A qualitative exploration of the impact of a 12-week group exercise class for those moderately affected with multiple sclerosis

Purpose: The evidence base to support therapeutic exercise for people with multiple sclerosis (MS) is improving; however few studies have considered the patients’ perspective. This study aimed to explore the experiences and views of people moderately affected with MS following participation in a 12-week exercise programme. Method: Twenty people with MS participated in a group exercise class. Subsequently, four men and ten women took part in one of two focus groups. Semi-structured questions were used to elicit participants’ views on the exercise class, outcomes from exercise and the exercise class and any perceived facilitators or barriers to exercise. Data were analysed using a general inductive method. Results: Benefits to participating in exercise for those with MS included social support and symptom improvement. Psychosocial factors, symptoms and lack of service emerged as exercise barriers. Three inter-related themes emerged; (1) The exercise class developed as a bridge to allow participants to realise, (2) the benefits of the class, helping them to overcome and (3) barriers to exercise. Conclusion: Taking part in an exercise class was a positive experience for people with MS. Healthcare professionals should work with exercise professionals to provide feasible exercise opportunities to help those with MS benefit from therapeutic exercise.

Implications for Rehabilitation

• People moderately affected with multiple sclerosis (MS) feel group exercise offers symptom improvement and social benefits.

• MS-related symptoms and a lack of service options may prevent those with MS exercising.

• Physiotherapists should work alongside exercise professionals to establish exercise services for those with MS.

     

Effect of different exercise programs on non-specific chronic low back pain and disability in people who perform sedentary work

BackgroundThis study compared the short- and long-term effects of different exercise programs on lumbar muscle function, cross-sectional area of the multifidus muscle, functional disability and low back pain in people who perform sedentary work.MethodsA total of 70 volunteer women with sedentary occupations suffering from low back pain were randomized to either the lumbar stabilization exercise program group or the lumbar muscle strengthening exercise program group. All subjects entered the 20-week exercise programs. The measurement of the cross-sectional area of the multifidus muscle was executed by using an ultrasound system, isokinetic peak torque was measured applying an isokinetic dynamometer.FindingsThe results indicated that the 20-week exercise programs reduced low back pain and functional disability. Positive effects for the cross-sectional area of the multifidus muscle, functional disability and low back pain lasted for 4 weeks after the application of lumbar muscle strengthening exercise program and for 12 weeks after the application of lumbar stabilization exercise program. The lumbar muscle strength increased and lasted for 8 weeks after both exercise programs.InterpretationThe 20-week lumbar stabilization exercise and muscle strengthening exercise programs were efficacious in decreasing LBP and functional disability in people performing sedentary work, however the lumbar stabilization exercise program was more effective, and this effect lasted for 12 weeks after completion of the program.     

Exercise bra discomfort is associated with insufficient exercise levels among Australian women treated for breast cancer

Purpose

Although participating in exercise is beneficial for breast cancer survivors, not being able to find a comfortable exercise bra can be a barrier to exercise. It is likely that side effects specific to breast cancer treatment exacerbate exercise bra discomfort. This study aimed to determine the relationship between patient characteristics, physical side effects, exercise bra discomfort and exercise behaviours.

Methods

Four hundred thirty-two breast cancer survivors completed an online survey related to their treatment and demographic background, current exercise levels, reported exercise bra discomfort and breast cancer treatment side effects. Patient characteristics and exercise levels were considered in a binary logistic regression against reporting bra discomfort to ascertain significant relationships (p?<?0.05) and predictive value (odds ratio). Pearson's chi-square statistics was used to determine significant relationships between reporting a side effect and exercise bra discomfort.

Results

Eight out of nine physical side effects were significantly related to reporting exercise bra discomfort. Reporting exercise bra discomfort was significantly related to not achieving a minimal recommended level of exercise.

