bluuebunny/crossref_metadata_2025 huggingface dataset:
PHYSICAL ACTIVITY AND SPINAL CORD INJURY: BEHAVIOUR, BARRIERS, MOTIVATIONS AND GAINS
Authors: Watson Mr Paul , Stendell Laura , Middleton James W , Arora Mohit , De Oliveira Camila Quel , Davis Glen M
Published: May 2024

INTRODUCTION & AIMS

To attain a comprehensive understanding of physical activity (PA) behaviour in individuals with a spinal cord injury (SCI) in Australia. Investigation and analysis included volumes, guideline-adherence, barriers, motivators, and perceived benefits of PA.

METHODS

Methodology included quantitative and qualitative approaches. Statistical tests were used on national survey data (n=1,579) to scrutinise PA volumes and guideline-adherence. Semi-structured interviews (n=105) were used to explore barriers to PA, whilst focus groups (six groups of six people) were used to uncover motivations for, and gains of, PA.

RESULTS

The average PA per week was 333 (+/-318) minutes, 42% of people were sedentary, and less than half (47%) of individuals met PA-specific guidelines. Sociodemographic and injury characteristics displayed very weak capacity (2-5% variance) in predicting PA volume. Barriers pertained to cost, accessibility, pain, self-consciousness, and a perceived lack of return of investment in PA. Whilst appearance/weight management and improved health appeared initially as motivators to PA, participants reported they gained more affiliation and revitalisation through PA, and less appearance/weight management and health change than they had anticipated. Focus group analysis highlighted that the primary (and more significant) motivators and benefits of PA include independence, reclamation of identity, restitution, reduced familial burden, and mitigation of perceived hastened aging.

CONCLUSION

People with SCI in Australia are amongst the most sedentary in the nation, and less than half of individuals meet PA guidelines. Specific attention is needed toward females, older individuals and people injured non-traumatically. Barriers are significant and affordable and accessible services, skilful and knowledgeable clinicians, and an inclusive environment are needed to improve consumer confidence. Motivation and perceived benefits extend beyond obvious physical advantages of PA. Clinicians and scientists need to understand the psychosocial influence of PA in this sedentary population and harness this knowledge to improve participation and quality of life.
ASSESSMENT OF SLEEP HEALTH IN ELITE FEMALE BASKETBALL PLAYERS DURING INTERNATIONAL COMPETITION: A CASE STUDY
Authors: Bird Prof Stephen P. , Charest Dr. Jonathan
Published: May 2024

INTRODUCTION & AIMS

Sleep health is recognised as an essential component to optimise overall wellbeing and athletic performance. However, athletes frequently report sleep disturbance prior to and during competition, with nearly a quarter of athletes experiencing moderate to severe sleep problems international travel and subsequent competition. The Athlete Sleep Screening Questionnaire (ASSQ) was developed as a sleep screening tool to detect clinically significant sleep disturbances and daytime dysfunction in athletes. The purpose of this study was to assess sleep health (sleep disturbances, sleep difficulty and daytime dysfunction) via a sleep screening tool in elite female basketball players during international competition.

METHODS

Participants were 12 elite female basketball players (New Zealand Women’s Senior National Team, Tall Ferns) competing at the 2021 International Basketball Federation Women’s Asia Cup in Amman Jordan. The Athlete Sleep Screening Questionnaire (16 item) was used to assess sleep health and associated factors during the 7-day tournament to determine the impact of international travel. The ASSQ was scored according to previous validated methods to determine chronotype, sleep difficulty score, clinical sleep problem category (none, mild, moderate, or severe), and potential referral to a sleep physician for assessment due to poor sleep health. Categorical variables were summarised with frequency and percent. The study was approved by the University of Southern Queensland Human Research Ethics Committee (H21REA182).

RESULTS

Clinical sleep problems, as categorised by sleep difficulty score ≥ 8, were reported in 33% of the athletes, with 25% classified as moderate and 8% classified as severe. Fifty percent of the athletes reported sleep disturbance during travel, while 42% reported daytime dysfunction when travelling for competition. According to chronotype classification, 75% of athletes were categorised into evening type, 33% ‘definitely evening’ type sub-category, with 25% categorised into morning type. In total, 42.0% of athletes (5 players) were identified for further assessment.

CONCLUSION

This study highlights the effective use of the ASSQ as an easy to administer sleep screening tool to determine sleep health in elite female basketball players. The ASSQ provides a method of accurately identifying athletes that would benefit from sleep hygiene education, sleep travel management and subsequent preventative measures related to clinically significant sleep problems. In this case study, a substantial portion of elite female basketball players appear to suffer from suboptimal sleep and would likely benefit from interventions targeting sleep health. This is an important consideration and provides valuable insights into indicators of sleep health in the management of female athlete sleep health and wellbeing during international competition.
INDIVIDUAL STRENGTH CHANGES FOLLOWING A VERY BRIEF INTERVENTION ON NATIONAL STRENGTH TRAINING GUIDELINES IN ADULTS AGED 50 - 75 YEARS
Authors: Gluchowski Dr. Ashley
Published: May 2024

BACKGROUND

There is little evidence that the public or healthcare practitioners are aware of and implementing the strength training component of the United Kingdom’s (UK) Chief Medical Officers’ physical activity guidelines in practice. Our study aimed to objectively measure strength following a very brief intervention with the strength component to determine if this practice could increase muscle strength.

