Physical Functioning After 1, 3, and 5 Years of Exercise Among People With Parkinson's Disease: A Longitudinal Observational Study.

BACKGROUND AND PURPOSE: Regular physical activity is thought to be crucial to maintaining optimal physical function in people with Parkinson's disease (PWP), and it may have neuroprotective effects. As with many medical treatments, exercise is most effective when performed consistently over a period of years. The primary aim of this study was to examine multiyear adherence to a community-based group exercise program for PWP. A secondary aim was to document how physical functioning progressed after 1, 3, and 5 years for participants who consistently attended a community-based, group, exercise program. METHODS: Forty-six individuals with idiopathic Parkinson's disease, who were at modified Hoehn and Yahr stage I, II, or III and were community ambulators, were recruited on a rolling basis between 2008 and 2013. Each provided yearly medical clearance to exercise. Participants engaged in a free, community-based, group exercise program offered 2 days per week, 1 hour per day, for three 10-week sessions per year. The program included supervised floor exercises for balance, coordination, strength, and flexibility along with resistance training on dual-action exercise machines. Participants who attended more than half the classes for 1, 3, or 5 years (n = 27, n = 14, n = 7, respectively) were considered to have completed the fitness program (consistent exercisers) and were included in the longitudinal data analysis; participants who either dropped out or attended less than half the classes (n = 19) were not included. Physical functioning was evaluated at baseline for all participants and yearly thereafter for consistent exercisers. Wilcoxon signed rank tests were used to compare baseline data with data collected after 1, 3, and 5 years of consistent exercise. RESULTS AND DISCUSSION: Over half of the participants initially evaluated completed at least 1 year of the fitness program (27 of the 46 = 59%) and a proportion completed 3 years (14 of the 39 = 39%), and 5 years (7 of the 24 = 29%). At baseline, consistent exercisers were younger than those who dropped out (63.9 vs 69.9 years, P < .05), but had similar modified Hoehn and Yahr medians (2.0 vs 2.3), and similar time since diagnosis (8.0 vs 5.6 years). Consistent exercisers showed small statistically significant improvements in grip strength (8.9% change), Berg Balance scores (5.1% change), and 6-minute walk test (11% change) from baseline to year 1. No significant differences were found in these variables after 3 or 5 years, or for gait speed and timed up and go after 1, 3, or 5 years. CONCLUSION: Despite the progressive nature of Parkinson's disease, many PWP can sustain a regular program of varied modes of community-based, group exercise over a period of years. Participants who did so maintained initial performance levels on key measures of physical functioning. By working with an interprofessional team in a supportive community-based exercise program, physical therapists can help many PWP engage in consistent and sustained exercise activity over multiyear periods.

Validation of photoplethysmography as a method to detect heart rate during rest and exercise.

Despite their enhanced marketplace visibility, validity of wearable photoplethysmographic heart rate monitoring is scarce. Forty-seven healthy participants performed seven, 6-min exercise bouts and completed a valid skin type scale. Participants wore an Omron HR500U (OHR) and a Mio Alpha (MA), two commercial wearable photoplethysmographic heart rate monitors. Data were compared to a Polar RS800CX (PRS). Means and error were calculated between devices using minutes 2-5. Compared to PRS, MA data was significantly different in walking, biking (2.41 ± 3.99 bpm and 3.26 ± 11.38 bpm, p < 0.05) and weight lifting (23.30 ± 31.94 bpm, p < 0.01). OHR differed from PRS in walking (4.95 ± 7.53 bpm, p < 0.05) and weight lifting (4.67 ± 8.95 bpm, p < 0.05). MA during elliptical, stair climbing and biking conditions demonstrated a strong correlation between jogging speed and error (r = 0.55, p < 0.0001), and showed differences in participants with less photosensitive skin.

Energy drink consumption and associated health behaviors among university students in an urban setting.

The objective of this study is to describe energy drink consumption and health behaviors among college students attending a predominantly minority university. Undergraduate and graduate students attending a private, minority-serving university were invited to participate in an online survey between September 2009 and August 2010. Out of 2,500 students, 407 participated yielding a response of 16 %. Analysis assessed energy drink consumption as well as participation in sport activities and high-risk behaviors. Energy drink consumption is significantly related with drinking alcohol to inebriation and driving (r = .14, p < .05) and to riding with a drunk driver (r = .15, p < .05). Athletes were more likely to engage in drinking alcohol to inebriation and driving F (1, 186) = 6.12, p < .02. Energy drink consumption is a common practice among racial minority university students. Tailored health promotion strategies and interventions are needed to address misconceptions of energy drink and alcohol mixing.

Comparison of steps and energy expenditure assessment in adults of Fitbit Tracker and Ultra to the Actical and indirect calorimetry.