Conclusions

This is the first study in the scientific literature that systematically links the reporting of exercise bra discomfort to not achieving recommended levels of exercise. This effect of bra discomfort on exercise was found after controlling for age, surgery type and current treatment among a large cohort of women treated for breast cancer. Furthermore, results from this study suggest that physical side effects, as a result of surgery and treatment associated with breast cancer, are linked to experiencing bra discomfort during exercise.     

Effect of exercise training and detraining on gas exchange kinetics in patients with chronic obstructive pulmonary disease

Symptom-limited incremental exercise tests are used to estimate the training effect on patients with chronic obstructive pulmonary disease (COPD). However, there is a need for objective parameters for measurement on submaximal exercise testing. The purpose of this study was to assess the usefulness of measurement of oxygen uptake (V?O₂) kinetics during a constant work rate exercise test of patients with COPD after exercise training. Eleven patients with COPD performed exercise tests before and after cycle ergometer training on 3 days per week for 8 weeks; they then went without training for 5 months and performed the same tests. They performed an incremental exercise test to symptom-limited maximum and a constant work rate exercise test for 6 min on a cycle ergometer. The time constant of V?O₂ during the onset of constant work rate exercise was significantly decreased (from 63·5±7·8 s to 53·2±8·0 s) after exercise training (P=0·021), but was significantly increased (to 73·4±14·9 s) after 5 months without training (P=0·001). The oxygen pulse at steady state during constant work rate exercise testing was significantly increased after exercise training but decreased 5 months later. The change in blood lactate from rest to steady state during constant work rate exercise was significantly decreased after exercise training, but increased 5 months later. Measurement of the time constant of V?O₂ and oxygen pulse during constant work rate exercise are useful for the objective evaluation of the training effect of patients with COPD.     

Women’s Self-Reported Factors That Influence Their Postpartum Exercise Levels

The birth of a child is a life transition that can signal an opportunity to promote wellness and self-care. Nurses and other health care providers can encourage women to engage in exercise for physical and mental health and to enhance weight loss after birth. However, incorporating an exercise routine into life with an infant can be challenging. Sixty-two women provided feedback about their exercise patterns before and during pregnancy, and 18 of these women gave additional insight into barriers to and facilitators of exercise engagement after childbirth. Three broad categories were identified as influencing exercise patterns in the postpartum period: Time, Maternal Responsibilities, and Physical Status. Recommendations for increasing exercise include providing individualized activity suggestions, identifying exercise groups specific to postpartum women, and connecting exercise with social support for better adherence.     

The Effects of Aerobic Exercise and Strengthening Exercise on Pain Pressure Thresholds

[Purpose] We assessed the effects of aerobic exercise and strengthening exercise on pain pressure thresholds (PPTs) over time. [Subjects and Methods] Fifteen healthy participants were recruited and randomly divided into 3 groups: aerobic exercise, strengthening exercise, and control. The subjects in the aerobic group walked on a treadmill for 40 min at 6.5 km/h. The subjects in the strength group performed circuit training that included bench press, lat pull down, biceps curl, triceps extension, and shoulder press based on the perceived exertion for 40 min. The subjects in the control group rested without any exercise in a quiet room for 40 min. The PPTs of 5 potential muscle trigger points before exercise, and immediately after 10 and 40 min of exercise or rest were measured using an electronic algometer (JTECH Medical, USA). The Friedman’s, Kruskal-Wallis, and Mann-Whitney tests were performed using SPSS 18.0 (IBM, Korea). [Results] The PPTs of all subjects decreased after 10 min of exercise, but the difference was not statistically significant. The PPTs of the control group decreased after 40 min. Furthermore, the PPTs of 3 muscles increased after 40 min of aerobic exercise and of 6 muscles after 40 min of strengthening exercise. No significant difference in PPTs was noted among the groups. [Conclusion] The results show that 40 min is a more appropriate exercise time, although the efficacy of controlling pain did not differ between strengthening exercise and aerobic exercise.Key words: Aerobic exercise, Strengthening exercise, Pain pressure thresholds     

