsitatea moderatu-ertainean burutzea, 2-3 saiorekin astean eta ordu bat inguruko entrenamenduekin praktika onuragarria da EA duten pertsonen bizi kalitatearentzat. Haatik, mugapen metodologikoak eta azterturiko entsegu klinikoen heterogeneotasuna kontutan hartuz eskuraturiko emaitzak kontuz hartu behar dira.

Background: Exercise training during hospitalization may prevent loss of physical function and hyperglycemia in patients with type 2 diabetes. The aim of this study was to assess motives and barriers to exercise training in hospitalized patients with type 2 diabetes. Methods: Data were collected using a questionnaire about motives and barriers to exercise training during hospitalization. Additional data for clinical characteristics of the participants were collected from patient records. Results: 79 patients participated (mean ± SD age 72 ± 12 years; 42% women), of whom 25% had a low level of education and 46% lived alone. The median (IQR) length of the stay was 6 (4–10) days. A total of 67% of the participants wished to be more physically active. Walking as exercise was preferred by 51%. The most frequently reported barriers to exercise training were bodily pain (48%) and dizziness (42%). Low vs. high level of education, and living alone vs. being married/living with a partner were associated with reduced odds of a wish to be more physically active, odds ratio (OR) 0.15 [95% CI 0.03; 0.76], p = 0.022, and 0.21 [0.05; 0.82], p = 0.025, respectively. Conclusion: Two out of three hospitalized patients with type 2 diabetes wished to be more physically active during admission. Bodily pain was a barrier to exercise training and needs attention in training programs. As a low level of education was associated with reduced odds of a wish to be more active, a strategy to include all patients in training programs which considers social inequality is needed.

Background: Dialysis treatments weigh heavily on patients' physical and psychosocial health. Multiple studies have assessed the potential for exercise training to improve outcomes in adults undergoing dialysis. However, uncertainties exist in its relevance and sustainable benefits for patient-important outcomes. This is an update of a review first published in 2011. Objectives: To assess the benefits and safety of regular structured exercise training in adults undergoing dialysis on patient-important outcomes including death, cardiovascular events, fatigue, functional capacity, pain, and depression. We also aimed to define the optimal prescription of exercise in adults undergoing dialysis. Search methods: In this update, we conducted a systematic search of the Cochrane Kidney and Transplant Register of Studies up to 23 December 2020. The Register includes studies identified from CENTRAL, MEDLINE, EMBASE, the International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov as well as kidney-related journals and the proceedings of major kidney conferences. Selection criteria: Randomised controlled trials (RCTs) and quasi-RCTs of any structured exercise programs of eight weeks or more in adults undergoing maintenance dialysis compared to no exercise or sham exercise. Data collection and analysis: Two authors independently assessed the search results for eligibility, extracted the data and assessed the risk of bias using the Cochrane risk of bias tool. Whenever appropriate, we performed random-effects meta-analyses of the mean difference in outcomes. The primary outcomes were death (any cause), cardiovascular events and fatigue. Secondary outcomes were health-related quality of life (HRQoL), depression, pain, functional capacity, blood pressure, adherence to the exercise program, and intervention-related adverse events. Main results: We identified 89 studies involving 4291 randomised participants, of which 77 studies (3846 participants) contributed to

Background: Exercise training during hospitalization may prevent loss of physical function and hyperglycemia in patients with type 2 diabetes. The aim of this study was to assess motives and barriers to exercise training in hospitalized patients with type 2 diabetes. Methods: Data were collected using a questionnaire about motives and barriers to exercise training during hospitalization. Additional data for clinical characteristics of the participants were collected from patient records. Results: 79 patients participated (mean ± SD age 72 ± 12 years; 42% women), of whom 25% had a low level of education and 46% lived alone. The median (IQR) length of the stay was 6 (4–10) days. A total of 67% of the participants wished to be more physically active. Walking as exercise was preferred by 51%. The most frequently reported barriers to exercise training were bodily pain (48%) and dizziness (42%). Low vs. high level of education, and living alone vs. being married/living with a partner were associated with reduced odds of a wish to be more physically active, odds ratio (OR) 0.15 [95% CI 0.03; 0.76], p = 0.022, and 0.21 [0.05; 0.82], p = 0.025, respectively. Conclusion: Two out of three hospitalized patients with type 2 diabetes wished to be more physically active during admission. Bodily pain was a barrier to exercise training and needs attention in training programs. As a low level of education was associated with reduced odds of a wish to be more active, a strategy to include all patients in training programs which considers social inequality is needed.

