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Resistance training and chronic disease: A Summary of the Current Evidence

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Abstract

Learning Objectives To understand that the effects of RT have been examined in persons with various chronic diseases, including cardiovascular disease, cancer, type 2 diabetes, chronic obstructive pulmonary disease, chronic kidney disease, Parkinson's disease, multiple sclerosis, fibromyalgia, and HIV/AIDS. To recognize that RT can be used as a tool to manage the wide array of debilitating symptoms experienced by various populations with chronic disease. To review the guidelines for developing an RT program for a select number of chronic disease populations. To gain the knowledge needed to further explore the research examining the effects of RT on chronic disease.
RESISTANCE TRAINING AND
CHRONIC DISEASE
A Summary of the Current Evidence
by Joseph T. Ciccolo,Ph.D., CSCS and Sanaz Nosrat, M.A.
Learning Objectives
To understand that the effects
of RT have been examined in per-
sons with various chronic dis-
eases, including cardiovascular
disease, cancer, type 2 diabetes,
chronic obstructive pulmonary
disease, chronic kidney disease,
Parkinsons disease, multiple scle-
rosis, fibromyalgia, and HIV/AIDS.
To recognize that RT can be
used as a tool to manage the wide
array of debilitating symptoms ex-
perienced by various populations
with chronic disease.
To review the guidelines for
developing an RT program for a
select number of chronic disease
populations.
To gain the knowledge needed
to further explore the research
examining the effects of RT on
chronic disease.
Key words: Resistance Training,
Chronic Disease, Muscular Strength,
Physical Function, Quality of Life
It is currently estimated that half of all American adults have at least one chronic
disease, which may include heart disease, cancer, type 2 diabetes, or chronic ob-
structive pulmonary disease (COPD) (31). The resulting effect of this level of illness
is astounding. In 2010, 86% of all health care spending was for those with one or
more chronic medical conditions, and seven of the top 10 causes of death were
chronic diseases (31). As such, efforts to limit the progression and reduce the intensity of
the symptoms experienced with chronic disease are desperately needed. Regular exercise,
of course, is a powerful behavior that can impact positively many of the most common dis-
eases experienced. Historically, aerobic exercise (and walking, in particular) has been the
most widely promoted form ofphysical activity; however, in 2008, the U.S. Department of
Health and Human Services released the first formal recommendation for Americans to
participate in at least 2 d/wk of resistance training (RT) as part of the national physical
activity guidelines. Since then, there has been a small bump in the participation rates of
RT (Figure 1), but the numbers remain low. Although there isno doubt that the continued
promotion of RT for apparently healthy adults is needed, efforts to encourage RT among
those with a current chronic disease also are critically important. Thus, the purpose of this
article is to promote the participation in RT by those with a chronic disease by (1) provid-
ing a brief summary of its positive effects on various chronic diseases and their associated
symptoms and (2) providing practical information and a guideline for developing an RT
program for a select number of chronic disease populations.
RESEARCH ON RESISTANCE TRAINING AND CHRONIC DISEASE
A wealth of research describing the effects of RT on the symptoms and management of
various chronic diseases now exists. Studies show that regular RT can slow the progression
44 ACSMsHealth & Fitness Journal
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Copyright © 2016 American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
of a disease and reduce the impact and severity of the symptoms
experienced. For example, RT can increase muscle strength,
functional capacity, and quality of life in patients with cardiovas-
cular disease (33,34). RT also can reduce dyspnea, fatigue, and
enhance the ability to perform activities of daily living for indi-
viduals with COPD (15,20). Other research shows that RT
may be uniquely suited for individuals with type 2 diabetes,
Parkinsons disease, and fibromyalgia. For instance, RT may
change the course of type 2 diabetes because it can increase
muscle mass and potentially alter insulin sensitivity via increased
muscle glucose storage (16). RT also can reduce the deteriora-
tion of muscle strength and improve balance and walking per-
formance for persons struggling with the negative effects of
Parkinsons disease (8). Finally, RT can combat many of the
muscle-related symptoms of fibromyalgia such as muscular
weakness, muscle pain, and generalized fatigue (22).
Thus, the evidence to date suggests that RT can be quite
helpful for those experiencing a chronic illness. More research
will be needed, however, because studies must continue to test
how to better prescribe and use RT to manage the symptoms
of various disease states. Future studies also should determine
how to increase adherence to an RT program and how this
might be used to prevent certain diseases. For more information
on the effects of RT for a number of different chronic diseases,
see the list of systematic reviews and meta-analyses in Table.
