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Does a personalised exercise prescription enhance training efficacy and limit training unresponsiveness? A randomised controlled trial

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Purpose: Evidence suggests considerable heterogeneity in exercise-induced changes in cardiorespiratory fitness and common cardiometabolic risk factors, with some individuals even experiencing adverse responses when exposed to regular exercise training. The purpose of this study was to compare the effectiveness of two exercise training programs for improving fitness and cardiometabolic health. Methods: Sedentary men and women (n=46) performed 60-75 min/day, 3 days/wk for 13 wk according to one of two exercise training regimens: 1) a standardised program, or 2) an individualised program (ACE IFT). Results: Maximal oxygen uptake (VO2max), body composition, systolic blood pressure (BP), and muscular fitness increased more favourably (p<0.05) in the ACE IFT treatment group. In the standardised treatment group 64.3% (9/14) of individuals experienced a favourable change in relative VO2max (Δ > +5.9%) and were categorised as responders. Alternatively, exercise training in the ACE IFT treatment group elicited a positive improvement in relative VO2max (Δ > +5.9%) in 100% (14/14) of the individuals. Furthermore, the incidence of anthropometric, cardiometabolic,and muscular fitness responders to exercise training were overall more favourable (p<0.05) in the ACE IFT treatment group: waist circumference (92.9% vs. 78.6%), percent body fat (100.0% vs. 78.6%), systolic BP (100.0%vs. 42.9%), HDL cholesterol (100.0% vs 50%), blood glucose(92.9% vs.42.9%), bench press 5-RM (100.0% vs 64.3%), and leg press 5-RM (100.0% vs 64.3%). Conclusions: The major findings from the present study were as follows: 1) an individualised exercise prescription elicited significantly (p<0.05) greater improvements in VO2max, muscular fitness, and key cardiometabolic risk factors when compared to a standardised exercise prescription, and 2) an individualised exercise prescription increased training responsiveness when compared to a standardised exercise training program as evidenced by the significantly reduced (p<0.05) incidence of exercise training non-responders in the ACE IFT treatment group. These novel findings are encouraging and underscore the importance of a personalised exercise prescription to enhance training efficacy and limit training unresponsiveness.
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Volume 5, Issue 3, December 2016 | JOURNAL OF FITNESS RESEARCH 15
ISSN 2201-5655 © 2016, Australian Institute of Fitness
ORIGINAL RESEARCH
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Lance C. Dalleck1, Devan E. Haney1, Christina A. Buchanan1, Ryan M. Weatherwax1
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Volume 5, Issue 3, December 2016 | JOURNAL OF FITNESS RESEARCH 16
INTRODUCTION
It is well accepted that regular exercise training
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elevated triglycerides and impaired fasting blood
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that considerable heterogeneity exists with respect to
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considerable individual variability in exercise-induced
changes in common cardiometabolic risk factors
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exposed to regular exercise training6-8,QGHHG
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responses in individual cardiometabolic risk factors
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individualised and evidence-based approach to the
exercise prescription is needed to enhance training
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such strategy that supports an individualised
approach to the exercise prescription is the
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designing programs based on the unique abilities,
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model incorporates components of
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Therefore, the purpose of this study was to compare
the effectiveness of two training programs for
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In contrast, the standardised exercise training
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METHODS
Participants
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local university, as well as the surrounding
community, via advertisement through the university
website, local community newspaper, and word-of-
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the study if they were low-to-moderate risk as
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considered sedentary if they reported not
participating in at least 30 min of moderate intensity
physical activity on at least three days of the week for
at least three months113DUWLFLSDQWVZHUHDOVRHOLJLEOH
for inclusion into the study if they verbally agreed to
continue previous dietary habits and not perform
additional exercise beyond that required for the
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of cardiovascular, pulmonary, and/or metabolic
disease as determined by medical history
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signed an informed consent form prior to
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Baseline and post-program experimental
testing procedures
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obtained both before and after the exercise training
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have employed previously in exercise training
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detail for each of these measurement are provided
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and blood glucose measurement participants
refrained from all food and drink other than water
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were also instructed to refrain from strenuous
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testing took place within 1 to 4 days of the last
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Volume 5, Issue 3, December 2016 | JOURNAL OF FITNESS RESEARCH 17
Resting Heart Rate and Blood Pressure measurement
The procedures for assessment of resting heart
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followed11%ULHÁ\SDUWLFLSDQWVZHUHVHDWHGTXLHWO\
for 5 minutes in a chair with a back support with feet
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of radial artery in the left wrist and recording the
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sphygmomanometer in duplicate and separated by
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Anthropometric measurements
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a medical grade scale and measured for height to the
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of the body using standardised anatomical sites
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measurements were performed until two were within
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measurements were obtained using a cloth tape
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measurement was taken at the narrowest point of the
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system has excellent reproducibility with standard
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lipoproteins13-14 and meets the National Cholesterol
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The procedures for assessment of functional and
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followed10)XQFWLRQDODVVHVVPHQWVZDVTXDQWLÀHG
using the stork-stand balance test to assess static
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the ground and bring the foot to lightly touch the
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Timing was stopped if any of the following
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direction, any part of elevated leg lost contact with
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10 repetitions of a weight the participant felt
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were performed to warm up muscles followed by
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followed by a 2 minute rest period
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then warm up
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weight was increased until maximum weight
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Volume 5, Issue 3, December 2016 | JOURNAL OF FITNESS RESEARCH 18
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researcher, weight was decreased until
participant successfully lifted the heaviest
weight possible
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Maximal exercise testing
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ramp graded exercise test on a motorised treadmill
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was increased by 1% every minute until the
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exchange data were recorded continuously during the
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exercise test, the metabolic analyser was calibrated
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was calculated by averaging the data collected 15s
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of the two processed data points represented
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time plotted against each relevant respiratory variable
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97ZDVDQLQFUHDVHLQ9(922 with no concurrent
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reevaluated and collectively a consensus was agreed
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to a non-exercise control group or one of two
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research design in that participants were unaware of
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and supervision of exercise sessions were unaware
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training groups performed 13wk of exercise training
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for both group were intended to satisfy the
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Volume 5, Issue 3, December 2016 | JOURNAL OF FITNESS RESEARCH 19
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exercise prescription details for each training group
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during week 4 of the overall study for both treatment
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sessions were supervised by researchers who closely
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Figure 1. Flow chart of experimental procedures and exercise prescription for each of the two exercise training treatment
groups and the non-exercise control group after randomisation. ACE IFT, American Council on Exercise Integrated Fitness
Training, HR, heart rate; HRR, heart rate reserve; RT, resistance training; VT1, rst ventilatory threshold; VT2, second ventilatory
threshold.
