Exercise Is Medicine: Primary Care Counseling on Aerobic Fitness and Muscle Strengthening

Resistance training and inter-interindividual response differences on cardiorespiratory fitness in older adults: An ancillary meta-analysis of randomized controlled trials

Examine true inter-individual response differences (IIRD) as a result of resistance training on cardiorespiratory fitness in older adults. Data from a recent meta-analysis of 22 randomized controlled trials representing 552 men and women (292 resistance training, 260 control) ≥ 60 years of age were included. The primary outcome was cardiorespiratory fitness (VO2max) in ml.kg-1.min-1. Using the inverse variance heterogeneity (IVhet) model, statistically significant treatment effect (resistance training minus control) increases in VO2max in ml.kg-1.min-1 were found (mean, 1.8, 95% CI, 0.4 to 3.3 ml.kg-1.min-1, p = 0.01; Q = 82.8, p < 0.001; I2 = 74.6%, 95% CI, 61.6 to 83.3%; τ 2 =1.1). The 95% prediction interval (PI) was -0.8 to 4.5 ml.kg-1.min-1. However, no statistically significant IIRD was observed (mean, 0.6, 95% CI, -1.1 to 1.4 ml.kg-1.min-1; τ 2 =1.5). The 95% PI was -1.8 to 2.0 ml.kg-1.min-1. In conclusion, while progressive resistance training may increase VO2max in ml.kg-1.min-1, a lack of true resistance-training-associated IIRD exist.

Associations between Symptoms and Exercise Barriers in Breast Cancer Survivors

Despite exercise benefits for cancer survivor health, most breast cancer survivors do not meet exercise recommendations. Few studies have examined associations between psychosocial symptoms and exercise barriers in this population. To improve physician exercise counseling by identifying survivors with high barriers in a clinical setting, associations between breast cancer symptoms (fatigue, mood, sleep quality) and exercise barriers were investigated. Physically inactive survivors (N = 320; average age 55 ± 8 years, 81% White, 77% cancer stage I or II) completed a baseline survey for a randomized physical activity trial and secondary analyses were performed. Potential covariates, exercise barriers interference score, Fatigue Symptom Inventory, Hospital Anxiety and Depression Scale (HADS), and Pittsburgh Sleep Quality Index were assessed. Based on multiple linear regression analyses, only HADS Global (B = 0.463, p < 0.001) and number of comorbidities (B = 0.992, p = 0.01) were independently associated with total exercise barriers interference score, explaining 8.8% of the variance (R2 = 0.088, F(2,317) = 15.286, p < 0.001). The most frequent barriers to exercise for survivors above the HADS clinically important cut point included procrastination, routine, and self-discipline. These results indicate greater anxiety levels, depression levels, and comorbidities may be independently associated with specific exercise barriers. Health professionals should consider mood and comorbidities when evaluating survivors for exercise barriers, and tailoring exercise counseling.

Effects of resistance training on body weight and body composition in older adults: An inter-individual response difference meta-analysis of randomized controlled trials

Whether true inter-individual response differences (IIRD) occur as a result of resistance training on body weight and body composition in older adults with overweight and obesity is not known. To address this gap, data from a previous meta-analysis representing 587 men and women (333 resistance training, 254 control) ≥ 60 years of age nested in 15 randomized controlled trials of resistance training ≥ 8 weeks were included. Resistance training and control group change outcome standard deviations treated as point estimates for body weight and body composition (percent body fat, fat mass, body mass index in kg.m2, and lean body mass) were used to calculate true IIRD from each study. True IIRD as well as traditional pairwise comparisons were pooled using the inverse-variance (IVhet) model. Both 95% confidence intervals (CI) and prediction intervals (PI) were calculated. While statistically significant improvements were found for body weight and all body composition outcomes (p < 0.05 for all), no statistically significant IIRD was observed for any of the outcomes (p > 0.05 for all) and all 95% PIs overlapped. Conclusions: While resistance training is associated with improvements in body weight and body composition in older adults, the lack of true IIRD suggests that factors other than training response variation (random variation, physiological responses associated with behavioral changes that are not the result of resistance training) are responsible for the observed variation in body weight and body composition.

The Effectiveness of an Online Learning Strategy on Changing Physical Activity Counseling Practice in Nurses

BACKGROUND

Nurses may be well poised for providing physical activity guidance and support to patients.