Background: The COVID-19 pandemic had a significant impact on the population's ability to be physically active. Purpose: Evaluate the effect of the COVID-19 mitigation measures on exercise tolerance in patients with congenital heart disease (CHD). Materials and methods: All subjects (880, 6-18 years old) who performed a stress test at our hospital from October 2020 to February 2021 and had a similar test one year earlier were enrolled. A questionnaire on the degree of physical activity carried out in 2020 concerning the period prior to the pandemic was compiled. Exercise tolerance and the main anthropometric parameters between the first and second tests were compared. Results: 110 subjects (11.9 & PLUSMN; 4.1 years) were included in the study. The percentage of patients engaged in regular physical activity (RPA) decreased significantly during the pandemic (p < 0.001), and BMI increased significantly (p < 0.001), except among the subjects who began RPA during the lockdown, whereas test duration did not decrease significantly overall but increased in this last subgroup (p < 0.05) Conclusions: The COVID-19 lockdown led to a less active lifestyle with a significant increase in BMI in our group of CHD. These data could have negative effects on the risk profile of this population. RPA practiced at home seems to be effective in counteracting such effects.

The benefits of physical activity have been widely demonstrated by researchers in different contexts. However, it is not always possible to be used in human participants of research with exercise training, due to the very long follow-up time, or the need for many participants due to prediction of abandonment, or the use of invasive procedures that would raise ethical issues. Thus, physical training protocols in experimental models have been developed over the years. The objective of this narrative review was to present different physical training protocols for experimental rodent models (rats and mice), as well as the procedures used to assess performance. This review also aimed to make academics and researchers aware of the importance of knowing the peculiarities of each model, enabling the choice of the appropriate protocol for purpose of this study, and favoring good practices in the use of animals in research. The physical training protocols for running on a treadmill, high-intensity interval physical training, swimming, resistance training by climbing stairs, weightlifting on the platform, isometric resistance training, combined physical training, and occasional physical activity are presented. Currently, the protocol most used by researchers is aerobic training on a treadmill because running is a training modality that is very accessible to the human population, and that the variables involved in prescription and safety are easily managed. However, more and more, researchers have used variations and / or combinations in studies, to investigate training protocols that are closer to what people are doing in societies. Lastly, the different training protocol options must be evaluated for each research objective, together with the possibilities of estimating the maximum load for the prescription of the appropriate intensity to which it is intended to study., Los beneficios de la actividad física han sido ampliamente demostrados por investigadores en diferentes contextos. Sin embargo, no siempre es posible utilizar participantes humanos en la investigación con entrenamiento físico, debido al largo tiempo de seguimiento, o la necesidad de muchos participantes debido a la predicción del abandono, o el uso de procedimientos invasivos que plantearían problemas éticos. Así, a lo largo de los años se han ido desarrollando protocolos de entrenamiento físico en modelos experimentales. El objetivo de esta revisión narrativa fue presentar diferentes protocolos de entrenamiento físico para modelos experimentales de roedores (ratas y ratones), así como los procedimientos utilizados para evaluar el rendimiento. La revisión también tuvo como objetivo concienciar a académicos e investigadores de la importancia de conocer las peculiaridades de cada modelo, posibilitando la elección del protocolo adecuado a la finalidad del estudio y favoreciendo las buenas prácticas en el uso de animales en investigación. Se presentan los protocolos de entrenamiento físico para correr en cinta, entrenamiento físico en intervalos de alta intensidad, natación, entrenamiento de resistencia subiendo escaleras, levantamiento de pesas en la plataforma, entrenamiento de resistencia isométrica, entrenamiento físico combinado y actividad física ocasional. Actualmente, el protocolo más utilizado por los investigadores es el del entrenamiento aeróbico en caminadora, debido a que correr es una modalidad de entrenamiento muy accesible a la población humana, y que las variables implicadas en la prescripción y la seguridad se gestionan fácilmente. Sin embargo, cada vez más, los investigadores han utilizado variaciones y/o combinaciones en los estudios, con el fin de investigar protocolos de entrenamiento más cercanos a lo que hacen las personas en las sociedades. Por fin, se deben evaluar las diferentes opciones de protocolo de entrenamiento para cada objetivo de inve, Os benefícios da prática de atividade física têm sido amplamente demonstrados por pesquisadores, em diferentes contextos. Entretanto, nem sempre é possível a utilização de participantes humanos em pesquisas com treinamento físico, devido ao tempo de acompanhamento muito prolongado, ou necessidade de muitos participantes devido à previsão de abandono, ou uso de procedimentos invasivos que levantariam questões éticas. Dessa forma, protocolos de treinamento físico em modelos experimentais foram desenvolvidos ao longo dos anos. O objetivo desta revisão narrativa foi apresentar diferentes protocolos de treinamento físico para modelos experimentais roedores (ratos e camundongos), bem como os procedimentos utilizados para avaliação do desempenho. A revisão também teve como objetivo conscientizar acadêmicos e pesquisadores sobre a importância de conhecer as peculiaridades de cada modelo, possibilitando a escolha do protocolo adequado ao objetivo do estudo, e favorecendo as boas práticas na utilização de animais em pesquisa. São apresentados os protocolos de treinamento físico de corrida em esteira ergométrica, treinamento físico intervalado de alta intensidade, natação, treinamento resistido por escalada em escada, levantamento de peso na plataforma, treinamento resistido isométrico, treinamento físico combinado, e prática de atividade física ocasional. Atualmente, o protocolo mais usado pelos pesquisadores é o de treinamento aeróbio em esteira ergométrica, em função da corrida ser uma modalidade de treinamento muito acessível pela população humana, e de fácil manejo das variáveis envolvidas na prescrição e segurança para a realização. Entretanto, cada vez mais, os pesquisadores têm se utilizado de variações e/ou combinações nos estudos, com o intuito de investigar protocolos de treinamento mais aproximados ao que as pessoas estão realizando nas sociedades. Por fim, as diferentes opções de protocolo de treinamento devem ser avaliadas para cada objetivo de pesquisa, juntamen

