Exercise Dose and Aerobic Fitness Response in Alzheimer’s Dementia in the FIT-AD Trial

The purpose of this study was to examine the effects of a 6-month cycling aerobic exercise intervention on cardiorespiratory fitness and the dose-response relationship in community-dwelling older adults with mild-to-moderate Alzheimer’s dementia. The FIT-AD trial was a single blind, 2-parallel group, pilot randomized controlled trial. The aerobic exercise group participated in a 6-month, thrice weekly, moderate-vigorous intensity cycling intervention while control group performed stretching. Cardiorespiratory fitness was evaluated by peak oxygen consumption from cardiopulmonary exercise test and peak walking distance from the shuttle walk test and 6-minute walk test. Aerobic exercise dose was calculated using the novel heart rate physical activity score. The aerobic exercise group significantly increased peak oxygen consumption (1.28 ml/kg/min; p=.03) in subgroup who achieved maximal criteria on cardiopulmonary exercise test. Changes in peak oxygen consumption and peak walking distance on the shuttle walk and 6-minute walk tests did not significantly differ between aerobic exercise and stretching groups. Notably, the aerobic exercise dose was strongly and significantly correlated to change in peak oxygen consumption (r=.60; n=16; p=.01), in subset who met maximal test criteria. Emphasis on exercise dose is needed in aerobic exercise programs to maximize cardiorespiratory fitness gains in persons with mild-moderate Alzheimer’s dementia.

Self-Directed Exergaming for Stroke Upper Limb Impairment Increases Exercise Dose Compared to Standard Care

Background. One of the strongest modifiable determinants of rehabilitation outcome is exercise dose. Technologies enabling self-directed exercise offer a pragmatic means to increase dose, but the extent to which they achieve this in unselected cohorts, under real-world constraints, is poorly understood. Objective. Here we quantify the exercise dose achieved by inpatient stroke survivors using an adapted upper limb (UL) exercise gaming (exergaming) device and compare this with conventional (supervised) therapy. Methods. Over 4 months, patients presenting with acute stroke and associated UL impairment were screened at a single stroke centre. Participants were trained in a single session and provided with the device for unsupervised use during their inpatient admission. Results. From 75 patients referred for inpatient UL therapy, we recruited 30 (40%), of whom 26 (35%) were able to use the device meaningfully with their affected UL. Over a median enrolment time of 8 days (IQR: 5–14), self-directed UL exercise duration using the device was 26 minutes per day (median; IQR: 16–31), in addition to 25 minutes daily conventional UL therapy (IQR: 12–34; same cohort plus standard care audit; joint n = 50); thereby doubling total exercise duration (51 minutes; IQR: 32–64) relative to standard care (Z = 4.0, P <.001). The device enabled 104 UL repetitions per day (IQR: 38–393), whereas conventional therapy achieved 15 UL repetitions per day (IQR: 11–23; Z = 4.3, P <.001). Conclusion. Self-directed adapted exergaming enabled participants in our stroke inpatient cohort to increase exercise duration 2-fold, and repetitions 8-fold, compared to standard care, without requiring additional professional supervision.

Automatic Identification of Upper Extremity Rehabilitation Exercise Type and Dose Using Body-Worn Sensors and Machine Learning: A Pilot Study

<b><i>Background:</i></b> Prior studies suggest that participation in rehabilitation exercises improves motor function poststroke; however, studies on optimal exercise dose and timing have been limited by the technical challenge of quantifying exercise activities over multiple days. <b><i>Objectives:</i></b> The objectives of this study were to assess the feasibility of using body-worn sensors to track rehabilitation exercises in the inpatient setting and investigate which recording parameters and data analysis strategies are sufficient for accurately identifying and counting exercise repetitions. <b><i>Methods:</i></b> MC10 BioStampRC® sensors were used to measure accelerometer and gyroscope data from upper extremities of healthy controls (<i>n</i> = 13) and individuals with upper extremity weakness due to recent stroke (<i>n</i> = 13) while the subjects performed 3 preselected arm exercises. Sensor data were then labeled by exercise type and this labeled data set was used to train a machine learning classification algorithm for identifying exercise type. The machine learning algorithm and a peak-finding algorithm were used to count exercise repetitions in non-labeled data sets. <b><i>Results:</i></b> We achieved a repetition counting accuracy of 95.6% overall, and 95.0% in patients with upper extremity weakness due to stroke when using both accelerometer and gyroscope data. Accuracy was decreased when using fewer sensors or using accelerometer data alone. <b><i>Conclusions:</i></b> Our exploratory study suggests that body-worn sensor systems are technically feasible, well tolerated in subjects with recent stroke, and may ultimately be useful for developing a system to measure total exercise “dose” in poststroke patients during clinical rehabilitation or clinical trials.