METHODS

This was a mixed method, one-arm, pre-post six-month study. Thirty adults aged 50-75 years had hand grip (upper) isometric strength and ankle plantarflexion (lower) isometric strength measured. The average of two trials on the dominant limb were recorded. Participants were provided a physical copy of the guidelines and were asked to follow the strength recommendations. The very brief intervention (five minutes) included information on why and how to follow the strength guidelines, example exercises, along with a proven behaviour change technique (providing a journal to record training sessions). Strength was tested after six-months.

RESULTS

The group average indicated that there was no change in upper or lower body strength from baseline. However, when data were viewed individually, upper body strength was gained in 21 of 30 participants and lost in 9 (range: -4.5 to +6 kg). 42% of participants gained more than 2 kg in hand strength after six-months. Lower body strength was gained in 15 participants and lost in 15 (range: -12.4 to +8.65 kg). 43% of participants lost more than 2 kg. Qualitatively participants took the opportunity to ‘procure some new weights’ as they found their weights at home ‘too easy.’ Participants had a new-found realisation that ‘strength training is vital to muscle strength.’ Some mentioned that ‘strength training is now part of my life.’ On the other hand, other participants wanted more, noting that ‘there should be more publicity, information about [strength training] to the general public’ and found it unnecessarily ‘hard to find [follow up information] online.’

CONCLUSIONS

In the movement to make ‘every contact count,’ a very brief intervention has been shown to raise awareness and change strength training behaviour. Healthcare practitioners should focus on lower body exercise examples alongside progression techniques to avoid rapid loss in lower body strength. Public health stakeholders need to work together to provide easily accessible strength training resources.
RETHINKING THE MANAGEMENT OF HEALTH IN PEOPLE WITH DIABETES-RELATED FOOT ULCERS FROM AN AEP PERSPECTIVE: AN UPDATE FROM THE DFUEX STUDY
Authors: Baker Dr Callum , Min Dr Danqing , Chuter Professor Vivienne , Twigg Professor Stephen , Johnson A/Professor Nathan
Published: May 2024

INTRODUCTION & AIMS

Current treatments for people with diabetes-related foot ulcers (DFUs) focus on foot outcomes - potentially at the expense of broader health and wellbeing considerations. There are barriers to exercise for people with DFU and hesitancy in promoting physical activity by clinicians. AEPs may have the clinical skills to help people with DFUs engage in safe and effective exercise. The aim of this study was to examine the impact of AEP supervised exercise intervention on cardiorespiratory fitness, health and wound healing in adults with DFU.

METHODS

Using a randomised control trial design (ANZTR registration: 12622000885796p) adults aged 18 to 70 years (n=32) with active DFU are being recruited from an interdisciplinary High-Risk Foot Service (iHRFS) at Royal Prince Alfred Hospital Sydney Australia, and randomised to receive 12 weeks of supervised exercise (aerobic and resistance) training (Exercise) with usual care or usual care (Control) Measurements including fitness, metabolic and wound outcomes are acquired at baseline and after 12 weeks.

RESULTS

Preliminary baseline demographic, fitness and health data will be presented. Consideration for the scope of practice for AEPs in the multidisciplinary management of DFUs will be discussed incorporating observations and guidance on implementing exercise in a high risk DFU population, where there is limited patient and practitioner knowledge about safe and effective exercise options, and historical avoidance of physical activity to lessen the risk of wound deterioration. This will include consideration of aspects around exercise which are unique to people with DFUs, such as working with iHRFS, patient ambulation and transport, wound type and location, diversity of wound offloading devices and individual facilitators and barriers to exercise participation.

CONCLUSIONS

There is a need for robust evidence concerning the efficacy and safety of exercise intervention, and a need for strategies to engage AEPs into the multidisciplinary care of people with DFUs. Supported by the Exercise and Sports Science Australia Research Grant.
REGULAR LOW-DOSE CAFFEINE SUPPLEMENTATION DURING TRAINING DOES NOT PROVIDE ADDITIONAL BENEFIT TO SUBSEQUENT EXERCISE PERFORMANCE IN AUSTRALIAN RULES FOOTBALL ATHLETES
Authors: Ducker Dr Kagan , Maylor Mr Joel , Hiscock Dr Daniel , Brade Dr Carly
Published: May 2024

INTRODUCTION & AIMS

Acute caffeine supplementation can improve exercise types like those completed by Australian Rules football (ARF) players during training. Hypothetically athletes could implement caffeine supplementation prior to training, allowing them to complete more training volume, improving adaptation and subsequent exercise performance. This study aimed to investigate the effect of regular low-dose caffeine ingestion pre-training during a training block on subsequent exercise performance.

METHODS

Twenty-nine male semi-professional ARF players were randomly allocated to a caffeine or placebo group. The four-week intervention period involved participants ingesting 2 mg·kg·BM-1 of caffeine or a placebo 60 min prior to two of their three weekly training sessions, which incorporated sport-specific conditioning and skills training. To assess exercise performance, a battery of tests was used before and after the intervention period including the Yo-Yo Intermittent Recovery Test Level 2 (YYIRT2), 20 m sprint and vertical jump (VJ). Performance differences were assessed using a linear mixed-effect model.

RESULTS

Mean session rating of perceived exertion (p = .24) and total training load (p =.53) were not different between caffeine and placebo groups over the intervention. There were no significant time x condition interaction effects for YYIRT2 accumulated distance (p = .87), or 5, 10 and 20 m sprint times (p =.06 - .44), however both caffeine and placebo groups improved YYIRT2 distance and sprint times following four weeks of training (p < 0.01). There was a significant effect for time showing decreased VJ performance (p < 0.01), with greater reductions in the placebo group (p = .03).