GUIDELINES FOR SELECT CHRONIC DISEASES
In the following sections, an overview of a select few chronic dis-
eases is provided, including some training recommendations
and special considerations when designing an RT program for
these populations. The recommendations are based on the cur-
rent research that has tested the effects of different RT variables
on markers of physical and mental health. Importantly, an effec-
tive RT program for an individual experiencing a chronic
disease is complex and requires significant planning and a sound
strategy that should be safe and matched to the exerciser's goals.
The factors of age, sex, symptoms experienced, and history of
participating in RT must be considered. Moreover, it is critical
for an individually tailored program to be constructed to effec-
tively stimulate the physiological and psychological changes nec-
essary to achieve the desired outcome. Practitioners should
always adhere to the key RT principles of progressive overload,spec-
ificity,andvariation when designing a program. Finally, the inten-
sity of different exercises within an RT program can be
prescribed using a percentage of the client's one-repetition max-
imum (1 RM); however, it may be necessary to estimate a 1 RM
froma5RMor10RMtestwhenaclienthasaconditionor
limitation that would make a 1 RM unsafe or excessively un-
comfortable (e.g., during a symptom flare-up).
CANCER
Cancer is the second leading cause of death in the United States
(1). Prostate, breast, and colon cancer are among the most com-
mon nondermatological cancers (1), and the treatments (e.g., sur-
gery, chemotherapy, radiotherapy) for each are accompanied
by debilitating adverse effects such as chronic fatigue, body fat
gain, physical impairments, bone loss, and a lower quality of life
(7). Fortunately, regular RT is known to reduce or prevent many
of these and other adverse effects, although the positive impact is
not uniform across all types of cancer (10,14). For more informa-
tion on the specific effects of RT in cancer survivors, see the sys-
tematic review by Hanson et al. (16).
Figure 1. Prevalence of U.S. adults meeting muscle
strengthening guidelines.
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Training Recommendations
In general, it is currently recommended that exercise profes-
sionals aim to implement a progressive full-body program with
2 to 3 sets per body part at 50% to 85% of 1 RM, two to four
times per week (14). Practitioners should be cautious with how
they progress their clients and carefully consider the type of can-
cer, whethersurgery was part of the treatment, and the length of
time the client has been in recovery. For example, although a
full-body program is recommended for all, the progression to
this will be different for breast cancer survivors (i.e., with poten-
tial upper body limitations) compared with prostate or colon
cancer survivors. For further reading, see the online case study,
Supplemental Digital Content 1, http://links.lww.com/FIT/
A35, which includes an example resistance training routine for
a cancer survivor.
Special Considerations
Although RT poses no major risk for an adverse event in this
population, there are several circumstances that need to be
taken into consideration. First, infection risk increases among
patients receiving chemotherapy. Closely monitor the clients
for signs of infection and take extra precautions in fitness facili-
ties to prevent infection (e.g., clean the equipment before use)
(6). Second, patients with bone metastases or with osteoporosis
may need an alternative program (e.g., more seated exercises)
to avoid the risk of falls, which might lead to bone fracture (6).
Third, patients with neuropathy might feel off-balance and have
problems with coordination. A program with fewer unilateral
movements or one modified to decrease the risk of falls and in-
jury is recommended (6). Lastly, it is important to take the time
to understand fully each client's full treatment and medication
regimen and adverse effects. Consultation with the client's
health care provider may be necessary. Moreover, if the individ-
ual has comorbid cardiovascular, pulmonary, and/or neurolog-
ical conditions, additional modifications to the program will be
needed (28).
CHRONIC KIDNEY DISEASE
Chronic kidney disease (CKD) is a condition characterized by a
gradual loss of kidney function through time, which may be
caused by high blood pressure, type 1 or 2 diabetes, or other
conditions (21). It is estimated that 26 million American adults
have CKD and millions of others are at increased risk (21). Pa-
tients with CKD who are on hemodialysis typically experience
muscle wasting and weakness, reduced physical activity, prob-
lems with performing activities of daily living, and poor mental
health (4). RT seems to be an ideal match for this population be-
cause it has been shown to significantly reduce muscle weakness
as well as increase muscle mass and strength, walking ability,
and improve quality of life (2). For more detailed information
and a review of the studies on RT and CKD, see Bessa et al. (4).
TABLE: Reviews and Meta-analyses on RT and Chronic Disease
Author/Year Topic Type Major Finding/Conclusion
Williams et al., 2007 (33) Cardiovascular disease Review RT can significantly alter the cardiovascular system and
modify cardiovascular disease risk.