Physical Exercise and Cancer: Exploring Chemotherapy Infusion as an Opportunity for Movement

ObjectiveExercise initiated in the early stages of cancer treatment may present as the most opportune time to reduce the detrimental side effects of treatment. Beginning exercise post-cancer treatment may not be early enough to elicit important improvements. The role of exercise alongside chemotherapy treatment, specifically during chemotherapy infusion may be an opportunity for the therapeutic delivery of exercise for cancer patients.Data SourcesNarrative review of peer-reviewed literature with a focus on exercise during chemotherapy infusions and therapeutic effects of exercise on the tumor microenvironment.ConclusionExercise initiated in the early stages of chemotherapy treatment may present as the most opportune time to improve therapeutic health outcomes and patient experience. If exercise during chemotherapy infusion could be feasible more testing is warranted to explore different modes including resistance-based exercise, dosage, intensity, and its potential affect on tumor hypoxia and chemotherapy drug uptake.Implications for Nursing PracticeOncology nurses are in the ideal position to initiate the conversation about exercise during chemotherapy treatments specifically the opportunity to provide light exercise during chemotherapy infusion. Starting exercise during this time may be the most beneficial timing to decrease the myriad of treatment side effects experienced. Further research is required to explore the potential affect of exercise during chemotherapy infusion on health benefits, tumor hypoxia, and drug uptake, all of which seem to be positively affected by physical exercise.     

Examining physiotherapist use of structured aerobic exercise testing to decrease barriers to aerobic exercise

Objective: To determine the frequency of physiotherapist-administered aerobic exercise testing/training, the proportion of physiotherapists who administer this testing/training, and the barriers that currently exist across different practice environments. A secondary objective is to identify the learning needs of physiotherapists for the development of an education curriculum in aerobic exercise testing and training with electrocardiograph (ECG) administration and interpretation. Design: National, cross-sectional survey. Participants: Registered physiotherapists practicing in Canada. Results: Out of 137 participants, most (75%) physiotherapists prescribed aerobic exercise on a regular basis (weekly); however, 65% had never conducted an aerobic exercise test. There were no significant differences in frequency of aerobic exercise testing across different practice environments or across years of physiotherapy experience. Physiotherapists perceived the main barriers to aerobic exercise testing as being a lack of equipment/space (78%), time (65%), and knowledge (56%). Although most (82%) were uncomfortable administering 12-lead ECG-monitored aerobic exercise tests, 60% stated they would be interested in learning more about ECG interpretation. Conclusion: This study found that physiotherapists are regularly implementing aerobic exercise. This exercise was infrequently guided by formal aerobic exercise testing, which could increase access to safe and effective exercise within the optimal aerobic training zone. As well, this could facilitate training in patients with cardiovascular diagnoses that require additional testing for medical clearance. Increased ECG training and access to equipment for physiotherapists may augment pre-screening aerobic exercise testing. This training should include learning the key arrhythmias for aerobic exercise test termination as defined by the American College of Sports Medicine.     

The intention to exercise and the execution of exercise among persons with multiple sclerosis – a qualitative metasynthesis

Purpose: This review was designed as a qualitative metasynthesis aiming to identify factors influencing the intention to exercise and the execution of exercise among persons with multiple sclerosis (PwMS). Method: Based on principles laid out by Sandelowski and Barroso, this qualitative metasynthesis started with a systematic literature search for studies of PwMS’s experiences relating to exercise in the following databases: CINAHL, Rehabilitation and Sports Medicine Source, PubMed, Web of Science and Psychology & Behavioral Science. The metasynthesis procedure also included critical appraisal using the Consolidated Criteria for Reporting Qualitative Research checklist, and integrating synthesis of the articles’ findings. Results: The metasynthesis included nine articles. Factors identified as influencing intention to exercise and the execution of exercise included social support, professional support and outcome expectations. Strong relationships between these three themes were detected for the intention to exercise, the execution of exercise or both among PwMS. Conclusions: The present metasynthesis offers a comprehensive understanding of factors influencing the intention to exercise and the execution of exercise among PwMS. Our findings reveal that health professionals influence the part of the process where PwMS enter the exercise setting, as well as the PwMS’s intention to exercise.