Volume 5, Issue 3, December 2016 | JOURNAL OF FITNESS RESEARCH 20
ensured proper technique for each exercise, and
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details of the resistance and functional exercise
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guidelines10 and consisted of multijoint/multiplanar
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allowed for free motion during the exercise and
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Volume 5, Issue 3, December 2016 | JOURNAL OF FITNESS RESEARCH 21
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RESULTS
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The exercise prescription in both treatment groups
was well tolerated for the 28 of 32 participants who
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Table 1. Physical and physiological characteristics at baseline and 13wk for control, Standardised, and ACE IFT groups.
(Values are mean ± SD).
Parameter
Control group
(n=14; women = 8, men = 6) Standardised group
(n=14; women = 6, men = 8) ACE IFT group
(n=14; women = 6, men = 8)
Baseline 13wk Baseline 13wk Baseline 13wk
Age (yr) 62.4 ± 6.8 ____ 67.4 ± 8.3 ____ 64.9 ± 10.0 ____
Height (cm) 167.2 ± 9.5 ____ 167.0 ± 8.1 ____ 168.9 ± 10.7 ____
Body mass (kg) 76.2 ± 8.3 76.4 ± 7.7 82.3 ± 16.8 81.7 ± 17.2 84.0 ± 19.8 83.2 ± 18.8
Waist circumference (cm) 89.2 ± 7.7 89.4 ± 7.3 95.6 ± 14.0 93.3 ± 14.6 92.4 ± 11.2 89.1 ± 10.6*†
Body fat (%) 30.5 ± 4.2 31.7 ± 4.2* 35.0 ± 6.0 33.6 ± 4.8† 35.1 ± 6.4 31.9 ± 6.5*‡
Fat free mass (kg) 53.0 ± 6.2 52.2 ± 5.8* 53.5 ± 11.7 54.3 ± 12.0† 54.5 ± 12.2 56.7 ± 11.1*‡
Resting HR (bumin-1) 66.8 ± 12.3 66.0 ± 8.4 75.3 ± 4.3 75.4 ± 6.9 71.4 ± 10.7 68.8 ± 14.7
Maximal HR (bumin-1) 156.5 ± 10.4 155.0 ± 7.9 148.7 ± 9.6 150.4 ± 8.6 152.7 ± 11.0 154.9 ± 9.6*
VO2max (mLukg-1umin-1) 25.1 ± 4.7 24.7 ± 4.4 22.2 ± 11.0 24.0 ± 10.8*† 25.5 ± 6.3 29.1 ± 6.8*‡
Systolic BP (mmHg) 117.4 ± 9.8 120.5 ± 9.3* 121.6 ± 10.3 121.7 ± 12.4 125.4 ± 6.2 118.3 ± 5.2*‡
Diastolic BP (mmHg) 77.6 ± 8.7 81.3 ± 5.2 77.3 ± 7.9 77.4 ± 8.0 79.4 ± 5.5 74.9 ± 6.2*‡
Total cholesterol (mmoluL-1) 5.17 ± 0.96 5.18 ± 0.79 5.03 ± 1.18 5.32 ± 1.44 5.08 ± 1.31 5.12 ± 1.25
HDL cholesterol (mmoluL-1) 1.24 ± 0.59 1.21 ± 0.51 1.37 ± 0.49 1.41 ± 0.47 1.29 ± 0.52 1.42 ± 0.52*†
LDL cholesterol (mmolguL-1) 3.05 ± 0.84 3.07 ± 0.73 3.01 ± 0.64 3.10 ± 0.52 2.78 ± 0.72 2.76 ± 0.77
Triglycerides (mmoluL-1) 1.41 ± 0.41 1.63 ± 0.54* 1.22 ± 0.66 1.12 ± 0.62*† 1.21 ± 0.46 1.09 ± 0.48*†
Blood Glucose (mmoluL-1) 4.97 ± 0.28 5.03 ± 0.41 5.07 ± 0.52 5.10 ± 0.59 5.20 ± 0.44 5.00 ± 0.41*†
Right leg Stork-stand (sec) 37.4 ± 29.7 35.4 ± 29.6 31.9 ± 28.4 37.4 ± 32.0* 26.9 ± 25.0 44.6 ± 35.3*‡
Left leg Stork-stand (sec) 29.1 ± 20.6 26.3 ± 19.3* 24.7 ± 20.0 31.1 ± 23.8*† 26.3 ± 23.9 41.7 ± 28.5*‡
Bench press 5-RM (kg) 21.9 ± 17.6 21.6 ± 17.7 25.3 ± 17.4 28.6 ± 20.7*† 25.9 ± 14.7 32.0 ± 16.1*‡
Leg press 5-RM (kg) 53.3 ± 48.9 53.4 ± 48.0 51.6 ± 32.0 64.3 ± 37.1*† 67.3 ± 24.4 91.3 ± 31.8*‡
* Within-group change is significantly different from baseline, p<0.05; † Change from baseline is significantly different than control group, p<0.05;
‡ Change from baseline is significantly different than control and Standardised groups, p<0.05.
