High-Intensity Physical Exercise in a Glioblastoma Patient under Multimodal Treatment Introduction Glioblastoma multiforme (GBM) carries a strongly unfavorable prognosis despite intensive multidisciplinary therapy. Physical exercise is rarely offered to patients for fear of adverse events such as falls, epileptic seizures, or bleeding, despite little supporting evidence. Here, we report a study of high-level and long-term exercise in a GBM patient. Methods A 33-yr-old male, diagnosed with a large cystic GBM, was included in our institution’s Personal Training Program after initial tumor resection and adjuvant radiochemotherapy. The program was designed to facilitate individual long-term high-intensity exercise. Supervised by a certified personal trainer, it consisted of at least four weekly training sessions and intermittent performance diagnostics. An activity tracker quantified training intensity. Results In this setting, the patient exercised at high intensity without adverse events for 87 continuous weeks (21 months). He averaged 43.7 metabolic equivalent of task hours per week (MET·h·wk−1), well above the 75th percentile of healthy males the same age, while undergoing multiple surgeries, chemotherapy, and radiation therapy regimens. The patient completed two marathons averaging less than 5 min·km−1 both times, despite tumor progression. Performance diagnostics indicated a gain of fitness even during continuous GBM treatment. Due to multiple intraventricular lesions and increasing intracranial pressure, training was stopped 6 wk before the patient passed away 2 yr after initial diagnosis. Conclusions This study demonstrates that high-intensity, long-term physical training regimens are feasible in GBM patients during full multidisciplinary therapy. In this patient, the exercise was pursued without adverse events and led to a gain of fitness despite tumor progression and intensive multiple therapies. We conclude that, in GBM patients, exercise regimens require further study instead of general discouragement.

Exercise Intensity Matters in Chronic Nonspecific Low Back Pain Rehabilitation Introduction Exercise therapy (ET) is advocated as a treatment for chronic nonspecific low back pain (CNSLBP). However, therapy effect sizes remain low. In other chronic disorders, training at higher intensity has resulted in greater improvements on both general health related and disease specific outcomes compared to lower-intensity ET. Possibly, high-intensity training also improves effect sizes in CNSLBP. Objective To compare the effects of a high-intensity ET program with a similar moderate-intensity ET program on disability, pain, function, exercise capacity, and abdominal/back muscle strength in persons with CNSLBP. Methods In a randomized controlled trial, persons with CNSLBP performed a 12-wk ET program (24 sessions, 1.5 h per session, twice per week) at high-intensity training (HIT) or moderate-intensity training (MIT). Questionnaires to assess disability (Modified Oswestry Index [MODI]), pain intensity (Numeric Pain Rating Scale), and function (Patient Specific Functioning Scale), a cardiopulmonary exercise test to assess exercise capacity (V˙O2max, cycling time), and a maximum isometric muscle strength test to assess abdominal/back muscle strength (maximum muscle torque) were administered at baseline and after the training program. Results Thirty-eight participants (HIT: n = 19, MIT: n = 19) were included (mean age, 44.1 yr, SD = 9.8, 12 males). Groups did not differ at baseline. Between group differences (P < 0.01) in favor of HIT were found for MODI, V˙O2max, and cycling time. Within group improvements (P < 0.01) were found in both groups on MODI (HIT:−64%, MIT:−33%), Numeric Pain Rating Scale (HIT, −56%; MIT, −39%), Patient-Specific Functioning Scale (HIT:+37%, MIT:+39%), V˙O2max (HIT:+14, MIT:+4%), cycling time (HIT:+18%, MIT:+13%), and back muscle strength (HIT:+10%, MIT:+14%). Conclusions High-intensity training proved to be a feasible, well tolerated, and effective therapy modality in CNSLBP. Moreover, it shows greater improvements on disability and exercise capacity than a similar ET performed at moderate intensity.

