Brad Wall

Exercise is recommended to improve sleep, but the role of exercise intensity is unclear. In addition, whether obesity interacts with exercise intensity to affect sleep is unknown.

PURPOSE: To investigate the effects of exercise intensity and obesity on parameters related to sleep quality (sleep efficiency [SE], sleep onset latency [SOL], wake after sleep onset [WASO], and awakenings).

METHODS: Six adults with obesity (OB; 2 M/4F; age: 35.7 ± 9.7 y; BMI: 34.4 ± 2.9; VO2peak: 21.4 ± 3.2 mL/kg/min) and seven normal weight adults (NW; 4 M/3F; age: 33.4 ± 14.5 y; BMI: 22.9 ± 1.9 kg/m2; VO2peak: 32.4 ± 5.6 mL/kg/min) completed a maximal graded cardiopulmonary peak oxygen uptake (VO2peak)/lactate threshold (LT) test on a cycle ergometer to determine exercise intensity for 3 randomized control or calorically matched exercise bouts: a) CON, no exercise; b) MOD, the power output (PO) at LT; c) HIGH, the PO associated with 75% of the difference between LT and VO2peak. Each visit occurred in the morning between 08:00-09:00 h. Sleep variables were recorded with Philips Respironics Actiwatch Spectrum Plus monitors. Participants wore the watch the day before each testing visit and through the night after the testing visit. The Cole-Kripke algorithm was used to score the actigraphy data. 2x3 mixed model ANOVAs were utilized to assess the effect of obesity status and exercise intensity on each sleep parameter using delta scores of the night before and night after each condition. Data are reported as mean ± SD.

RESULTS: NW slept an average of 7.8 ± 1.35 hrs, and OB slept an average of 7.15 ± 1.4 hrs; sleep duration was not significantly different in any group or condition (p = 0.51-0.99). Compared with CON, MOD was associated with a lower SE (-2.8 ± 5.3% vs + 3.4 ± 6.2%, p < 0.01) and higher SOL (+5.1 ± 12.2 vs -9.3 ± 20.4 minutes, p < 0.05). Sleep parameters were not different between HIGH and CON or HIGH and MOD (all;p > 0.05). Regardless of condition, SE was higher in the OB group compared with NW (+2.6 ± 6% vs -1.4 ± 5.1 %, p = 0.01).

CONCLUSION: SE and SOL may be affected by moderate intensity exercise. In addition, obesity status may impact the quality of sleep.

Background
Many people with MS do not meet the recommended exercise regime to elicit health benefits. This study aimed to determine the feasibility, safety, acceptability, and appropriateness of an exercise intervention delivered online to persons with MS that meets current exercise recommendations and behaviour change principles.

Methods
Seventy-two participants (age: 43.3 ± 13.3 years) with mild to moderate MS were stratified according to previous exercise behaviour and block-randomised into one of three groups: Control (CON; n = 24), General Exercise (GE; n = 24) who at screening did not meet current exercise recommendations, and Advanced Exercise, (AE; n = 24) who at screening met the current exercise recommendations. GE and AE groups received a four-month online-supervised, behaviour change theory-based exercise program and were assessed at baseline, four-months, five-months, and eleven-months for physical activity participation. The feasibility of process, resources, management, and scientific outcomes was assessed.

Results
Of 198 potential participants, 143 met the eligibility criteria (72 %), and 72 were randomised. Fifty-three participants completed the intervention (74 % immediate retention), and 44 were retained at the six-month follow-up (61 %). Personnel time was 369 h, and total per-participant cost was Au$1036.20. Adherence rate to ≥70 % of exercise sessions was 73 % (GE) and 38 % (AE). The GE group observed a small magnitude of improvement in physical activity (d = −0.23).

Conclusions
An online exercise program embedded with behaviour interventions for either GE or AE appears feasible, acceptable, appropriate and safe and may show long-term efficacy in increased exercise behaviours for persons with mild to moderate MS.

Trial registration: ANZCRT number ACTRN12619000228189p.