Volume 5, Issue 3, December 2016 | JOURNAL OF FITNESS RESEARCH 22
both treatment groups throughout the duration of
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Table 2. Prescribed and actual exercise intensity for cardiorespiratory exercise for Standardised and ACE IFT treatment groups
throughout the 13wk exercise intervention.
Standardised Group (n=14) ACE IFT Group (n=14)
Week Prescribed
intensity THR Actual HR Prescribed
intensity THR Actual HR
1 40-45% HRR 105 ± 12 to 108 ± 12 107 ± 11 HR < VT1 104 ± 10 to 113 ± 10 109 ± 11
2 40-45% HRR 105 ± 12 to 108 ± 12 108 ± 12 HR < VT1 104 ± 10 to 113 ± 10 111 ± 9
3 40-45% HRR 105 ± 12 to 108 ± 12 107 ± 9 HR < VT1 104 ± 10 to 113 ± 10 112 ± 8
4 40-45% HRR 105 ± 12 to 108 ± 12 108 ± 10 HR < VT1 104 ± 10 to 113 ± 10 112 ± 8
5-6 50-55% HRR 112 ± 13 to 116 ± 14 113 ± 12 +597WR97 114 ± 11 to 123 ± 12 118 ± 10
7-8 50-55% HRR 112 ± 14 to 116 ± 15 115 ± 11 +597WR97 114 ± 11 to 123 ± 12 119 ± 11
9-13 60-65% HRR 118 ± 14 to 121 ± 14 120 ± 12 +597 124 ± 12 to 132 ± 11 127 ± 10
Values are mean ± SD. HR, heart rate; HRR, heart rate reserve; THR, target heart rate; VT1, first ventilatory threshold; VT2, second ventilatory
threshold.
Figure 2. Individual variability in relative VO2max response (%
change) to exercise training in the Standardised (A) and ACE
IFT (B) treatment groups.
Volume 5, Issue 3, December 2016 | JOURNAL OF FITNESS RESEARCH 23
Incidence of VO2max non-responders and
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including age, baseline cardiometabolic risk factor
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Incidence of anthropometric non-
responders and responders
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anthropometric responders to exercise training were
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treatment group when compared to the standardised
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factors of responder/non-responder, including age,
baseline anthropometric value, exercise adherence,
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Incidence of muscular and neuromotor
fitness non-responders and responders
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contrast, the incidence of muscular and neuromotor
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non-responder, including age, baseline muscular and
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VH[
DISCUSSION
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HOLFLWHGVLJQLÀFDQWO\SJUHDWHULPSURYHPHQWV
LQ922PD[PXVFXODUÀWQHVVDQGNH\
cardiometabolic risk factors when compared to a
standardised exercise prescription following 13wk of
H[HUFLVHWUDLQLQJDQGDQLQGLYLGXDOLVHGH[HUFLVH
prescription increased training responsiveness when
Volume 5, Issue 3, December 2016 | JOURNAL OF FITNESS RESEARCH 24
compared to a standardised exercise training
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Therefore, these current results support both our
research hypotheses and underscores the importance
of a personalised exercise prescription to enhance
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7RRXUNQRZOHGJHWKLVLVWKHÀUVWSURVSHFWLYH
randomised, controlled trial to compare individual
variation in training responses following
comprehensive, individualised exercise training
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factors are known to mediate the heterogeneity in
training responses, including the parameters of the
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previously been demonstrated that one of the most
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to exercise training is a greater volume of exercise22
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of exercise intensity prescription may underpin the
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exercise training237KHSUHYLRXVVWXGLHV3-4,24 that have
reported widespread variability in the individual
922max response to exercise training have used one
of several relative exercise intensity methods,
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methods elicit large inter-individual variation in the
metabolic responses to exercise training23,252QWKLV
premise, it has been suggested that the individual
variation in metabolic response will subsequently
lead to differences in the overall homeostatic stress
from each training session which will ultimately
result in heterogeneity in the exercise training
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of a threshold based method for establishing exercise
intensity might better normalise the metabolic
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threshold based exercise intensity prescription, as
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922max, systolic blood pressure, and body
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to exercise training elicited greater training
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treatment group when compared to the standardised
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stand scores and a higher incidence of responders in
all of these parameters were also observed in the
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neuromotor exercise prescription can enhance
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problems linked to age-related declines in muscle
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In the past few decades both low cardiorespiratory