CONCLUSION

It is more beneficial to implement an effective training program for athletes rather than focusing effort on regular low-dose caffeine supplementation to augment the training stimulus. The training stimulus itself is typically greater for developing endurance and sprint effort performance, with supplemental caffeine showing no additional performance benefit.
EXPERIENCES AND PERCEPTIONS OF PHYSICAL ACTIVITY AND EXERCISE IN PEOPLE WITH METABOLIC-ASSOCIATED FATTY LIVER DISEASE: A META-ETHNOGRAPHIC REVIEW
Authors: Keating Dr Shelley , Dreyer Carla , Hallsworth Dr Kate , Stine Associate Professor Jonathan , Hickman Associate Professor Ingrid
Published: May 2024

INTRODUCTION & AIMS

Metabolic-associated fatty liver disease (MAFLD) affects one third of adults worldwide (>5 million Australians) with significant health and socioeconomic burden. Physical activity (PA) is an effective component of MAFLD management, with Australian exercise guidelines recently developed. However, <20% of people with MAFLD meet recommended PA targets. We aimed to review published data on the lived experiences and perceptions of PA and exercise in people with MAFLD.

METHODS

A meta-ethnographic synthesis was utilised to systematically review articles published in English relating to the experiences and perceptions of PA/exercise in people with MAFLD. Databases (PubMed, Embase, Web of Science) were searched from inception to November 2023. Two researchers (CD, SK) independently screened titles and extracted data. Data (study-level themes and subthemes) were coded and themed using the validated Noblit and Hare model. Study quality was assessed using the Critical Appraisal Skills Programme checklist.

RESULTS

A total of 1538 articles were screened, with seven studies included (n=161 participants across six countries; overall study quality rated ‘high’). Semi-structured interviews and focus groups were the predominant methods. Key findings encompassed barriers to PA/exercise uptake and maintenance including: lack of awareness of MAFLD, which lowered risk perception; lack of information provision regarding the role and importance of PA/exercise for MAFLD management; lack of resources, tailored exercise plans or referrals; multiple comorbidities and symptoms including obesity, musculoskeletal conditions, pain and fatigue; ambivalence of perceived exercise capabilities and low exercise-related self-efficacy; lack of time and competing priorities. Reported enablers of PA/exercise included: accountability to themselves (e.g., habit forming) and to the healthcare professional; social support from family, friends, and healthcare providers; the experience of symptom relief and holistic benefits.

CONCLUSION

This study translated first-hand experiences and perceptions of physical activity and exercise for people with MAFLD, identifying priorities to target for improved uptake and maintenance.
RESISTANCE TRAINING PRESCRIPTION FOR ATHLETES DURING PERIODS OF PLANNED DE-LOADING: A SURVEY OF STRENGTH AND CONDITIONING COACHES
Authors: Marco Ms Kristen De , Goods Dr Paul , Baldwin Dr Kate , Hiscock Dr Daniel , Scott Associate Professor Brendan
Published: May 2024

INTRODUCTION & AIMS

Implementing resistance training (RT) for athletes may be difficult during some training-phases due to competing demands. However, it is currently unknown how strength and conditioning coaches prescribe RT during periods of planned de-loading. Therefore, we aimed to investigate the RT prescription practices of coaches during four common de-loading periods (taper, competitive season, tournament, travel).

METHODS

An anonymous online survey was shared globally to coaches, with data analysed from 204 responders (current level of athlete coached: world class n=68, elite/international n=62, highly-trained n=64, trained n=10). Coaches only provided answers about prescription for de-loading periods which they reported encountering. Where a coach indicated not prescribing RT for specific de-loading periods, they provided information on any barriers preventing RT prescription.

RESULTS

Weekly RT prescription across all de-load periods was typically reported as: 1-2 sessions, 30-60 min, 1-3 sets, 1-6 repetitions. Most coaches reported decreasing volume during all periods (taper: 89.1%, competitive season: 70.4%, tournament: 84.1%, travel: 74.6%), with the most common reduction in RT volume reported as 0-25%. Most coaches also decreased intensity during a taper (52.9%), tournament (54.8%) and travel (53.6%), with a 0-25% reduction most common. ‘Lack of equipment and facilities’ and ‘scheduling/time’ were common barriers cited to RT prescription during the competitive season (100% for scheduling/time), tournament (55.6% and 50.0%), and travel (57.3% and 60.0%). During a taper, ‘recovery’ was the most reported reason (41.7%).

CONCLUSION

During planned de-loading periods, both training volume and intensity are generally decreased by coaches compared to periods of normal training. The similarity of barriers to RT prescription during de-load periods suggests the experiences of coaches are not influenced by the phase. To address barriers experienced by some coaches, researchers should examine the use of alternative RT strategies for periods of planned de-loading to maintain training stimulus.
SOLVING THE HIGH-INTENSITY MUTLIMODAL TRAINING PRESCRIPTION PUZZLE: A SYSTEMATIC MAPPING REVIEW
Authors: Sharp Miss Tijana , Slattery Dr Katie , Coutts Distinguished Professor Aaron , van Gogh Miss Mikah , Ralph Miss Lara , Wallace Dr Lee
Published: May 2024

INTRODUCTION & AIMS

High-Intensity Multimodal Training (HIMT) refers to all styles of high-intensity combined aerobic, resistance and/or bodyweight exercise. Previous heterogeneity in exercise prescription and reporting in HIMT reduces the understanding of which factors should be commonly considered when prescribing HIMT (e.g., exercise volume, intensity, duration). Previous studies have demonstrated positive effects of HIMT on health and performance outcomes. However, methodological disparities limit comparisons between findings. This systematic mapping review examines the prescriptive considerations and health and performance outcomes of HIMT in the context of training.