Evaluating Exercise Progression in an Australian Cardiac Rehabilitation Program: Should Cardiac Intervention, Age, or Physical Capacity Be Considered?

Progression of prescribed exercise is important to facilitate attainment of optimal physical capacity during cardiac rehabilitation. However, it is not clear how often exercise is progressed or to what extent. This study evaluated whether exercise progression during clinical cardiac rehabilitation was different between cardiovascular treatment, age, or initial physical capacity. The prescribed exercise of sixty patients who completed 12 sessions of outpatient cardiac rehabilitation at a major Australian metropolitan hospital was evaluated. The prescribed aerobic exercise dose was progressed using intensity rather than duration, while repetitions and weight lifted were utilised to progress resistance training dose. Cardiovascular treatment or age did not influence exercise progression, while initial physical capacity and strength did. Aerobic exercise intensity relative to initial physical capacity was progressed from the first session to the last session for those with high (from mean (95%CI) 44.6% (42.2–47.0) to 68.3% (63.5–73.1); p < 0.001) and moderate physical capacity at admission (from 53.0% (50.7–55.3) to 76.3% (71.2–81.4); p < 0.001), but not in those with low physical capacity (from 67.3% (63.7–70.9) to 85.0% (73.7–96.2); p = 0.336). The initial prescription for those with low physical capacity was proportionately higher than for those with high capacity (p < 0.001). Exercise testing should be recommended in guidelines to facilitate appropriate exercise prescription and progression.

Inter-rater reliability of an exercise adherence measurement tool: Measurement Of adherence Via Exercise Demonstration (MOVED)

Objective: To explore the inter-rater reliability of the Measurement Of adherence Via Exercise Demonstration (MOVED) adherence tool. Design: Reliability study of a patient adherence measurement tool.Setting: Simulated physiotherapist-patient consultations. Participants: Sixteen experienced physiotherapists rated patient adherence to exercise. Interventions: N/A Main Outcome Measure: Inter-rater reliability of MOVED.Methods: The MOVED tool consists of two parts. Part one asks patients to self-report their adherence to exercise dose (including number of completed sessions, sets and repetitions in the last seven days). Part two asks patients to demonstrate each exercise. Component scores are totalled to give an overall level of patient adherence to each exercise.Participants were provided with a copy of five physiotherapist-prescribed exercises. Participants were then shown five corresponding video vignettes of simulated physiotherapist-patient consultations where patients were asked to self-report exercise frequency, sets and repetitions and demonstrate each exercise within the context of a consultation. Participants were asked to rate the level of patient adherence to each of the five exercises using the MOVED tool. Inter-rater reliability of MOVED scores was assessed using Intraclass Correlation Coefficient (ICC) and 95% Confidence Intervals. Results: The ICC of part one (self-report) was .90 (95%CI .74-.98), part two (demonstration) was .98 (95%CI .94-.99) and total score was .96 (95%CI .88-.99), demonstrating excellent inter-rater reliability. Conclusion: The MOVED tool, which can highlight whether patients are adhering to exercise technique as well as exercise dose, may provide clinicians and researchers with a more robust measure of exercise adherence when compared with other measures currently available.