• Implications for Rehabilitation

• Social support, professional support and outcome expectations are potential facilitators and barriers for the intention to exercise and the execution of exercise among PwMS.

• Health professionals specializing in MS rehabilitation can influence the intention and the execution of physical exercise among PwMS when there exists a personal and supportive patient–professional relationship.

• Outcome expectations may impact the motivational and volitional phases of physical exercise.

     

The effectiveness of physical exercise on cognitive and psychological outcomes in individuals with mild cognitive impairment: A systematic review and meta-analysis

ObjectiveIndividuals with mild cognitive impairment (MCI) are at high risk for developing dementia. Physical exercise is a promising intervention for cognitive decline. Systematic reviews regarding the effects of physical exercise on cognitive and psychological outcomes among MCI patients are limited, and a systematic review exploring the effects of exercise modalities on the results has not been conducted. This study evaluated the effects of physical exercise on cognitive and psychological outcomes for MCI patients and attempted to identify which specific modality of exercise is more effective.DesignSystematic review and meta-analysis.Data sourcesA systematic search of Medline, CINAHL, EMBASE, PsycINFO, SPORTDiscus, and the China National Knowledge Infrastructure was performed.Review methodsTwo reviewers independently assessed the study quality using the Effective Public Health Practice Project Quality Assessment Tool. Meta-analysis was conducted when data were available, with further subgroup analyses for exercise types. A series of sensitivity analyses were conducted to explore the influence of study quality and control types on the primary outcome. A narrative analysis was performed when statistical synthesis was inappropriate.ResultsEleven studies met the inclusion criteria. The exercise interventions can be classified into three types: (a) aerobic exercise, (b) resistance exercise, and (c) multi-modal exercise. Results showed that physical exercise had beneficial effects for global cognition [standard mean difference (SMD) = 0.30, 95% confidence interval (CI): 0.10–0.49, p = 0.002]. Further subgroup analysis demonstrated that aerobic exercise programmes are consistently associated with medium effect size (SMD: 0.54–0.58). However, the effects of physical exercise on domain-specific cognitive function and psychological outcomes in MCI patients remain inconclusive. Results of sensitivity analysis indicated that types of control exert influence on the outcomes.ConclusionsPhysical exercise, aerobic exercise in particular, benefits global cognition in MCI patients. The evidence of physical exercise on domain-specific cognitive function and psychological outcomes remains unclear, more trials with rigorous study design are necessary to provide the evidence.     

Women's perceptions of home-based exercise performed during adjuvant chemotherapy for breast cancer

PurposeTo describe women's perceptions of a home-based exercise intervention in which they participated while receiving adjuvant chemotherapy for breast cancer.Methods and sampleParticipants were 8 women who were involved in a home-based exercise program while receiving 24 weeks of adjuvant chemotherapy for breast cancer. They were asked about their exercise program every 2 weeks by telephone, and completed a feasibility and acceptability questionnaire at the end of the study. The two principal investigators performed a content analysis on the resulting data.Key resultsParticipants highly valued the exercise program. The content analysis resulted in two major categories: exercise challenges and exercise facilitators and strategies. The most common exercise challenges were side effects of chemotherapy, particularly fatigue and pain. The women overcame challenges in many ways, most notably adapting the routine, internal motivation and external support. Their comprehension of breast cancer and its treatment, reinforced by expert advice and resources on exercise, helped them develop successful strategies to maintain the exercise program.ConclusionsIn spite of challenges, women in this study perceived that a customized, flexible, home-based exercise program was beneficial while they were undergoing adjuvant chemotherapy for breast cancer. Resource material and regular guidance helped them implement strategies to maintain the exercise program.     

