Prescribing physical activity: applying the ACSM protocols for exercise type, intensity, and duration across 3 training frequencies

Effect of contraction type at varying angular velocities on isokinetic muscle strength training

The aim of this study is to determine whether concentric and eccentric isokinetic training performed at certain angular velocities in sedentary individuals is effective only in the angular velocities and contraction type where the training is performed, or at other angular velocities and contraction types that are not being trained. Twenty-eight sedentary individuals (matched according to weight, age and gender) volunteered to participate in this case study. The study was conducted on a total of 56 extremities belonging to 28 individuals (14 women, 14 men) aged between 24 and 60 years. Concentric and eccentric strength tests were performed at 30-60-90-120-150-180°/sec. The participants were randomly divided into two groups as concentric training group and eccentric training group, through stratified randomization matching. The training was done 3 days a week for a total of 6 weeks. At the end of the study, no difference was found between the pre- and posttraining measurements in the concentric training group (P>0.05). In the eccentric training group, the eccentric muscle strength of the knee flexors and extensors at angular velocity of 90°/sec, the eccentric strength of the knee extensors at angular velocity of 120°/sec, and the eccentric muscle strength of the knee flexors at angular velocity of 180°/sec were found to be different and an increase was seen after the training (P=0.032, P=0.049, P=0.041, P=0.032). These results demonstrate that eccentric training may be preferred in cases where muscle strength increase is needed in short time.

Effects of Low- and High-Frequency Cardiac Rehabilitation on Risk Factors, Physical Fitness and Quality of Life in Middle-Aged Women with Coronary Heart Disease

Cardiac rehabilitation (CR) is a system that comprehensively manages risk factors to reduce the recurrence rate after cardiovascular disease treatment. This study compared the effects of home-based low-frequency CR (1-2 times/week) and center-based high-frequency CR (3-5 times/week) for 12 weeks. This study was conducted as an observational case-control study. Ninety women, ages 45 to 60, who underwent coronary artery stenting were enrolled. Measurement variables were waist circumference, body mass index (BMI), blood pressure (BP), total cholesterol (TC), low-density lipoprotein cholesterol (LDLC), high-density lipoprotein cholesterol (HDLC), triglycerides (TG), glucose, VO₂ peak, body composition, and quality of life. Significant changes were observed in systolic BP, TC, LDLC, TG, VO₂ peak, exercise duration, and quality of life in both groups. However, BMI, waist circumference, body fat percentage, HDLC, and blood glucose only exhibited significant changes with HFT. The interaction effects according to time and group were as follows: systolic BP, waist circumference, body fat, BMI, HDLC, and glucose (p < 0.05). Therefore, in CR participants, HFT improved more than LFT on obesity factors, HDLC, and glucose change. As well as center-based HFT, home-based LFT also improved risk factors for cardiovascular disease, fitness, and quality of life. For female patients who have difficulty visiting the CR center frequently, home-based LFT may be a CR program that can be presented as an alternative.

A rehabilitation program to increase balance and mobility in ataxia of Charlevoix-Saguenay: An exploratory study

Autosomal recessive spastic ataxia of Charlevoix-Saguenay (ARSACS) is characterized by balance impairment and mobility limitations, which both increase the risk of falling. The objective of this study was to explore the effects of a rehabilitation program aimed at increasing trunk and lower limb motor control on balance and walking abilities, and accomplishment of activities of daily living. In this exploratory study, a group-supervised rehabilitation program was performed three times a week for 8 weeks (two sessions at a rehabilitation gym and one pool session). Outcome measures included the Ottawa Sitting Scale, Berg Balance Scale, modified Activities-specific Balance Confidence Scale, 30-Second Chair Stand Test, 10-Meter Walk Test, Barthel Index, and Scale for the Assessment and Rating of Ataxia. Significant improvements in balance, trunk control, maximal and self-selected walking speed difference, ataxia severity and accomplishment of specific activities of daily living were noted for the whole group at the end of the program. At the individual level, all participants improved beyond the standard error of measurement in at least two outcome measures. Also, most participants reported many perceived improvements related to balance, posture and functional mobility. This study provides encouraging results on the effects of a rehabilitation program for ambulatory people with ARSACS. Group intervention could have a positive impact on their daily lives and improve the health care service offered to this population. Future studies with larger sample sizes including control groups and other forms of ataxia are necessary to validate our results to generalize them.

Intelligent Physical Exercise Training (IPET) in the offshore wind industry: a feasibility study with an adjusted conceptual model

Background

Good physical health and capacity is a requirement for offshore wind service technicians (WTs) who have substantial physical work demands and are exposed to numerous health hazards. Workplace physical exercise has shown promise for improving physical health and work ability among various occupational groups. Therefore, we aimed to assess the feasibility and preliminary efficacy of Intelligent Physical Exercise Training (IPET) among WTs in the offshore wind industry.

Methods

A within-subject design was used to assess the feasibility and preliminary efficacy of IPET (one hour/week individualized exercise during working hours). The intervention period was 12 weeks, with the first eight weeks performed on site as supervised or partly supervised exercise during work hours and the last four weeks planned as home-administered exercise after the seasonal offshore service period. Three assessments, T1 (six months prior to intervention start), T2 (start of intervention) and T3 (end of intervention), of physical health and capacity (self-reported and objective measurements) were conducted and the period between T1 and T2 served as a within-subject control period. Primary outcome was feasibility measured as compliance, adherence, adverse events, and participant acceptability. Descriptive statistics were used to present feasibility outcomes. Preliminary efficacy was reported as mean differences with 95% confidence intervals for health and physical capacity outcomes between T1 and T2, between T2 and T3 and between T1 and T3.

Results

All WTs at the included wind farm (n=24, age: 40 years (SD±8)) participated in the study. No serious adverse events were reported. Compliance and adherence of 95 and 80% respectively, were reached in the eight-week supervised part, but were lower when exercise was home-administered (<20%). Acceptability was high for the supervised part, with 83% indicating that the exercise program worked well and 100% that exercise should be implemented as an integrated part of the working structure. Changes in physical capacity and health indicators, such as VO2max (ml O2/kg/min) at T1 (38.6 (SD±7.2)), T2 (44.1 (SD±9)) and T3 (45.8 (SD±6.5)), may indicate seasonal fluctuations as well as improvements from the intervention.

Conclusion

On-site Intelligent Physical Exercise Training during working hours was feasible and well received among WTs in the offshore wind industry. The proceeding of larger-scale evaluation and implementation is therefore recommended.

Trial registration

ClinicalTrials.gov (Identifier: NCT04995718). Retrospectively registered on August 6, 2021,

The non-modifiable factors age, gender, and genetics influence resistance exercise

Muscle mass and force are key for movement, life quality, and health. It is well established that resistance exercise is a potent anabolic stimulus increasing muscle mass and force. The response of a physiological system to resistance exercise is composed of non-modifiable (i.e., age, gender, genetics) and modifiable factors (i.e., exercise, nutrition, training status, etc.). Both factors are integrated by systemic responses (i.e., molecular signaling, genetic responses, protein metabolism, etc.), consequently resulting in functional and physiological adaptations. Herein, we discuss the influence of non-modifiable factors on resistance exercise: age, gender, and genetics. A solid understanding of the role of non-modifiable factors might help to adjust training regimes towards optimal muscle mass maintenance and health.

