scholarly journals Exercise Intolerance, Benefits, and Prescription for People Living With a Fontan Circulation: The Fontan Fitness Intervention Trial (F-FIT)—Rationale and Design

2022 ◽  
Vol 9 ◽  
Author(s):  
Derek L. Tran ◽  
Hannah Gibson ◽  
Andrew J. Maiorana ◽  
Charlotte E. Verrall ◽  
David W. Baker ◽  
...  
Keyword(s):  
Physical Activity ◽  
Exercise Training ◽  
Usual Care ◽  
Exercise Prescription ◽  
Fontan Circulation ◽  
Exercise Intolerance ◽  
Intervention Trial ◽  
Randomized Controlled ◽  
Aerobic Exercise Capacity ◽  
Vigorous Intensity

Background: Despite developments in surgical techniques and medical care, people with a Fontan circulation still experience long-term complications; non-invasive therapies to optimize the circulation have not been established. Exercise intolerance affects the majority of the population and is associated with worse prognosis. Historically, people living with a Fontan circulation were advised to avoid physical activity, but a small number of heterogenous, predominantly uncontrolled studies have shown that exercise training is safe—and for unique reasons, may even be of heightened importance in the setting of Fontan physiology. The mechanisms underlying improvements in aerobic exercise capacity and the effects of exercise training on circulatory and end-organ function remain incompletely understood. Furthermore, the optimal methods of exercise prescription are poorly characterized. This highlights the need for large, well-designed, multi-center, randomized, controlled trials.Aims and Methods: The Fontan Fitness Intervention Trial (F-FIT)—a phase III clinical trial—aims to optimize exercise prescription and delivery in people with a Fontan circulation. In this multi-center, randomized, controlled study, eligible Fontan participants will be randomized to either a 4-month supervised aerobic and resistance exercise training program of moderate-to-vigorous intensity followed by an 8-month maintenance phase; or usual care (control group). Adolescent and adult (≥16 years) Fontan participants will be randomized to either traditional face-to-face exercise training, telehealth exercise training, or usual care in a three-arm trial with an allocation of 2:2:1 (traditional:telehealth:control). Children (<16 years) will be randomized to either a physical activity and exercise program of moderate-to-vigorous intensity or usual care in a two-arm trial with a 1:1 allocation. The primary outcome is a change in aerobic exercise capacity (peak oxygen uptake) at 4-months. Secondary outcomes include safety, and changes in cardiopulmonary exercise testing measures, peripheral venous pressure, respiratory muscle and lung function, body composition, liver stiffness, neuropsychological and neurocognitive function, physical activity levels, dietary and nutritional status, vascular function, neurohormonal activation, metabolites, cardiac function, quality of life, musculoskeletal fitness, and health care utilization. Outcome measures will be assessed at baseline, 4-months, and 12-months. This manuscript will describe the pathophysiology of exercise intolerance in the Fontan circulation and the rationale and protocol for the F-FIT.

scholarly journals Modulation of endothelial cell phenotype by physical activity: impact on obesity-related endothelial dysfunction

2015 ◽  
Vol 309 (1) ◽  
pp. H1-H8 ◽  
Author(s):  
Shawn B. Bender ◽  
M. Harold Laughlin
Keyword(s):  
Physical Activity ◽  
Endothelial Cell ◽  
Endothelial Dysfunction ◽  
Exercise Training ◽  
Soleus Muscle ◽  
Gastrocnemius Muscle ◽  
Muscle Fibers ◽  
Exercise Intolerance ◽  
Cell Phenotype ◽  
Obesity And Diabetes