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attention as independent and powerful predictors of
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reduced risk of all-cause mortality27/LNHZLVH
Williams28 showed in a meta-analysis that there was a
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individuals moved out of the lowest quartile of
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accounted for more overall deaths when compared
to deaths which could be attributed to traditional
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from the current study have novel clinical and public
health relevance, as a large number of adults fall into
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LQGLYLGXDOV2YHUDOO922max was improved on
Volume 5, Issue 3, December 2016 | JOURNAL OF FITNESS RESEARCH 25
DYHUDJHE\0(7VLQWKH$&(,)7WUHDWPHQW
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improvements likely have important long-term
prevention implications as it has been previously
UHSRUWHGWKDWD0(7LQFUHDVHLQ922max was
associated with an 18% reduction in deaths due to
&9'31
There are a few limitations to the present study
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size in our study is lower than other major exercise
training studies in the literature19,22+RZHYHU
advantages of a smaller sample size were the ability
to better supervise the exercise program and more
closely interact with participants on a daily basis
during exercise sessions32,QSDUWLFXODUWKH
adherence to the prescribed exercise program was
H[FHOOHQWIRUERWKH[HUFLVHWUHDWPHQWJURXSV6HFRQG
while participants were instructed to maintain their
regular dietary intake during the 13wk intervention,
diet intake was not strictly controlled for in this
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behaviour outside of the training program and
prescribed medications were not monitored, and thus
PD\KDYHLQÁXHQFHGWKHFXUUHQWÀQGLQJV
CONCLUSION
There is a wealth of previous research reporting
that regular exercise training confers positive effects
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numerous other cardiometabolic outcomes related to
FDUGLRYDVFXODUPRUELGLW\DQGPRUWDOLW\1RQHWKHOHVV
it has also been highlighted that considerable
heterogeneity exists with respect to the individual
UHVSRQVHVWRFKURQLFH[HUFLVHWUDLQLQJ,QWKHSUHVHQW
study it was demonstrated that a personalised
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OLPLWHGWUDLQLQJXQUHVSRQVLYHQHVV
PRACTICAL APPLICATIONS
In the present study an individualised exercise
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The individualised exercise prescription consisted of
DWKUHVKROGEDVHGDSSURDFKDQG50PHWKRGWR
establishing exercise intensity for cardiorespiratory
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GLUHFWGHWHUPLQDWLRQRI 97DQG97DUHQRW
available, practitioners can make use of the talk test
to establish the appropriate and individualised
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exercise prescription33,QVXPPDU\WKHQRYHO
ÀQGLQJVIURPWKHSUHVHQWVWXG\DUHHQFRXUDJLQJDQG
provide important preliminary data for exercise
SK\VLRORJLVWVÀWQHVVSURIHVVLRQDOVDQGRWKHUVZKR
design exercise training programs in the adult/older
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DISCLOSURE OF SOURCES OF
FUNDING:
This investigation was supported by a research
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/'7KH$PHULFDQ&RXQFLORQ([HUFLVHZDVQRW
involved in development of the study design, data
collection and analysis, or preparation of the
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AUTHORS’ CONTRIBUTIONS:
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REFERENCES
 *DUEHU&(%OLVVPHU%'HVFKHQHV05
)UDQNOLQ%$/DPRQWH0-/HH,1LHPDQ
'&6ZDLQ'34XDQWLW\DQGTXDOLW\RI 
exercise for developing and maintaining
cardiorespiratory, musculoskeletal, and
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Volume 5, Issue 3, December 2016 | JOURNAL OF FITNESS RESEARCH 27
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... We contend that altering how exercise intensity is prescribed appears to have a marked impact on response rates. For example, prescribing exercise intensity relative to physiological thresholds (termed herein as thresholdbased ET; Table 1), as opposed to prescribing intensity relative to maximum physiological values (termed herein as traditionally prescribed ET; Table 2), appears to have a positive impact on response rates (Byrd et al., 2019;Dalleck et al., 2016;Weatherwax et al., 2019;Wolpern et al., 2015). When intensity is anchored relative to physiological thresholds, a more homogeneous exercise stimulus is elicited among individuals (Baldwin et al., 2000;Black et al., 2017;Lansley et al., 2011). ...
... Scharhag-Rosenberger et al. (2012) reported that following 1 year of ET at 60% HRR, the mean increase iṅ V O 2 max was ∼14%, but changes ranged from −3-37%, and 22% of the participants were deemed non-responders. Moreover, a series of studies implementing ET progressing from 40-65% HRR evoked nonresponse rates ranging from ∼30-60% (Byrd et al., 2019;Dalleck et al., 2016;Weatherwax et al., 2019;Wolpern et al., 2015). It is acknowledged that chronic adaptations from ET are composed of 'micro-adaptations' experienced over time (Flück, 2006), and thus it is plausible, but not yet demonstrated, that heterogeneous acute responses to exercise, when repeated over time, may manifest as heterogeneous chronic responses (Mann et al., 2013;Scharhag-Rosenberger et al., 2010). ...