The benefits of physical activity have been widely demonstrated by researchers in different contexts. However, it is not always possible to be used in human participants of research with exercise training, due to the very long follow-up time, or the need for many participants due to prediction of abandonment, or the use of invasive procedures that would raise ethical issues. Thus, physical training protocols in experimental models have been developed over the years. The objective of this narrative review was to present different physical training protocols for experimental rodent models (rats and mice), as well as the procedures used to assess performance. This review also aimed to make academics and researchers aware of the importance of knowing the peculiarities of each model, enabling the choice of the appropriate protocol for purpose of this study, and favoring good practices in the use of animals in research. The physical training protocols for running on a treadmill, high-intensity interval physical training, swimming, resistance training by climbing stairs, weightlifting on the platform, isometric resistance training, combined physical training, and occasional physical activity are presented. Currently, the protocol most used by researchers is aerobic training on a treadmill because running is a training modality that is very accessible to the human population, and that the variables involved in prescription and safety are easily managed. However, more and more, researchers have used variations and / or combinations in studies, to investigate training protocols that are closer to what people are doing in societies. Lastly, the different training protocol options must be evaluated for each research objective, together with the possibilities of estimating the maximum load for the prescription of the appropriate intensity to which it is intended to study., Los beneficios de la actividad física han sido ampliamente demostrados por investigadores en diferentes contextos. Sin embargo, no siempre es posible utilizar participantes humanos en la investigación con entrenamiento físico, debido al largo tiempo de seguimiento, o la necesidad de muchos participantes debido a la predicción del abandono, o el uso de procedimientos invasivos que plantearían problemas éticos. Así, a lo largo de los años se han ido desarrollando protocolos de entrenamiento físico en modelos experimentales. El objetivo de esta revisión narrativa fue presentar diferentes protocolos de entrenamiento físico para modelos experimentales de roedores (ratas y ratones), así como los procedimientos utilizados para evaluar el rendimiento. La revisión también tuvo como objetivo concienciar a académicos e investigadores de la importancia de conocer las peculiaridades de cada modelo, posibilitando la elección del protocolo adecuado a la finalidad del estudio y favoreciendo las buenas prácticas en el uso de animales en investigación. Se presentan los protocolos de entrenamiento físico para correr en cinta, entrenamiento físico en intervalos de alta intensidad, natación, entrenamiento de resistencia subiendo escaleras, levantamiento de pesas en la plataforma, entrenamiento de resistencia isométrica, entrenamiento físico combinado y actividad física ocasional. Actualmente, el protocolo más utilizado por los investigadores es el del entrenamiento aeróbico en caminadora, debido a que correr es una modalidad de entrenamiento muy accesible a la población humana, y que las variables implicadas en la prescripción y la seguridad se gestionan fácilmente. Sin embargo, cada vez más, los investigadores han utilizado variaciones y/o combinaciones en los estudios, con el fin de investigar protocolos de entrenamiento más cercanos a lo que hacen las personas en las sociedades. Por fin, se deben evaluar las diferentes opciones de protocolo de entrenamiento para cada objetivo de inve, Os benefícios da prática de atividade física têm sido amplamente demonstrados por pesquisadores, em diferentes contextos. Entretanto, nem sempre é possível a utilização de participantes humanos em pesquisas com treinamento físico, devido ao tempo de acompanhamento muito prolongado, ou necessidade de muitos participantes devido à previsão de abandono, ou uso de procedimentos invasivos que levantariam questões éticas. Dessa forma, protocolos de treinamento físico em modelos experimentais foram desenvolvidos ao longo dos anos. O objetivo desta revisão narrativa foi apresentar diferentes protocolos de treinamento físico para modelos experimentais roedores (ratos e camundongos), bem como os procedimentos utilizados para avaliação do desempenho. A revisão também teve como objetivo conscientizar acadêmicos e pesquisadores sobre a importância de conhecer as peculiaridades de cada modelo, possibilitando a escolha do protocolo adequado ao objetivo do estudo, e favorecendo as boas práticas na utilização de animais em pesquisa. São apresentados os protocolos de treinamento físico de corrida em esteira ergométrica, treinamento físico intervalado de alta intensidade, natação, treinamento resistido por escalada em escada, levantamento de peso na plataforma, treinamento resistido isométrico, treinamento físico combinado, e prática de atividade física ocasional. Atualmente, o protocolo mais usado pelos pesquisadores é o de treinamento aeróbio em esteira ergométrica, em função da corrida ser uma modalidade de treinamento muito acessível pela população humana, e de fácil manejo das variáveis envolvidas na prescrição e segurança para a realização. Entretanto, cada vez mais, os pesquisadores têm se utilizado de variações e/ou combinações nos estudos, com o intuito de investigar protocolos de treinamento mais aproximados ao que as pessoas estão realizando nas sociedades. Por fim, as diferentes opções de protocolo de treinamento devem ser avaliadas para cada objetivo de pesquisa, juntamen