Hanson et al., 2016 (14) Cancer Systematic review Effects of RTare not uniform across all types of cancer, with
the exception of muscular strength. Other improvements
may include physical function, body composition,
psychosocial functioning, and quality of life.
Liao et al., 2015 (20) COPD Systematic review
and meta-analysis
RT can improve muscular strength, dyspnea, and lung
function (i.e., FEV1).
Ishiguro et al., 2016 (16) Type 2 diabetes Systematic review
and meta-analysis
RT is most likely beneficial in the early stages of type 2
diabetes. There are more benefits for less obese individuals.
Bessa et al., 2015 (4) Chronic kidney disease Review RT can increase physical capacity, muscular strength, body
composition, and quality of life.
Chung et al., 2016 (8) Parkinsons disease Systematic review
and meta-analysis
RT produces increases in muscular strength, balance, and
motor symptoms in people with early to moderate
Parkinsons disease.
Kjølhede et al., 2012 (18) Multiple sclerosis Systematic review RT can increase muscular strength, with smaller but
positive effects on functional capacity, balance, fatigue,
and quality of life.
Nelson, 2015 (22) Fibromylagia Review RT can increase muscular strength and reduce muscle pain.
Gomes Neto et al., 2013 (11) HIV/AIDS Systematic review
and meta-analysis
Combined aerobic and RT can improve peak VO
2
, muscle
strength, physical function, and quality of life.
RESISTANCE TRAINING AND CHRONIC DISEASE
46 ACSMsHealth & Fitness Journal
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Copyright © 2016 American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
Training Recommendations
It is common for health care providers to recommend that indi-
viduals with CKD alter their diet, participate in regular exercise,
and reduce their body fat/weight. Thus, an RT program is just
one important part of a more comprehensive exercise routine. A
full-body RT program should be started with two sessions per
week. The program can begin with 1 to 3 sets per exercise, 10
to 20 repetitions, at an intensity of 40% to 60% of 1 RM and
progress up to 80% of 1 RM. Blood sugar and blood pressure
should be monitored before and after exercise for safety; be sure
to not take blood pressure on the arm with a fistula. Research
shows that favorable results can occur in as few as 6 weeks (4).
Special Considerations
When working with clients with CKD, certain exercise recom-
mendations should be followed. First, always initiate the RT
program at low intensity and progress appropriately in accor-
dance with the client's tolerance (25). Second, it is important
to continually monitor the client's symptoms and make sure
RT sessions are not undertaken during acute illness. Individuals
with CKD may experience bone pain, drowsiness, muscle
cramps, shortness of breath, sleep problems, and they may
bruise easily. Such symptoms should be monitored regularly, es-
pecially to ensure that none are exacerbated in response to exer-
cise. Third, RT done during dialysis (i.e., intradialytic RT) may
be a convenient way to begin RT with this population and
should be explored; proper supervision will be needed (e.g.,
dialysis nurse), however. Fourth and finally, patients with renal
osteodystrophy have a higher risk of fracture and tendon rup-
ture; therefore, high-impact exercises should be avoided with
these patients (25).
MULTIPLE SCLEROSIS
Multiple Sclerosis (MS) is a chronic autoimmune disease that re-
sults in the demyelination of the axons in the brain, brain stem,
and spinal cord. In the northern parts of North America and
Europe, where the disease is most common, the prevalence is
approximately one to two per 1,000 persons of the population
(12). Patients with MS experience a variety of symptoms that
can be attributed to the disease itself as well as inactive lifestyle.
These may include a loss of function and feeling in the limbs, a
loss of balance/coordination, reduced muscular strength (espe-
cially in the lower body), fatigue, and/or depression symptoms
(17,27). Because some individuals with MS have lower-body
balance impairments and gait problems, aerobic exercise fo-
cused on walking or running can be overly challenging. RT,
on the other hand, may be a more practical option because it
is known to be valuable for and well tolerated by those with
MS. Specifically, a wealth of studies have consistently shown
RT to induce improvements in muscular strength, muscle size,
functional capacity, fatigue, and mental health in patients with
MS (18,19,26). For more information and a systematic review
of the studies conducted, see Kjølhede et al. (18).