... Therefore, when repeated over time, threshold-based ET is proposed to result in more homogeneous chronic adaptations and reduced response variability (Mann et al., 2013;Scharhag-Rosenberger et al., 2010). An increase in response rates following threshold-based ET has indeed been reported in some studies (Byrd et al., 2019;Dalleck et al., 2016;Weatherwax et al., 2019;Wolpern et al., 2015). Nonetheless, Karavirta et al. (2011) reported a considerable range of changes inV O 2 max following ET prescribed above and below T 1 combined with RT (−8 to 42%). ...
Article
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New findings: What is the topic of this review? We review biological and methodological factors associated with the variable changes in cardiorespiratory fitness in response to endurance training. What advances does it highlight? Several biological and methodological factors exist that each contribute, to a given extent, to response variability. Notably, prescribing exercise intensity relative to physiological thresholds reportedly increases cardiorespiratory fitness response rates compared to when prescribed relative to maximum physiological values. As threshold-based approaches elicit more homogenous acute physiological responses among individuals, when repeated over time, these uniform responses may manifest into more homogenous chronic adaptations thereby reducing response variability. Abstract: Changes in cardiorespiratory fitness (CRF) in response to endurance training (ET) exhibit large variations, possibly due to a multitude of biological and methodological factors. It is acknowledged that ∼20% of individuals may not achieve meaningful increases in CRF in response to ET. Genetics, the most potent biological contributor, has been shown to explain ∼50% of response variability, whilst age, sex, and baseline CRF appear to explain a smaller proportion. Methodological factors represent the characteristics of the ET itself including the type, volume, and intensity of exercise, as well as the method used to prescribe and control exercise intensity. Notably, methodological factors are modifiable and, upon manipulation, alter response rates to ET, eliciting increases in CRF regardless of an individual's biological predisposition. Particularly, prescribing exercise intensity relative to a physiological threshold (e.g. ventilatory threshold) is shown to increase CRF response rates compared to when intensity is anchored relative to a maximum physiological value (e.g. maximum heart rate). It is, however, uncertain whether the increased response rates are primarily attributable to reduced response variability, greater mean changes in CRF, or both. Future research is warranted to elucidate whether more homogenous chronic adaptations manifest over time among individuals, as a result of exposure to more homogenous exercise stimuli elicited by threshold-based practices. This article is protected by copyright. All rights reserved.
... To calculate %HRR, resting HR was subtracted from the maximal HR reached during the GXT. Guidelines from previous research were used to determine VT1 and VT2 during the GXT by using time points and the ventilatory equivalents of O2 (VE/ VO2) and CO2 (VE/VCO2) while also visually analysing the gas exchange data (Wolpern et al., 2015;Dalleck et al., 2016;Weatherwax et al., 2016). Previous research suggests VT1 occurs when VE/ VO2increases without a linear increase in VE/VCO2, while VT2 occurs where both VE/ VO2 and VE/VCO2 increase concurrently. ...
... The use of an individualised ventilatory thresholdbased model to prescribe exercise was shown to be significantly better compared to standardised prescription at improving CRF (Katzmarzyk et al., 2004;Wolpern et al., 2015;Dalleck et al., 2016). However, current guidelines do not prescribe exercise using a ventilatory threshold method (Liguori 2020). ...
Article
A poor Fitness Fatness Index (FFI) is associated with type 2 diabetes incidence, other chronic conditions (Alzheimer’s, cancer, and cardiovascular disease) and all-cause mortality. Recent investigations have proposed that an individualised exercise prescription based on ventilatory thresholds is more effective than a standardised prescription in improving cardiorespiratory fitness (CRF), a key mediator of FFI. Thus, the aim of the current study was to determine the effectiveness of individualised versus standardised exercise prescription on FFI in sedentary adults. Thirty-eight sedentary individuals were randomised to 12-weeks of: (1) individualised exercise training using ventilatory thresholds (n = 19) or (2) standardised exercise training using a percentage of heart rate reserve (n = 19). A convenience sample was also recruited as a control group (n=8). Participants completed CRF exercise training three days per week, for 12-weeks on a motorised treadmill. FFI was calculated as CRF in metabolic equivalents (METs), divided by fatness determined by waist to height ratio (WtHR). A graded exercise test was used to measure CRF, and anthropometric measures (height and waist circumference) were assessed to ascertain WtHR. There was a difference in FFI change between study groups, whilst controlling for baseline FFI, F (2, 42) = 19.382 p < .001, partial η2 = 0.480. The magnitude of FFI increase from baseline was significantly higher in the individualised (+15%) compared to the standardised (+10%) (p = 0.028) and control group (+4%) (p = <.001). The main finding of the present study is that individualised exercise prescription had the greatest effect on improving FFI in sedentary adults compared to a standardised prescription. Therefore, an individualised based exercise prescription should be considered a viable and practical method of improving FFI in sedentary adults.