Increased levels of physical activity are associated with reduced cardiovascular disease (CVD) risk and mortality in obesity and diabetes. Available evidence suggests that local factors, including local hemodynamics, account for a significant portion of this CVD protection, and numerous studies have interrogated the therapeutic benefit of physical activity/exercise training in CVD. Less well established is whether basal differences in endothelial cell phenotype between/among vasculatures related to muscle recruitment patterns during activity may account for reports of nonuniform development of endothelial dysfunction in obesity. This is the focus of this review. We highlight recent work exploring the vulnerability of two distinct vasculatures with established differences in endothelial cell phenotype. Specifically, based largely on dramatic differences in underlying hemodynamics, arteries perfusing soleus muscle (slow-twitch muscle fibers) and those perfusing gastrocnemius muscle (fast-twitch muscle fibers) in the rat exhibit an exercise training-like versus an untrained endothelial cell phenotype, respectively. In the context of obesity, therefore, arteries to soleus muscle exhibit protection from endothelial dysfunction compared with vulnerable arteries to gastrocnemius muscle. This disparate vulnerability is consistent with numerous animal and human studies, demonstrating increased skeletal muscle blood flow heterogeneity in obesity coincident with reduced muscle function and exercise intolerance. Mechanistically, we highlight emerging areas of inquiry exploring novel aspects of hemodynamic-sensitive signaling in endothelial cells and the time course of physical activity-associated endothelial adaptations. Lastly, further exploration needs to consider the impact of endothelial heterogeneity on the development of endothelial dysfunction because endothelial dysfunction independently predicts CVD events.

Aerobic interval training increases peak oxygen uptake more than usual care exercise training in myocardial infarction patients: a randomized controlled study

2011 ◽  
Vol 26 (1) ◽  
pp. 33-44 ◽  
Author(s):  
Trine Moholdt ◽  
Inger Lise Aamot ◽  
Ingrid Granøien ◽  
Lisbeth Gjerde ◽  
Gitte Myklebust ◽  
...  
Keyword(s):  
Heart Rate ◽  
Exercise Training ◽  
Oxygen Uptake ◽  
Usual Care ◽  
Interval Training ◽  
Peak Oxygen Uptake ◽  
Peak Heart Rate ◽  
Randomized Controlled ◽  
Aerobic Interval Training

Objective: Exercise capacity strongly predicts survival and aerobic interval training (AIT) increases peak oxygen uptake effectively in cardiac patients. Usual care in Norway provides exercise training at the hospitals following myocardial infarction (MI), but the effect and actual intensity of these rehabilitation programmes are unknown. Design: Randomized controlled trial. Setting: Hospital cardiac rehabilitation. Subjects: One hundred and seven patients, recruited two to 12 weeks after MI, were randomized to usual care rehabilitation or treadmill AIT. Interventions: Usual care aerobic group exercise training or treadmill AIT as 4 × 4 minutes intervals at 85–95% of peak heart rate. Twice weekly exercise training for 12 weeks. Main measures: The primary outcome measure was peak oxygen uptake. Secondary outcome measures were endothelial function, blood markers of cardiovascular disease, quality of life, resting heart rate, and heart rate recovery. Results: Eighty-nine patients (74 men, 15 women, 57.4 ± 9.5 years) completed the programme. Peak oxygen uptake increased more ( P = 0.002) after AIT (from 31.6 ± 5.8 to 36.2 ± 8.6 mL·kg−1·min−1, P < 0.001) than after usual care rehabilitation (from 32.2 ± 6.7 to 34.7 ± 7.9 mL·kg−1·min−1, P < 0.001). The AIT group exercised with significantly higher intensity in the intervals compared to the highest intensity in the usual care group (87.3 ± 3.9% versus 78.7 ± 7.2% of peak heart rate, respectively, P < 0.001). Both programmes increased endothelial function, serum adiponectin, and quality of life, and reduced serum ferritin and resting heart rate. High-density lipoprotein cholesterol increased only after AIT. Conclusions: AIT increased peak oxygen uptake more than the usual care rehabilitation provided to MI patients by Norwegian hospitals.

scholarly journals A Clinician Referral and 12-Week Exercise Training Program for Men With Prostate Cancer: Outcomes to 12 Months of the ENGAGE Cluster Randomized Controlled Trial