Dose-response association of aerobic and muscle-strengthening physical activity with mortality: a national cohort study of 416 420 US adults

OBJECTIVES

To investigate the dose-response association of aerobic physical activity (PA) and muscle-strengthening exercise (MSE) with all-cause mortality.

METHODS

National Health Interview Survey data (1997-2014) were linked to the National Death Index through 2015, which produced a cohort of 416 420 US adults. Cox proportional-hazard models were used to estimate HRs and 95% CIs for the associations of moderate aerobic PA (MPA), vigorous aerobic PA (VPA) and MSE with mortality risk. Models controlled for age, sex, race-ethnicity, income, education, marital status, survey year, smoking status, body mass index and chronic conditions.

RESULTS

Relative to those who engaged in no aerobic PA, substantial mortality risk reduction was associated with 1 hour/week of aerobic PA (HR: 0.85, 95% CI: 0.83 to 0.86) and levelled off at 3 hours/week of aerobic PA (0.73, 0.71 to 0.75). Similar results were observed for men and women and for individuals younger and older than 60 years. MSE conferred additional mortality risk reduction at 1 time/week (0.89, 0.81 to 0.97) and appeared no longer beneficial at 7 times/week (0.99, 0.94 to 1.04).

CONCLUSION

The minimum effective dose of aerobic PA for significant mortality risk reduction was 1 hour/week of MPA or VPA, with additional mortality risk reduction observed up to 3 hours/week. For older adults, only small decreases in mortality risk were observed beyond this duration. Completing MSE in combination with aerobic PA conferred additional mortality risk reduction, with a minimum effective dose of 1-2 times/week.

Aerobic or Muscle-Strengthening Physical Activity: Which Is Better for Health?

ABSTRACT

The Physical Activity Guidelines recommend performing 150 min of moderate- to vigorous-intensity aerobic physical activity (MVPA) per week. These guidelines also recommend muscle-strengthening physical activity (MSPA) on ≥2 d·wk-1 for additional benefits including muscular fitness and bone health. The majority of the scientific evidence supporting the PA recommendations for health comes from studies of MVPA while the possible contributions of MSPA in these findings have been overlooked historically. Emerging evidence suggests that MSPA can independently protect against major cardiometabolic risk factors, chronic diseases, and mortality. Additional data from clinical trials indicate that many of the well-known health benefits of exercise, like improvements in cardiovascular disease risk factors, are more robust with combined MVPA and MSPA. This review will clarify the relative benefits of MSPA versus MVPA on health-related outcomes to determine the best type of PA for health.

Increases in Muscle-Strengthening Activities Among Latinas in Seamos Saludables

BACKGROUND

Only 17% of Latinas meet national physical activity (PA) guidelines for both moderate-to-vigorous aerobic and muscle-strengthening PA. Additional health benefits are derived from the combination of aerobic and muscle-strengthening PA (vs. aerobic alone), yet there is paucity in research on muscle-strengthening activity in Latinas. The aim of this study was to examine changes in muscle-strengthening activity from baseline to 6 and 12 months in Seamos Saludables, a 12-month PA randomized controlled trial for Latinas.

METHODS

A secondary data analysis was conducted among 131 Latinas ages 18-65 years, who were randomized to either a PA Intervention or a Wellness Control. Self-reported muscle-strengthening exercise was measured at baseline, 6 months, and 12 months via adapted muscle-strengthening questions from the Behavioral Risk Factor Surveillance System.

RESULTS

There was a 16-minute/week difference in median minute/week of muscle-strengthening activity between Intervention and Wellness at 6 months (SE = 7.91, p = .04) and 45-minute/week difference at 12 months (SE = 25.80, p = .06) adjusting for baseline. Significantly more PA Intervention participants met muscle-strengthening guidelines of 2 or more days/week at 6 months versus Wellness Control participants (odds ratio [OR] = 4.29, 95% confidence interval [CI] = [1.03, 17.84]).

CONCLUSION

Results from the current study showed that Latinas engaged in muscle-strengthening activity in an intervention that emphasized primarily aerobic PA outcomes, suggesting they may be interested in engaging in muscle-strengthening activities. Future interventions targeting both aerobic and muscle-strengthening activity could achieve greater health improvements and help more Latinas reach the full national PA guidelines.ClinicalTrials.gov Identifier. NCT01583140.

Motivational Factors and Barriers Towards Initiating and Maintaining Strength Training in Women: a Systematic Review and Meta-synthesis

Strength training (ST) or resistance training is important in the development and maintenance of musculoskeletal and cardiovascular health in women of all ages; however, uptake of ST amongst women is low. To improve female musculoskeletal health, it is vital that more women are encouraged to participate in ST to maintain musculoskeletal integrity. This systematic review aimed to identify motivators and barriers to women initiating and maintaining ST. Following protocol registration and systematic search, studies were included if they were primary qualitative or mixed-method studies reporting participant verbatim quotes, included adult women, and focused on motivators and barriers for ST. Searches generated 2534 articles from 3 databases, with 20 studies (N = 402 participants) meeting eligibility criteria. Participant quotes and authors' interpretations were analysed using thematic synthesis. The most frequently observed barriers were gender-based stigmas, discouragement, and negative comments, particularly in women currently engaging in ST. Other factors associated with poor adherence included boredom, poor knowledge of ST, poor gym accessibility, lack of supervision or routine, and difficulty in balancing work and family life. Social support from friends and family, words of affirmation, and accompaniment facilitated ST, particularly in older women. Women who saw expected results such as weight loss were motivated to continue ST. Interventions aimed at increasing participation in ST amongst women should focus on the specific benefits valued by women and the dissemination of accurate information to counter misconceptions and increase knowledge. The adaptation of gym environments to make them more welcoming to women, and reduce gender-focused criticism, is especially important.

A scoping review of interventions to improve strength training participation

Background

Low participation rates (1–31%) and unique barriers to strength training (e.g., specialized knowledge, equipment, perceived complexity) suggest effective strength training interventions may differ from effective aerobic or general physical activity interventions. The purpose of this scoping review was to examine interventions used to improve strength training participation through mapping theory, intervention characteristics, prescription parameters, and behaviour change techniques.

