Rehabilitation program combining physical exercise and heart rate variability biofeedback in hematologic patients: a feasibility study.

PURPOSE: Hematologic patients have a poorer health-related quality of life due to the disease and its treatments. Non-pharmacological interventions represent an opportunity in tertiary cancer prevention to manage persistent symptoms and support patients in their return to active daily living. This interventional study aimed to evaluate the feasibility of a program combining physical exercise (PE) and heart rate variability biofeedback (HRVB) in hematologic patients. METHOD: Hematologic patients in remission within 6 months participated in a 12-week rehabilitation program including 24 supervised sessions of PE associated with 10 supervised sessions of HRVB and daily home-based practice of paced breathing. We assessed patient adherence, fatigue, physical function, and heart rate variability. RESULTS: Twenty patients were included, 17 completed the protocol and 3 dropped out due to disease progression or time constraints; no adverse events or incidents were reported. Participation rates were 85% for PE and 98% for HRVB-supervised sessions. Significant improvements of physical capacity (6-min walk test, p < 0.001; 50-foot walk test, p < 0.001), muscle strength (grip force test, p < 0.01), and flexibility (toe-touch test, p < 0.001; back scratch test, p < 0.05) were measured. Coherence ratio (p < 0.001) and low-frequency spectral density of HRV signal (p < 0.003) increased significantly, suggesting improved autonomic function. Fatigue, static balance, and other time and frequency indicators of HRV were not improved (all p > 0.05). CONCLUSION: A rehabilitation program combining PE and HRVB is feasible in hematologic patients and effective on physical function. Further research with a larger sample size is needed to investigate effectiveness on patients' autonomic functions and their impacts on symptomatology.

Heart rate variability biofeedback in chronic disease management: A systematic review.

BACKGROUND: Heart rate variability biofeedback (HRVB) is a non-pharmacological intervention used in the management of chronic diseases. METHOD: A systematic search was performed according to eligibility criteria including adult chronic patients, HRVB as main treatment with or without control conditions, and psychophysiological outcomes as dependent variables. RESULTS: In total, 29 articles were included. Reported results showed the feasibility of HRVB in chronic patients without adverse effects. Significant positive effects were found in various patient profiles on hypertension and cardiovascular prognosis, inflammatory state, asthma disorders, depression and anxiety, sleep disturbances, cognitive performance and pain, which could be associated with improved quality of life. Improvements in clinical outcomes co-occurred with improvements in heart rate variability, suggesting possible regulatory effect of HRVB on autonomic function. CONCLUSIONS: HRVB could be effective in managing patients with chronic diseases. Further investigations are required to confirm these results and recommend the most effective method.

Obesity-related alterations in anticipatory postural mechanisms associated with gait initiation.

Obesity is known to have a detrimental effect on balance and motor performance during daily motor tasks. However, it remains unclear whether these obesity-related impairments are due to deficient anticipatory postural adjustments (APA) that precede voluntary movement. The objective of this study was to examine the effects of obesity on APA and the impacts related on motor performance and mediolateral postural stability during gait initiation. Fifteen obese and ten normal-weight young participants performed a series of gait initiation at their preferred speed. Our results showed that the durations and amplitudes of APA along both anteroposterior and mediolateral directions did not differ between the two groups (P > 0.05). In contrast, compared to normal-weight participants, mechanical effectiveness of APA was reduced in obese participants (P < 0.05). As a result, we observed a decreased motor performance (P < 0.05), in terms of peak anteroposterior center-of-mass velocity at the end of the first step, and a reduced mediolateral stability at swing foot contact in obese participants compared to normal-weight participants (P < 0.05). These findings suggest that APA effectiveness during gait initiation is reduced in obese adults, resulting in a decrease of both mediolateral stability and motor performance compared to their lean counterparts.

Estimating energy expenditure from accelerometer data in healthy adults and patients with type 2 diabetes.

OBJECTIVE: The aim of this study was to develop specific prediction equations based on acceleration data measured at three body sites for estimating energy expenditure (EE) during static and active conditions in middle-aged and older adults with and without type 2 diabetes (T2D). RESEARCH METHODS: Forty patients with T2D (age: 40-74 yr, body mass index (BMI): 21-29.4 kg·m-2) and healthy participants (age: 47-79 yr, BMI: 20.2-29.8 kg·m-2) completed trials in both static conditions and treadmill walking. For all trials, gas exchange was monitored using indirect calorimetry and vector magnitude was calculated from acceleration data measured using inertial measurement units placed to the participant's center of mass (CM), hip and ankle. Stepwise multiple regression analyses were conducted to select relevant variables to include in the three EE prediction equations, and three Monte Carlo cross-validation procedures were used to evaluate each separate equation. RESULTS: Vector magnitude (p < 0.0001) and personal data (gender, diabetes status and BMI; p < 0.0001) were used to develop three linear prediction equations to estimate EE during static conditions and walking. Cross-validation revealed similar robust coefficients of determination (R2: 0.81 to 0.85) and small bias (mean bias: 0.008 to -0.005 kcal·min-1) for all three equations. However, the equation based on CM acceleration exhibited the lowest root mean square error (0.60 kcal·min-1 vs. 0.65 and 0.69 kcal·min-1 for the hip and ankle equations, respectively; p < 0.001). CONCLUSION: The three equations based on acceleration data and participant characteristics accurately estimated EE during sedentary conditions and walking in middle-aged and older adults, with or without diabetes.