2017 ◽  
Vol 14 (5) ◽  
pp. 353-359 ◽  
Author(s):  
Cadeyrn J. Gaskin ◽  
Melinda Craike ◽  
Mohammadreza Mohebbi ◽  
Kerry S. Courneya ◽  
Patricia M. Livingston
Keyword(s):  
Physical Activity ◽  
Prostate Cancer ◽  
Exercise Training ◽  
Training Program ◽  
Controlled Trial ◽  
Vigorous Physical Activity ◽  
Randomized Controlled ◽  
Exercise Training Program ◽  
Cluster Randomized

Background:The ENGAGE (efficacy of a referral and physical activity program for survivors of prostate cancer) study established that a clinician referral and 12-week exercise training program increased vigorous physical activity at 12 weeks among men with prostate cancer. Here, we report the 6- and 12-month outcomes.Methods:In this multicenter cluster randomized controlled trial, we compared a clinician referral and exercise training program to usual care. Discounted gym membership was offered to men in the intervention condition on completion of the 12-week exercise program. Self-reported physical activity at 6 and 12 months was the primary outcome. Quality of life, anxiety, and depressive symptoms were secondary outcomes.Results:A total of 147 men meeting eligibility criteria agreed to participate (54 intervention, 93 control). A positive interaction effect for vigorous physical activity was observed at 6 months, but not 12 months. No significant effects for the secondary outcomes were found.Conclusions:A clinician referral and community-based supervised and unsupervised exercise training program, along with discounted gym membership, had a positive short-term effect on vigorous physical activity levels, but did not improve quality of life, in men with prostate cancer.

scholarly journals Targeted Exercise Training for Cancer Patients: Moving beyond Generic Exercise Guidelines in Clinical Oncology

2021 ◽  
pp. 43-52
Author(s):  
Ciaran M Fairman ◽  
Jesper F Christensen
Keyword(s):  
Physical Activity ◽  
South Carolina ◽  
Exercise Training ◽  
Cancer Patients ◽  
Clinical Oncology ◽  
Exercise Prescription ◽  
Exercise Interventions ◽  
Sports Science ◽  
Exercise Guidelines ◽  
Exercise Oncology

Targeted Exercise Training for Cancer Patients: Moving beyond Generic Exercise Guidelines in Clinical Oncology Ciaran M Fairman1 and Jesper F Christensen()2,3  1Department of Exercise Science, University of South Carolina, USA 2Center for Physical Activity Research, Rigshospitalet, Copenhagen, Denmark 3Department of Sports Science and Clinical Biomechanics, Faculty of Health Sciences, University of Southern Denmark, Denmark © The Authors   Abstract The field of exercise oncology has rapidly evolved over the past 30 years. Initial investigations of safety and feasibility have progressed towards efficacy and effectiveness trials with a variety of health-related outcomes in mind. More recently, it has been recognized that interventions aimed at modifying physical activity behavior (i.e. behavioral interventions to increase participation in un/structured physical activity) are distinctly different from those aiming to target a clinically relevant outcome (using a specific exercise prescription). There is a strong rationale for the latter, where cancer/treatment toxicities can result in musculoskeletal, cardiopulmonary, and/or hematological declines with important prognostic implications. Treatment intolerance, unfavorable tumor response and heightened risk of mortality are all consequences of leaving these impairments unaddressed. Importantly, the control/reversal of the decline in these systems is more likely to occur through a targeted exercise prescription, specifically designed to target the impairment, rather than interventions trying to change behavior. This requires careful consideration in the study design in exercise oncology in relation to the selection of clinically relevant outcomes, decisions on methods of assessments and ensuring the exercise is targeted to the outcome.     The objective of this review is to 1) conceptualize and provide a clinical rationale for targeted exercise interventions in exercise oncology, and 2) provide a framework for consideration in the design and execution in targeted exercise interventions in oncology. We hope that this framework can encourage research into targeted exercise interventions in oncology and that our framework can be used to inform the design of future trials.

scholarly journals Exercise Training as a Treatment for Cardiometabolic Risk in Sedentary Adults: Are Physical Activity Guidelines the Best Way to Improve Cardiometabolic Health? The FIT-AGEING Randomized Controlled Trial