Training Recommendations
Several types of RT equipment are appropriate for use when de-
signing a program, such as elastic bands, free weights, machine
weights, and pulley systems. The program should be individual-
ized based on the client's disability level. For example, free
weights and machines may be more suitable for high-
functioning individuals with MS, whereas resistance bands may
be better for low-functioning individuals with MS. In general, it
is recommended that exercise professionals implement a full-
body routine initiating with 3 sets per exercise of 8 to 15 repeti-
tionsat65%of1RM,2to3timesperweek.Theintensitycan
be progressed gradually up to 3 sets of 80% of 1 RM. Significant
improvements in muscular strength can occur in as few as 8 to
12 weeks (9,19).
Special Considerations
A few guidelines are recommended for working with clients with
MS. First, caution is recommended when beginning an RT pro-
gram because those with MS typically have low muscular
strength. To decrease the risk of injury with clients who have sig-
nificant imbalances in bilateral strength, exercises should be
done with or on stable equipment, such as with machines or in
a seated position. Second, special supervision is required when
working with individuals with proprioceptive deficits or poor co-
ordination (32). Again, stable exercises are recommended, as are
slow and controlled movements. Third, the rate of progression
of an RT program for those with MS should be done with
Volume 20 | Number 5 www.acsm-healthfitness.org 47
Copyright © 2016 American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
caution to prevent overuse injuries or excessive fatigue. It is rec-
ommended that the resistance is increased by 2% to 5% when
15 repetitions are completed with no major fatigue in consecu-
tive training sessions (32). If the individual experiences an exac-
erbation of his or her symptoms, he or she should be encouraged
to reduce or abstain from exercise until his or her symptoms im-
prove. Lastly, a frequent concern for exercise with individuals
with MS is triggering the Uhtoff phenomenon (i.e., triggering
of MS symptoms because of overheating). Because many indi-
viduals with MS might demonstrate an impairment in thermo-
regulatory reflexes (e.g., sweating and vasodilation), it is
recommended that exercise professionals pay special attention
to room temperature and consider using cooling devices (27).
Exercise sessions should be scheduled to avoid the hotter times
of the day (i.e., mornings when it is cooler and body temperature
is typically lower) (32).
HUMAN IMMUNODEFICIENCY VIRUS/ACQUIRED
IMMUNE DEFICIENCY SYNDROME
Human Immunodeficiency Virus (HIV) is a virus that progres-
sively destroys the T lymphocyte cells (T cells) by using the
CD4+ glycoprotein on the surface of the cell to gain entry into
the cell. The HIV disease can progress into Acquired Immune
Deficiency Syndrome (AIDS), which is the final stage of infec-
tion where the immune system is severely compromised (mea-
sured by CD4+ cell count) or the individual becomes ill with
opportunistic infections.
It is currently estimated that there are more than 1.2 million
adults living with HIV in the United States, with nearly 50,000
becoming newly infected each year (5). With the advancement
in HIV medication, the HIV disease is now considered a chronic
condition with many negative adverse effects. These may in-
clude muscle wasting, insulin resistance, high cholesterol, central
adiposity, low bone density, depression, and anxiety. Several
studies haveexamined the benefits of RT with people living with
HIV (PLWH), and results show positive and significant effects
on each of the aforementioned symptoms (11,29). It should
be noted that RT does not have any adverse effects on the in-
dividuals immune system or HIV viral load (24). For more in-
formation on RT and HIV, see the systematic review and
meta-analysis by Gomes Neto et al. (11).
Training Recommendations
RT programs for this population should start with 2 to 3 sets of 8
to 12 repetitions per exercise and body part. Intensity can be
50% to 60% of 1 RM and progress up to 80% based on the in-
dividual's increasing fitness level (24,30). Sessions should occur
two to three times per week and can increase in frequency as
needed. There is considerable variation among those with
HIV/AIDS, with some being able to progress rapidly in their
program without any exacerbation of their HIV/AIDS symp-
toms or medication side effects, whereas others will experi-
ence more severe illness symptoms that will interrupt and slow
their progression.
Special Considerations
Fitness professionals need to continually monitor the general
health of clients who live with HIV/AIDS. One of the most
prevalent symptoms is fatigue (3), thus, the exercise provider
should modify the program when intense fatigue is present dur-
ing or after exercise. This is specifically important for individuals
in a more advanced state of the disease or those who are diag-
nosed with AIDS (23). PLWH also might have peripheral neu-
ropathy, which may cause problems with balance and
coordination. In these cases, modification to the exercise pro-
gram might be needed to reduce the risk of injuries and falls
(23). PLWH also might have comorbid conditions such as type
2 diabetes or cardiovascular disease; therefore, it is important
to follow the special recommendations for other chronic diseases
when applicable (23). Lastly, it is important to postpone the ex-
ercise sessions in case of diarrhea, vomiting, fever, or severe mus-
cle weakness until these symptoms are resolved (13).