Methods

Recommendations by Levac et al. (2010) and PRISMA-ScR were followed in the conduct and reporting of this review, respectively. Patients and exercise professionals participated in developing the research question and data extraction form, interpreting the findings, and drafting the manuscript. Medline, Embase, PsycINFO, CINAHL, SPORTDiscus, and PubMed databases (inception–December 2020) were searched. The inclusion criteria were (a) original peer-reviewed articles and grey literature, (b) intervention study design, and (c) behavioural interventions targeted towards improving strength training participation. Two reviewers performed data screening, extraction, and coding. The interventions were coded using the Behaviour Change Technique Taxonomy version 1. Data were synthesized using descriptive and frequency reporting.

Results

Twenty-seven unique interventions met the inclusion criteria. Social cognitive theory (n = 9), the transtheoretical model (n = 4), and self-determination theory (n = 2) were the only behaviour change theories used. Almost all the interventions were delivered face-to-face (n = 25), with the majority delivered by an exercise specialist (n = 23) in community or home settings (n = 24), with high variability in exercise prescription parameters. Instructions on how to perform the behaviour, behavioural practice, graded tasks, goal setting, adding objects to the environment (e.g., providing equipment), and using a credible source (e.g., exercise specialist delivery) comprised the most common behaviour change techniques.

Conclusions

Our results highlight gaps in theory, intervention delivery, exercise prescription parameters, and behaviour change techniques for future interventions to examine and improve our understanding of how to most effectively influence strength training participation.

Minimal-Dose Resistance Training for Improving Muscle Mass, Strength, and Function: A Narrative Review of Current Evidence and Practical Considerations

Resistance training (RT) is the only non-pharmacological intervention known to consistently improve, and therefore offset age-related declines in, skeletal muscle mass, strength, and power. RT is also associated with various health benefits that are underappreciated compared with the perceived benefits of aerobic-based exercise. For example, RT participation is associated with reduced all-cause and cancer-related mortality and reduced incidence of cardiovascular disease, hypertension, and symptoms of both anxiety and depression. Despite these benefits, participation in RT remains low, likely due to numerous factors including time constraints, a high-perceived difficulty, and limited access to facilities and equipment. Identification of RT strategies that limit barriers to participation may increase engagement in RT and subsequently improve population health outcomes. Across the lifespan, declines in strength and power occur up to eight times faster than the loss of muscle mass, and are more strongly associated with functional impairments and risks of morbidity and mortality. Strategies to maximise healthspan should therefore arguably focus more on improving or maintaining muscle strength and power than on increasing muscle mass per se. Accumulating evidence suggests that minimal doses of RT, characterised by lower session volumes than in traditional RT guidelines, together with either (1) higher training intensities/loads performed at lower frequencies (i.e. low-volume, high-load RT) or (2) lower training intensities/loads performed at higher frequencies and with minimal-to-no equipment (i.e. resistance 'exercise snacking'), can improve strength and functional ability in younger and older adults. Such minimal-dose approaches to RT have the potential to minimise various barriers to participation, and may have positive implications for the feasibility and scalability of RT. In addition, brief but frequent minimal-dose RT approaches (i.e. resistance 'exercise snacking') may provide additional benefits for interrupting sedentary behaviour patterns associated with increased cardiometabolic risk. Compared to traditional approaches, minimal-dose RT may also limit negative affective responses, such as increased discomfort and lowered enjoyment, both of which are associated with higher training volumes and may negatively influence exercise adherence. A number of practical factors, including the selection of exercises that target major muscle groups and challenge both balance and the stabilising musculature, may influence the effectiveness of minimal-dose RT on outcomes such as improved independence and quality-of-life in older adults. This narrative review aims to summarise the evidence for minimal-dose RT as a strategy for preserving muscle strength and functional ability across the lifespan, and to discuss practical models and considerations for the application of minimal-dose RT approaches.

The Comparison of the Effects between Continuous and Intermittent Energy Restriction in Short-Term Bodyweight Loss for Sedentary Population: A Randomized, Double-Blind, Controlled Trial

Objective: To compare the effects of continuous energy restriction (CER) and intermittent energy restriction (IER) in bodyweight loss plan in sedentary individuals with normal bodyweight and explore the influence factors of effect and individual retention. Methods: 26 participants were recruited in this randomized controlled and double-blinded trial and allocated to CER and IER groups. Bodyweight (BW), body mass index (BMI), and resting metabolic rate (RMR) would be collected before and after a 4-week (28 days) plan which included energy restriction (CER or IER) and moderate-intensity exercise. Daily intake of three major nutrients (protein, carbohydrate, fat) and calories were recorded. Results: A significant decrease in BW and BMI were reported within each group. No statistically significant difference in the change of RMR in CERG. No statistically significant difference was reported in the effect between groups, neither as well the intake of total calories, three major nutrients, and individual plan retention. The influence factors of IER and CER are different. Conclusion: Both CER and IER are effective and safe energy restriction strategies in the short term. Daily energy intake and physical exercise are important to both IER and CER.

Effects of clinical Pilates exercises on cardiovascular endurance and psychosomatic parameters on primary caregivers of special needs children: A randomized controlled trial

OBJECTIVE

Our objective was to investigate the effects of clinical Pilates exercises (CPE), applied to the primary caregivers of special needs children, on cardiovascular endurance (CVE) and psychosomatic parameters in comparison to a control group.

METHODS

Fifty-five primary caregivers of special needs children, divided into two groups as the CPE and control groups, were included in the study. The six-minute walk test, the Fatigue Severity Scale, the Coping Orientation for Problems Experienced (COPE) Inventory, the Beck Depression Inventory and the State-Trait Anxiety Inventory were used to measure CVE, fatigue severity, attitudes toward coping with problems, depression levels and anxiety levels, respectively.

RESULTS

Statistically significant differences between the groups in favor of the CPE group were found concerning the denial parameter of COPE, fatigue (which was the primary outcome), depression and anxiety (all p values < 0.05). Statistically significant intragroup comparison differences were only detected in the CPE group in the fatigue, depression, anxiety and COPE (use of instrumental and emotional social support and focus on and venting of emotions) questionnaire results (all p values < 0.05).

CONCLUSIONS

CPE are an applicable and effective method for the primary caregivers of special needs children in improving psychosomatic parameters, albeit not effective for CVE. It is recommended to investigate the long-term effects of clinical Pilates exercises on a similar group.

Delivery Approaches Within Exercise Referral Schemes: A Survey of Current Practice in England

BACKGROUND

Exercise referral schemes in England offer referred participants an opportunity to take part in an exercise prescription in a nonclinical environment. The aim of these schemes is to effect clinical health benefits, yet there is limited evidence of schemes' effectiveness, which could be due to the heterogeneity in design, implementation, and evaluation. Additionally, there has been no concerted effort to map program characteristics.

OBJECTIVE

To understand what key delivery approaches are currently used within exercise referral schemes in England.

METHODS

Across England, a total of 30 schemes with a combined total of 85,259 exercise referral scheme participants completed a Consensus on Exercise Reporting Template-guided questionnaire. The questionnaire explored program delivery, nonexercise components, and program management.