2019 ◽  
Vol 8 (12) ◽  
pp. 2097 ◽  
Author(s):  
Francisco J. Amaro-Gahete ◽  
Alejandro De-la-O ◽  
Lucas Jurado-Fasoli ◽  
Borja Martinez-Tellez ◽  
Jonatan R. Ruiz ◽  
...  
Keyword(s):  
Physical Activity ◽  
Randomized Controlled Trial ◽  
Exercise Training ◽  
Cardiometabolic Risk ◽  
Controlled Trial ◽  
Whole Body ◽  
Control Group ◽  
Middle Aged ◽  
Randomized Controlled ◽  
Middle Aged Adults

This 12-week randomized controlled trial investigates the effects of different training modalities on cardiometabolic risk in sedentary, middle-aged adults, and examines whether alterations in cardiometabolic risk are associated with changes in those health-related variables that are modifiable by exercise training. The study subjects were 71 middle-aged adults (~54 years old; ~50% women) who were randomly assigned to one of the following treatment groups: (1) no exercise (control group), (2) concurrent training based on international physical activity recommendations (PAR group), (3) high intensity interval training (HIIT) group, or (4) HIIT plus whole-body electromyostimulation (HIIT+EMS group). A cardiometabolic risk score was calculated based on the International Diabetes Federation’s clinical criteria. A significant reduction in cardiometabolic risk was observed for all exercise training groups compared to the control group (all p < 0.05), which persisted after adjusting potential confounders (all p < 0.05). However, the HIIT+EMS group experienced the most significant reduction (p < 0.001). A significant inverse relationship was detected between the change in lean mass and the change in cardiometabolic risk (p = 0.045). A 12-week exercise training programs-especially the HIIT+EMS program-significantly reduced cardiometabolic risk in sedentary, middle-aged adults independent of sex, age, and cardiorespiratory fitness.

Effect of short‐course exercise training on the frequency of exacerbations and physical activity in patients with COPD : A randomized controlled trial

Respirology ◽  
2020 ◽  
Vol 26 (1) ◽  
pp. 72-79 ◽  
Author(s):  
Fanny Wai‐San Ko ◽  
Wilson Tam ◽  
Eddy H.S. Siu ◽  
Ka‐Pang Chan ◽  
Jenny Chun‐Li Ngai ◽  
...  
Keyword(s):  
Physical Activity ◽  
Randomized Controlled Trial ◽  
Exercise Training ◽  
Controlled Trial ◽  
Randomized Controlled ◽  
Short Course

Who Will Stay and Who Will Go? A Review of Older Adults’ Adherence to Randomized Controlled Trials of Exercise

2001 ◽  
Vol 9 (2) ◽  
pp. 91-114 ◽  
Author(s):  
Kathleen A. Martin ◽  
Adrienne R. Sinden
Keyword(s):  
Older Adults ◽  
Exercise Training ◽  
Randomized Controlled Trials ◽  
Exercise Prescription ◽  
Training Programs ◽  
Exercise Adherence ◽  
Aerobic Exercise Training ◽  
Controlled Trials ◽  
Physically Active ◽  
Randomized Controlled

This study examined exercise-adherence rates and their predictors across 21 randomized controlled trials (RCTs) involving older adults (age ≥ 55 years). On average, participants completed 78% of their prescribed exercise bouts. Adherence tended to be greater in strength- and flexibility-exercise training programs (M = 87%) than in aerobic-exercise training programs (M = 75%). The best adherers were individuals who were fitter at baseline, had a history of a physically active lifestyle, were nonsmokers, and had higher exercise self-efficacy. Different variables predicted adherence (a) at different time points in a RCT. (b) to different types of exercise, and (c) to different aspects of the exercise prescription (i.e., frequency, intensity, and duration). The findings suggest that older adults might be more adherent to exercise prescriptions than younger adults are. There is also a need for more theory-based research to examine predictors of adherence to various aspects of the exercise prescription.

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