Epidemic levels of inactivity are associated with chronic diseases and rising healthcare costs. To address this, accelerometers have been used to track levels of activity. The Fitbit and Fitbit Ultra are some of the newest commercially available accelerometers. The purpose of this study was to determine the reliability and validity of the Fitbit and Fitbit Ultra. Twenty-three subjects were fitted with two Fitbit and Fitbit Ultra accelerometers, two industry-standard accelerometers and an indirect calorimetry device. Subjects participated in 6-min bouts of treadmill walking, jogging and stair stepping. Results indicate the Fitbit and Fitbit Ultra are reliable and valid for activity monitoring (step counts) and determining energy expenditure while walking and jogging without an incline. The Fitbit and standard accelerometers under-estimated energy expenditure compared to indirect calorimetry for inclined activities. These data suggest the Fitbit and Fitbit Ultra are reliable and valid for monitoring over-ground energy expenditure.

Transference of kettlebell training to strength, power, and endurance.

Kettlebells are a popular implement in many strength and conditioning programs, and their benefits are touted in popular literature, books, and videos. However, clinical data on their efficacy are limited. The purpose of this study was to examine whether kettlebell training transfers strength and power to weightlifting and powerlifting exercises and improves muscular endurance. Thirty-seven subjects were assigned to an experimental (EXP, n = 23; mean age = 40.9 ± 12.9 years) or a control group (CON; n = 14; mean age = 39.6 ± 15.8 years), range 18-72 years. The participants were required to perform assessments including a barbell clean and jerk, barbell bench press, maximal vertical jump, and 45° back extensions to volitional fatigue before and after a 10-week kettlebell training program. Training was structured in a group setting for 2 d·wk(-1) for 10 weeks. A repeated measures analysis of variance was conducted to determine group × time interactions and main effects. Post hoc pairwise comparisons were conducted when appropriate. Bench press revealed a time × group interaction and a main effect (p < 0.05). Clean and jerk and back extension demonstrated a trend toward a time × group interaction, but it did not reach significance (p = 0.053). However, clean and jerk did reveal a main effect for time (p < 0.05). No significant findings were reported for maximal vertical jump. The results demonstrate a transfer of power and strength in response to 10 weeks of training with kettlebells. Traditional training methods may not be convenient or accessible for strength and conditioning specialists, athletes, coaches, and recreational exercisers. The current data suggest that kettlebells may be an effective alternative tool to improve performance in weightlifting and powerlifting.

Long-term group exercise for people with Parkinson's disease: a feasibility study.

BACKGROUND AND PURPOSE: Aerobic and strengthening exercises have been shown to benefit people with Parkinson's disease (PD) on the basis of highly structured, short-term, clinical protocols. This study extended previous research by investigating feasibility of an ongoing, community-based, group exercise program for people with PD on the basis of short-term (10 weeks) and long-term (14 months) data. METHODS: Twenty people with PD (Hoehn and Yahr stages I to III) participated in at least one of four 10-week sessions. Classes were held twice weekly for 1 hour and included strength, flexibility, and balance and walking exercises. Evaluations were done 1.5 hours after medication intake 1 week before and 1 week after each session. Gait speed, 6-Minute Walk test (6MWT), "Timed Up and Go" test, and grip strength were used to assess physical function. Analysis of short-term results were based on 18 participants (2 dropped out prior to posttest), and long-term results were based on 8 participants who started in the first session continued through the 14-month period. RESULTS: Attendance rates were moderate to high (73% overall). No injuries were reported. Wilcoxon signed ranks tests based on each participant's first 10-week session demonstrated significant improvements in 6MWT, and grip strength. Long-term participants showed significant improvements in grip strength, and a trend toward improved 6MWT. Gait speed and Timed Up and Go test did not change significantly in the short or long terms. DISCUSSION/CONCLUSIONS: Our community-based group exercise program was safe, feasible, and appears to be effective. While some measures showed no improvement, there was no evidence of decline. This is an important outcome for persons with progressive neurological disorders, and suggests community-based group exercise is a promising option for people with PD.

A comparison of energy expenditure estimates from the Actiheart and Actical physical activity monitors during low intensity activities, walking, and jogging.

Combining accelerometry with heart rate monitoring has been suggested to improve energy estimates, however, it remains unclear whether the single, currently existing commercially available device combining these data streams (Actiheart) provides improved energy estimates compared to simpler and less expensive accelerometry-only devices. The purpose of this study was to compare the validity of the heart rate (HR), accelerometry (ACC), and combined ACC/HR estimates of the Actiheart to the ACC estimates of the Actical during low and moderate intensity activities. Twenty-seven participants (mean age 26.3 ± 7.3) wore an Actical, Actiheart and indirect calorimeter (K4b(2)) while performing card playing, sweeping, lifting weights, walking and jogging activities. All estimates tended to underestimate energy, sometimes by substantial amounts. Viewed across all activities studied, there was no significant difference in the ability of the waist-mounted Actical and torso-mounted Actiheart (ACC, HR, ACC/HR) estimates to predict energy expenditure. However, the Actiheart provided significantly better estimates than the Actical for the activities in which acceleration of the pelvis is not closely related to energy expenditure (card playing, sweeping, lifting weights) and the Actical provided significantly better estimates for level walking and level jogging. Similar to a previous study, the ACC component of the Actiheart was found to be the weakest predictor of energy suggesting it may be responsible for the failure of the combined ACC/HR estimate to equal or better the estimates derived solely from a waist mounted ACC device.