RESULTS

Results found that program delivery varied, though many schemes were typically 12 weeks in length, offering participants 2 exercise sessions in a fitness gym or studio per week, using a combination of exercises. Adherence was typically measured through attendance, with nonexercise components and program management varying by scheme.

CONCLUSION

This research provides a snapshot of current delivery approaches and supports the development of a large-scale mapping exercise to review further schemes across the whole of the United Kingdom in order to provide evidence of best practice and delivery approaches nationwide.

Advancing health-enhancing physical activity at workplace: Sport4Heath 2020 scientific forum

Physical activity at workplace can positively impact various wellbeing outcomes yet developing and implementing exercise programs that are straightforward, time-efficient and widely applicable remains a notable public health challenge. Sport4Health Network (SPORT4H) project co-funded by the European Union Erasmus+ programme unites health and sport professionals in an effort to encourage participation in physical activity among working population and reduce health risk factors for lifestyle diseases. A two-day SPORT4H scientific forum on non-traditional types of work-place exercise interventions was organized from 14th to 15th September 2020, to critically evaluate evidence on stretching and resistance exercise programs targeted to working population in aim to identify knowledge gaps and future areas of research and application. Evidence on traditional interventions (e.g., walking initiatives, active travel) appears more robust while only few studies evaluated the applicability of non-traditional PA programs in working population. However, we identified a moderate-to-strong link between non-traditional PA programs at the workplace and several health-related physical fitness indices, with resistance exercise turned out to be superior to other exercise interventions analyzed. It appears that low-volume high-repetition resistance exercise favorably affects musculoskeletal disorders, work performance and health-related quality of life in employees who exercised at least 3 times per week for over 8 weeks. In terms of safety, screening protocols should employ health-related questionnaires, adopting a progressive training load, and prescribing training programs to individual participants' needs. Implementing non-traditional PA programs aimed to improve health-related physical fitness and counteract sedentary behavior at workplace might be therefore of utmost importance to contribute to health promotion in this sensible population.

Protocol for Minute Calisthenics: a randomized controlled study of a daily, habit-based, bodyweight resistance training program

BACKGROUND

Resistance-training (RT) provides significant health benefits. However, roughly 3/4 of adults in the United States do not meet current Physical Activity Guidelines in this regard. There has been a call for research examining the effectiveness of interventions to increase participation in physical activity and to better understand the dose response relationship upon health outcomes. Studies are needed that assess the effectiveness of RT programs that are time-efficient and simple to perform. This fully-powered, randomized controlled study will assess a habit-based RT program consisting of one set of push-ups, angled-rows, and bodyweight-squats performed every weekday for 12-24 weeks in untrained individuals.

METHODS

Forty-60 untrained osteopathic medical students and college/university employees who work in an office setting will be recruited and randomized (1:1) to an intervention or waitlist control group. After 12-week follow-up assessment, the intervention group will continue the program and the control group will initiate the program for 12 weeks. In addition to the equipment and training needed to safely perform the exercises, all participants will receive training in the Tiny Habits® Method (THM) and digital coaching for the duration of the study. Participants will complete weekly assessments regarding the program during their initial 12-week intervention phase. The primary outcome is the change from baseline to 12 weeks in the intervention group versus the control group, in the combined number of repetitions performed in one set of each of the three exercises (composite repetitions) under a standardized protocol. Secondary outcomes include adherence to and satisfaction with the program, and change from baseline to 12- and 24-week follow-up in blood pressure, fasting lipid panel, hemoglobin A1c, body mass index, anthropometry, body composition, mid-thigh muscle thickness, and habit strength.

DISCUSSION

This study will evaluate a simple, habit-based RT intervention in untrained individuals. The approach is unique in that it utilizes brief but frequent bodyweight exercises and, via the THM, focuses on consistency and habit formation first, with effort being increased as participants are motivated and able. If effective, the program can be easily scaled for wider adoption.

TRIAL REGISTRATION

This study was prospectively registered at ClinicalTrials.gov, identifier NCT04207567 , on December 23rd, 2019.

Using smartphone accelerometer data to obtain scientific mechanical-biological descriptors of resistance exercise training

Background

Single repetition, contraction-phase specific and total time-under-tension (TUT) are crucial mechano-biological descriptors associated with distinct morphological, molecular and metabolic muscular adaptations in response to exercise, rehabilitation and/or fighting sarcopenia. However, to date, no simple, reliable and valid method has been developed to measure these descriptors.

Objective

In this study we aimed to test whether accelerometer data obtained from a standard smartphone placed on the weight stack can be used to extract single repetition, contraction-phase specific and total TUT.

Methods

Twenty-two participants performed two sets of ten repetitions of their 60% one repetition maximum with a self-paced velocity on nine commonly used resistance exercise machines. Two identical smartphones were attached on the resistance exercise weight stacks and recorded all user-exerted accelerations. An algorithm extracted the number of repetitions, single repetition, contraction-phase specific and total TUT. All exercises were video-recorded. The TUT determined from the algorithmically-derived mechano-biological descriptors was compared with the video recordings that served as the gold standard. The agreement between the methods was examined using Limits of Agreement (LoA). The association was calculated using the Pearson correlation coefficients and interrater reliability was determined using the intraclass correlation coefficient (ICC 2.1).

Results

The error rate of the algorithmic detection of single repetitions derived from two smartphones accelerometers was 0.16%. Comparing algorithmically-derived, contraction-phase specific TUT against video, showed a high degree of correlation (r>0.93) for all exercise machines. Agreement between the two methods was high on all exercise machines as follows: LoA ranged from -0.3 to 0.3 seconds for single repetition TUT (0.1% of mean TUT), from -0.6 to 0.3 seconds for concentric contraction TUT (7.1% of mean TUT), from -0.3 to 0.5 seconds for eccentric contraction TUT (4.1% of mean TUT) and from -1.9 to 1.1 seconds for total TUT (0.5% of mean TUT). Interrater reliability for single repetition, contraction-phase specific TUT was high (ICC > 0.99).

Conclusion

Data from smartphone accelerometer derived resistance exercise can be used to validly and reliably extract crucial mechano-biological descriptors. Moreover, the presented multi-analytical algorithmic approach enables researchers and clinicians to reliably and validly report missing mechano-biological descriptors.

Evaluation of the Lower Limb Muscles' Electromyographic Activity during the Leg Press Exercise and Its Variants: A Systematic Review

The aim of this study was to analyze the literature on muscle activation measured by surface electromyography (sEMG) of the muscles recruited when performing the leg press exercise and its variants. The Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed to report this review. The search was carried out using the PubMed, Scopus, and Web of Science electronic databases. The articles selected met the following inclusion criteria: (a) a cross-sectional or longitudinal study design; (b) neuromuscular activation assessed during the leg press exercise, or its variants; (c) muscle activation data collected using sEMG; and (d) study samples comprising healthy and trained participants. The main findings indicate that the leg press exercise elicited the greatest sEMG activity from the quadriceps muscle complex, which was shown to be greater as the knee flexion angle increased. In conclusion, (1) the vastus lateralis and vastus medialis elicited the greatest muscle activation during the leg press exercise, followed closely by the rectus femoris; (2) the biceps femoris and the gastrocnemius medialis showed greater muscular activity as the knee reached full extension, whereas the vastus lateralis and medialis, the rectus femoris, and the tibialis anterior showed a decreasing muscular activity pattern as the knee reached full extension; (3) evidence on the influence of kinematics modifications over sEMG during leg press variants is still not compelling as very few studies match their findings.