METHODS

A systematic literature search was conducted using Ovid Medline, SPORTDiscus and Cochrane Library databases and additional sources to identify studies up until February 2023. A total of 37090 records were retrieved, of which 221 were included for review. 247 individual HIMT protocols were included for categorical analysis against the Consensus on Exercise Reporting Template (CERT) and Applied Research Model for the Sport Sciences.

RESULTS

A total of 85 unique terms were used to describe HIMT. Included studies most commonly prescribed HIMT using a consistent exercise selection and circuit format. Exercise intensity was inconsistently reported on and a large proportion of studies incorrectly prescribed ‘high-intensity’ exercise according to ACSM definitions (i.e., <77% HRmax). Participation location, supervision and participation format were the most commonly reported non-training variables. The most frequently reported outcomes were cardiovascular health, perceptual outcomes, body composition and biochemical outcomes. A large proportion of previous HIMT research was experimental in design.

CONCLUSIONS

Previous HIMT research demonstrates a lack of standardisation in reporting. Future studies should seek to follow guidelines such as the CERT to improve reporting rigour. Additionally, forthcoming research should attempt to actively involve practitioners in implementation studies to improve ecological validity among interventions.

REGISTRATION

This review adhered to PRISMA-ScR guidelines. Preregistration: osf.io/yknq4.
A VALIDATION OF A NOVEL RUNNING ECONOMY PROTOCOL AND COMPARISON OF TWO CARBON-PLATED RUNNING SHOES IN FEMALE LONG-DISTANCE RUNNERS
Authors: Freeman Dr Brock , Cripps Dr Ashley , Merrells Mr Rob , McCulloch Ms Kayla , Baldwin Dr Kate , Badenhorst Dr Claire , Rønnestad Dr Bent , Smith Nathan D.W.
Published: May 2024

INTRODUCTION

Running economy (RE) is the strongest predictor of long-distance running performance in well-trained athletes (1). Carbon-plated running shoes have indicated improvements of 4% in RE when compared to previous generation non-carbon-plated running shoes (2). However, these studies have key methodological limitations; the prescribed intensities didn’t replicate race demands, the influence of fatigue was not considered, and testing was only completed on males. AIM: The primary aim of this study was to develop an appropriate protocol to measure RE in female long-distance runners. The secondary aim was to compare performance and RE of two carbon-plated performance shoes in female long-distance runners.

METHODS

Seven female endurance athletes (age: 30.7 ± 6.6 y, mass: 59.1 ± 5 kg, VO2max: 55.3 ± 4.1 ml/kg/min) completed a graded exercise test to establish a relative race intensity (90% of lactate threshold). Participants completed two testing sessions during the follicular phase of the menstrual cycle in alternating footwear, which consisted of four 7-minute trials, a 25-minute continuous run, four 7-minute trials, and a 13-minute distance trial. RE was recorded as the oxygen consumption and energetic cost of running from minutes 5-7 of each trial. Shoe preference was recorded midway through the first session and the end of the second session. A linear mixed model was used to compare economy and performance metrics.

RESULTS

There was no significant difference in RE because of fatigue and no significant difference between shoes. However, large individual variations were evident. Participants reported disagreement between preferred shoe and the shoe that demonstrated greatest RE.

CONCLUSION

A longer protocol that controlled for the menstrual cycle did not induce fatigue related changes in female participants, supporting a higher resistance to fatigue in females (3). The individual variation between shoes suggests that further analyses should be conducted to inform shoe selection for female long-distance runners.
ACUTE INTERMITTENT HEAT EXPOSURE WITH MORE FREQUENT AND SHORTER COOLING BREAKS ENHANCES PERFORMANCE AND ELICITS COMPARABLE PHYSIOLOGICAL RESPONSES TO CONTINUOUS HEAT EXPOSURE
Authors: Ramos Julian , Ducker Dr Kagan , Riddell Dr Hugh , Landers Dr Grant , Girard Dr Olivier , Brade Dr Carly
Published: May 2024

INTRODUCTION & AIMS

Heat acclimation (HA) is critical to mitigate the adverse effects of heat on exercise performance. While these methods yield physiological adaptations to heat, it also results in greater internal training load. This can potentially compromise training quality and lead to overreaching. Therefore, there is a need for HA protocols that address situations where training quality is crucial, yet the heat stimulus is necessary. The aim of this study was to investigate the influence of shorter, more frequent rest breaks with per-cooling (PerC) as an alternative HA session on physiological, perceptual, and self-paced maximal cycling performance, compared to continuous heat exposure.

METHODS

Thirteen participants completed one continuous and three intermittent heat exposure (IHE) maximal self-paced cycling protocols matched for total exercise and rest duration, in a random order in heat (36°C, 80% relative humidity): 1 x 60-min exercise (CON), 3 x 20-min exercise with 7.5-min rest between sets (IHE-20), 4 x 15-min exercise with 5-min rest between sets (IHE-15), 6 x 10-min exercise with 3-min rest between sets (IHE-10). Mixed-method PerC (crushed-ice ingestion and cooling vest) was applied during rest periods of all IHE protocols.