We examined the sweat characteristics and fluid balance of elite female field hockey players during two heat training camps. Fourteen elite female field hockey players from the Australian national squad participated in two heat training camps held ∼6 months apart, following winter- (Camp 1) and summer-based training (Camp 2). Daily waking body mass (BM) and urine specific gravity (USG) were collected, along with several markers of sweat and fluid balance across two matches per camp. There was a 19% mean reduction in estimated whole-body sweat sodium concentration from Camp 1 (45.8 ± 6.5 mmol/L) to Camp 2 (37.0 ± 5.0 mmol/L; p < .001). Waking urine specific gravity ≥ 1.020 was observed in 31% of samples, with no significant differences in mean urine specific gravity or BM between camps (p > .05), but with substantial interindividual variation. Intramatch sweat rates were high (1.2–1.8 L/hr), with greater BM losses in Camp 1 (p = .030), resulting in fewer players losing ≥2% BM in Camp 2 (0%–8%), as compared with Camp 1 (36%–43%; p = .017). Our field data suggest that elite female field hockey players experience substantial sweat losses during competition in the heat regardless of the season. In agreement with previous findings, we observed substantial interindividual variation in sweat and hydration indices, supporting the use of individualized athlete hydration strategies.

There is a marked inflammatory and hypermetabolic response following a burn injury. The interlinked responses are more pronounced than for other forms of trauma and can persist for >= 3 years post-injury in burned patients. After a burn, patients have an increased risk of diseases of ageing including cancer, diabetes and cardiovascular disease, highlighting the need for effective long-term strategies to ameliorate the stress response post-burn. Current therapeutic strategies for post-burn recovery include removal of damaged tissue with surgical excision and wound repair, nutritional supplementation and rehabilitative exercise. These strategies aim to minimize the hypermetabolic and inflammatory responses, as well as reducing the loss of lean body mass. This review briefly summarises the inflammatory and hypermetabolic responses and provides an update on the current therapeutic strategies for burned patients. The review examines the persistent nutritional challenge of ensuring sufficient energy intake of each macronutrient to fuel the hypermetabolic and counteract the catabolic response of burn injury, whilst reducing periods of hyperglycaemia and hypertriglyceridemia. Patients require individualized treatment options tailored to unique systemic responses following a burn, facilitated by a precision medicine approach to improve clinical and physiological outcomes in burned patients. Thus, this review discusses the utility of metabolic flexibility assessment to aid clinical decision making and prescription relating to nutritional supplementation and rehabilitative exercise in the burned patient.

Background Major burn patients have been shown to exhibit a hyper-metabolic state of activity which can persist for up to two years after burn. The relationship between total body surface area (TBSA) and resting metabolic rate (RMR) has been investigated in larger burns (≥20% TBSA), however not in non-severe burns (≤15% TBSA). The primary aim of this observational study was to examine the association between the acute effects of burns <15% TBSA with RMR in patients using indirect calorimetry, as well as any potential covariates. The secondary aim was to determine 24-h energy balance. Methods The study included data from 39 participants (82% male), all admitted to the State Adult Burn Unit at Fiona Stanley Hospital. Each patient was recruited upon admission and RMR data was collected on day four (± one day) after burn. Results The pooled data bivariate correlation showed a significant relationship between RMR and TBSA (r = 0.435, p = 0.009). A stronger relationship was also found between RMR and TBSA in males (r = 0.634, p = 0.001). Patients recorded a caloric deficit of 116 kcal/day. Conclusion This study demonstrated that a moderately strong linear association exists between RMR and TBSA in males for burns of ≤15% TBSA. The energy balance data indicated that supplementation of calorific intake for non-severe burns suggests careful consideration.