Fatigue, quality of life and physical fitness following an exercise intervention in multiple myeloma survivors (MASCOT): an exploratory randomised Phase 2 trial utilising a modified Zelen design

Background

Exercise may improve fatigue in multiple myeloma survivors, but trial evidence is limited, and exercise may be perceived as risky in this older patient group with osteolytic bone destruction.

Methods

In this Phase 2 Zelen trial, multiple myeloma survivors who had completed treatment at least 6 weeks ago, or were on maintenance only, were enrolled in a cohort study and randomly assigned to usual care or a 6-month exercise programme of tailored aerobic and resistance training. Outcome assessors and usual care participants were masked. The primary outcome was the FACIT-F fatigue score with higher scores denoting less fatigue.

Results

During 2014–2016, 131 participants were randomised 3:1 to intervention (n = 89) or usual care (n = 42) to allow for patients declining allocation to the exercise arm. There was no difference between groups in fatigue at 3 months (between-group mean difference: 1.6 [95% CI: −1.1–4.3]) or 6 months (0.3 [95% CI: −2.6–3.1]). Muscle strength improved at 3 months (8.4 kg [95% CI: 0.5–16.3]) and 6 months (10.8 kg [95% CI: 1.2–20.5]). Using per-protocol analysis, cardiovascular fitness improved at 3 months (+1.2 ml/kg/min [95% CI: 0.3–3.7]). In participants with clinical fatigue (n = 17), there was a trend towards less fatigue with exercise over 6 months (6.3 [95% CI: −0.6–13.3]). There were no serious adverse events.

Conclusions

Exercise appeared safe and improved muscle strength and cardiovascular fitness, but benefits in fatigue appeared limited to participants with clinical fatigue at baseline. Future studies should focus on patients with clinical fatigue.

Clinical trial registration

The study was registered with ISRCTN (38480455) and is completed.

High-intensity Interval Training Promotes the Shift to a Health-Supporting Dietary Pattern in Young Adults

A healthy lifestyle is based on a correct diet and regular exercise. Little is known about the effect of different types of exercise on dietary preferences. To address the question of whether high-intensity interval training (HIIT) could modulate spontaneous food choices, an experimental study was carried out on 32 young, healthy normal-weight subjects. The spontaneous diet of each subject has been monitored over nine weeks of indoor-cycling training, divided into three mesocycles with an incremental pattern: total energy intake, macronutrients and micronutrients have been analysed. A two-way mixed model has been used to assess differences in dietary variables; a principal factor analysis has been performed to identify sample subgroups. An increased energy intake (+17.8% at T3; p < 0.01) has been observed, although macronutrients' proportions did not vary over time, without differences between sexes. An increase of free fat mass was found in the last mesocycle (+3.8%), without an augmentation of body weight, when, despite the increased training load, a stabilization of energy intake occurred. Three different subgroups characterized by different dietary modifications could be identified among participants that showed a common trend towards a healthier diet. Nine weeks of HIIT promoted a spontaneous modulation of food choices and regulation of dietary intake in young normal-weight subjects aged 21-24. Importantly, this life-period is critical to lay the foundation of correct lifestyles to prevent metabolic diseases and secure a healthy future with advancing age.

Electromyographic activity in deadlift exercise and its variants. A systematic review

The main purpose of this review was to systematically analyze the literature concerning studies which have investigated muscle activation when performing the Deadlift exercise and its variants. This study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Statement (PRISMA). Original studies from inception until March 2019 were sourced from four electronic databases including PubMed, OVID, Scopus and Web of Science. Inclusion criteria were as follows: (a) a cross-sectional or longitudinal study design; (b) evaluation of neuromuscular activation during Deadlift exercise or variants; (c) inclusion of healthy and trained participants, with no injury issues at least for six months before measurements; and (d) analyzed "sEMG amplitude", "muscle activation" or "muscular activity" with surface electromyography (sEMG) devices. Major findings indicate that the biceps femoris is the most studied muscle, followed by gluteus maximus, vastus lateralis and erector spinae. Erector spinae and quadriceps muscles reported greater activation than gluteus maximus and biceps femoris muscles during Deadlift exercise and its variants. However, the Romanian Deadlift is associated with lower activation for erector spinae than for biceps femoris and semitendinosus. Deadlift also showed greater activation of the quadriceps muscles than the gluteus maximus and hamstring muscles. In general, semitendinosus muscle activation predominates over that of biceps femoris within hamstring muscles complex. In conclusion 1) Biceps femoris is the most evaluated muscle, followed by gluteus maximus, vastus lateralis and erector spinae during Deadlift exercises; 2) Erector spinae and quadriceps muscles are more activated than gluteus maximus and biceps femoris muscles within Deadlift exercises; 3) Within the hamstring muscles complex, semitendinosus elicits slightly greater muscle activation than biceps femoris during Deadlift exercises; and 4) A unified criterion upon methodology is necessary in order to report reliable outcomes when using surface electromyography recordings.

Mobility Improvements are Found in Older Veterans After 6-Months of Gerofit Regardless of BMI Classification

Veterans represent a unique population of older adults as they are more likely to self-report disability and be overweight or obese compared to the general population. We sought to compare changes in mobility function across the obesity spectrum in older Veterans participating in six-months of Gerofit, a clinical exercise program. 270 Veterans completed baseline, three, and six-month functional assessment and were divided post-hoc into groups: normal weight, overweight, and obese. Physical function assessment included: ten-meter walk time, six-minute walk distance, 30-second chair stands, and eight-foot up-and-go time. No significant weight x time interactions were found for any measure. However, significant (P<0.02) improvements were found for all mobility measures from baseline to three-months and maintained at six-months. Six-months of participation in Gerofit, if enacted nationwide, appears to be one way to improve mobility and function in older Veterans at high risk for disability regardless of weight status.