Adapted physical activity and cardiac coherence in hematologic patients (APACCHE): study protocol for a randomized controlled trial.

BACKGROUND: Hematologic malignancies and their treatments are recognized for their significant long-term adverse effects on health-related quality of life. As a part of cancer treatment, physical exercise is known to improve physical functioning, but there are still questions regarding its impact on psychological and emotional functioning. Nonetheless, heart rate variability biofeedback (HRVB) is recognized for its positive effects on autonomic nervous system balance and emotional self-regulation. The Adapted Physical Activity and Cardiac Coherence in Hematologic Patients (APACCHE) protocol is a randomized, controlled superiority trial designed to evaluate the effects of HRBV training combined with an adaptive physical activity (APA) program compared to APA alone on the post-treatment quality of life of adult hematologic patients. METHODS: Seventy patients aged 18-70 years, with various forms of hematological malignancies, in post-treatment remission within six months prior to beginning the study and who have been prescribed APA by a hematologist, will be randomly allocated in a 1:1 ratio to two 12-week treatment groups: HRVB + APA versus APA alone. APA sessions will consist of aerobic and resistance training for 1-h twice weekly. The HRVB training will consist of controlled breathing exercises with biofeedback of heart rate variability for 10 sessions and will include a daily home-based practice. The primary outcome will be to evaluate health-related quality of life (QLQ-C30, SF-36). The secondary outcomes will be to evaluate fatigue (MFI-20); anxiety and depression (HADS); clinical status with blood pressure, progression-free survival, overall survival, and body mass index; heart rate variability level and cardiac coherence score. All of these assessments will be evaluated initially (T1), 6 weeks after (T2), at the end of the 12 weeks (T3), and then at a 12-week post-intervention follow-up (T4). DISCUSSION: To our knowledge, this is the first protocol to investigate the additional value of HRVB on physical exercise. In addition, there has been no study previously published about HRVB in hematologic patients. We hypothesize that overall quality of life and psychological and physical functioning will be improved, potentially offering a better understanding of supportive cancer care in hematology and inferring new perspectives in psychophysiological research in cancer. TRIAL REGISTRATION: Current randomized controlled trial was registered 29 November 2017 on Clinical Trials.gov (NCT number: NCT03356171).

Effect of type 2 diabetes on energy cost and preferred speed of walking.

PURPOSE: Although walking is the most commonly recommended activity for patients with type 2 diabetes (T2D), these patients walk daily less than their healthy peers and adopt a lower self-selected speed. It has been suggested that gait alterations observed in this population could be responsible for a higher metabolic rate (MR) during walking. Thus, the aim of this study was to compare relationship between MR, the energy cost of walking per unit of distance (Cw) and self-selected walking speed in T2D patients and healthy individuals. METHODS: We measured metabolic and spatiotemporal parameters for 20 T2D patients and 20 healthy control subjects, while they walked on a treadmill at different speeds (0.50-1.75 m s-1) using a breath-by-breath gas analyzer and an inertial measurement unit, respectively. RESULTS: Net MR was 14.3% higher for T2D patients on average across all speeds, and they preferred to walk 6.8% slower at their self-selected compared with their non-diabetics counterparts (1.33 vs. 1.42 m s-1, respectively; p = 0.045). Both groups naturally walked at a self-selected speed close to their minimum gross Cw per distance, with similar values of minimum gross Cw (3.53 and 3.32 J kg-1 m-1 in T2D patients and control subjects, respectively). CONCLUSION: When compared with healthy subjects, T2D patients walk with a higher MR at any given speed. Thus, the slower self-selected speed observed in T2D patients seems to correspond to the speed at which their gross energy cost per distance was minimized and allows T2D patients to walk at the same intensity than healthy subjects.

Validation of a method for estimating energy expenditure during walking in middle-aged adults.

