Detection and Management of the Female Athlete Triad

The female athlete triad is a disorder seen in physically active females that manifests as three interrelated syndromes that may or may not occur simultaneously.1,2,3 It is a multi-component disease initiated by an energy-deficient state (possibly from an eating disorder), bone mineral density abnormalities and menstrual changes.1,2,3 Prevention and early intervention are important in averting permanent debilitating damage. The cornerstone of treatment is creating a positive net energy availability, which requires a multidisciplinary approach comprised of a licensed physician, nutritionist, exercise physiologist, mental health practitioner, athletic trainer, coaches, the athlete and their parents.

Change in the Mindset of a Paediatric Exercise Physiologist: A Review of Fifty Years Research

In this review, the career of a pediatric exercise physiologist (HCGK) is given over a period of almost 50 years. His research was concentrated on the relationship of physical activity (physical education, sport, and daily physical activity) with health and fitness in teenagers in secondary schools. (1) His first experiment was an exercise test on a bicycle ergometer to measure aerobic fitness by estimating physical work capacity at a heart rate of 170 beats/minute (PWC170). (2) Secondly, a randomized control trial (RCT) was performed with an intervention of more intensive physical education (PE) with circuit interval training during three lessons per week over a period of six weeks. (3) Thereafter, a second RCT was performed with an intervention of two extra PE lessons per week over a whole school year. The results of these two RCTs appeared to be small or nonsignificant, probably because the effects were confounded by differences in maturation and the habitual physical activity of these teenagers. (4) Therefore, the scope of the research was changed into the direction of a long-term longitudinal study (the Amsterdam Growth And Health Longitudinal Study). This study included male and female teenagers that were followed over many years to get insight into the individual changes in biological factors (growth, fitness, obesity, hypercholesterolemia, and hypertension) and lifestyle parameters such as nutrition, smoking, alcohol usage, and daily physical activity. With the help of new advanced statistical methods (generalized estimating equations, random coefficient analysis, and autoregression analysis) suitable for longitudinal data, research questions regarding repeated measurements, tracking, or stability were answered. New measurement techniques such as mineral bone density by means of dual-energy X-ray absorptiometry (DEXA) showed that bone can also be influenced by short bursts of mechanical load. This changed his mind: In children and adolescents, not only can daily aerobic exercise of at least 30 to 60 min duration increase the aerobic power of muscles, but very short highly intensive bursts of less than one minute per day can also increase the strength of their bones.

Interrupting the trajectory of frailty in dementia with Lewy bodies with anabolic exercise, dietary intervention and deprescribing of hazardous medications

An 87-year-old man with dementia with Lewy bodies, living in residential aged care, exhibited rapid functional decline and weight loss associated with injurious falls over 9 months. Independent clinicians (geriatrician and exercise physiologist) assessed him during an extended wait-list period prior to his commencement of a pilot exercise trial. The highly significant role of treatable factors including polypharmacy, sarcopenia and malnutrition as contributors to frailty and rapid functional decline in this patient are described. The results of a targeted intervention of deprescribing, robust exercise and increased caloric intake on his physical and neuropsychological health status are presented. This case highlights the need to aggressively identify and robustly treat reversible contributors to frailty, irrespective of advanced age, progressive ‘untreatable’ neurodegenerative disease and rapidly deteriorating health in such individuals. Frailty is not a contraindication to robust exercise; it is, in fact, one of the most important reasons to prescribe it.

Epidemiologic Research: A Primer for the Clinical Exercise Physiologist

ABSTRACT An understanding of epidemiologic methods is important for the clinical exercise physiologist to assess the complex relationships between physical activity and health and disease. It is essential to the practice of preventive and rehabilitative care to understand the web of causation and complex interactions among agent (exercise), host (individual), and environment (affects transmission of agent source to host) in relationship to disease/injury and clinical outcomes. Application of the epidemiologic measures of disease/injury occurrence, variations in occurrence, and statistical measures of attributable risk and population attributable risk contribute to the clinician's skill level in assessing potential cause-effect relationships reported in the literature about exercise medicine, physical activity, and public health. By becoming familiar with the study methods used in epidemiology, the clinical exercise physiologist will be better positioned to assess criteria for a cause-effect relationship as well as to critically evaluate the assessment efforts used across a variety of study designs and applications of epidemiology in clinical research and practice.