RESULTS

Total distance completed was greater in IHE-10, IHE-15, and IHE-20 compared to CON (+11%, +9%, and +8%, respectively), with no difference observed between IHE protocols. Total time spent above 38.5°C core temperature (Tc) was longer in CON compared to IHE-15 and IHE-20 (+62% and +78%, respectively), but similar to IHE-10 (+5%). Furthermore, a longer time above 38.5°C Tc occurred in IHE-10 versus IHE-15 and IHE-20 (+54% and +69%, respectively). Sweat loss did not differ between conditions.

CONCLUSION

Intermittent heat exposure with PerC may be a viable alternative HA protocol in situations where training quality takes precedence over thermal stimulus, or when both factors hold equal priority.
EXPLORING THE ROLE OF SKELETAL MUSCLE MICROVASCULAR BLOOD FLOW IN EXERCISE CAPACITY AMONG INDIVIDUALS WITH CONTROLLED TYPE 2 DIABETES
Authors: Parker Dr Lewan , Thomas Dr Hannah , Way Dr Kimberley , Nolan Dr Mark , Maddison Prof. Ralph , Marwick Professor Tom , Keske Prof Michelle
Published: May 2024

INTRODUCTION & AIMS

The cardiac and macrovascular system is vital for human exercise capacity, yet the microvascular network is primarily responsible for delivering nutrients and oxygen to metabolically active tissues like skeletal muscle. Due to methodological limitations, few studies have investigated the role of muscle microvascular blood flow in determining exercise capacity or intolerance in individuals with chronic conditions such as type 2 diabetes. Our aim was to use modern contrast-enhanced ultrasound to directly measure microvascular blood flow in skeletal muscle at rest and after a maximal treadmill exercise test in individuals with controlled type 2 diabetes.

METHODS

Fifteen adults with controlled type 2 diabetes (age: 62.5 ± 8.0 years [M ± SD]; BMI: 31.6 ± 6.9 kg/m2; HbA1c: 6.7 ± 0.9%; 13 females and 2 male) attended the laboratory after a 2-hour fast and completed a Modified Bruce treadmill exercise test until exhaustion. Microvascular blood velocity, volume, and flow in the vastus lateralis muscle was assessed at rest, immediately post-exercise, and 30 minutes post-exercise via contrast-enhanced ultrasound during a constant-rate intravenous contrast agent infusion (DEFINITY®). Participants also completed a whole-body dual x-ray absorptiometry scan and a six-minute walk test (6MWT).

RESULTS

Microvascular blood velocity, volume, and flow increased immediately after exercise (∼230%, ∼79%, and ∼529%, respectively; all p<0.001), and remained elevated above baseline levels 30 minutes post-exercise (∼79%, ∼25%, and ∼139%, respectively; all p≤0.003). Resting and post-exercise skeletal muscle microvascular blood flow measures were not associated with VO2peak (ml/min/kg), time to exhaustion, or six-minute walk distance (all p>0.05).

CONCLUSION

Muscle microvascular blood flow remains elevated for up to 30 minutes following maximal aerobic exercise in individuals with controlled type 2 diabetes. The lack of association between muscle microvascular blood flow and exercise capacity is not clear but may indicate considerable blood flow redundancy or reserve within the vascular network.
ADHERENCE TO PRESCRIBED EXERCISE AND CLINICAL OUTCOMES IN PEOPLE WITH CHRONIC NONSPECIFIC LOW BACK PAIN: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Bastianon Andrew , Wood Dr Lianne , Gilanyi Mr Yannick , Hansford Mr Harrison , Gibbs Dr Mitchell T. , Dean Prof Sarah , Foster Prof Nadine , Hayden Dr Jill , Jones Matthew D
Published: May 2024

BACKGROUND

Exercise is widely accepted as a first-line treatment for chronic non-specific low back pain (CNSLBP). However, the benefits of exercise diminish over time, as does adherence to exercise. It is unclear whether greater exercise adherence is associated with improvements in pain intensity (PI) and functional limitation (FL). We explored the relationship between exercise adherence and patient-reported outcomes in people with CNSLBP.

METHODS

We conducted a secondary analysis of the Cochrane systematic review, ‘Exercise therapy for chronic low back pain’, using a subset of 24 trials that measured exercise adherence compared to usual care. Random-effects meta-analysis was performed in R for PI and FL at the closest time point post-intervention. We used predefined subgroups of exercise adherence of ‘Good’ (90-100%), ‘Moderate’ (70-89%), or ‘Poor’ (14-69%) adherence. We used the risk of bias judgements provided by Cochrane.

RESULTS

All trials included were deemed low risk of bias. Compared to usual care, ‘Good’ adherence was associated with reduced PI by 17.83 points on a 100-point scale (95% CI -26.23 to -9.43; I2 = 81.7%) and FL by 9.69 points on a 100-point scale (95% CI -12.64 to -6.74; I2 = 18.9%). ‘Moderate’ adherence was associated with reduced PI by 6.93 points (95% CI -10.43 to -3.44; I2 = 18.3%) and FL by 3.80 points (95% CI -6.10 to -1.49; I2 = 0%). ‘Low’ adherence was associated with reduced PI by 7.50 points (95% CI -19.83 to -4.84; I2 = 89.7%) and FL by 3.35 points (95% CI -10.45 to -3.74; I2 = 82.7%).