The benefits of physical activity have been widely demonstrated by researchers in different contexts. However, it is not always possible to be used in human participants of research with exercise training, due to the very long follow-up time, or the need for many participants due to prediction of abandonment, or the use of invasive procedures that would raise ethical issues. Thus, physical training protocols in experimental models have been developed over the years. The objective of this narrative review was to present different physical training protocols for experimental rodent models (rats and mice), as well as the procedures used to assess performance. This review also aimed to make academics and researchers aware of the importance of knowing the peculiarities of each model, enabling the choice of the appropriate protocol for purpose of this study, and favoring good practices in the use of animals in research. The physical training protocols for running on a treadmill, high-intensity interval physical training, swimming, resistance training by climbing stairs, weightlifting on the platform, isometric resistance training, combined physical training, and occasional physical activity are presented. Currently, the protocol most used by researchers is aerobic training on a treadmill because running is a training modality that is very accessible to the human population, and that the variables involved in prescription and safety are easily managed. However, more and more, researchers have used variations and / or combinations in studies, to investigate training protocols that are closer to what people are doing in societies. Lastly, the different training protocol options must be evaluated for each research objective, together with the possibilities of estimating the maximum load for the prescription of the appropriate intensity to which it is intended to study., Los beneficios de la actividad física han sido ampliamente demostrados por investigadores en diferentes contextos. Sin embargo, no siempre es posible utilizar participantes humanos en la investigación con entrenamiento físico, debido al largo tiempo de seguimiento, o la necesidad de muchos participantes debido a la predicción del abandono, o el uso de procedimientos invasivos que plantearían problemas éticos. Así, a lo largo de los años se han ido desarrollando protocolos de entrenamiento físico en modelos experimentales. El objetivo de esta revisión narrativa fue presentar diferentes protocolos de entrenamiento físico para modelos experimentales de roedores (ratas y ratones), así como los procedimientos utilizados para evaluar el rendimiento. La revisión también tuvo como objetivo concienciar a académicos e investigadores de la importancia de conocer las peculiaridades de cada modelo, posibilitando la elección del protocolo adecuado a la finalidad del estudio y favoreciendo las buenas prácticas en el uso de animales en investigación. Se presentan los protocolos de entrenamiento físico para correr en cinta, entrenamiento físico en intervalos de alta intensidad, natación, entrenamiento de resistencia subiendo escaleras, levantamiento de pesas en la plataforma, entrenamiento de resistencia isométrica, entrenamiento físico combinado y actividad física ocasional. Actualmente, el protocolo más utilizado por los investigadores es el del entrenamiento aeróbico en caminadora, debido a que correr es una modalidad de entrenamiento muy accesible a la población humana, y que las variables implicadas en la prescripción y la seguridad se gestionan fácilmente. Sin embargo, cada vez más, los investigadores han utilizado variaciones y/o combinaciones en los estudios, con el fin de investigar protocolos de entrenamiento más cercanos a lo que hacen las personas en las sociedades. Por fin, se deben evaluar las diferentes opciones de protocolo de entrenamiento para cada objetivo de inve, Os benefícios da prática de atividade física têm sido amplamente demonstrados por pesquisadores, em diferentes contextos. Entretanto, nem sempre é possível a utilização de participantes humanos em pesquisas com treinamento físico, devido ao tempo de acompanhamento muito prolongado, ou necessidade de muitos participantes devido à previsão de abandono, ou uso de procedimentos invasivos que levantariam questões éticas. Dessa forma, protocolos de treinamento físico em modelos experimentais foram desenvolvidos ao longo dos anos. O objetivo desta revisão narrativa foi apresentar diferentes protocolos de treinamento físico para modelos experimentais roedores (ratos e camundongos), bem como os procedimentos utilizados para avaliação do desempenho. A revisão também teve como objetivo conscientizar acadêmicos e pesquisadores sobre a importância de conhecer as peculiaridades de cada modelo, possibilitando a escolha do protocolo adequado ao objetivo do estudo, e favorecendo as boas práticas na utilização de animais em pesquisa. São apresentados os protocolos de treinamento físico de corrida em esteira ergométrica, treinamento físico intervalado de alta intensidade, natação, treinamento resistido por escalada em escada, levantamento de peso na plataforma, treinamento resistido isométrico, treinamento físico combinado, e prática de atividade física ocasional. Atualmente, o protocolo mais usado pelos pesquisadores é o de treinamento aeróbio em esteira ergométrica, em função da corrida ser uma modalidade de treinamento muito acessível pela população humana, e de fácil manejo das variáveis envolvidas na prescrição e segurança para a realização. Entretanto, cada vez mais, os pesquisadores têm se utilizado de variações e/ou combinações nos estudos, com o intuito de investigar protocolos de treinamento mais aproximados ao que as pessoas estão realizando nas sociedades. Por fim, as diferentes opções de protocolo de treinamento devem ser avaliadas para cada objetivo de pesquisa, juntamen