PURPOSE: The aim of this study was to test the validity of a method using an inertial measurement unit for estimating activity-related energy expenditure (AEE) during walking in middle-aged adults. METHODS: Twenty healthy middle-aged participants completed different treadmill walking trials with an inertial measurement unit adhered to their lower back. Gas exchange was monitored with indirect calorimetry. Mechanical data were used to estimate AEE from an algorithm developed by Bouten et al. (Med Sci Sport Exer 26(12):1516-1523, 1994). Three methods for removing the gravitational component were proposed and tested: mean subtraction method (MSM), high-pass filter method (HPM) and free acceleration method (FAM). RESULTS: The three methods did not differ significantly from the indirect calorimetry [bias = - 0.08 kcal min-1; p = 0.47 (MSM), bias = - 0.08 kcal min-1; p = 0.48 (HPM) and bias = - 0.15 kcal min-1; p = 0.23 (FAM)]. Mean root mean square errors were 0.43, 0.42 and 0.51 kcal min-1 for MSM, HPM and FAM, respectively. CONCLUSION: This study proposed an accurate method for estimating AEE in middle-aged adults for a large range of walking intensities, from slow to brisk walking, based on Bouten's algorithm.

Energy Expenditure in People with Diabetes Mellitus: A Review.

Physical activity (PA) is an important non-therapeutic tool in primary prevention and treatment of diabetes mellitus (DM). To improve activity-based health management, patients need to quantify activity-related energy expenditure and the other components of total daily energy expenditure. This review explores differences between the components of total energy expenditure in patients with DM and healthy people and presents various tools for assessing the energy expenditure in subjects with DM. From this review, it appears that patients with uncontrolled DM have a higher basal energy expenditure (BEE) than healthy people which must be considered in the establishment of new BEE estimate equations. Moreover, studies showed a lower activity energy expenditure in patients with DM than in healthy ones. This difference may be partially explained by patient with DMs poor compliance with exercise recommendations and their greater participation in lower intensity activities. These specificities of PA need to be taken into account in the development of adapted tools to assess activity energy expenditure and daily energy expenditure in people with DM. Few estimation tools are tested in subjects with DM and this results in a lack of accuracy especially for their particular patterns of activity. Thus, future studies should examine sensors coupling different technologies or method that is specifically designed to accurately assess energy expenditure in patients with diabetes in daily life.

Individualized Exercise Training at Maximal Fat Oxidation Combined with Fruit and Vegetable-Rich Diet in Overweight or Obese Women: The LIPOXmax-Réunion Randomized Controlled Trial.

OBJECTIVES: Lifestyle combined interventions are a key strategy for preventing type-2 diabetes (T2DM) in overweight or obese subjects. In this framework, LIPOXmax individualized training, based on maximal fat oxidation [MFO], may be a promising intervention to promote fat mass (FM) reduction and prevent T2DM. Our primary objective was to compare three training programs of physical activity combined with a fruit- and vegetable-rich diet in reducing FM in overweight or obese women. DESIGN AND SETTING: A five months non-blinded randomized controlled trial (RCT) with three parallel groups in La Réunion Island, a region where metabolic diseases are highly prevalent. SUBJECTS: One hundred and thirty-six non-diabetic obese (body mass index [BMI]: 27-40 kg/m2) young women (aged 20-40) were randomized (G1: MFO intensity; G2: 60% of VO2-peak intensity; G3: free moderate-intensity at-home exercise following good physical practices). OUTCOMES: Anthropometry (BMI, bodyweight, FM, fat-free mass), glucose (fasting plasma glucose, insulin, HOMA-IR) and lipid (cholesterol and triglycerides) profiles, and MFO values were measured at month-0, month-3 and month-5. RESULTS: At month-5, among 109 women assessed on body composition, the three groups exhibited a significant FM reduction over time (G1: -4.1±0.54 kg; G2: -4.7±0.53 kg; G3: -3.5±0.78 kg, p<0.001, respectively) without inter-group differences (p = 0.135). All groups exhibited significant reductions in insulin levels or HOMA-IR index, and higher MFO values over time (p<0.001, respectively) but glucose control improvement was higher in G1 than in G3 while MFO values were higher in G1 than in G2 and G3. Changes in other outcome measures and inter-group differences were not significant. CONCLUSION: In our RCT the LIPOXmax intervention did not show a superiority in reducing FM in overweight or obese women but is associated with higher MFO and better glucose control improvements. Other studies are required before proposing LIPOXmax training for the prevention of T2DM in overweight or obese women. TRIAL REGISTRATION: ClincialTrials.gov NCT01464073.

Pelvis morphology, trunk posture and standing imbalance and their relations to the Cobb angle in moderate and severe untreated AIS.