PURPOSE

The purposes of this study were to examine the effectiveness of a concise, evidence based online learning modules strategy (OLMS) for improving nurses' physical activity counselling.

METHODS

68 nurses were randomly assigned to either an OLMS group or control group. The OLMS group completed a series of six online learning modules aimed at improving physical activity counselling practice.

RESULTS

The OLMS group, compared to the control group, showed a trend for improvement in Physical Activity Counselling Practice (p = .063) after controlling for baseline values, and significant improvement in (a) Self-efficacy for Physical Activity Counselling (p = .001), (b) Knowledge of Physical Activity Guidelines, (p = .031), and (c) Perceived Benefits of Physical Activity Counselling (p = .014) over the course of the intervention. No significant change was found for Barriers for Providing Physical Activity Counselling (p > .05).

CONCLUSIONS

The OLMS tested may be an effective means for improving self-efficacy, knowledge, and perceived benefits of physical activity counselling, suggesting the utility of online learning strategies for improving nurses' physical activity counselling practice. Given barriers to providing physical activity counselling were not affected by the intervention, future interventions and policy change could target these barriers specifically in order to give nurses more tools and time for reaching patients and addressing physical activity counselling in practice.

Health outcomes in primary care: a 20-year evidence map of randomized controlled trials

OBJECTIVE

To quantify the different types of health outcomes assessed as primary outcomes in randomized controlled trials (RCTs) in the primary care (PC) setting during the last 20 years and identify whether potential gaps exist in specific types of health care and types of intervention.

METHODS

We systematically searched PubMed, Scopus, and Cochrane Central Register of Controlled Trials, from January 2000 to September 2020 for published RCTs in PC. We recorded characteristics of eligible studies and mapped evidence by health outcome category (patient health outcomes, health services outcomes); and for each outcome category, by types of health care (preventive, acute, chronic, palliative), and by types of intervention (drug, behavioural, on structure, and on process). For RCTs assessing patient health outcomes as primary outcomes, we further mapped using the quality-of-care dimensions, that is, effectiveness, safety, and patient-centredness.

RESULTS

Of the 518 eligible RCTs in PC, 357 (68.9%) evaluated a patient health outcome as the primary outcome, and 161 (31.1%) evaluated only health services outcomes as primary outcomes. Many focused on population with chronic illness (224 trials; 43.2%) and evaluated interventions on processes of health care (239 trials; 46.1%). Research gaps identified include preventive and palliative care, behavioural interventions, and safety and patient-centredness outcomes as primary outcomes.

CONCLUSION

Our evidence map showed research gaps in certain types of health care and interventions. It also showed research gaps in assessing safety and measures to place patient at the centre of health care delivery as primary outcomes.

INFLUENCES OF STRENGTH TRAINING ON ATHLETES’ SKILLS IN TABLE TENNIS

ABSTRACT Introduction The progressive advance of table tennis athletes’ competitive level demands restructuring the traditional strength training program to readjust itself to the current athletic abilities. Objective Explore a strategy based on strength training to improve table tennis athletes’ physical capacity and hitting ability. Methods Thirty table tennis students from a physical education college were selected as research volunteers. A strength training protocol was added to the traditional protocol in the experimental group. The duration of the exercises in the experimental group and the control group was the same, with a frequency of 3 times a week, totaling 9 weeks. Results The optimization scheme of the strength training combination proposed in this paper revealed an improved effect on table tennis players’ performance of hitting skills and fitness. Its range of improvement was greater than the traditional strength training scheme of the control group. Conclusion The optimization scheme combining strength training proposed in this paper can be adjusted to the training according to the athletes’ situation and benefit the athletes’ training efficiency. It can also prevent repetitive injuries caused by the standard training mode in the long run, increasing the athletes’ enthusiasm. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