Muscle pain induced by novel eccentric exercise does not disturb the sleep of normal young men

This experiment sought to determine if delayed-onset muscle pain following novel eccentric exercise would disrupt sleep. Nine young adult men performed eccentric exercise and, during a separate week, concentric exercise consisting of 8 sets of 10 repetitions at 80% of 1-repetition maximum for 3 muscle groups. Sleep was assessed polysomnographically the night before and 2 nights following the exercise bouts. Muscle pain intensity in the biceps, triceps, and quadriceps muscle groups was significantly increased following eccentric exercise (all P <.02), and upper arm range of motion was significantly decreased following eccentric exercise (F = 19.19; df [degrees of freedom] = 2,16; P <.0001). A Condition-by-Trial interaction was observed for stage 1 sleep (F = 6.91; df = 2,16; P =.007), and minutes of stage 1 sleep were reduced following eccentric exercise and increased following concentric exercise. In general, however, the hypothesized sleep disruptions following eccentric exercise were not observed. It is concluded that delayed onset muscle pain induced by novel eccentric exercise does not disturb the sleep of normal young men.     

Review of attrition and adherence in exercise studies following hematopoietic stem cell transplantation

PurposeImplementing exercise programs in people receiving high-dose chemotherapy followed by bone marrow (BMT) or hematopoietic stem cell transplantation (SCT) presents unique challenges. This review examines subject attrition rates and reasons for attrition as well as adherence to exercise interventions following BMT/SCT.MethodsStudies published between January 1985 and December 2012 that prospectively tested an exercise intervention following BMT or SCT were included in the review. Evaluation criteria included: (1) exercise modality; (2) the amount of supervision required to implement the intervention; (3) timing of the intervention; (4) subject attrition rates and reasons for attrition; and (5) exercise adherence rates.ResultsOf the 20 studies reviewed, most tested an aerobic exercise intervention or a combination of aerobic and strength training. Supervised exercise sessions were more commonly used than unsupervised sessions. The overall attrition rate was 18% for the 998 subjects enrolled in the studies. Major reasons for attrition included death, change in health status, protocol issues, personal issues with subjects, and lost to follow-up/no reason provided. Authors of supervised exercise programs rarely published exercise adherence information. Unsupervised exercise programs relied mainly on self-report to document adherence.ConclusionExercise research following BMT/SCT is becoming more sophisticated as researchers build upon the expanding literature base. Questions regarding subject attrition and adherence to exercise interventions must be addressed to identify interventions that are likely to be successful when translated into clinical practice. Subject attrition from exercise studies following BMT/SCT is relatively low. Adherence information for exercise interventions needs to be regularly addressed.     

Associations between the settings of exercise habits and health-related outcomes in community-dwelling older adults

[Purpose] The purpose of this study was to examine the associations between the settings of exercise habits and health-related outcomes in community-dwelling older adults. [Subjects] A total of 304 Japanese community-dwelling older adults (70.3 ± 4.1 years; 113 males and 191 females) participated in this study. [Methods] Demographic characteristics, medical conditions, exercise habits, and health-related outcomes were assessed by face-to-face interviews and self-reported questionnaires. Older adults who had exercise habits were classified into two groups: individual- and group-based exercise habits groups, and the health-related outcomes were compared between groups. [Results] The scores for the Geriatric Depression Scale, exercise self-efficacy, and dietary variety of older adults who had group-based exercise habits were better than those of older adults who had individual-based exercise habits. In addition, the exercise settings (individual- and group-based) were significantly associated with scores for the Geriatric Depression Scale (odds ratio = 0.76) and exercise self-efficacy (odds ratio = 1.26), even after adjusting for age and gender. [Conclusion] These results implied that habitual exercise in group settings may have an effective role in promoting exercise self-efficacy and mental health.Key words: Exercise habits, Group exercise, Exercise self-efficacy     

The Perspectives and Lived Experience of Postoperative Patients with Lung Cancer Participating in a Home-Based Exercise Intervention