CONCLUSIONS

Greater adherence to exercise is associated with greater improvements in PI and FL in adults with CNSLBP. Further research is needed to understand the causal effect of adherence on patient-reported outcomes. Better reporting of this potentially important exercise parameter in randomised trials is also needed.
IN-HOME COMMUNITY AGED CARE FALLS PREVENTION TELEHEALTH PILOT
Authors: Street Richelle , Anderson Jane
Published: May 2024

BACKGROUND

A small scale pilot was conducted to test the concept of a remotely delivered in-home prescriptive exercise program for older Australians at risk of falling or with a history of falls. There is limited evidence for the efficacy of remotely delivered falls prevention programs within the aged community setting. Most community models are in-person and resource poor. This can result in older Australians living in isolated locations not having access to a service or provision of a service that cannot support the intervention intensity to produce effective functional gains. In the Residential aged care facility setting, the SUNBEAM trial is evidenced to reduce falls prevalence in participating residents. This pilot aimed to discover if exercise prescription modeled on the SUNBEAM trial could be delivered in a remote format to in-home clients and result in improvement in strength, mobility and balance scores associated with a reduced risk of falling.

METHOD

The pilot commenced in April 2023 and was delivered by an Accredited Exercise Physiologist for a period of 14 weeks, offering a total of 28 hours of exercise to 6 participants with a history of falls. Participants were provided with a home exercise kit for use and all sessions were conducted as individual appointments, using videoconferencing via the telehealth platform, Coviu. A series of strength and balance related outcome measures and assessments were collected using modified methodology for telehealth.

RESULTS

The individual results of the program demonstrated gains in strength and balance, directly linked to reducing falls risk. Participants reported meaningful impacts on sense of self from the program.

CONCLUSION

The pilot was successful in proving the concept of a remotely delivered falls prevention exercise-based program can work for the in-home aged care setting. This warrants future efforts to expand on findings to benefit the wider aged care population residing in their own homes.
FATIGUE SCIENCE INFORMING LONG COVID RECOVERY: A CASE STUDY
Authors: Giles Mrs Adriana , Phillips Dr Vicky , Sinclair Mr Chris
Published: May 2024

CASE SETTING

42-year-old female client referred for unmanaged long covid symptoms, six months following severe acute COVID-19 infection. Referred by an occupational therapist under Life Insurance to restore health and function for return to work (RTW). Experiencing cognitive and physical fatigue, muscular aches, breathlessness, post-exertional malaise, reduced cognitive capacity and exacerbated asthma symptoms at referral. Reduced functional capacity to perform activities of daily living and usual work duties and hours.

TREATMENT/REHABILITATION PROVIDED

14 hours of exercise physiology was delivered by telehealth over nine months, during fortnightly or monthly consultations. Additional multidisciplinary collaboration occurred with occupational therapist, return to work co-ordinator, and general practitioner. The intervention consisted of educational coaching sessions on the physiology of fatigue, pacing strategies, individualised wellness strategies (sleep, mindfulness/relaxation, exercise, diet), relapse planning, and RTW planning. A commercially available wearable device obtained 24/7 biometric data, which tracked resting heart rate variability (rHRV), resting heart rate, respiratory rate, and sleep performance. rHRV objectively measured fatigue. Wellness strategies were coached from analysing the impact of client behaviours on rHRV trends. Two functional goals of housework and socialising were established.

RESULTS

Validated inventories measured self-reported improvements in; fatigue symptoms: 12-item SPHERE-12, range: 0-68 points [42 baseline; 4 final]; function: two 11-item patient-specific functional scale [housework, socialising], range: 0-20 points [5 baseline; 19 final]; and quality of life: 16-item quality of life scale, range: 0-112 [54 baseline; 79 final]. rHRV improved [10ms baseline, 56ms final]. RTW improved from four days/week to five days/week in her pre-disability role as a client manager.

REFLECTIONS/LEARNINGS

rHRV provided an objective marker of fatigue. The subject responded positively to rHRV monitoring. Real time biometric data enables individualised fatigue coaching including behaviour change, wellness and planning/pacing strategies. This approach improved fatigue and restored function to perform daily activities and RTW.
THE EFFECT OF INTRA-INFUSION EXERCISE ON CHEMOTHERAPY SIDE EFFECTS; AN INTERIM ANALYSIS
Authors: Seet-Lee Catherine , Yee Jasmine , Marvin Sarah , Mizrahi Dr David , Mahon Kate , Lacey A/Prof Judith , Edwards Dr Kate
Published: May 2024

INTRODUCTION

Chemotherapy treatment results in side effects that impact quality of life and physical activity behaviours. Aerobic exercise in parallel with chemotherapy reduces side effects particularly fatigue and improves quality of life. Our recent clinical pilot work has shown that an acute bout of aerobic exercise increases blood flow to tumours. Therefore, if exercise is performed during chemotherapy (intra-infusion exercise), the result may be increased drug delivery and treatment efficacy. Intra-infusion exercise also provides a supervised opportunity to overcome patient-reported barriers to exercise during a period where a patient would be otherwise sedentary. AIM: The aim of this ongoing randomised controlled trial is to determine the effects of aerobic intra-infusion exercise on chemotherapy side effects and physical activity behaviours.