It’s Not Just Physical: Exercise Physiologist-Led Exercise Program Promotes Functional and Psychosocial Health Outcomes in Aged Care

Regular physical activity has multiple benefits for older adults, including improved physical, cognitive, and psychosocial health. This exploratory study investigated the benefits of a 12-week exercise program for older adults (n = 11 control and n = 13 intervention) living in a residential aged care facility in Perth, Western Australia. The program, prescribed and delivered by an accredited exercise physiologist, aimed to maintain or improve participants’ physical capacity. It comprised one-on-one exercise sessions (1 hr × 2 days/week × 12 weeks), involving a components-approach intervention. Physical performance measures (balance, strength, flexibility, and mobility) were assessed preintervention and postintervention. Qualitative interviews postintervention with residents participating in the exercise intervention, and with family members, staff, and research team members, explored barriers and enablers to participation and perceived psychosocial outcomes. Findings indicate the program provided physical benefits and enhanced social engagement for participants, illustrating the value of providing exercise physiology services in the aged care sector.

MODERNIZING EXERCISE WITH TELE-VIDEO TO REACH A RURAL GERIATRIC POPULATION OF VETERANS

Rural Veterans often lack access to health care. Veterans Affairs (VA) supports telehealth technologies to provide services remotely that are comparable to onsite in-person care. We piloted VA Video Connect (VVC), to deliver an interactive exercise program for Veterans modeled on the VA Gerofit Program, a successful facility-based exercise program. VVC connects an exercise physiologist directly to the home with smart devices. Invitations to join Gerofit were mailed to 216 rural Veterans. Of 17 respondents, 7 (mean age 68) agreed to VVC tele-exercise 1x week for 12 weeks. Two Veterans were lost to follow-up prior to enrollment. Baseline VVC assessments (N=5) were indicative of high functional impairment in comparison to age-based norms: 2-minute step test (67.2 steps, 5th%tile), 30-second chair stands (12.4 stands, 26th%tile), and 30-second arm curls (15.3 curls, 25th%tile). Feasibility, barriers, and program impact will be discussed. Functional impairment indicates need for telehealth to reach Rural Veterans.

Four-year overview of enrollment and participation in research studies conducted at the Prostate Cancer Supportive Care (PCSC) Program.

39 Background: The mission of the Prostate Cancer Supportive Care (PCSC) Program at the Vancouver Prostate Centre (VPC) is to provide clinical care focused on the needs of prostate cancer patients and partners. It is comprised of six modules that are administered by medical professionals in urology, radiation oncology, sexual health nurses, registered dieticians, certified exercise physiologist, male pelvic floor physiotherapists, and couples’ counselling. Incorporation of research into daily care provides evidence for these practices, identifies areas for improvement, and tests new approaches. In order to evaluate the interface between the clinical and research programs, we reviewed the metrics of our PCSC program. Methods: Research studies were grouped by type. Screening and enrollment logs were reviewed to tally the total number of patients approached versus enrolled. Reasons for non-participation based on data in our enrollment logs were categorized. Results: Between Feb 2015 and Mar 2019, PCSC Program participated in 22 research studies: 9 therapeutic or lifestyle intervention studies (3 RCTs), 3 observational studies, 2 registries, 1 survey, 1 genetic study, 1 databank , 2 collaborative programmatic studies, 3 “permission to contact” studies (referral to the study team only). 8 of the 22 studies included recruitment of dyads (both patient and their partner or caregiver). Of 1080 consenting patients, 760 (70.4%) enrolled in 1 study, 210 (19.4%) in 2 studies, and 110 (10.2%) in > 3 studies. 583 patients did not consent due to lack of interest (43.7%), not available (21.1%), time constraints (10.3%), travel distance (6.7%). Conclusions: Our data show that a subspecialty supportive care program can provide a rich environment in which to conduct clinical research. We believe that the integration of the research program and personnel into the clinical setting is key to our success. Current on-going studies are evaluating the impact of and patient satisfaction with all PCSC modules.