Background: Exercise training induces beneficial effects on neurodegenerative diseases, and specifically on multiple sclerosis (MS) and it's model experimental autoimmune encephalomyelitis (EAE). However, it is unclear whether exercise training exerts direct protective effects on the central nervous system (CNS), nor are the mechanisms of neuroprotection fully understood. In this study, we investigated the direct neuroprotective effects of high-intensity continuous training (HICT) against the development of autoimmune neuroinflammation and the role of resident microglia. Methods: We used the transfer EAE model to examine the direct effects of training on the CNS. Healthy mice performed HICT by treadmill running, followed by injection of encephalitogenic proteolipid (PLP)-reactive T-cells to induce EAE. EAE severity was assessed clinically and pathologically. Brain microglia from sedentary (SED) and HICT healthy mice, as well as 5-days post EAE induction (before the onset of disease), were analyzed ex vivo for reactive oxygen species (ROS) and nitric oxide (NO) formation, mRNA expression of M1/M2 markers and neurotrophic factors, and secretion of cytokines and chemokines. Results: Transfer of encephalitogenic T-cells into HICT mice resulted in milder EAE, compared to sedentary mice, as indicated by reduced clinical severity, attenuated T-cell, and neurotoxic macrophage/microglial infiltration, and reduced loss of myelin and axons. In healthy mice, HICT reduced the number of resident microglia without affecting their profile. Isolated microglia from HICT mice after transfer of encephalitogenic T-cells exhibited reduced ROS formation and released less IL-6 and monocyte chemoattractant protein (MCP) in response to PLP-stimulation. Conclusions: These findings point to the critical role of training intensity in neuroprotection. HICT protects the CNS against autoimmune neuroinflammation by reducing microglial-derived ROS formation, neurotoxicity, and pro-inflammatory respo