Purpose: To examine the influence of temporal location of high-intensity interval training (HIIT) within a cycling session on the time spent ≥90% of maximal oxygen consumption and physiological and perceptual responses. Methods: In a randomized, crossover design, 16 trained cyclists (male, n = 13 and female, n = 3) completed three 90-minute cycling sessions with HIIT placed at the beginning, middle, or end of the session (13, 36, and 69 min, respectively). Intervals consisted of three 3-minute efforts at 90% of the power output associated with maximal oxygen consumption interspersed with 3 minutes of recovery. Oxygen consumption, minute ventilation, respiratory rate, and heart rate were recorded continuously during work intervals. Rate of perceived exertion was recorded at the end of work intervals, and sessional rate of perceived exertion was collected 20 minutes after session completion. Results: No differences were observed for mean oxygen consumption (P = .479) or time spent ≥90% maximal oxygen consumption (P = .753) between condition. The mean rate of perceived exertion of all intervals were greater in the Middle (P < .01, effect size = 0.83) and End (P < .05, effect size = 0.75) compared with Beginning conditions. Mean minute ventilation was greater in the End compared with Beginning condition (P = .015, effect size = 0.63). However, no differences in mean respiratory rate were observed between conditions (P = .297). Conclusions: Temporal location of HIIT has no impact on oxygen consumption or cardiovascular stress within a cycling session. However, HIIT performed later in the session resulted in higher ventilation, which may indicate the need for greater anaerobic contribution to these intervals.

Undergoing general anaesthetic and complex surgery is associated with significant risk. Compounding this, reduced muscle mass is proven to be linked to increased post-operative complications and increased length of stay. Exercise focused prehabilitation research is emergent and increasingly supportive of preventive strategies to improve post-surgical outcomes. PURPOSE To investigate the role of a multi-site strength focussed exercise intervention in improving patient condition prior to surgery to enhance recovery METHODS 43 (26 male, 17 females; 68.3 ± 9.3 years) patients scheduled for surgery were randomly assigned to one of 3 groups; 1) prehabilitation [pre-surgery exercise] 2) prehabilitation + rehabilitation [pre and post-surgery exercise] or 3) usual care. The exercise program consisted of an aerobic component and 6 resistance exercises targeting the major muscle groups. Primary outcomes were length of stay (days) and post-operative complications. Secondary measures included; whole body resistance, muscular strength, aerobic fitness, physical function and quality of life. RESULTS There was no difference in length of stay between groups (prehab: 11.2±10.3; pre+rehab: 13.2±6.2; control: 13.9±12.4). Post-operative complications were not different between groups. A significant time*group interaction was observed for isometric grip strength (p=0.046). Patients reported significantly greater quality of recovery in the prehab+rehab exercise group compared to control (p=0.05). No differences were observed between groups for whole body resistance, aerobic fitness, measures of physical function or self-reported quality of life. CONCLUSION The preliminary results of this study indicate resistance-based exercise training prior to and following surgery results in greater muscular strength and enhanced quality of recovery compared to current standard care practices. These findings provide promising support for the development of future strength focused prehabilitation programs to improve patient function prior to surgery and reduce the surgery stress response, promoting an accelerated recovery. Supported by WA Cancer and Palliative Care Network NMHS20193593; Spinnaker Medical Research Foundation

Purpose: Androgen deprivation therapy (ADT) in men with prostate cancer (PCa) is associated with an array of adverse effects, including reduced bone mineral density (BMD) predisposing patients to increased fracture risk. Our purpose was to examine the effects of targeted exercise modes on BMD in men with PCa undergoing ADT. Methods: Between 2009 and 2012, 154 PCa patients 43-90 yr old on ADT were randomized to exercise targeting the musculoskeletal system (impact loading + resistance training [ImpRes], n = 57) supervised for 12 months, cardiovascular and muscular systems (aerobic + resistance training, n = 50) supervised for 6 months followed by a 6-month home-based program, or delayed aerobic exercise (DelAer, n = 47) received exercise information for 6 months followed by 6 months of supervised aerobic exercise (stationary cycling). End points were lumbar spine, hip and whole-body BMD measured by dual-energy x-ray absorptiometry with secondary end points of lean and fat mass, appendicular skeletal muscle mass, and neuromuscular strength. ANOVA was used to compare the exercise groups with DelAer at 6 and 12 months. Results: There was a between-group difference in BMD for ImpRes and DelAer at the spine (6 months, P = 0.039; 12 months, P = 0.035) and femoral neck (6 months, P = 0.050), with decline attenuated in ImpRes (~-1.0% vs ~-2.0%). Compared with DelAer, ImpRes increased appendicular skeletal muscle at 6 months (0.3 kg, P = 0.045) and improved muscle strength at 6 and 12 months (P <= 0.012) by 9%-34%. A limitation was inclusion of well-functioning patients. Conclusion: Combined impact loading and resistance exercise attenuates bone loss at the spine and enhances overall musculoskeletal function in PCa patients undergoing ADT.