INTENSIVE TRAINING EFFECTS ON SHOULDER MUSCLE INJURY IN TABLE TENNIS PLAYERS

ABSTRACT Introduction: The glenohumeral joint has the greatest range of motion. Its stability is relatively poor. It depends on muscle strengthening and increased proprioception in the articular and adjacent joint tissues. Muscle-strengthening training for this joint is still an empirical subject related to table tennis players. Objective: Explore muscle strengthening training's effect on shoulder muscle injury in table tennis players. Methods: Eight table tennis players from a university were selected as a research subject, separated, and classified between injured and control group. Three weeks of strengthening training were adopted to rehabilitate the rotator cuff injury of the table tennis team athletes. The joint angle test and kinematics were collected with isokinetic force measurement employing Cybex-6000. The EMG and other relevant data were collected before and after the experiment. Results: The infraspinatus strength test results of 8 athletes before the experiment were 1.88 ± 2.10 versus 1.61 ± 1.80 after the experiment; there was no change in pain among 5 of the eight athletes, the shoulder pain of 1 athlete increased, and the shoulder pain of the other 2 table tennis players decreased. Conclusion: Strengthening exercise by intensive shoulder training proved effective in conjunction with traditional rehabilitation, positively influencing hypertrophy and proprioception of the joint complex. Evidence Level II; Therapeutic Studies – Investigating the results.

Diurnal variation of fat oxidation rate and energy expenditure in an acute bout of endurance exercise by young healthy males

Background:

Few studies have reported that circadian rhythm affects fat oxidation (FOx) during exercise. Time-of-day causing greater FOx and energy expenditure (EE) during exercise would be beneficial in the prevention of physical inactivity-related health disorders such as metabolic syndrome. The study aims to compare EE and FOx rate after an endurance exercise session done in the morning and late-afternoon hours by apparently healthy young male participants.

Material and Methods:

The present crossover quasi-experimental study involved 10 moderately active but physically untrained male participants of age 18–25 years with normal body mass index. Participants did a steady-state exercise on a motorized treadmill for 30 minutes at a moderate-intensity (50 ± 2% of their heart rate reserve) on two separate occasions at 9:00–10:00 and 15:00–16:00. A similar meal followed by 2 hours of fasting was done before each trial session. During the last 2 minutes of the exercise session, the respiratory gas analysis estimated volume of oxygen (VO₂) and volume of carbon dioxide (VCO₂) consumed in L/min. Indirect calorimetry equations assessed FOx (mg/min), EE (Kcal/min) and respiratory exchange ratio (RER). Data of one participant were removed to adjust for extreme chronotype. Paired t-test was applied, and P ≤ 0.05 was considered significant.

Results:

Morning versus late-afternoon variations in FOx (269 ± 110 vs 290 ± 110, P = 0.016), RER (0.86 ± 0.05 vs 0.85 ± 0.05, P = 0.040), EE (5.454 ± 0.987 vs 5.494 ± 0.959, P = 0.079) and VO2 (1.104 ± 0.201 vs 1.113 ± 0.196, P = 0.035) were present after adjustment for chronotype.

Conclusion:

In an acute bout of endurance, exercise done by young and healthy male individuals, FOx was significantly higher, while EE tends to be higher in late-afternoon than in the morning.

Perspective: Opportunities and Challenges of Technology Tools in Dietary and Activity Assessment: Bridging Stakeholder Viewpoints

The science and tools of measuring energy intake and output in humans have rapidly advanced in the last decade. Engineered devices such as wearables and sensors, software applications, and Web-based tools are now ubiquitous in both research and consumer environments. The assessment of energy expenditure in particular has progressed from reliance on self-report instruments to advanced technologies requiring collaboration across multiple disciplines, from optics to accelerometry. In contrast, assessing energy intake still heavily relies on self-report mechanisms. Although these tools have improved, moving from paper-based to online reporting, considerable room for refinement remains in existing tools, and great opportunities exist for novel, transformational tools, including those using spectroscopy and chemo-sensing. This report reviews the state of the science, and the opportunities and challenges in existing and emerging technologies, from the perspectives of 3 key stakeholders: researchers, users, and developers. Each stakeholder approaches these tools with unique requirements: researchers are concerned with validity, accuracy, data detail and abundance, and ethical use; users with ease of use and privacy; and developers with high adherence and utilization, intellectual property, licensing rights, and monetization. Cross-cutting concerns include frequent updating and integration of the food and nutrient databases on which assessments rely, improving accessibility and reducing disparities in use, and maintaining reliable technical assistance. These contextual challenges are discussed in terms of opportunities and further steps in the direction of personalized health.