Sprint performance plays an important role in the success of many sports including track and field and team-based sports. Resisted sprint equipment has shown to be an effective method to increase sprint velocity and acceleration. The aim of the study was to determine the intrasession and intersession (7 days) reliability of a commercially available resisted sprint machine in recreationally trained individuals for two resistance settings. Fourteen recreationally active participants partook in the study (male = 10, female = 4) over a 7-day period. Three maximal 15m sprints, at two resistance levels (R0 and R5), were undertaken in a randomised order (6 sprints in total at each trial). Intrasession (comparison of the first 3 sprints for each trial) and intersession (mean of the 3 sprints for both trials) correlation coefficient (ICC), coefficients of variation (%CV), average variability, SEM and minimal detectable difference were calculated for 5 and 15m for both resistance levels. Intrasession reliability was very large to nearly perfect across both distances and resistance levels (ICC range 0.79-0.98), %CV ranged between 2.4-5.8% with larger values seen during the first trial for three of the four indices. Intersession reliability was very large to nearly perfect across all variables (ICC range 0.87-0.97), %CV was small and ranged between 2.0-4.1%. Average variability was small for all measurements. The Run RocketTM showed high intra and intersession reliability. The results show that this equipment could be reliably used within a sprint programme for recreationally trained individuals.

Background: To evaluate the short- and mid-term effect of a specially tailored resistance and balance training provided in addition to usual cardiac rehabilitation (CR) care program in older patients after valve surgery/intervention. Methods: Single-center (inpatient CR clinic in Lithuania) randomized controlled trial. Two hundred fifty-two patients were assessed for eligibility on the first day of admittance to CR early after (14.5?±?5.9?days) valve surgery/intervention between January 2018 and November 2019. Participants were coded centrally in accordance with randomization 1:1 using a computerized list. Control group (CG) patients were provided with usual care phase-II-CR inpatient multidisciplinary CR program, while intervention group (IG) patients received additional resistance and balance training (3 d/wk). Patients participated in a 3-month follow-up. Main outcome measures were functional capacity (6?min walk test (6MWT, meters), cardiopulmonary exercise testing), physical performance (Short Physical Performance Battery (SPPB, score) and 5-m walk test (5MWT, meters/second)), strength (one repetition maximum test for leg press), physical frailty (SPPB, 5MWT). Results: One hundred sixteen patients (76.1?±?6.7?years, 50% male) who fulfilled the study inclusion criteria were randomized to IG (n?=?60) or CG (n?=?56) and participated in CR (18.6?±?2.7?days). As a result, 6MWT (IG 247?±?94.1 vs. 348?±?100.1, CG 232?±?102.8 vs. 333?±?120.7), SPPB (IG 8.31?±?2.21 vs. 9.51?±?2.24, CG 7.95?±?2.01 vs. 9.08?±?2.35), 5MWT (IG 0.847?±?0.31 vs. 0.965?±?0.3, CG 0.765?±?0.24 vs 0.879?±?0.29) all other outcome variables and physical frailty level improved significantly (p?