Feasibility of Two High-Intensity Interval Training Protocols in Cancer Survivors Purpose High-intensity interval training (HIIT) is a time-efficient and promising tool for enhancing physical fitness. However, there is lack of research concerning safety and feasibility of HIIT in cancer survivors. Therefore, two different HIIT protocols were investigated in terms of safety, feasibility, and acute exercise responses. Methods Forty cancer survivors (20 breast and 20 prostate cancer survivors, 62.9 ± 9.2 yr, BMI 27.4 ± 3.9 kg·m−2, 6 to 52 wk after the end of primary therapy) completed a maximal cardiopulmonary exercise test and two HIIT protocols on a cycle ergometer: 10 × 1 min at peak power output (10 × 1) and 4 × 4 min at 85%–95% peak HR (4 × 4). Safety (adverse events), acute physiological responses (HR, blood lactate concentration) and acute psychological responses (RPE, enjoyment) were recorded. Results No major but three minor adverse events occurred. Ninety-five percent of participants were able to complete each HIIT protocol. Estimated energy expenditure (159 ± 15 vs 223 ± 45 kcal, P < 0.001), HR (128 ± 20 vs 139 ± 18 bpm; P < 0.001), blood lactate concentration (5.4 ± 1.0 vs 5.9 ± 1.9 mmol·L−1; P = 0.035), and RPE legs/breathing (13.8 ± 2.0/13.1 ± 2.0 vs 14.6 ± 2.1/14.3 ± 2.0; P = 0.038/0.003) were significantly higher in the 4 × 4. Enjoyment did not differ between protocols (P = 0.301). Conclusions The two HIIT protocols as single sessions appear safe and in the vast majority of breast and prostate cancer survivors after the end of primary therapy also feasible and enjoyable. The 4 × 4 elicited higher energy expenditure and higher cardio-circulatory and metabolic strain and might therefore be preferred if a high training stimulus is intended.

Medical Tent Utilization at 10-km Road Races: Injury, Illness, and Influencing Factors Purpose To increase awareness of the need for coordinated medical care at 10-km races and to help direct future medical planning for these events. Methods We related medical encounter data from nineteen 10-km road races to runner, race, and environmental characteristics. We quantified the most commonly used resources and described the disposition of runners in these encounters. Results Across the 19 races and 90,265 finishers, there were 562 medical events for a cumulative incidence of 6.2 events per 1000 finishers (95% confidence interval, 5.7–6.8). Race size was associated with an increased incidence of medical events. Overall, the most common diagnosis was heat-related illness (1.6 per 1000 finishers), followed by musculoskeletal complaints (1.3 per 1000 finishers) and fluid–electrolyte imbalances (1.2 per 1000 finishers). For all diagnoses, runners with finishing times in the first performance quintile and in the fifth performance quintile had greater representation in the medical tent than mid-pack runners. Most runners were treated with supportive care, basic first aid, and oral rehydration. Ninety-four runners (1.0 per 1000 finishers) required ice water immersion for exertional heat stroke. There were low rates of hospital transport (0.2 per 1000 finishers), and no fatalities. Conclusions In 10-km road races, injury rates are low compared with longer races in similar weather conditions. Common medical issues can be managed with basic resources in the on-site medical tent. Green flag start race conditions may not predict race safety with regard to exertional heat stroke risk. There were no deaths in nearly 100,000 finishers.