METHODS

Adults under 75 years receiving chemotherapy with stage I-III breast, colorectal or ovarian cancer, and ECOG 0-2 were eligible. Four chemotherapy sessions were included, cycle 1 (C1) a baseline and cycles 2-4 (C2-4) included exercise intervention or usual care. The exercise task was 20-minutes of moderate intensity cycling (40-50% heart rate reserve) during infusion. All participants received exercise education. A 7-day symptom diary (including Brief Fatigue Inventory (BFI) and Edmonton Symptom Assessment System (ESAS)) was completed following C1-C4 and an activity monitor worn.

RESULTS

Nineteen participants have completed the trial (79% female), with no adverse events reported in either group. Physical symptoms increased across cycles in both groups (p=0.003). 1-week mean ESAS physical symptoms total in the exercise group (C1 16±9.8, C4 23±13.7) and control group (C1 18±7.1, C4 23±12.7) were similar. No significant effects were seen for fatigue or step count.

CONCLUSION

Intra-infusion exercise is safe and does not increase side effects in patients receiving chemotherapy. Expected increases in physical symptoms were observed without difference between usual care and exercise. Further analysis with ongoing recruitment will continue to examine any differences between groups.
DOES EXERCISE CHANGE BLOOD FLOW TO TUMOURS? ACUTE AEROBIC EXERCISE EFFECTS ON LIVER METASTASES BLOOD FLOW: A CASE SERIES
Authors: Seet-Lee Catherine , Yee Jasmine , Clarke Jillian , Edwards Dr Kate
Published: May 2024

AIM

Effective cancer treatment relies on intravenous chemotherapy penetrating the entire tumour in sufficient concentrations, which is largely reliant on effective blood supply into and within the tumour. However, tumours contain abnormal vasculature with inefficient blood perfusion leading to the inability for chemotherapy to reach the target tumour. Pre-clinical evidence suggests acute exercise may increase blood flow by 200%. However, most pre-clinical studies investigate the effects of light-to-moderate intensity exercise and subsequently there is little evidence regarding the most effective exercise intensity for improved tumour vasculature. Therefore, the aim of this ongoing case series is to determine whether exercise changes tumour blood flow in a clinical model using non-invasive techniques, and how exercise intensity effects degree of change in blood flow to tumours in patients with liver metastases.

METHODS

Participants were eligible if they were aged over 18 years, had stage IV cancer with liver metastasis and ECOG 0-2. The study visit consisted of an aerobic fitness test (YMCA) to determine cardiorespiratory fitness and three 5-minute bouts of exercise at low, moderate and high intensities. After each exercise bout, Doppler ultrasound was used to measure a liver tumour vessel and the hepatic artery (as a control) to determine blood flow parameters.

RESULTS

Exercise increased peak systolic velocities (PSV) to liver tumours at all intensities compared to rest. Moderate and high exercise intensities showed a marked increase in PSV within the first 2 minutes after exercise. The hepatic artery showed less variability in PSV with time compared to the liver tumour. Cardiorespiratory fitness did not affect tumour PSV.

CONCLUSION

The results of this case series thus far suggest that exercise increases tumour blood flow at all exercise intensities with particular emphasis on moderate and high intensities. This supports the potential for using exercise as an adjunct to standard treatment to improve chemotherapy efficacy.
EFFICACY, FEASIBILITY AND OPTIMAL TRAINING PARAMETERS FOR RUNNING IN ADULTS WITH CHRONIC LOW BACK PAIN: THE ASTEROID RANDOMISED CONTROLLED TRIAL
Authors: Neason Christopher , Samanna Claire L , Belavy Prof Daniel L , Bowe A/Prof Steven J , Clarkson Dr Matthew J , Connell A/Prof David , Craige Emma A , Gollan Romina , Main A/Prof Luana C , Miller Dr Clint T , Mitchell Prof Ulrike H , Mundell Dr Niamh L , Scott A/Prof David , Tagliaferri Dr Scott D , Tait Dr Jamie L , Vincent Dr Grace E , Owen A/Prof Patrick J
Published: May 2024

INTRODUCTION & AIMS

Running is common and one of the most accessible forms of exercise training, yet the suitability for adults with chronic low back pain is unknown. This study assessed the efficacy and feasibility of running in adults with chronic low back pain (LBP) and explored the relationship between training parameters and pain intensity.

METHODS

This two-arm parallel (1:1) individually randomised controlled trial allocated 40 participants (mean [SD] age: 33 [6] years, female: 50%) with non-specific chronic LBP to a 12-week intervention or waitlist control. The intervention was a progressive run-walk interval program comprising three 30-minute sessions per week, that were digitally delivered and remotely supported by an exercise physiologist. Efficacy outcomes were self-reported average and current pain intensity (100-point visual analogue scale) and disability (100-point Oswestry Disability Index). Training parameters examined were fortnightly adherence, pace and distance.

RESULTS

At 12-week follow-up, the intervention decreased average pain intensity (mean net difference [95%CI]: -15.30 [-25.33, -5.27] points, P=0.003), current pain intensity (-19.35 [32.01, -6.69] points, P=0.003) and disability (-5.20 [-10.12, -0.24] points, P=0.038), compared to control. There was no attrition and mean (SD) training adherence was 70% (20%; i.e. 2.1 of 3 sessions per week). Nine non-serious adverse events deemed potentially study-related were reported (lower limb injury/pain: n=7, cardiac syncope associated with an underlying condition: n=1, LBP: n=1). Greater fortnightly adherence (-0.04 [-0.33, 0.25] points), pace (0.23 [-0.48, 0.02] points) and distance (-0.03 [-0.13, 0.06] points) tended to be associated with greater reductions in pain intensity, yet did not reach statistical significance.