... [7][8][9] Recently, GET-based personalized training programs, conducted in efforts to increase the efficacy of rehabilitation programs, are gaining popularity. [10][11][12][13] Traditional programs based on a certain percentage of maximal heart rate (HR) have resulted in widely differing lactate values; however, exercising at the same percentage of maximal HR or VO 2 did not result in a similar lactate response. [14] Therefore, one may argue that this traditional exercise protocol does not address the individual's metabolic profile. ...
... [19,20] The definition of "GET-level" training remains ambiguous. Most of the GET-based training studies [10,11,13] used a work rate or heart rate slightly below the GET level determined during Inc-Ex. A physiological way to correct for the lag in VO 2 response has been recently reported. ...
Article
Full-text available
The gas exchange threshold (GET), which is determined during incremental exercise (Inc-Ex) testing, is often considered a safe training intensity for cardiac rehabilitation. However, there are only a limited number of reports on the actual implementation of this method. We assessed the applicability of GET-guided exercise using a constant load exercise (CL-Ex) protocol. We recruited 20 healthy older individuals (healthy, age: 69.4 ± 6.8 years) and 10 patients with cardiovascular diseases or risk factors (patient, age: 73.0 ± 8.8 years). On day 1, we determined the GET during symptomatic maximal Inc-Ex. On day 2, CL-Ex at work rate (watt: W) where the GET manifested during Inc-Ex (therefore, not corrected for the known oxygen response delay) was maintained for 20 minute. Arterialized blood lactate (BLa) levels were also determined. Oxygen uptake reached a steady state in all participants, with a mean respiratory exchange ratio of < 1.0. The mean BLa at the GET during Inc-Ex was 1.51 ± .29 mmol·l−1 in the healthy group and 1.78 ± .42 mmol·L−1 in the patient group, which was about .5 mmol·L−1 above the resting level. During CL-Ex, BLa increased significantly over the value at the GET (Inc-Ex). However, it reached a steady-state level of 2.65 ± 1.56 (healthy) and 2.53 ± 0.95 (patient) mmol·L−1. The %peak oxygen uptake, %peak heart rate, and %heart rate reserve during CL-Ex were 58.8 ± 11.5, 71.8 ± 10.3, and 44.9 ± 17.4, respectively. All participants could complete CL-Ex with mean perceived exertion ratings (Borg/20) of 11.8 ± 1.3 (healthy) and 12.2 ± 1.3 (patient). These heart rate-related indices and exertion ratings were all within the recommended international guidelines for cardiac rehabilitation. CL-Ex at the GET appears to be the optimal exercise intensity for cardiac rehabilitation.
... ventilatory thresholds) will not only encourage more positive physiological adaptations, but may account for some of the variability in training responsiveness by taking into consideration individual metabolic differences. In recent years, our laboratory has consistently reported that when exercise intensity is titrated according to a threshold-based model (i.e., ventilatory thresholds), the prevalence of a favorable VO2max training response (i.e., responders) is 100% [6][7][8][9] . In comparison, incidence of responders has ranged from 41.7% to 68.8% when the exercise intensity was 'standardized' or prescribed according to a relative percent method (i.e., % HRR) [6][7][8][9] . ...
... In recent years, our laboratory has consistently reported that when exercise intensity is titrated according to a threshold-based model (i.e., ventilatory thresholds), the prevalence of a favorable VO2max training response (i.e., responders) is 100% [6][7][8][9] . In comparison, incidence of responders has ranged from 41.7% to 68.8% when the exercise intensity was 'standardized' or prescribed according to a relative percent method (i.e., % HRR) [6][7][8][9] . Collectively our findings suggest that design of individualized exercise prescriptions based on ventilatory thresholds will enhance training efficacy and limit training unresponsiveness. ...
Article
Full-text available
Aim: We retrospectively analyzed a cohort of graded exercise tests (GXT) and compared ventilatory thresholds (VT1 and VT2) predicted from ventilation (PRED) to ventilatory thresholds derived from the gold-standard method using indirect calorimetry (TRUE). Methods: A cohort of 202 participants (132 women, 70 men; age range 18–69 years) completed GXT in the High Altitude Performance Laboratory at Western Colorado University between September 2014 and February 2020. Bland–Altman 95% limits-of-agreement were used to quantify the agreement between TRUE and PRED VT1 and VT2. Results: For VT1 time point detection, the mean differences between TRUE and PRED were -0.05 ± 1.28 min (95% CI, -2.56 to 2.46 min). For VT2 time point detection, the mean differences between TRUE and PRED were 0.10 ± 1.55 min (95% CI, -2.93 to 3.12 min). Conclusion: In this retrospective study, it was shown that modeling ventilation data elicited acceptably accurate estimates for VT1 and VT2 time point detection, workloads, and heart rates during both treadmill and cycle ergometer GXT. These novel findings are encouraging and provide critical preliminary data for the successful translation of the threshold-based training paradigm to a larger demographic of the population.
... Previous research shows that individualizing exercise prescription and including participant preferences increase attendance and improves motivation compared with using generic and standardized approaches [54]. Further, individualized exercise increases outcome effect sizes and minimizes adverse events compared with generic exercise prescription [55,56]. Therefore, individualized exercise prescription should be aimed for when implementing exercise at the workplace for ensuring sustained high adherence and participation rates as well as optimal physical health and capacity outcomes [53]. ...