Cytokine and Sclerostin Response to High-Intensity Interval Running versus Cycling Purpose This study examined whether the exercise-induced changes in inflammatory cytokines differ between impact and no-impact high-intensity interval exercise, and whether they are associated with postexercise changes in sclerostin. Methods Thirty-eight females (n = 19, 22.6 ± 2.7 yr) and males (n = 19, 22.3 ± 2.4 yr) performed two high-intensity interval exercise trials in random order (crossover design): running on a treadmill and cycling on a cycle ergometer. Trials consisted of eight repetitions of 1 min running or cycling at ≥90% maximal heart rate, separated by 1 min passive recovery intervals. Blood was collected preexercise and 5 min, 1 h, 24 h, and 48 h postexercise, and it was analyzed for serum levels of interleukins (IL-1β, IL-6, and IL-10), tumor necrosis factor alpha (TNF-α), and sclerostin. Results Inflammatory cytokines significantly increased over time in both sexes with some differences between trials. Specifically, IL-1β significantly increased from pre- to 5 min after both trials (23%, P < 0.05), IL-6 increased 1 h after both trials (39%, P < 0.05), IL-10 was elevated 5 min after running (20%, P < 0.05) and 1 h after both running and cycling (41% and 64%, respectively, P < 0.05), and TNF-α increased 5 min after running (10%, P < 0.05). Sclerostin increased 5 min after both trials, with a greater increase in males than that in females (62 vs 32 pg·mL−1 in running, P = 0.018; 63 vs 30 pg·mL−1 in cycling, P = 0.004). In addition, sclerostin was significantly correlated with the corresponding changes in inflammatory cytokines, and 34% of the variance in its postexercise gain score (Δ) was explained by sex and the corresponding gain scores in TNF-α, which was the strongest predictor. Conclusion A single bout of either impact or no-impact high-intensity exercise induces changes in inflammatory cytokines, which are associated with the postexercise increase in sclerostin.

Impact of Exercise and Activity on Weight Regain and Musculoskeletal Health Post-Ovariectomy The purpose of this study was to determine whether obesity and/or exercise training alters weight regain and musculoskeletal health after ovariectomy (OVX). Female rats were fed high-fat diet (HFD) to reveal obesity-prone (OP) and obesity-resistant (OR) phenotypes. The OP and OR exercising (EX) and sedentary (SED) rats were calorically restricted to lose 15% of body weight using medium-fat diet. Rats were then maintained in energy balance for 8 wk before OVX. After OVX and a brief calorically limited phase, rats were allowed to eat ad libitum until body weight plateaued. Starting at weight loss, EX ran 1 h·d−1, 6 d·wk−1, 15 m·min−1. Energy intake, spontaneous physical activity (SPA), and total energy expenditure were evaluated at the end of weight maintenance pre-OVX, and at three time points post-OVX: before weight regain, during early regain, and after regain. Data are presented as mean ± SE. Exercise attenuated weight regain after OVX in OP only (OP-EX, 123 ± 10 g; OP-SED, 165 ± 12 g; OR-EX, 121 ± 6 g; OR-SED, 116 ± 6 g), which was primarily an attenuation of fat gain. The early post-OVX increase in energy intake explained much of the weight regain, and was similar across groups. Exercising improved bone strength, as did maintaining SPA. Group differences in muscle mitochondrial respiration were not significant. The large decrease in SPA due to OVX was persistent, but early weight regain was dependent on decreased SPA. In conclusion, leanness and exercise do not necessarily protect from OVX-induced weight gain. Exercise prevented weight gain in obese rats, but loss of SPA was the greatest contributor to post-OVX weight gain. Thus, understanding the mechanisms resulting in reduction in SPA after ovarian hormone loss is critical in the prevention of menopause-associated metabolic dysfunction.

Area-level Socioeconomic Environment and Cardiorespiratory Fitness in Youth Introduction Cardiorespiratory fitness is one of the most important markers of cardiometabolic health and is a strong predictor of cardiovascular disease and all-cause mortality across the lifespan. However, little is known regarding the relationship of area-level socioeconomic environment on cardiorespiratory fitness during childhood and adolescence. Purpose To examine the relationship between area-level socioeconomic environment and cardiorespiratory fitness in a diverse sample of school-age youth; and to determine the extent to which grade level, sex, race/ethnicity, and student poverty status moderate this relationship. Methods South Carolina FitnessGram data for school year 2015 to 2016 were obtained for 44,078 youth. Cardiorespiratory fitness was determined using Progressive Aerobic Cardiovascular Endurance Run or 1-mile run/walk test. Area-level socioeconomic environment was expressed as a composite index score at the census tract level using data from the American Community Survey. Multilevel logistic regression analyses were conducted, controlling for individual-level characteristics and nesting within schools and districts. Interaction terms were then introduced to the model to examine their effect of multiple sociodemographic moderators. Results Approximately half of the sample had inadequate cardiorespiratory fitness for health. The odds of achieving the Healthy Fitness Zone for cardiorespiratory fitness decreased by approximately 25% to 34% with increasing deprivation of the area-level socioeconomic environment, after controlling for covariates. The association between area-level socioeconomic environment and cardiorespiratory fitness also varied significantly by sex, grade level, and race/ethnicity subgroups. Conclusions Cardiorespiratory fitness was positively associated with area-level socioeconomic environment; however, the relationship varied by demographic characteristics. These results highlight the importance of examining the influence of area-level socioeconomic environment on health across the life span. Additional research is needed to explore how area-level socioeconomic environment may impact evidence-based efforts to improve youth cardiorespiratory fitness levels.