Adolescent idiopathic scoliosis (AIS) is the most common form of scoliosis and usually affects young girls. Studies mostly describe the differences between scoliotic and non-scoliotic girls and focus primarily on a single set of parameters derived from spinal and pelvis morphology, posture or standing imbalance. No study addressed all these three biomechanical aspects simultaneously in pre-braced AIS girls of different scoliosis severity but with similar curve type and their interaction with scoliosis progression. The first objective of this study was to test if there are differences in these parameters between pre-braced AIS girls with a right thoracic scoliosis of moderate (less than 27°) and severe (more than 27°) deformity. The second objective was to identify which of these parameters are related to the Cobb angle progression either individually or in combination of thereof. Forty-five scoliotic girls, randomly selected by an orthopedic surgeon from the hospital scoliosis clinic, participated in this study. Parameters related to pelvis morphology, pelvis orientation, trunk posture and quiet standing balance were measured. Generally moderate pre-brace idiopathic scoliosis patients displayed lower values than the severe group characterized by a Cobb angle greater than 27°. Only pelvis morphology and trunk posture were statistically different between the groups while pelvis orientation and standing imbalance were similar in both groups. Statistically significant Pearson coefficients of correlation between individual parameters and Cobb angle ranged between 0.32 and 0.53. Collectively trunk posture, pelvis morphology and standing balance parameters are correlated with Cobb angle at 0.82. The results suggest that spinal deformity progression is not only a question of trunk morphology distortion by itself but is also related to pelvis asymmetrical bone growth and standing neuromuscular imbalance.

Cardiac rehabilitation in chronic heart failure: effect of an 8-week, high-intensity interval training versus continuous training.

OBJECTIVE: To compare the effects of an 8-week, high-intensity interval training protocol versus continuous training. DESIGN: Randomized controlled trial. SETTING: Cardiac rehabilitation center. PARTICIPANTS: Patients (N=26; mean age ± SD, 54±12y) with chronic heart failure were enrolled in a cardiac rehabilitation program for 8 weeks. INTERVENTIONS: Patients were randomly assigned into 2 groups that performed either interval training (IT) or continuous training (CT). IT consisted of 3 sessions of 12 repetitions of 30 seconds of exercise at very high intensity, followed by 60 seconds of complete rest. The CT group performed CT exercises, which consisted of 45 minutes of aerobic exercise. MAIN OUTCOME MEASURES: Parameters of gas exchanges: peak oxygen consumption (Vo(2)peak), first ventilator threshold (VT1), distance at six-minute walk test (6MWT), and level of anxiety and depression were measured. RESULTS: The IT group increased significantly their Vo(2)peak, the duration of the exercise test, the oxygen pulse, oxygen consumption at the VT1, and the distance walked during the 6MWT. The CT group only increased the time at the VT1 and the distance performed at the 6MWT. The improvement in the time at the VT1 was significantly higher for the IT group than for the CT group. CONCLUSIONS: This study shows that IT at very high intensity for patients with heart failure appears to be more effective than CT in improving indices of submaximal exercise capacity.

Effect of long-term physical activity practice after cardiac rehabilitation on some risk factors.

The objective of this study was to evaluate the effects of long-term physical activity practice after a cardiac rehabilitation program on weight, physical capacity and arterial compliance. The Dijon Physical Activity Score was used to identify two groups: sedentary and active. Weight, distance at the 6-min walk test and the small artery elasticity indice were measured at the beginning, at the end of the rehabilitation program and at 18.3 ± 5.3 months after. After the cardiac rehabilitation, sedentary patients showed a significant increase in weight and a significant reduction in distance on the 6-min walk test and in the arterial compliance. Active patients did not show any alteration in these parameters. We concluded that, after a cardiac rehabilitation program, the sedentary lifestyle has a negative influence on weight, physical capacity and arterial compliance, which are major markers of risk factors. In contrast, the practice of physical activity preserves these parameters.

Evaluation of maximal O2 uptake with undergraduate students at the University of La Reunion.

The maximal rate of O2 consumption (VO2 max) constitutes one of the oldest fitness indexes established for the measure of cardiorespiratory fitness and aerobic performance. Procedures have been developed in which VO2 max is estimated from physiological responses during submaximal exercise. Generally, VO2 max is estimated using the classical renowned Astrand-Ryhming test. In young adults, poor fitness and low aerobic performance are often associated with a sedentary lifestyle, which is a well-described factor for the development of obesity and its related disorders such as cardiovascular diseases and type 2 diabetes. In the Indian Ocean, the inhabitants of La Reunion Island, a French overseas department, exhibit an increasing prevalence of obesity and type 2 diabetes. At the University of La Reunion, a new laboratory course involving students was designed to teach the indirect evaluation of their VO2 max from the classical Astrand-Ryhming test and using a cycle ergometer as the exercise mode. Inverse and significant correlations were established between the students' fat mass percentages and their VO2 max and between their waist-to-hip ratio and VO2 max as well. Results from the international physical activity questionnaire showed that most participants in this laboratory were sedentary students. Therefore, this laboratory makes the students practice and understand the use of a classical test to estimate their VO2 max. It also alerts them to the correlation between a sedentary lifestyle and higher body fat content. This exercise allowed students to use a scientific method to engage the problem of sedentary lifestyle, which is a real world issue.