Article
Full-text available
Background: Good physical health and capacity is a requirement for offshore wind service technicians (WTs) who have substantial physical work demands and are exposed to numerous health hazards. Workplace physical exercise has shown promise for improving physical health and work ability among various occupational groups. Therefore, we aimed to assess the feasibility and preliminary efficacy of Intelligent Physical Exercise Training (IPET) among WTs in the offshore wind industry. Methods: A within-subject design was used to assess the feasibility and preliminary efficacy of IPET (one hour/week individualized exercise during working hours). The intervention period was 12 weeks, with the first eight weeks performed on site as supervised or partly supervised exercise during work hours and the last four weeks planned as home-administered exercise after the seasonal offshore service period. Three assessments, T1 (six months prior to intervention start), T2 (start of intervention) and T3 (end of intervention), of physical health and capacity (self-reported and objective measurements) were conducted and the period between T1 and T2 served as a within-subject control period. Primary outcome was feasibility measured as compliance, adherence, adverse events, and participant acceptability. Descriptive statistics were used to present feasibility outcomes. Preliminary efficacy was reported as mean differences with 95% confidence intervals for health and physical capacity outcomes between T1 and T2, between T2 and T3 and between T1 and T3. Results: All WTs at the included wind farm (n=24, age: 40 years (SD±8)) participated in the study. No serious adverse events were reported. Compliance and adherence of 95 and 80% respectively, were reached in the eight-week supervised part, but were lower when exercise was home-administered (<20%). Acceptability was high for the supervised part, with 83% indicating that the exercise program worked well and 100% that exercise should be implemented as an integrated part of the working structure. Changes in physical capacity and health indicators, such as VO2max (ml O2/kg/min) at T1 (38.6 (SD±7.2)), T2 (44.1 (SD±9)) and T3 (45.8 (SD±6.5)), may indicate seasonal fluctuations as well as improvements from the intervention. Conclusion: On-site Intelligent Physical Exercise Training during working hours was feasible and well received among WTs in the offshore wind industry. The proceeding of larger-scale evaluation and implementation is therefore recommended. Trial registration: ClinicalTrials.gov (Identifier: NCT04995718 ). Retrospectively registered on August 6, 2021.
... Subsequent studies that have observed exercise response variability categorise participants depending on the magnitude of change and are classified accordingly as "high responders", "low responders", "non-responders" or "adverse responders" [9,10]. As such, this has guided the individualisation of exercise interventions to maximise the magnitude and rate of positive responses [11,12]. ...
Article
Participation in resistance training improves muscle strength and size, as well as reduced risk of chronic disease and frailty. However, the exercise response to resistance training is highly variable. In part this may be attributed to individual physiological differences. Identification of biomarkers that can distinguish between high and low responders to exercise are therefore of interest. Exhaled volatile organic compounds may provide a non-invasive method of monitoring the physiological response to resistance training. However, the relationship between exhaled organic compounds and the acute response to resistance exercise is not fully understood. Therefore, this research will investigate exhaled volatile organic compounds in acute response to resistance exercise with an aim to discover a common group of compounds that can predict high and low responders to standardised resistance training.
... Both analyses demonstrate how response rates are group statistics that highly depend on response thresholds ( Figure 4A) and mean changes ( Figure 4B; Atkinson et al., 2019). Future research should therefore avoid attributing lower response rates to reduced interindividual variability, an interpretation made in several studies included in our review (Wolpern et al., 2015;Dalleck et al., 2016;Byrd et al., 2019), and should recognize that response rates provide little if any, useful information at the individual level (Atkinson et al., 2019). ...
Book
Full-text available
The second volume of the Research Topic entitled “Precision Physical Activity and Exercise Prescriptions for Disease Prevention: The Effect of Interindividual Variability Under Different Training Approaches” has been successfully completed, as expected. As stated in the preface to the first volume, this Research Topic was initially intended to address a challenge in this field, but this topic is becoming, over time, an important cornerstone for scientists who are exploring the fascinating subject of “Precision Physical Activity and Exercise Prescriptions for Disease Prevention” (Ramírez-Vélez et al., 2017). This Research Topic consists of 10 articles, of which seven contain original data, one is a systematic review with meta-analysis and two are opinion/hypothesis articles.
... Both analyses demonstrate how response rates are group statistics that highly depend on response thresholds ( Figure 4A) and mean changes ( Figure 4B; Atkinson et al., 2019). Future research should therefore avoid attributing lower response rates to reduced interindividual variability, an interpretation made in several studies included in our review (Wolpern et al., 2015;Dalleck et al., 2016;Byrd et al., 2019), and should recognize that response rates provide little if any, useful information at the individual level (Atkinson et al., 2019). ...
Article
The novel coronavirus disease (COVID-19) has emerged at the end of 2019 and caused a global pandemic. The disease predominantly affects the respiratory system; however, there is evidence that it is a multisystem disease that also impacts the cardiovascular system. Although the long-term consequences of COVID-19 are not well-known, evidence from similar diseases alerts for the possibility of long-term impaired physical function and reduced quality of life, especially in those requiring critical care. Therefore, rehabilitation strategies are needed to improve outcomes in COVID-19 survivors. Among the possible strategies, resistance training (RT) might be particularly interesting, since it has been shown to increase functional capacity both in acute and chronic respiratory conditions and in cardiac patients. The present article aims to propose evidence-based and practical suggestions for RT prescription for people who have been diagnosed with COVID-19 with a special focus on immune, respiratory, and cardiovascular systems. Based on the current literature, we present RT as a possible safe and feasible activity that can be time-efficient and easy to be implemented in different settings.