SUMMARY
This article provides just a brief overview of the current evidence
supporting the use of RT as a method to manage and treat the
symptoms of several of the most common chronic diseases. Stud-
ies repeatedly show that RT can produce meaningful increases
in muscle mass, strength, physical function, and quality of life.
This occurs across different disease states and provides signifi-
cant relief for individuals experiencing the debilitating symp-
toms of their disease. Overall, much more research is needed,
and larger, more diverse trials must be conducted. Given the nu-
merous benefits that have already been uncovered, however,
and the fact that almost 80% of the population fail to meet the
nationally recommended guidelines, it is now time to act. The
fitness community, clinicians, and researchers should continue
to promote new efforts to find ways to get both apparently
healthy and known disease populations engaged in RT.
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Disclosure: The authors declare no conflict of interest and do not have any
financial disclosures.
Joseph T. Ciccolo, Ph.D., CSCS, is an assistant
professor of Movement Sciences in the Department of
Biobehavioral Sciences at Teachers College, Columbia
University. His primary research interest is on the use
of resistance training as a method to prevent and treat
chronic disease, with a specific focus on substance use
disorder and mental health.
Sanaz Nosrat, M.A., is a doctoral research fellow in
the Department of Biobehavioral Sciences at Teachers
College, Columbia University. Her research examines
the effects of resistance exercise on mental health in
people living with HIV.
BRIDGING THE GAP
The numerous health benefits gained from regularly
participating in RT are now well known. These benefits
may be particularly important for individuals with a
chronic disease because reduced muscular strength and
decreased physical function are some of the most
prevalent disease effects. Current evidence suggests
that RT can and should be recommended for those with a
chronic disease because it has been shown to be a safe
and effective way to alter the disease trajectory and
reduce the negative impact of different disease states.
Volume 20 | Number 5 www.acsm-healthfitness.org 49
Copyright © 2016 American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
... Resistance training (RT) is the anaerobic category of exercise involving the repeated movements against unaccustomed loads to stimulate a stronger muscle contraction (38). There is a wealth of research describing the beneficial effects of RT on symptoms and management of several chronic diseases such as diabetes, cardiovascular disease, and cancer (7). Since muscle contraction involves both mechanical and metabolic properties (39), this exercise modality is associated with increased functional strength (40), improved insulin sensitivity, quicker rapid glucose uptake (38), clinically decreased blood pressure over time, and increased basal metabolic rate (responsible for approximately two thirds of total energy expenditure) (39). ...
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BACKGROUND: Elderly people present alterations in body composition and physical fitness, compromising their quality of life. Chronic diseases, including HIV/AIDS, worsen this situation. Resistance exercises are prescribed to improve fitness and promote healthier and independent aging. Recovery of strength and physical fitness is the goal of exercise in AIDS wasting syndrome. OBJECTIVE: This study describes a case series of HIV-positive elderly patients who participated in a progressive resistance training program and evaluates their body composition, muscular strength, physical fitness and the evolution of CD4+ and CD8+ cell counts. METHODS: Subjects were prospectively recruited for nine months. The training program consisted of three sets of 8-12 repetitions of leg press, seated row, lumbar extension and chest press, performed with free weight machines hts, twice/week for one year. Infectious disease physicians followed patients and reported all relevant clinical data. Body composition was assessed by anthropometric measures and dual-energy x-ray absorptiometry before and after the training program. RESULTS: Fourteen patients, aged 62-71 years old, of both genders, without regular physical activity who had an average of nine years of HIV/AIDS history were enrolled. The strengths of major muscle groups increased (74%-122%, p=0.003-0.021) with a corresponding improvement in sit-standing and walking 2.4 m tests (p=0.003). There were no changes in clinical conditions and body composition measures, but triceps and thigh skinfolds were significantly reduced (p=0.037). In addition, there were significant increases in the CD4+ counts (N=151 cells; p=0.008) and the CD4+/CD8+ ratio (0.63 to 0.81, p=0.009). CONCLUSION: Resistance training increased strength, improved physical fitness, reduced upper and lower limb skinfolds, and were associated with an improvement in the CD4+ and CD4+/CD8+ counts in HIV positive elderly patients without significant side effects.