Presence of Spotters Improves Bench Press Performance: A Deception Study

Sheridan, A, Marchant, DC, Williams, EL, Jones, HS, Hewitt, PA, and Sparks, SA. Presence of spotters improves bench press performance: a deception study. J Strength Cond Res 33(7): 1755-1761, 2019-Resistance exercise is a widely used method of physical training in both recreational exercise and athletic populations. The use of training partners and spotters during resistance exercise is widespread, but little is known about the effect of the presence of these individuals on exercise performance. The purpose of the current study was to investigate the effect of spotter presence on bench press performance. Twelve recreationally trained participants (age, 21.3 ± 0.8 years, height, 1.82 ± 0.1 m, and mass, 84.8 ± 11.1 kg) performed 2 trials of 3 sets to failure at 60% of 1 repetition maximum on separate occasions. The 2 trials consisted of spotters being explicitly present or hidden from view (deception). During the trials, total repetitions (reps), total weight lifted, ratings of perceived exertion (RPE), and self-efficacy were measured. Total reps and weight lifted were significantly greater with spotters (difference = 4.5 reps, t = 5.68, p < 0.001 and difference = 209.6 kg, t = 5.65, p < 0.001, respectively). Although RPE and local RPE were significantly elevated in the deception trials (difference = 0.78, f = 6.16, p = 0.030 and difference = 0.81, f = 5.89, p = 0.034, respectively), self-efficacy was significantly reduced (difference = 1.58, f = 26.90, p < 0.001). This study demonstrates that resistance exercise is improved by the presence of spotters, which is facilitated by reduced RPE and increased self-efficacy. This has important implications for athletes and clients, who should perform resistance exercise in the proximity of others, to maximize total work performed.

Comparison of single- and multi-joint lower body resistance training upon strength increases in recreationally active males and females: a within-participant unilateral training study

The present study compared strength increases resulting from either single-joint (SJ) or multi-joint (MJ) lower body resistance exercise. A within-participants design was utilised. Ten recreationally active participants (males; n=5, and females; n=5) had their lower limbs randomly allocated to perform both unilateral MJ (leg press; LP) and unilateral SJ (knee extension; KE, and seated knee flexion; KF) exercises. Participants trained 2 d.week-1 for 6 weeks. Pre- and post-intervention maximal strength (1-repetition maximum; 1RM) was measured for leg press, knee extension, and seated knee flexion exercises. Statistically significant strength increases occurred for both SJ and MJ groups, with significantly greater increases in 1RM for the MJ compared to the SJ group (p < 0.001 for all exercises). This study supports the use of MJ exercise for strength increases across lower body MJ and SJ movements, suggesting a time-efficient, and simple approach to resistance training may be efficacious. This might serve to promote greater adherence in the lay population as well as serving useful for rehabilitation professionals and strength and conditioning coaches in managing resistance exercise around skill/sport specific training.

Resistance training frequency and skeletal muscle hypertrophy: A review of available evidence

OBJECTIVES

Current reviews and position stands on resistance training (RT) frequency and associated muscular hypertrophy are based on limited evidence holding implications for practical application and program design. Considering that several recent studies have shed new light on this topic, the present paper aimed to collate the available evidence on RT frequency and the associated effect on muscular hypertrophy.

DESIGN

Review article.

METHODS

Articles for this review were obtained through searches of PubMed/MEDLINE, Scopus, and SPORTDiscus. Both volume-equated (studies in which RT frequency is the only manipulated variable) and non-volume-equated (studies in which both RT frequency and volume are the manipulated variables) study designs were considered.

RESULTS

Ten studies were found that used direct site-specific measures of hypertrophy, and, in general, reported that RT once per week elicits similar hypertrophy compared to training two or three times per week. In addition, 21 studies compared different RT frequencies and used lean body mass devices to estimate muscular growth; most of which reported no significant differences between training frequencies. Five studies were identified that used circumference for estimating muscular growth. These studies provided findings that are difficult to interpret, considering that circumference is a crude measure of hypertrophy (i.e., it does not allow for the differentiation between adipose tissue, intracellular fluids, and muscle mass).

CONCLUSIONS

Based on the results of this review, it appears that under volume-equated conditions, RT frequency does not seem to have a pronounced effect of gains in muscle mass.

The effects of exercise referral schemes in the United Kingdom in those with cardiovascular, mental health, and musculoskeletal disorders: a preliminary systematic review

BACKGROUND

Exercise referral schemes within clinical populations may offer benefits for inactive and sedentary individuals, and improve and aid treatment of specific health disorders. This systematic review aims to provide an overview, and examine the impact, of exercise referral schemes in patients with cardiovascular, mental health, and musculoskeletal disorders. This review focuses on populations within the United Kingdom (UK) only, with an aim to inform national exercise referral policies and guidelines.

METHOD

Data was collected from specific sources using validated methodology through PRISMA. Systematic searches were performed using Locate, PubMed, Scopus and Pro Quest: Public Health databases. Thirteen studies met inclusion criteria set for each sub group. This included that all studies aimed to prevent, observe, or decrease ill-health relating to the disorder, participants over the age of sixteen, and health disorders and outcomes were reviewed. All studies were conducted in the UK only.

RESULTS

In the 13 articles, a variety of modes and types of exercise were utilised. One-to-one supervised exercise sessions based in a gym environment were most frequently employed. Results showed that longer length schemes (20+ weeks) produced better health outcomes, and had higher adherence to physical activity prescribed, than those of shorter length (8-12 weeks). In patients referred with cardiovascular disorders, cardiovascular-related measures showed significant decreases including blood pressure. Schemes increased physical activity levels over the length of scheme for all disorders.

CONCLUSION

Longer length schemes (20+ weeks) improved adherence to physical activity prescribed over the course of the scheme, and could support longer term exercise adherence upon completion, however additional research on larger samples should examine this further. An implication is that schemes currently recommended in guidelines do not tailor programmes to support long term adherence to exercise, which must be addressed. There is currently a lack of research examining programmes tailored to suit the individual's health conditions thus further research might allow providers to tailor delivery and build upon policy recommendations in the UK.

User Experience, Actual Use, and Effectiveness of an Information Communication Technology-Supported Home Exercise Program for Pre-Frail Older Adults

Objective

The main objective of this study was to investigate the use and user experience of an Information Communication Technology-supported home exercise program when offered for independent use to pre-frail older adults. Our secondary aim was to explore whether the program improved quality of life and health status compared to a control group.

Methods

A cohort multiple randomized controlled trail is being performed. Physically pre-frail older adults (65-75 years) living independently at home were included and randomly assigned to a control group or an intervention group. The intervention group received a home exercise program (strength, balance, and flexibility exercises) for a minimal duration of 12 weeks. The control group received usual care. Primary outcomes were: use of the intervention (frequency and duration), adherence to a 3-day exercise protocol and user experience [System Usability Scale (SUS); rating 1-10]. Secondary outcomes were quality of life measured with the SF12 (Physical Component Scale and Mental Component Scale) and health status (EQ-5D), assessed before the study starts and after 12 weeks of exercising.

Results

Thirty-seven independently living older adults participated in the study. Sixteen participants were allocated to the intervention group and 21 to the control group. The average score on the SUS was 84.2 (±13.3), almost reaching an excellent score. Participants rated the intervention with an 8.5. Eighty percent of the participants finished the 12 week exercise protocol. The adherence to the 3-day exercise protocol was 68%. Participants in the intervention group trained on average 2.2 times (±1.3) each week. The mean duration of login for each exercise session was 24 min. The Mental Component Scale of the SF12 was significantly higher in the intervention group compared to the control group. A trend was seen in the change over time in the health status between groups.