CONCLUSION

Running was feasible and improved pain intensity and disability in individuals aged 18-45 years with non-specific chronic LBP when compared to control. An individualised and conservative run-walk program should be considered a suitable form of physical activity for adults with chronic LBP.
ACUTE EFFECT OF INTERVAL TRAINING SET STRUCTURE ON PHYSIOLOGICAL AND PERCEPTUAL RESPONSES TO EXERCISE
Authors: Ducker Dr Kagan , Heath Ms Chelsey , Brade Dr Carly , Hiscock Dr Daniel , Scott Associate Professor Brendan , Shaw Mr Jacob , Riddell Dr Hugh , Ng Mr Isaac
Published: May 2024

INTRODUCTION & AIMS

A novel method for prescribing maximal aerobic speed (MAS) interval sessions involves the use of rest redistribution (RR). This approach could reduce perceived exertion and fatigue, preventing a decline in performance. This study aimed to compare acute physiological and perceptual responses between traditional (TS) and RR MAS interval training in endurance athletes.

METHODS

Twenty-five endurance runners (19 males, 6 females; age=31.9±8.5 y; maximal oxygen consumption (V̇O2max)=54.6±5.7 ml·kg·min-1; height=1.77±0.10 m; body-mass=74.0±13.0 kg) who ran >5 hours/week participated. Participants completed two MAS interval sessions equal in duration (18 min total, 360 s exercise, TS=660 s rest/RR=680 s rest) in a randomised order; TS: 3 sets x 6 repetitions (1 rep=20 s running:20 s rest) at 110% MAS and RR: 18 sets x 1 repetition (20 s running:40 s rest) at 110% MAS. During both sessions V̇O2 and heart rate (HR) were measured after each repetition, and blood lactate (HLa-) measured pre-exercise and after repetitions 6, 12 and 18. Rating of perceived exertion (RPE) was measured after repetitions 6, 12, and 18, and overall session RPE 10 minutes post-session.

RESULTS

Linear mixed effects models showed that TS led to a faster increase in V̇O2 (β=.16, p=.04) and HLa- (β=.09, p<.01), with consistently higher HR than RR (β=5.35, p<.01). Additionally, RPE (β=1.35, p<.01) and session RPE were lower in RR than TS (β=1.13, p<.01).

CONCLUSION

Results indicate that when session time is similar, TS (1:1 work-to-rest ratio), produces a greater physiological stimulus with higher V̇O2, HR and HLa-. Conversely, RR (1:2 work-to-rest ratio) resulted in lower perceived exertion and metabolic stress. This makes RR an appropriate choice for training periods with lower physiological stress or during periods of fatigue management. The reduced physiological demands in RR can facilitate a more controlled and sustainable training experience while still providing valuable training benefits.
PHYSICAL ACTIVITY AND MENTAL HEALTH IN AUSTRALIAN ADULTS WITH PSYCHOLOGICAL DISTRESS
Authors: Mundell Dr Niamh , Teychenne Dr Megan , Ashtree Dr Deborah N , Bryan Dr Marita , Chatterton Dr Mary Lou , Davis Dr Jessica , John Ms Tayla , Mahoney Ms Sophie , Rosenbaum Simon , Saunders Dean , Turner Megan , Versace Vincent , Young Lauren M , O’Neil Adrienne
Published: May 2024

INTRODUCTION & AIMS

Adults with mental health concerns face compounded barriers to physical activity engagement. We recently conducted a randomised controlled trial to determine whether a lifestyle intervention targeting PA and nutrition was non-inferior to psychotherapy in managing depression (the CALM non-inferiority trial). While we demonstrated non-inferiority, participants assigned to the lifestyle intervention demonstrated improvements in dietary adherence and intake but not self-reported activity measures. The aim of this sub-study was to analyse actigraphy-derived measures to identify whether objective changes occurred and determine whether these were associated with mental health.

METHODS

This study included a sub-set of 36 of the 70 participants assigned to the lifestyle therapy intervention from the larger trial (ACTRN12621000387820) who were recruited based on indicative depression (Distress Questionnaire Scale 8+). A Fitbit Charge-2 measured daily steps (n), distance travelled (km), floors climbed (n) and minutes in sedentary, light, moderate and vigorous activity. Questionnaires measured psychological distress (Kessler-10), anxiety (Generalised Anxiety Disorder scale-7) and depressive symptoms (Patient Health Questionnaire-9). Linear mixed models determined within-group change over time. Spearman rank correlation coefficients examined associations between change scores over 8-weeks.

RESULTS

From baseline to 8-week follow-up, floors climbed increased 38% (mean change [95%CI]: 2.8 [0.0, 5.5], P=0.047) and minutes sedentary increased 9% (66.9 [20.8, 133.0], P=0.004). We found no change in daily steps, distance travelled, or minutes spent lightly, moderately, or vigorously active. Reducing sedentary time was associated with reduced depressive symptoms (rs=0.350, P=0.043), similarly increasing time spent in vigorous activity was associated with reduced psychological distress (rs=0.346, P=0.045).

CONCLUSION

Changes in activity were mixed, however vigorous physical activity and reduced sedentary time were associated with improved mental health in adults with psychological distress participating in a lifestyle therapy intervention for depression. Future investigations should seek to quantify minimum changes required to benefit mental health in this vulnerable population.