Lifestyle interventions with weight loss can improve insulin sensitivity in type 2 diabetes (T2D), but mechanisms are unclear. We explored circulating and skeletal muscle metabolite signatures of altered peripheral (pIS) and hepatic insulin sensitivity (hIS) in overweight and obese T2D individuals that were randomly assigned a 12-week Paleolithic-type diet with (diet-ex, n = 13) or without (diet, n = 13) supervised exercise. Baseline and post-intervention measures included: mass spectrometry-based metabolomics and lipidomics of skeletal muscle and plasma; pIS and hIS; ectopic lipid deposits in the liver and skeletal muscle; and skeletal muscle fat oxidation rate. Both groups lowered BMI and total % fat mass and increased their pIS. Only the diet-group improved hIS and reduced ectopic lipids in the liver and muscle. The combined improvement in pIS and hIS in the diet-group were associated with decreases in muscle and circulating branched-chain amino acid (BCAA) metabolites, specifically valine. Improved pIS with diet-ex was instead linked to increased diacylglycerol (34:2) and triacylglycerol (56:0) and decreased phosphatidylcholine (34:3) in muscle coupled with improved muscle fat oxidation rate. This suggests a tissue crosstalk involving BCAA-metabolites after diet intervention with improved pIS and hIS, reflecting reduced lipid influx. Increased skeletal muscle lipid utilization with exercise may prevent specific lipid accumulation at sites that perturb insulin signaling.

Lifestyle interventions with weight loss can improve insulin sensitivity in type 2 diabetes (T2D), but mechanisms are unclear. We explored circulating and skeletal muscle metabolite signatures of altered peripheral (pIS) and hepatic insulin sensitivity (hIS) in overweight and obese T2D individuals that were randomly assigned a 12-week Paleolithic-type diet with (diet-ex, n = 13) or without (diet, n = 13) supervised exercise. Baseline and post-intervention measures included: mass spectrometry-based metabolomics and lipidomics of skeletal muscle and plasma; pIS and hIS; ectopic lipid deposits in the liver and skeletal muscle; and skeletal muscle fat oxidation rate. Both groups lowered BMI and total % fat mass and increased their pIS. Only the diet-group improved hIS and reduced ectopic lipids in the liver and muscle. The combined improvement in pIS and hIS in the diet-group were associated with decreases in muscle and circulating branched-chain amino acid (BCAA) metabolites, specifically valine. Improved pIS with diet-ex was instead linked to increased diacylglycerol (34:2) and triacylglycerol (56:0) and decreased phosphatidylcholine (34:3) in muscle coupled with improved muscle fat oxidation rate. This suggests a tissue crosstalk involving BCAA-metabolites after diet intervention with improved pIS and hIS, reflecting reduced lipid influx. Increased skeletal muscle lipid utilization with exercise may prevent specific lipid accumulation at sites that perturb insulin signaling.

Lifestyle interventions with weight loss can improve insulin sensitivity in type 2 diabetes (T2D), but mechanisms are unclear. We explored circulating and skeletal muscle metabolite signatures of altered peripheral (pIS) and hepatic insulin sensitivity (hIS) in overweight and obese T2D individuals that were randomly assigned a 12-week Paleolithic-type diet with (diet-ex, n = 13) or without (diet, n = 13) supervised exercise. Baseline and post-intervention measures included: mass spectrometry-based metabolomics and lipidomics of skeletal muscle and plasma; pIS and hIS; ectopic lipid deposits in the liver and skeletal muscle; and skeletal muscle fat oxidation rate. Both groups lowered BMI and total % fat mass and increased their pIS. Only the diet-group improved hIS and reduced ectopic lipids in the liver and muscle. The combined improvement in pIS and hIS in the diet-group were associated with decreases in muscle and circulating branched-chain amino acid (BCAA) metabolites, specifically valine. Improved pIS with diet-ex was instead linked to increased diacylglycerol (34:2) and triacylglycerol (56:0) and decreased phosphatidylcholine (34:3) in muscle coupled with improved muscle fat oxidation rate. This suggests a tissue crosstalk involving BCAA-metabolites after diet intervention with improved pIS and hIS, reflecting reduced lipid influx. Increased skeletal muscle lipid utilization with exercise may prevent specific lipid accumulation at sites that perturb insulin signaling.