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Background People with HIV are living longer with the health-related consequences of HIV, multi-morbidity, and aging. Exercise is a key strategy that may improve or sustain health for people living with HIV. Our aim was to examine the safety and effectiveness of aerobic exercise interventions on immunological, virological, cardiorespiratory, strength, weight, body composition, and psychological outcomes in adults living with HIV. Methods We conducted a systematic review using the Cochrane Collaboration protocol. We searched databases up to April 2013. We included randomized controlled trials comparing aerobic exercise with no exercise or another intervention performed at least three times per week for at least four weeks among adults living with HIV. Two reviewers independently determined study eligibility. Data were extracted from studies that met inclusion criteria using standardized forms. We assessed risk of bias using the Cochrane Collaboration’s tool for assessing risk of bias. Outcomes were analyzed as continuous and meta-analyses conducted using random effects models with Review Manager (RevMan) computer software. ResultsTwenty-four studies met inclusion criteria (n = 936 participants at study completion); the majority of participants were men (73 %) and the majority were taking antiretroviral therapy (19/24 included studies). The exercise intervention included aerobic exercise alone (11 studies) or a combination of aerobic and resistive exercise (13 studies) ranging from 5 to 52 weeks. Fifty-eight meta-analyses were performed. Main results indicated statistically significant improvements in selected outcomes of cardiorespiratory status (maximum oxygen consumption, exercise time), strength (chest press, knee flexion), body composition (lean body mass, percent body fat, leg muscle area), depression symptoms, and quality of life (SF-36 questionnaire) among exercisers compared with non-exercisers. No significant differences in change in CD4 count and viral load were found. Conclusions Performing aerobic exercise or a combination of aerobic and resistive exercise at least three times per week for at least five weeks is safe and can lead to improvements in cardiorespiratory fitness, strength, body composition and quality of life for adults with HIV. Aerobic exercise is safe and beneficial for adults living with HIV who are medically stable.
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Background: Resistance training (RT) is effective for glycemic control in type 2 diabetes mellitus (T2DM) patients. However, the characteristics of an RT program that will maximize its effect and those of patients that will especially benefit from RT are unknown. Objective: The objectives of this systematic review were to identify via a comprehensive meta-analysis the characteristics of an RT program for patients with T2DM that might increase the patients' improvement in glycemic control and the characteristics of patients that will benefit from RT. Data sources: Electronic-based literature searches of MEDLINE and EMBASE entries from 1 January 1966 to 25 August 2014 were conducted to identify clinical trials examining the effect of RT on glycemic control among patients with T2DM. Study keywords were text words and thesaurus terms related to RT and T2DM. Study selection: Studies were included if they (1) were clinical trials consisting of two groups with and without RT exercise intervention; (2) had an intervention period of at least 5 weeks; (3) clarified that all patients had T2DM; and (4) reported or made it possible to estimate the effect size [i.e., change in glycosylated hemoglobin (HbA1c) in the RT group minus that in the control group] and its corresponding standard error. Study appraisal and synthesis methods: The effect size in each study was pooled with a random-effects model. Analyses were stratified by several key characteristics of the patients and RT exercise programs; meta-regression analysis was then used to detect a difference in the effect size among strata within each factor. Linear regression analyses were added by entering each of the following profiles: patients' baseline characteristics [mean baseline age, body mass index (BMI), and HbA1c levels] and exercise characteristics (total sets per week, total sets per bout of exercise, frequency, and intensity). Results: There were 23 eligible studies comprising 954 patients with T2DM. The pooled effect size (95 % confidence interval) was -0.34 % (-0.53 to -0.16). A program with multiple sets (≥21 vs. <21) per one RT bout was associated with a large effect size (P = 0.03); however, the linear correlation between the number of sets and effect size was not significant (P = 0.56). A larger effect size was observed in studies with participants with diabetes of a relatively short duration (<6 vs. ≥6 years; P = 0.04) or a high baseline HbA1c [≥7.5 % (58 mmol/mol) vs. <7.5 %; P = 0.01] while a smaller effect size was observed in studies with a particularly high mean baseline BMI value (≥32 vs. <32 kg/m(2); P = 0.03). Linear regression analyses predicted that each increment of 1 % in the baseline HbA1c would enlarge the effect size by 0.036 %, while each increment of 1 kg/m(2) in the baseline BMI decreased it by 0.070 % in the range between 22.3 and 38.8 kg/m(2). Conclusion: In terms of glycemic control, RT could be recommended in the early stage of T2DM, especially for patients with relatively poor glycemic control. More benefit would be elicited in less obese patients within a limited range of the BMI. A substantial amount of exercise might be required to stimulate post-exercise glucose uptake, although the dose-dependency was not specifically clarified.