A syndemics approach to exercise is medicine

This paper offers new insights into the promotion of the Exercise is Medicine (EIM) framework for mental illness and chronic disease. Utilising the Syndemics Framework, which posits mental health conditions as corollaries of social conditions, we argue that medicalized exercise promotion paradigms both ignore the social conditions that can contribute to mental illness and can contribute to mental illness via discrimination and worsening self-concept based on disability. We first address the ways in which the current EIM framework may be too narrow in scope in considering the impact of social factors as determinants of health. We then consider how this narrow scope in combination with the emphasis on independence and individual prescriptions may serve to reinforce stigma and shame associated with both chronic disease and mental illness. We draw on examples from two distinct research projects, one on exercise interventions for depression and one on exercise interventions for multiple sclerosis (MS), in order to consider ways to improve the approach to exercise promotion for these and other, related populations.

Physical Activity Counseling among Adults in Primary Health Care Centers in Brazil

Physical activity (PA) counseling by health professionals has promising results in behavior change. However, few studies have evaluated its prevalence in Primary Health Care in Latin American countries. This study aimed to describe the prevalence and analyze the associated factors of PA counseling in adults in Primary Health Care in Brazil. This is a cross-sectional study with a representative sample of 779 adults (70% women). Counseling was identified among those who reported having received PA counseling during a health professional consultation in the last 12 months. Sociodemographic factors, health conditions, and leisure-time PA were analyzed with Poisson regression. The prevalence of counseling was 43% (95% Confidence Interval [CI]: 39.5-46.4%), higher in people aged ≥40 years (Prevalence Ratio [PR]: 1.44; 95% CI: 1.19-1.75], who are married (PR: 1.27; 95% CI: 1.07-1.59), obese (PR: 1.53; 95% CI: 1.23-1.90), take prescription medication (PR: 1.83; 95% CI: 1.47-2.27), and walk for leisure (PR: 1.28; 95% CI: 1.06-1.54). People with more education were less likely to receive PA counseling (PR: 0.82; 95% CI: 0.68-0.99). In conclusion, 4 out of 10 users reported receiving PA counseling and this was associated with sociodemographic factors, health conditions, and walking for leisure. These results can guide PA promotion in Primary Health Care.

Physical Activity Promotion in a Safety-net Clinic: Does the Provider Make a Difference? A Pilot Study

BACKGROUND

Despite the long-term health benefits of physical activity, many Americans across the lifespan do not meet the recommended levels. However, physical activity discussions in the clinic setting may hold promise. The purpose of this study aimed to understand health care providers' beliefs and practices about physical activity discussions being a part of patients' healthcare treatment.

METHODS

Semi-structured, audiotaped interviews were conducted to elicit narratives from ten health care providers. Interview data were transcribed verbatim, then coded and analyzed by two qualitative researchers using NVivo12.

RESULTS

Three major themes emerged: importance of regular PA counseling for vulnerable populations, patients' lack of regular physical activity, including subthemes of lack of time, current health conditions, and social determinants of health, and healthcare provider's reflections about their own physical activity.

CONCLUSION

Healthcare providers have an important role when it comes to promoting good health. Having physical activity discussions with patients at every clinic visit is a great opportunity to encourage patients to engage in healthy lifestyle behaviors such as regular physical activity. From this pilot study, implications for practice may include increased awareness of the healthcare providers to discuss physical activity at every visit, which may lead to improved provider-patient communications related to the benefits of daily physical activity behaviors. These discussions may even have a secondary gain of encouraging the providers themselves to adopt the healthy behavior and thereby serve as a role model for their patients.

Women Reduce the Performance Difference to Men with Increasing Age in Ultra-Marathon Running

Age and sex are well-known factors influencing ultra-marathon race performance. The fact that women in older age groups are able to achieve a similar performance as men has been documented in swimming. In ultra-marathon running, knowledge is still limited. The aim of this study was to analyze sex-specific performance in ultra-marathon running according to age and distance. All ultra-marathon races documented in the online database of the German Society for Ultra-Marathon from 1964 to 2017 for 50-mile races (i.e., 231,980 records from 91,665 finishers) and from 1953 to 2017 for 100-mile races (i.e., 107,445 records from 39,870 finishers) were analyzed. In 50-mile races, race times were 11.74 ± 1.95 h for men and 12.31 ± 1.69 h for women. In 100-mile races, race times were 26.6 ± 3.49 h for men and 27.47 ± 3.6 h for women. The sex differences decreased with older age and were smaller in 100-mile (4.41%) than in 50-mile races (9.13%). The overall age of peak performance was 33 years for both distances. In summary, women reduced the performance difference to men with advancing age, the relative difference being smaller in 100-mile compared to 50-mile races. These findings might aid coaches and ultra-marathon runners set long-term training goals considering their sex and age.