Is patellofemoral pain preventable? A systematic review and meta-analysis of randomised controlled trials

ObjectiveTo evaluate the effectiveness of interventions to reduce the risk of incident patellofemoral pain.DesignSystematic review and meta-analysis, with strength of evidence evaluated separately for each intervention type.Data sourcesMEDLINE, EMBASE, CINAHL, Web of Science and SPORTDiscus.Eligibility criteria for selecting studiesRandomised controlled trials evaluating the effectiveness of interventions to reduce patellofemoral pain risk compared with a control/non-exposed group.ResultsThirteen trials of mostly military recruits and young athletes analysed six different interventions. There was low certainty evidence from two trials (227 participants) that patellofemoral braces worn during physical activity (compared with no brace) effectively reduced the risk of patellofemoral pain (risk ratio (RR) 0.40, 95% CI 0.22 to 0.73; I2=24.0%). There was low certainty evidence from one trial (320 participants) that running technique retraining to (run softer) reduced patellofemoral pain risk (RR 0.21, 95% CI 0.07 to 0.60). There was low certainty evidence from four trials (3364 participants) that multicomponent (strengthening/neuromuscular) exercise programmes did not significantly reduce the risk of patellofemoral pain (RR 0.49, 95% CI 0.18 to 1.36; I2=64.9%), although broad CIs may reflect exercise dose variations among studies. There was very low certainty evidence from four trials (2314 participants) that foot orthoses (compared with flat inserts/no orthosis) did not significantly reduce the risk of patellofemoral pain (RR 0.63, 95% CI 0.35 to 1.13; I2=0.0%). Static stretching and a running programme that progressed intensity (compared with volume) did not significantly influence patellofemoral pain risk (single studies).ConclusionThere is low-level evidence that patellofemoral braces and running technique retraining can reduce the risk of patellofemoral pain by 60%–79%.

Automatic Identification of Upper Extremity Rehabilitation Exercise Type and Dose Using Body-Worn Sensors and Machine Learning: A Pilot Study

Background: Prior studies suggest that participation in rehabilitation exercises improves motor function post-stroke; however, studies on optimal exercise dose and timing have been limited by the technical challenge of quantifying exercise activities over multiple days. Objective: In this exploratory study, we assessed the feasibility of using body-worn sensors to track rehabilitation exercises in the inpatient setting and investigated which recording parameters and data analysis strategies are sufficient for accurately identifying and counting exercise repetitions. Methods: MC10 BioStampRC® sensors were used to measure accelerometry and gyroscopy data from arms of healthy controls (n=13) and patients with upper extremity (UE) weakness due to recent stroke (n=13) while the subjects performed three pre-selected UE exercises. Sensor data was then labeled by exercise type, and this labeled data set was used to train a machine learning classification algorithm for identifying exercise type. The machine-learning algorithm and a peak-finding algorithm were used to count exercise repetitions in non-labeled data sets. Results: We achieved a repetition counting accuracy of 95.6 ± 2.4 % overall, and 95.0 ± 2.3 % in patients with UE weakness due to stroke. Accuracy was decreased when using fewer sensors or using accelerometry data alone. Conclusions: Our exploratory study suggests that body-worn sensor systems are technically feasible, well-tolerated in subjects with recent stroke, and may ultimately be useful for developing a system to measure total exercise “dose” in post-stroke patients during clinical rehabilitation or clinical trials.

UK cardiac rehabilitation fit for purpose? A community-based observational cohort study

ObjectivesThis study aimed to characterise the exercise performed in UK cardiac rehabilitation (CR) and explore relationships between exercise dose and changes in physiological variables.DesignObservational cohort study.SettingOutpatient community-based CR in Leeds, UK. Rehabilitation sessions were provided twice per week for 6 weeks.ParticipantsSixty patients (45 male/15 female 33–86 years) were recruited following referral to local outpatient CR.Outcome measuresThe primary outcome was heart rate achieved during exercise sessions. Secondary outcomes were measured before and after CR and included incremental shuttle walk test (ISWT) distance and speed, blood pressure, brachial artery flow-mediated dilatation, carotid arterial stiffness and accelerometer-derived habitual physical activity behaviours.ResultsThe mean % of heart rate reserve patients exercised at was low and variable at the start of CR (42%±16 %) and did not progress by the middle (48%±17 %) or end (48%±16 %) of the programme. ISWT performance increased following CR (440±150 m vs 633±217 m, p<0.001); however, blood pressure, body weight, endothelial function, arterial stiffness and habitual physical activity behaviours were unchanged following 6 weeks of CR (p>0.05).ConclusionPatients in a UK CR cohort exercise at intensities that are variable but generally low. The exercise dose achieved using this CR format appears inadequate to impact markers of health. Attending CR had no effect on physical activity behaviours. Strategies to increase the dose of exercise patients achieve during CR and influence habitual physical activity behaviours may enhance the effectiveness of UK CR.