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Dementia And Physical Activity (DAPA) trial of moderate to high intensity exercise training for people with dementia: randomised controlled trial
AbstractObjectiveTo estimate the effect of a moderate to high intensity aerobic and strength exercise training programme on cognitive impairment and other outcomes in people with mild to moderate dementia.DesignMulticentre, pragmatic, investigator masked, randomised controlled trial.SettingNational Health Service primary care, community and memory services, dementia research registers, and voluntary sector providers in 15 English regions.Participants494 people with dementia: 329 were assigned to an aerobic and strength exercise programme and 165 were assigned to usual care. Random allocation was 2:1 in favour of the exercise arm.InterventionsUsual care plus four months of supervised exercise and support for ongoing physical activity, or usual care only. Interventions were delivered in community gym facilities and NHS premises.Main outcome measuresThe primary outcome was score on the Alzheimer’s disease assessment scale-cognitive subscale (ADAS-cog) at 12 months. Secondary outcomes included activities of daily living, neuropsychiatric symptoms, health related quality of life, and carer quality of life and burden. Physical fitness (including the six minute walk test) was measured in the exercise arm during the intervention.ResultsThe average age of participants was 77 (SD 7.9) years and 301/494 (61%) were men. By 12 months the mean ADAS-cog score had increased to 25.2 (SD 12.3) in the exercise arm and 23.8 (SD 10.4) in the usual care arm (adjusted between group difference −1.4, 95% confidence interval −2.6 to −0.2, P=0.03). This indicates greater cognitive impairment in the exercise group, although the average difference is small and clinical relevance uncertain. No differences were found in secondary outcomes or preplanned subgroup analyses by dementia type (Alzheimer’s disease or other), severity of cognitive impairment, sex, and mobility. Compliance with exercise was good. Over 65% of participants (214/329) attended more than three quarters of scheduled sessions. Six minute walking distance improved over six weeks (mean change 18.1 m, 95% confidence interval 11.6 m to 24.6 m).ConclusionA moderate to high intensity aerobic and strength exercise training programme does not slow cognitive impairment in people with mild to moderate dementia. The exercise training programme improved physical fitness, but there were no noticeable improvements in other clinical outcomes.Trial registrationCurrent Controlled Trials ISRCTN10416500.
Journal Article
Keeping fit
In this book, readers will learn what it means to be physically fit and why its important to stay active.
Book
Motor competence and health related physical fitness in youth: A systematic review
This study aimed to review the scientific evidence on associations between motor competence (MC) and components of health related physical fitness (HRPF), in children and adolescents.
Systematic review.
Systematic search of Academic Search Premier, ERIC, PubMed, PsycInfo, Scopus, SportDiscus, and Web of Science databases was undertaken between October 2012 and December 2013. Studies examining associations between MC and HRPF components (body weight status, cardiorespiratory fitness, musculoskeletal fitness and flexibility) in healthy children and adolescents, published between 1990 and 2013, were included. Risk of bias within studies was assessed using CONSORT and STROBE guidelines. The origin, design, sample, measure of MC, measure of the HRPF, main results and statistics of the studies were analyzed and a narrative synthesis was conducted.
Forty-four studies matched all criteria; 16 were classified as low risk of bias and 28 as medium risk. There is strong scientific evidence supporting an inverse association between MC and body weight status (27 out of 33 studies) and a positive association between MC and cardiorespiratory fitness (12 out of 12 studies) and musculoskeletal fitness (7 out of 11 studies). The relationship between MC and flexibility was uncertain.
Considering the noted associations between various assessments of MC and with multiple aspects of HRPF, the development of MC in childhood may both directly and indirectly augment HRPF and may serve to enhance the development of long-term health outcomes in children and adolescents.
Journal Article
The Health Benefits of Muscular Fitness for Children and Adolescents: A Systematic Review and Meta-Analysis
Background
Physical fitness during childhood and adolescence has been identified as an important determinant of current and future health status. While research has traditionally focused on the association between cardio-respiratory fitness and health outcomes, the association between muscular fitness (MF) and health status has recently received increased attention.
Objective
The aim of this systematic review and meta-analysis was to evaluate the potential physiological and psychological benefits associated with MF among children and adolescents.
Methods
A systematic search of six electronic databases (PubMed, SPORTDiscus, Scopus, EMBASE, PsycINFO and OVID MEDLINE) was performed on the 20th May, 2013. Cross-sectional, longitudinal and experimental studies that quantitatively examined the association between MF and potential health benefits among children and adolescents were included. The search yielded 110 eligible studies, encompassing six health outcomes (i.e., adiposity, bone health, cardiovascular disease [CVD] and metabolic risk factors, musculoskeletal pain, psychological health and cognitive ability). The percentage of studies reporting statistically significant associations between MF and the outcome of interest was used to determine the strength of the evidence for an association and additional coding was conducted to account for risk of bias. Meta-analyses were also performed to determine the pooled effect size if there were at least three studies providing standardised coefficients.