Background: Physical exercise mitigates fatigue during androgen deprivation therapy (ADT); however, the effects of different exercise prescriptions are unknown. Objectives: To determine the long-term effects of different exercise modes on fatigue in prostate cancer patients undergoing ADT. Design, setting, and participants: Between 2009 and 2012, 163 prostate cancer patients aged 43-90 y on ADT were randomised to exercise targeting the musculoskeletal system (impact loading + resistance training; ILRT; n = 58), the cardiovascular and muscular systems (aerobic + resistance training; ART; n = 54), or to usual care/delayed exercise (DEL; n = 51) for 12 mo across university-affiliated exercise clinics in Australia. Intervention: Supervised ILRT for 12 mo, supervised ART for 6 mo followed by a 6-mo home program, and DEL received a printed booklet on exercise information for 6 mo followed by 6-mo stationary cycling exercise. Outcome measurements and statistical analysis: Fatigue was assessed using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 36 and vitality using the Short Form-36. Analysis of variance was used to compare outcomes for groups at 6 mo and 12 mo. Results and limitations: Fatigue was reduced (p =0.005) in ILRT at 6 mo and 12 mo (∼5 points), and in ART (p =0.005) and DEL (p =0.022) at 12 mo. Similarly, vitality increased for all groups (p ≤0.001) at 12 mo (∼4 points). Those with the highest levels of fatigue and lowest vitality improved the most with exercise (p trend <0.001). A limitation was inclusion of mostly well-functioning individuals. Conclusions: Different exercise modes have comparable effects on reducing fatigue and enhancing vitality during ADT. Patients with the highest levels of fatigue and lowest vitality had the greatest benefits. Patient summary: We compared the effects of different exercise modes on fatigue in men on androgen deprivation therapy. All exercise programs reduced fatigue and enhanced vitality. We conclude that undertaking some form of exercise will help reduce fatigue, especially in those who are the most fatigued. We compared the effects of different exercise modes on fatigue in men on androgen deprivation therapy. All exercise programs reduced fatigue and enhanced vitality. We conclude that undertaking some form of exercise will help reduce fatigue, especially in those who are the most fatigued.

INTRODUCTION: Prostate cancer is the most common cancer in men and patients treated with androgen deprivation therapy (ADT) experience unfavourbale changes in body composition and associated metabolic complications, which can increase the risk of cardiovascular disease. We examined the effect of a 6-month program of aerobic and resistance exercise aimed at improving body composition and cardiorespiratory health in this population. METHODS: Ninety-seven men (43-90 years) with localized prostate cancer receiving ADT were randomized to either exercise (EX, n=50) or usual care (CON, n=47). Supervised exercise was undertaken twice-weekly at moderate-to-high intensity. Measures of cardiorespiratory capacity (V[Combining Dot Above]O2max), resting metabolic rate, central blood pressure, hemodynamic variables, blood markers, and body composition were assessed. RESULTS: There was a significant group by time interaction present for V[Combining Dot Above]O2max (p=0.033) with a treatment effect for EX of 0.11 (95% CI, 0.04-0.19) L.min [relative to body mass 1.3 (95% CI, 0.3-2.3) ml.kg.min], and fat oxidation (p=0.037) of 12.0 (95% CI, 2.3-21.7) mg.min. Similarly, there was a significant improvement in glucose (p<0.001) for EX of -0.5 (95% CI, -0.8 to -0.3) mmol/L, with no change in PSA or testosterone as a result of exercise. Body composition was enhanced for EX with adjusted mean differences in lean mass (p=0.015) of 0.8 (95% CI, 0.3-1.3) kg, total fat mass (p=0.020) of -1.1 (95% CI, -1.8 to -0.5) kg, and trunk fat mass (p<0.001) of -1.0 (95% CI, -1.4 to -0.6) kg. CONCLUSION: A 6-month combined aerobic and resistance exercise program has a significant favorable impact on cardiorespiratory capacity, resting fat oxidation, glucose and body composition despite the adverse effects of hormone suppression. Combined aerobic and resistance training should be considered a key adjuvant component in men undergoing ADT for the treatment of prostate cancer.