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Chronic kidney disease (CKD) is a public health problem. Although physical activity is essential for the prevention and treatment of most chronic diseases, exercise is rarely prescribed for CKD patients. The objective of the study was to search for and appraise evidence on the effectiveness of exercise interventions on health endpoints in CKD patients. A systematic review was performed of randomized clinical trials (RCTs) designed to compare exercise with usual care regarding effects on the health of CKD patients. MEDLINE, EMBASE, Cochrane Central, Clinical Trials registry, and proceedings of major nephrology conference databases were searched, using terms defined according to the PICO (Patient, Intervention, Comparison and Outcome) methodology. RCTs were independently evaluated by two reviewers. A total of 5489 studies were assessed for eligibility, of which 59 fulfilled inclusion criteria. Most of them included small samples, lasted from 8 to 24 weeks and applied aerobic exercises. Three studies included only kidney transplant patients, and nine included pre-dialysis patients. The remaining RCTs allocated hemodialysis patients. The outcome measures included quality of life, physical fitness, muscular strength, heart rate variability, inflammatory and nutritional markers and progression of CKD. Most of the trials had high risk of bias. The strongest evidence is for the effects of aerobic exercise on improving physical fitness, muscular strength and quality of life in dialysis patients. The benefits of exercise in dialysis patients are well established, supporting the prescription of physical activity in their regular treatment. RCTs including patients in earlier stages of CKD and after kidney transplantation are urgently required, as well as studies assessing long-term outcomes. The best exercise protocol for CKD patients also remains to be established.
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Background: The aim of this prospective randomized controlled trial was to investigate if a short-term endurance or combined endurance/resistance exercise program was sufficient to improve aerobic capacity and maximum force in adult patients (18-65 years) with multiple sclerosis (MS). Methods: All patients performed a three-month exercise program consisting of two training sessions per week, lasting 40 min each, with moderate intensity. All patients had a maximum value of 6 (low to moderate disability) on the Expanded Disability Status Scale (EDSS). One group (combined workout group (CWG); 15 females, 4 males) completed a combined endurance/resistance workout (20 min on a bicycle ergometer, followed by 20 min of resistance training), while the other group (endurance workout group (EWG); 13 females, 5 males) completed a 40 min endurance training program. Aerobic capacity was assessed as peak oxygen uptake, ventilatory anaerobic threshold, and workload expressed as Watts. Maximum force of knee and shoulder extensors and flexors was measured using isokinetic testing. Quality of life was assessed with the SF-36 questionnaire, and fatigue was measured using the Modified Fatigue Impact Scale. Results: Both training groups increased in aerobic capacity and maximum force. EWG, as well as CWG, showed improvement in several subscales of the SF-36 questionnaire and decrease of their fatigue. Conclusion: A short exercise intervention increased both aerobic capacity and maximum force independent of whether endurance or combined endurance/resistance workouts were performed.
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Objectives: To provide a quantitative synthesis of randomized controlled trials (RCT) examining the effect of exercise training on muscular and cardiorespiratory fitness in persons with MS. Data sources: Three electronic databases, Pubmed, Google Scholar and Web of Science were searched for all relevant articles published up until October 2014. Study selection: Keywords included "exercise" OR "aerobic" OR "strength" OR "resistance training" OR "cardiorespiratory" AND "multiple sclerosis". Trials examining the effect of exercise training on muscular and/or cardiorespiratory fitness parameters were included. Data extraction: The initial search yielded 1501 articles of which 62 were reviewed in detail and 20 RCTs met the inclusion criteria and provided enough data to compute effect sizes (ESs; Cohen d). The meta-analyses was conducted using Comprehensive Meta-Analysis software and a random-effects model was used to compute the overall or mean ES per fitness parameter. Data synthesis: The mean ES was 0.27 (SE=0.05, 95% CI=0.17-0.38, z=5.05, p< .001) for muscular fitness outcomes and 0.47 (SE=0.09, 95% CI=0.30-0.65, z=5.40, p< .001) for cardiorespiratory fitness outcomes. The weighted mean ES was not heterogeneous for muscular (Q=11.09, df=13, p=.60, I(2)=0.00) or cardiorespiratory (Q=7.83, df=9, p=0.55, I(2)=0.00) fitness outcomes. Conclusions: The cumulative evidence supports that exercise training is associated with changes in muscular (small in magnitude) and cardiorespiratory (moderate in magnitude) fitness outcomes in persons with MS. Such an indication of magnitude is important for clinical research and practice by providing an evidence-based estimate of the actual benefit that exercise training confers on physiological fitness.