Results
Strong evidence was found for an inverse association between MF and total and central adiposity, and CVD and metabolic risk factors. The pooled effect size for the relationship between MF and adiposity was
r
= −0.25 (95 % CI −0.41 to −0.08). Strong evidence was also found for a positive association between MF and bone health and self-esteem. The pooled effect size for the relationship between MF and perceived sports competence was
r
= 0.39 (95 % CI 0.34–0.45). The evidence for an association between MF and musculoskeletal pain and cognitive ability was inconsistent/uncertain. Where evidence of an association was found, the associations were generally low to moderate.
Conclusion
The findings of this review highlight the importance of developing MF in youth for a number of health-related benefits.
Journal Article
Maximum interval training
Utilizing overlooked equipment like heavy ropes, suspension devices, and sandbags, Maximum Interval Training offers a proven plan for developing power, strength, explosiveness, quickness, and agility. It features 148 exercises for athletes and serious strength and conditioning enthusiasts alike.
Book
Aerobic and resistance exercise improves physical fitness, bone health, and quality of life in overweight and obese breast cancer survivors: a randomized controlled trial
Background
Exercise is an effective strategy to improve quality of life and physical fitness in breast cancer survivors; however, few studies have focused on the early survivorship period, minorities, physically inactive and obese women, or tested a combined exercise program and measured bone health. Here, we report the effects of a 16-week aerobic and resistance exercise intervention on patient-reported outcomes, physical fitness, and bone health in ethnically diverse, physically inactive, overweight or obese breast cancer survivors.
Methods
One hundred breast cancer survivors within 6 months of completing adjuvant treatment were assessed at baseline, post-intervention, and 3-month follow-up (exercise group only) for physical fitness, bone mineral density, serum concentrations of bone biomarkers, and quality of life. The exercise intervention consisted of moderate-vigorous (65–85% heart rate maximum) aerobic and resistance exercise thrice weekly for 16 weeks. Differences in mean changes for outcomes were evaluated using mixed-model repeated measure analysis.
Results
At post-intervention, the exercise group was superior to usual care for quality of life (between group difference: 14.7, 95% CI: 18.2, 9.7;
p
< 0.001), fatigue (p < 0.001), depression (p < 0.001), estimated VO
2max
(p < 0.001), muscular strength (p < 0.001), osteocalcin (
p
= 0.01), and BSAP (
p
= 0.001). At 3-month follow-up, all patient-reported outcomes and physical fitness variables remained significantly improved compared to baseline in the exercise group (
p
< 0.01).
Conclusions
A 16-week combined aerobic and resistance exercise program designed to address metabolic syndrome in ethnically-diverse overweight or obese breast cancer survivors also significantly improved quality of life and physical fitness. Our findings further support the inclusion of supervised clinical exercise programs into breast cancer treatment and care.
Trial registration
This trial is registered on ClinicalTrials.gov:
NCT01140282
as of June 9, 2010.
Journal Article
Faster, better, stronger : your exercise bible, for a leaner, healthier body in just 12 weeks
A five-time Olympic gold medalist and a U.S. Olympic team physician present a fitness program based on a philosophy of applying exercise as a prescription medication, in a guide that discusses key principles in fitness and weight loss.
Book
2020 WHO guidelines on physical activity and sedentary behaviour for children and adolescents aged 5–17 years: summary of the evidence
Background
The World Health Organization (WHO) released in 2020 updated global guidelines on physical activity and sedentary behaviour for children, adolescents, adults, older adults and sub-populations such as pregnant and postpartum women and those living with chronic conditions or disabilities.
Objective
To summarize the evidence on the associations between physical activity, sedentary behaviour, and health-related outcomes used to inform the 2020 WHO guidelines on physical activity and sedentary behaviour for children and adolescents aged 5–17 years.
Methods
The update of the WHO guideline recommendations for children and adolescents utilized and systematically updated the evidence syntheses on physical activity and sedentary behaviour conducted for the 2016 Canadian 24-Hour Movement Guidelines for Children and Youth, the 2019 Australian 24-Hour Movement Guidelines for Children and Young People (5–17 years), and the 2018 Physical Activity Guidelines for Americans, Second Edition. Systematic reviews published from 2017 up to July 2019 that addressed the key questions were identified, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework was used to rate the certainty of the evidence for the entire body of evidence.
Results
The updated literature search yielded 21 relevant systematic reviews. The evidence base reviewed (i.e., existing and new systematic reviews) provided evidence that greater amounts and higher intensities of physical activity as well as different types of physical activity (i.e., aerobic and muscle and bone strengthening activities) are associated with improved health outcomes (primarily intermediate outcomes). There was sufficient evidence to support recommendations on limiting sedentary behaviours, which was not addressed in the 2010 WHO guidelines. However, there is still insufficient evidence available to fully describe the dose-response relationships between physical activity or sedentary behaviour and health outcomes, and whether the associations vary by type or domain of physical activity or sedentary behaviour.
Conclusions
Addressing the identified research gaps will better inform guideline recommendations in children and adolescents, and future work should aim to prioritize these areas of research. In the meantime, investment and leadership is needed to scale up known effective policies and programs aimed at increasing activity in children and adolescents.
Journal Article