... Previous research show that individualizing exercise prescription and including participant preferences increase attendance and improves motivation compared with using generic and standardized approaches [52]. Further, individualized exercise increases outcome effect sizes and minimizes adverse events compared with generic exercise prescription [53,54]. Therefore, individualized exercise prescription should be aimed for when implementing exercise at the workplace for ensuring sustained high adherence and participation rates as well as optimal physical health and capacity outcomes [51]. ...
Preprint
Full-text available
Background: Good physical health and capacity is a requirement for offshore wind service technicians (WTs) who have substantial physical work demands and are exposed to numerous health hazards. Workplace physical exercise has shown promising results as a strategy for maintaining and improving physical health and work ability among various types of workers. Therefore, we aimed to assess the feasibility and preliminary efficacy of the Intelligent Physical Exercise Training (IPET) concept among WTs in the offshore wind industry. Methods: The present study used a within-subject design to assess the feasibility and preliminary efficacy of IPET (one hour/week individualized exercise during working hours). The intervention period was 12 weeks, with the first eight weeks performed on site as supervised or partly supervised exercise during work hours and the last four weeks planned as home-administered exercise after termination of the seasonal offshore service period. Three assessments, T1 (six months prior to intervention start), T2 (start of intervention) and T3 (end of intervention), of physical health and capacity (self-reported and objective measurements) were conducted and the period between T1 and T2 served as a within-subject control period. Primary outcome was feasibility measured as compliance, adherence, adverse events, and participant acceptability. Descriptive statistics were used to present feasibility outcomes and pairwise comparisons were performed to assess for differences in outcomes between T1, T2 and T3. Results: All WTs at the included wind farm (n=24, age: 40 years (SD±8)) participated in the study. No serious adverse events were reported. Compliance and adherence of 95 and 80% respectively, were reached in the eight-week supervised part, but lower when exercise was home-administered (<20%). Acceptability was high for the supervised part, with 83% indicating that the exercise program worked well and 100% that exercise should be implemented as an integrated part of the working structure. Physical capacity and health parameters collected at T1, T2 and T3 increased before and during the intervention period, indicating seasonal fluctuations in addition to possible improvements caused by the intervention. Conclusion: Implementation of Intelligent Physical Exercise Training on site and during working hours seems to be feasible and well received among WTs in the offshore wind industry. Trial registration: ClinicalTrials.gov (Identifier: NCT04995718). Retrospectively registered on August 6, 2021, https://clinicaltrials.gov/ct2/show/NCT04995718?term=NCT04995718&draw=2&rank=1
... Both analyses demonstrate how response rates are group statistics that highly depend on response thresholds ( Figure 4A) and mean changes ( Figure 4B; Atkinson et al., 2019). Future research should therefore avoid attributing lower response rates to reduced interindividual variability, an interpretation made in several studies included in our review (Wolpern et al., 2015;Dalleck et al., 2016;Byrd et al., 2019), and should recognize that response rates provide little if any, useful information at the individual level (Atkinson et al., 2019). ...
Article
Full-text available
Background: Many reports describe statistical approaches for estimating interindividual differences in trainability and classifying individuals as “responders” or “non-responders.” The extent to which studies in the exercise training literature have adopted these statistical approaches remains unclear. Objectives: This systematic review primarily sought to determine the extent to which studies in the exercise training literature have adopted sound statistical approaches for examining individual responses to exercise training. We also (1) investigated the existence of interindividual differences in trainability, and (2) tested the hypothesis that less conservative thresholds inflate response rates compared with thresholds that consider error and a smallest worthwhile change (SWC)/minimum clinically important difference (MCID). Methods: We searched six databases: AMED, CINAHL, EMBASE, Medline, PubMed, and SportDiscus. Our search spanned the aerobic, resistance, and clinical or rehabilitation training literature. Studies were included if they used human participants, employed standardized and supervised exercise training, and either: (1) stated that their exercise training intervention resulted in heterogenous responses, (2) statistically estimated interindividual differences in trainability, and/or (3) classified individual responses. We calculated effect sizes (ES IR ) to examine the presence of interindividual differences in trainability. We also compared response rates ( n = 614) across classification approaches that considered neither, one of, or both errors and an SWC or MCID. We then sorted response rates from studies that also reported mean changes and response thresholds ( n = 435 response rates) into four quartiles to confirm our ancillary hypothesis that larger mean changes produce larger response rates. Results: Our search revealed 3,404 studies, and 149 were included in our systematic review. Few studies ( n = 9) statistically estimated interindividual differences in trainability. The results from these few studies present a mixture of evidence for the presence of interindividual differences in trainability because several ES IR values lay above, below, or crossed zero. Zero-based thresholds and larger mean changes significantly (both p < 0.01) inflated response rates. Conclusion: Our findings provide evidence demonstrating why future studies should statistically estimate interindividual differences in trainability and consider error and an SWC or MCID when classifying individual responses to exercise training. Systematic Review Registration: [website], identifier [registration number].
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