Cardiac rehabilitation (CR) is a multidisciplinary intervention including patient assessment and medical actions to promote stabilization, management of cardiovascular risk factors, vocational support, psychosocial management, physical activity counselling, and prescription of exercise training. Millions of people with cardiac implantable electronic devices live in Europe and their numbers are progressively increasing, therefore, large subsets of patients admitted in CR facilities have a cardiac implantable electronic device. Patients who are cardiac implantable electronic devices recipients are considered eligible for a CR programme. This is not only related to the underlying heart disease but also to specific issues, such as psychological adaptation to living with an implanted device and, in implantable cardioverter-defibrillator patients, the risk of arrhythmia, syncope, and sudden cardiac death. Therefore, these patients should receive special attention, as their needs may differ from other patients participating in CR. As evidence from studies of CR in patients with cardiac implantable electronic devices is sparse, detailed clinical practice guidelines are lacking. Here, we aim to provide practical recommendations for CR in cardiac implantable electronic devices recipients in order to increase CR implementation, efficacy, and safety in this subset of patients.

Background: The aim of this study was to examine feasibility of trial processes and group-based, structured exercise training in patients with first-episode psychosis.Methods: Twenty-five patients with first-episode psychosis took part in a two-arm randomised feasibility trial. They were individually randomised (1:1) via a computer-generated randomisation sequence and allocated to either an exercise intervention group (INT) or a control group (CON). Patients allocated to INT completed a physical exercise training programme at moderate-to-vigorous intensity, 1 h three times weekly for 8 weeks. CON patients were encouraged to continue their usual level of activity and were offered the training programme after 8 weeks. Primary outcomes included screening rate, recruitment rate, retention rate, attendance and adverse events. Secondary outcomes included heart rate response during training, cardiovascular health (VO2max, resting heart rate, blood pressure), body composition (muscle mass, fat percentage), muscle strength (sit-to-stand, grip strength, jump height) and balance.Results: Recruitment lasted 6 weeks and 86 out of 324 patients (27%) were screened, 71 of whom (83%) were deemed eligible. Twenty-five (35%) accepted inclusion (mean age 25.5; mean body mass index 25.1) and were subsequently randomised (INT = 13, CON = 12). Retention of patients was 76% and 52% at the 8-week and 16-week follow-up, respectively. Attendance was 43% (min. 9%, max. 96%). No significant changes were observed between groups in secondary physiological outcome measures.Conclusions: Feasibility was challenged by limited recruitment and retention rates, suggesting that modifications are required if a large-scale randomised controlled trial is to be conducted. Recommendations for modifications are presented and discussed.TRIAL REGISTRATION: Clinicaltrials.gov, NCT03409393 . Retrospectively registered.

Exercise training improves peripheral insulin sensitivity and leads to molecular adaptations in the skeletal muscle. We investigated changes in the expression of key muscle proteins in the glucose metabolic pathway following active commuting by bike or leisure-time exercise at two different intensities. In addition, potential associations between insulin sensitivity and muscle protein expression were examined. This per-protocol analysis included 72 out of 130 physically inactive, healthy women and men (20-45 years) with overweight/obesity (BMI: 25-35 kg/m2) who completed 6 months of no intervention (CON, n = 12), active commuting by bike (BIKE, n = 14), or leisure-time exercise of moderate (MOD, n = 28) or vigorous (VIG, n = 18) intensity. Exercise was prescribed 5 days/week with a weekly exercise energy expenditure of 1,600 kcal for women and 2,100 kcal for men. Insulin sensitivity was determined by a hyperinsulinemic euglycemic clamp and skeletal muscle biopsies were obtained from m. vastus lateralis and analyzed for protein expression at baseline and after 3 and 6 months of intervention. We found an increased expression of pyruvate dehydrogenase (PDH) in the exercise groups compared with the control group following 6 months of training. No differential effects were observed on the protein expression following moderate versus vigorous intensity exercise. In addition, we found a positive association between insulin sensitivity and the expression of glucose transporter type 4 as well as PDH. The positive association and the increase in expression of PDH after exercise training points toward a role for PDH in the training-induced enhancement of insulin sensitivity.