ObjectivesPostoperative patients with lung cancer experience a cluster of symptoms and reduced quality of life. This study aimed to collect the pre- and postexercise intervention opinions of postoperative patients with lung cancer and to identify their perceptions of barriers, facilitators, and benefits of a home-based exercise intervention and its impact on their future exercise.Data SourcesFourteen participants (aged 53 to 78) were purposively recruited from a tertiary hospital to participate in a 4-week home-based walking exercise intervention after discharge. Semi-structured, one-on-one interviews were conducted to collect data. The interviews were transcribed verbatim, and the data were analyzed using a thematic analysis approach. Details regarding the exercise duration and intensity for each participant were collected using a sports watch app, and participants exercise diaries.ConclusionThree main themes emerged: (1) participants’ differing opinions preintervention, (2) barriers and facilitators encountered during the exercise period, and (3) the positive impact on participants’ future exercise. Other results showed that 12 of the 14 participants reached the goal of exercise duration and intensity. Postoperative patients with lung cancer need an exercise intervention to motivate and guide them to perform exercise after discharge. This study showed that a home-based walking exercise intervention was feasible and acceptable; patients perceived benefits and became more active and confident about their future exercise plans.Implications for Nursing PracticeAgainst the backdrop of inadequate staffing, insufficient funding, and lack of supervised exercise programs for this rapidly increasing population, this study of a nurse-led home-based exercise program provides a feasible and realistic approach and qualitative evidence to address these issues.     

Comparison of Effects of a Proprioceptive Exercise Program in Water and on Land the Balance of Chronic Stroke Patients

[Purpose] The purpose of this study was to compare changes in balance ability of land exercise and underwater exercise on chronic stroke patients. [Subjects] A total of 60 patients received exercise for 40 minutes, three times a week, for 6 weeks. [Methods] Subjects from both groups performed general conventional treatment during the experimental period. In addition, all subjects engaged in extra treatment sessions. This extra treatment consisted of unstable surface exercise. The underwater exercise group used wonder boards in a pool (depth 1.1m, water temperature 33.5 °C, air temperature 27 °C) dedicated to underwater exercise, and the land exercise group used balance mats. [Result] The joint position sense, sway area, Berg Balance Scale showed significant improvements in both groups. However, the joint position sense test, sway area, and Berg Balance Scale showed there was more improvement in the underwater exercise group than in the land exercise group. [Conclusion] The results suggest that underwater exercise is more effective than land exercise at improving the joint position sense and balance of stroke patients.Key words: Underwater exercise, Joint position sense, Balance     

Difference in Physiological Components of VO2 Max During Incremental and Constant Exercise Protocols for the Cardiopulmonary Exercise Test

[Purpose] VO₂ is expressed as the product of cardiac output and O₂ extraction by the Fick equation. During the incremental exercise test and constant high-intensity exercise test, VO₂ results in the attainment of maximal O₂ uptake at exhaustion. However, the differences in the physiological components, cardiac output and muscle O₂ extraction, have not been fully elucidated. We tested the hypothesis that constant exercise would result in higher O₂ extraction than incremental exercise at exhaustion. [Subjects] Twenty-five subjects performed incremental exercise and constant exercise at 80% of their peak work rate. [Methods] Ventilatory, cardiovascular, and muscle oxygenation responses were measured using a gas analyzer, Finapres, and near-infrared spectroscopy, respectively. [Results] VO₂ was not significantly different between the incremental exercise and constant exercise. However, cardiac output and muscle O₂ saturation were significantly lower for the constant exercise than the incremental exercise at the end of exercise. [Conclusion] These findings indicate that if both tests produce a similar VO₂ value, the VO₂ in incremental exercise would have a higher ratio of cardiac output than constant exercise, and VO₂ in constant exercise would have a higher ratio of O₂ extraction than incremental exercise at the end of exercise.Key words: Cardiopulmonary exercise test, Fick equation, Near-infrared spectroscopy