Conclusions

This study provides evidence that a home-based exercise program is easy to use and has potential in improving quality of life and health status of pre-frail older adults who live at home. However, further refinement of the program is required to improve adherence and maximize the benefits and potential of exercising in the home environment.

Trial Registration

Unique Identifier: NTR5304. URL: http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=5304.

A minimal dose approach to resistance training for the older adult; the prophylactic for aging

A plethora of research has supported the numerous health benefits of resistance training as we age, including positive relationships between muscular strength, muscle mass and reduced all-cause mortality. As such, resistance training has been referred to as medicine. However, participation and adherence remains low, with time constraints and perceived difficulty often cited as barriers to resistance training. With this in mind, we aimed to summarise the benefits which might be obtained as a product of a minimal dose approach. In this sense, participation in resistance training might serve as a prophylactic to delay or prevent the onset of biological aging. A short review of studies reporting considerable health benefits resulting from low volume resistance training participation is presented, specifically considering the training time, frequency, intensity of effort, and exercises performed. Research supports the considerable physiological and psychological health benefits from resistance training and suggests that these can be obtained using a minimal dose approach (e.g. ≤60min, 2d-wk^-1), using uncomplicated equipment/methods (e.g. weight stack machines). Our hope is that discussion of these specific recommendations, and provision of an example minimal dose workout, will promote resistance training participation by persons who might otherwise have not engaged. We also encourage medical professionals to use this information to prescribe resistance exercise like a drug whilst having an awareness of the health benefits and uncomplicated methods.

A higher effort-based paradigm in physical activity and exercise for public health: making the case for a greater emphasis on resistance training

It is well known that physical activity and exercise is associated with a lower risk of a range of morbidities and all-cause mortality. Further, it appears that risk reductions are greater when physical activity and/or exercise is performed at a higher intensity of effort. Why this may be the case is perhaps explained by the accumulating evidence linking physical fitness and performance outcomes (e.g. cardiorespiratory fitness, strength, and muscle mass) also to morbidity and mortality risk. Current guidelines about the performance of moderate/vigorous physical activity using aerobic exercise modes focuses upon the accumulation of a minimum volume of physical activity and/or exercise, and have thus far produced disappointing outcomes. As such there has been increased interest in the use of higher effort physical activity and exercise as being potentially more efficacious. Though there is currently debate as to the effectiveness of public health prescription based around higher effort physical activity and exercise, most discussion around this has focused upon modes considered to be traditionally 'aerobic' (e.g. running, cycling, rowing, swimming etc.). A mode customarily performed to a relatively high intensity of effort that we believe has been overlooked is resistance training. Current guidelines do include recommendations to engage in 'muscle strengthening activities' though there has been very little emphasis upon these modes in either research or public health effort. As such the purpose of this debate article is to discuss the emerging higher effort paradigm in physical activity and exercise for public health and to make a case for why there should be a greater emphasis placed upon resistance training as a mode in this paradigm shift.

Effect of concurrent resistance and sprint training on body composition and cardiometabolic health indicators in masters cyclists

In older previously sedentary individuals endurance training imposes a more effective stimulus to enhance cardiometabolic health compared with resistance or sprint training. We examined the effect of replacing a portion of endurance training with combined resistance and/or sprint training and how this influences cardiometabolic health indicators in masters endurance cyclists. Twenty-seven well-trained male road cyclists (53.7±8.2 years) were allocated to a resistance and track sprint-cycling training group (RTC, n=10), an endurance and track sprint-cycling group (ETC, n=7) or a control endurance group (CTRL, n=10). Both the RTC and ETC groups completed a 12-week intervention of specific training while the CTRL group maintained their endurance training load. Lower limb lean mass (LLM), trunk fat mass (TFM), fasting blood glucose (FBG), total cholesterol (TC), triglycerides (TG), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were measured before and after the intervention period. TFM decreased for all groups (P<0.05) while LLM significantly increased for RTC and ETC groups (P<0.05). No significant between group or time effects were observed for FBG, TC, TG, SBP, or DBP. The results suggest that replacing a portion of endurance training with 12 weeks of ETC or RTC training favourably affects body composition by lowering TFM and increasing LLM without negatively affecting cardiometabolic health indicators in well-trained masters endurance cyclists.

Can we use the 6-minute step test instead of the 6-minute walking test? An observational study

OBJECTIVE

To verify whether or not heart rate is maintained below the calculated submaximal level in healthy, sedentary subjects when they perform the 6-minute step test (6MST) and the 6-minute walking test (6MWT), and to compare the maximal heart rate achieved by the subjects at the end of each test.

DESIGN

Observational, cross-sectional study.

SETTING

One tertiary centre.

PARTICIPANTS

Two hundred and fifty-three participants from a pool of 330 healthy and sedentary subjects between 20 and 80 years of age.

INTERVENTIONS

Both the 6MWT and the 6MST were performed in accordance with the American Thoracic Society's statement. Dyspnoea, blood pressure, oxygen saturation and heart rate were measured before and after each test.

RESULTS

Mean heart rate immediately after the 6MST was significantly higher than mean heart rate immediately after the 6MWT {125 [standard deviation (SD) 19] vs 111 (SD 17) beats/minute; mean difference 13 (95% confidence interval of the difference 10 to 16); P<0.001}. Moreover, mean heart rate during (3minutes after commencement) the 6MST [118 (SD 18) beats/minute] was statistically higher than mean heart rate at the end of the 6MWT [111 (SD 18) beats/minute; P<0.001]. None of the subjects achieved the calculated submaximal heart rate.

CONCLUSIONS

The 6MST and 6MWT are safe and produce submaximal effort in healthy participants. However, they are not interchangeable, and the 6MST requires more energy than the 6MWT.

Relationship between physical activity and cognitive function in apparently healthy young to middle-aged adults: A systematic review

OBJECTIVES

There is increasing evidence that physical activity (PA) positively affects cognitive function (CF). Existing research has focussed on this association in children and the elderly, with less research available in young to middle-aged adults who constitute a substantial proportion of the population.

DESIGN

A systematic review investigating the relationship between habitual PA (≥12 months) and CF in young to middle-aged adults (18-50 years).

METHODS

A search was conducted using AMED, CINAHL, MEDLINE, PsychINFO, AUSPORT MED and SPORTDiscus databases. Eligible studies had to report descriptive statistics for CF and PA levels in healthy participants 18-50 years. Effect sizes (ES) (Hedges g) were calculated where possible.

RESULTS

The initial search netted 26,988 potentially relevant manuscripts, with four more identified through hand searching. Fourteen were included for review. A range of validated platforms assessed CF across three domains: executive function (12 studies), memory (four studies) and processing speed (seven studies). Habitual PA was assessed via questionnaire/self-report methods (n=13, 8 validated) or accelerometers (n=1). In studies of executive function, five found a significant ES in favour of higher PA, ranging from small to large. Although three of four studies in the memory domain reported a significant benefit of higher PA, there was only one significant ES, which favoured low PA. Only one study examining processing speed had a significant ES, favouring higher PA.