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Although 1-in-5 adults have multiple (≥2) chronic conditions, limited attention has been given to the association between multiple chronic conditions and employment. Cross-sectional data (2011 National Health Interview Survey) and multivariate regression analyses were used to examine the association among multiple chronic conditions, employment, and labor force outcomes for U.S. adults aged 18-64 years, controlling for covariates. Among U.S. adults aged 18-64 years (unweighted, n = 25,458), having multiple chronic conditions reduced employment probability by 11-29%. Some individual chronic conditions decreased employment probability. Among employed adults (unweighted, n = 16,096), having multiple chronic conditions increased the average number of work days missed due to injury/illness in the past year by 3-9 days. Multiple chronic conditions are a barrier to employment and increase the number of work days missed, placing affected individuals at a financial disadvantage. Researchers interested in examining consequences of multiple chronic conditions should give consideration to labor force outcomes. Am. J. Ind. Med. Published 2015. This article is a U.S. Government work and is in the public domain in the USA. Published 2015. This article is a U.S. Government work and is in the public domain in the USA.
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The goal of this study was to evaluate the effects of resistance training on subjects with COPD. We performed a systematic search in MEDLINE, PubMed, Embase, CINAHL, Elsevier ScienceDirect, EBM Reviews, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov and also of leading respiratory journals for randomized controlled trials on COPD treatment for ≤4 weeks with resistance training compared with non-exercise control or with combined resistance and endurance training compared with endurance training alone. Data from these studies were pooled to calculate odds ratio and weighted mean differences (WMDs) with 95% CI. Eighteen trials with 750 subjects with advanced COPD met the inclusion criteria. There were 2 primary and 5 secondary outcomes. Compared with non-exercise control, resistance training led to significant improvements in the dyspnea domain of the Chronic Respiratory Disease Questionnaire (WMD of 0.59, 95% CI 0.26-0.93, I(2) = 0%, P < .001), skeletal muscle strength, and percent-of-predicted FEV1 (WMD of 6.88%, 95% CI 0.41-13.35%, I(2) = 0%, P = .04). The combination of resistance and endurance training significantly improved the St George Respiratory Questionnaire total score (WMD of -7.44, 95% CI -12.62 to -2.25, I(2) = 0%, P = .005), each domain score, and skeletal muscle strength. There were no significant differences in 6-min walk distance, 6-min pegboard and ring test, maximum exercise work load, and maximum oxygen consumption between the 2 groups. There were no reports of adverse events related to resistance-training intervention. Resistance training can be successfully performed alone or in conjunction with endurance training without increased adverse events during pulmonary rehabilitation in COPD. Copyright © 2015 by Daedalus Enterprises.
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Despite the publication of two dozen observational epidemiological studies investigating the association between recreational physical activity (RPA) and epithelial ovarian cancer (EOC) risk and survival over the past two decades, taken collectively, data from retrospective and prospective studies are mixed and remain inconclusive. Our primary purpose was to conduct a careful review and summary of the epidemiological literature depicting the association between EOC and RPA in the framework of identifying factors which may be impeding our ability to observe consistent associations in the literature. Secondly, in the backdrop of the more broad scientific evidence regarding the benefits of RPA, we provide a summary of guidelines for practitioners to utilize in the context of exercise prescription for cancer patients, including a discussion of special considerations and contraindications to exercise which are unique to EOC patients and survivors. We performed a comprehensive literature search via PubMed to identify epidemiologic investigations focused on the association between RPA and EOC. To be included in the review, studies had to assess RPA independently of occupational or household activities. In total, 26 studies were identified for inclusion. Evidence of a protective effect of RPA relative to EOC risk is more consistent among-case control studies, with the majority of studies demonstrating significant risk reductions between 30-60% among the most active women. Among cohort studies, half yielded no significant associations, while the remaining studies provided mixed evidence of an association. Given the limitations identified in the current body of literature, practitioners should not rely on inconclusive evidence to dissuade women from participating in moderate or vigorous RPA. Rather, emphasis should be placed on the greater body of scientific evidence which has demonstrated that RPA results in a plethora of health benefits that can be achieved in all populations, including those with cancer. Copyright © 2015. Published by Elsevier Inc.