Response time to stimuli in division I soccer players.

The purpose of this investigation was to examine the effect of auditory stimuli (AS) and visual stimuli (VS) on sprint time, sprint speed, and reaction time in National Collegiate Athletic Association Division I male soccer players. Fifteen healthy subjects (mean age 22.1 ± 1.6 years) volunteered for the study. This experiment was conducted on a regulation soccer field, using a wireless timing system. Subjects stood on a touch-and-release pad and were instructed a prompt (AS: "go" command via a microphone interface, VS: movement of a player located 10 m from the start) to run 20 m through the finish line timing gates without decelerating. After 3 submaximal sprint trials at 50%, conditions (AS and VS) were randomized and performed 3 times by each subject. The best sprint time, sprint speed, and reaction time were recorded. Paired t-tests were conducted on dependent variables to determine statistically significant differences. An alpha level was set at p ≤ 0.05. Sprint time was reduced in response to VS as compared to AS (3.76 ± 0.16 seconds vs. 3.85 ± 0.15 seconds, p = 0.001). Sprint speed (distance covered) was greater in VS compared to AS (5.3 ± 0.21 m · s vs. 5.1 ± 0.19 m · s, p < 0.001), and reaction time was reduced in VS compared to AS (0.53 ± 0.048 seconds vs. 0.61 ± 0.044 seconds, p = 0.001). These data show that VS rather than AS improve sprint response times in collegiate male soccer athletes. The data suggest that performance on the field may be improved if coaches and players strategize to integrate visual cues (e.g., gestures and signals) during practices and games.

Gender influence on response time to sensory stimuli.

The purpose of this investigation was to examine the effect of auditory stimuli (AS) and visual stimuli (VS) on response time, speed, and distance in male and female college athletes. Thirty-five healthy National Collegiate Athletic Association Division I men's soccer and women's lacrosse athletes (mean age 20.7 +/- 2.3 years) participated in the study. This experiment was conducted in a laboratory environment, using a Cybex "Reactor" a 14-sensor force plate device used to detect response times, speed, and distance. Subjects stood on the "start" sensor and were instructed at the prompt (auditory: a prerecorded "go" command, visual: an illuminated circle on a television monitor) to run through the "end" sensor without braking. Three trials of each condition were performed by each subject. Movement time, speed, and distance were recorded for each trial. General linear model repeated measure analyses and post hoc 1-way analysis of variance were conducted on all dependent variables (p < or = 0.05). Movement time was significantly faster in men compared with women under AS (p = 0.008) and VS (p < 0.05) conditions. A trend toward a faster transit time was noted in men in the AS condition (p = 0.072), but transit time was faster in men in the VS condition (p < 0.001). Transit speed (distance covered) was faster in men in response to AS (p < 0.05) and VS (p < 0.001). Male athletes respond faster as compared with female athletes, and cover greater distance when presented with VSs as compared to ASs. Data suggest that performance in male athletes related to response times, speed, and distance may be enhanced with the use of visual cueing or VSs.

Exercise training improves cardiovascular and autonomic profiles in HIV.

OBJECTIVES: Human immunodeficiency virus (HIV) is associated with cardiovascular (CV) and autonomic dysfunction, however the effects of fitness on vascular and autonomic mechanisms in HIV disease are unknown. METHODS: We studied forty-eight subjects (40.4 +/- 4.2 years) in a cross-sectional design matched for age, gender, BMI, and fitness. Participants were assigned to 1 in 4 groups: 1) Healthy Unfit (HU), 2) Healthy Fit (HF), 3) HIV Positive Unfit (HPU), and 4) HIV Positive Fit (HPF). Fitness was assessed via open-circuit spirometry; arterial compliance and autonomic modulations were measured via applanation tonometry and power spectral analysis, respectively, and baroreflex sensitivity was obtained using the alpha index. RESULTS: Arterial compliance was augmented in HPF vs. HPU [7.4 +/- 1.9 mmHg x second vs. 4.4 +/- 1.7 mmHg x second (P = 0.006)]. Parasympathetic modulation was higher in HPF vs. HPU [2244.5 +/- 2997.6 msecond(2) vs. 489.1 +/- 552.9 msecond(2) (P < 0.05)]. Sympathetic modulation was lower in HPF vs. HU [4.7 +/- 5.0 mmHg(2) vs. 12.9 +/- 9.7 mmHg(2) (P < 0.05)]. Baroreflex sensitivity was higher in HPF vs. HPU [17.3 +/- 10.2 msecond/mmHg vs. 7.4 +/- 3.8 msecond/mmHg (P = 0.003)], and HPF vs. HU [17.3 +/- 10.2 msecond/mmHg vs. 6.2 +/- 3.0 msecond/mmHg (P = 0.004)]. CONCLUSIONS: Augmentations in arterial compliance and baroreflex sensitivity associated with fitness portent an improved CV and autonomic profile for HIV-positive individuals. Physical activity may be an adjuvant method to enhance the overall vascular health in HIV-compromised individuals.