CONCLUSIONS

A limited body of evidence supports a positive effect of PA on CF in young to middle-aged adults. Further research into this relationship at this age stage is warranted.

Exercise patterns, ingestive behaviors, and energy balance

Ingestive and exercise behaviors are important determinants of whole body energy balance and weight control. An acute bout of exercise generates a transient energy deficit, which is only partially compensated for by food intake at the next eating occasion or within the next day (loose dietary coupling). Such an energy deficit, when repeated chronically, leads to moderate weight loss and improved body composition. For this narrative review, we assessed the effects of exercise patterns on energy intake, energy balance, and weight control in adults primarily using results from randomized acute exercise and chronic training studies. The patterns assessed were exercise mode (e.g. resistance, aerobic exercise), intensity, duration, time of day, and frequency. The body of evidence indicates that exercise training frequency and quantity are influential for weight loss. Aerobic training is superior to resistance training for weight loss, although resistance training helps preserve lean body mass better. Weight loss does not differ among different intensities when energy expenditure is matched by adjusting duration. Differing patterns of physical activity exhibited by normal weight, overweight, and obese people during weekdays and weekend days are consistent with their weight status; leaner people are more physically active. Collectively, these findings support acute and chronic exercise patterns as important modifiable behaviors to improve energy balance and weight control in adults while having minor effects on absolute energy intake.

Nutrition programs enhance exercise effects on body composition and resting blood pressure

The purpose of our study was to examine the effects of exercise alone and exercise combined with specific nutrition programs on body composition and resting blood pressure rate. Adult participants (99 women, 22 men; aged 20-86 years) completed a combined strength and endurance exercise program (Exercise Only), or in conjunction with 1 of 2 nutrition plans (Exercise/Protein; Exercise/Protein/Diet). The Exercise-Only group performed 1 set of 9 resistance machines regimens interspersed with 3 bouts of recumbent cycling (5 minutes each). The Exercise/Protein group performed the same exercise program as Exercise-Only group, plus consumed 1.5 g of protein per kg of ideal body weight on a daily basis. The Exercise/Protein/Diet group followed an identical Exercise/Protein protocol along with a restricted daily caloric intake (1200-1500 cals/day for women; 1500-1800 cals/day for men). After 10 weeks of training, the Exercise/Protein group attained greater increases (P < 0.05) in lean weight and greater decreases (P < 0.05) in diastolic blood pressure (DBP) rate than the Exercise-Only group. The Exercise/Protein/Diet group experienced greater reductions (P < 0.05) in body weight, body mass index (BMI), percent fat, fat weight, waist circumference (WC), systolic blood pressure (SBP) rate, and DBP rate than the Exercise-Only group, as well as greater reductions (P < 0.05) in body weight, BMI, percent fat, fat weight, and WC than the Exercise/Protein group. Our findings suggest that a higher protein nutrition plan may enhance the effects of exercise for increasing subject lean weight and decreasing DBP rate. The findings further indicate that a higher protein and lower calorie nutrition plan may enhance the effects of exercise for decreasing subject body weight, BMI, percent fat, fat weight, WC, SBP rate, and DBP rate, while attaining similar gains in lean body mass.

A web-based intervention to improve and prevent low back pain among office workers: a randomized controlled trial

STUDY DESIGN

Randomized controlled trial.

OBJECTIVES

To test the feasibility, safety, and efficacy of a web-based multidisciplinary intervention for office workers with subacute, nonspecific low back pain.

BACKGROUND

Low back pain is one of the most frequent ailments seen in primary care consultations.

METHODS

The trial included 100 office workers with subacute low back pain. The intervention group had access to both the study intervention and standard care. The control group had access to standard care only. Standard care was defined as all existing non-web-based interventions offered by the University of Extremadura's Preventive Medicine Service. The web-based program was offered via the Preventive Medicine Service website. The participants in the intervention group were asked to engage in the web-based program at their work site for 11 minutes each day, 5 days a week. Primary outcomes were functional disability, as measured by the Roland-Morris Disability Questionnaire, and health-related quality of life, as measured by the European Quality of Life-5 Dimensions-3 Levels. Secondary outcomes were the number of episodes of low back pain and trunk muscle endurance. Outcomes were measured before and after the 9-month intervention period.

RESULTS

Over the 9-month study, the score on the Roland-Morris Disability Questionnaire for the participants in the web-based intervention group improved by a mean of -7.36 points (95% confidence interval [CI]: -8.41, -6.31) compared to a worsening of 1.89 points (95% CI: 0.71, 2.65) in the control group. The between-group difference in change on the Roland-Morris Disability Questionnaire over the study period was -9.25 points (95% CI: -10.57, -7.89). Similarly, over the 9-month study, the intervention group had a significant improvement in quality of life of 0.24 points (95% CI: 0.20, 0.29) compared to the control group.

CONCLUSION

A 9-month web-based intervention is feasible and effective to improve function and health-related quality of life and to decrease episodes of low back pain among office workers with a history of subacute, nonspecific low back pain.

Clinical effects of a nine-month web-based intervention in subacute non-specific low back pain patients: a randomized controlled trial

OBJECTIVE

To test the clinical effect of a web-based lower back pain intervention on quality of life and selected lower back pain outcomes.

DESIGN

A prospective single-blinded randomized intervention.

SETTING

Occupational preventive service.

SUBJECTS

One hundred office workers with non-specific subacute lower back pain.

INTERVENTION

The 50 intervention group subjects were educated daily about sitting correctly and asked to perform exercises shown by video demonstrations on the university website. The exercise routines included strengthening, mobility and stretching exercises focused on the postural stability muscles. The 50 control group subjects only received standard occupational care.

MEASURES

Outcomes were measured by the EuroQol questionnaire five dimensions three levels, the Oswestry Disability Index, and the StarT Back Screening Tool questionnaires. At nine months, the intervention group outcomes were compared to the baseline data and the control group outcomes.

RESULTS

For 97% (n = 45) of the experimental group quality of life (clinical utility) improved significantly; 3.58 times greater than the control group. Oswestry Disability Index showed an odds ratio (OR) of 5.42 with a 37% (n = 17) change for the intervention group with respect to the control group. With regard to the StarT Back Screening Tool, 76% (n = 35) of the intervention group improved their clinical state (odds ratio = 3.04 with respect to the control group improvement). Logistic regression analysis revealed positive changes in EuroQol questionnaire, increasing the likelihood of observing positive changes in StarT Back Screening Tool (OR = 15.5) and Oswestry Disability Index (OR = 4.5).

CONCLUSIONS

The intervention showed clinical improvements in quality of life and selected lower back pain outcomes in the experimental group compared to the control group.