Correlates of Children’s Physical Activity: A Canadian Multisite Study Purpose To inform future physical activity (PA) interventions among children, we investigated the correlates of PA among 8- to 12-yr-olds in three regions of Canada: Ottawa, Trois-Rivières, and Vancouver. Methods We recruited 1699 children (55.0% girls) in 37 schools located in urban, suburban, and rural areas that differed in socioeconomic status. Children wore a sealed SC-StepRx pedometer capable of measuring moderate- to vigorous-intensity physical activity (MVPA) for seven consecutive days. Children and one of their parents/guardians completed a questionnaire that captured multiple potential PA correlates. Publicly available data on weather and neighborhood walkability were obtained. Multiply-imputed gender-stratified linear mixed models were used to examine the correlates of daily step counts and MVPA while controlling for age, site, type of urbanization, and area-level socioeconomic status. Results Each additional hour spent outdoors was associated with higher PA in boys (+769 steps per day; +3.7 min MVPA per day) and girls (+596 steps per day; +3.5 min·d−1). Boys’ PA declined with age (−500 steps per day; −3.7 min·d−1). Boys were less active if they had a long-standing injury/illness (−1862 steps per day; −3.7 min·d−1) or their parents reported driving to work (−835 steps per day; −4.4 min·d−1), were worried about traffic (−982 steps per day; −6.4 min·d−1), or about other people in their neighborhood (−1250 steps per day). Girls speaking neither English nor French at home were less active (−620 steps per day; −3.7 min·d−1). In girls, each degree Celsius increase in morning temperature was associated with 77 additional steps per day, and each kilometer increase in active school travel distance was associated with 0.5 more MVPA minutes per day. Conclusion Consistent with previous studies, our results suggest that PA interventions should aim to increase outdoor time. The observed gender differences in PA correlates suggest the need for a gender-sensitized approach to PA promotion.

Estimated Cardiorespiratory Fitness and Risk of Atrial Fibrillation: The Nord-Trøndelag Health Study Purpose To investigate the association between estimated cardiorespiratory fitness (eCRF) and risk of atrial fibrillation (AF), and examine how long-term changes in eCRF affects the AF risk. Methods This prospective cohort study includes data of 39,844 men and women from the HUNT2 (August 15, 1995 to June 18, 1997) and the HUNT3 study (October 3, 2006 to June 25, 2008). The follow-up period was from HUNT3 until AF diagnosis or November 30, 2015. The AF diagnoses were retrieved from hospital registers and validated by medical doctors. A nonexercise test based on age, waist circumference, resting heart rate and self-reported physical activity was used to estimate CRF. Cox regression was performed to assess the association between eCRF and AF. Results The mean age was 50.6 ± 14.6 yr for men and 50.2 ± 15.2 yr for women. Mean follow-up time was 8.1 yr. One thousand fifty-seven cases of AF were documented. For men, the highest risk reduction of AF was 31% in the fourth quintile of eCRF when compared with the first quintile (hazard ratio [HR], 0.69; 95% confidence interval [CI], 0.53–0.89). For women, the highest risk reduction was 47% in the fifth quintile when compared with the first quintile (HR, 0.53; 95% CI, 0.38–0.74). One metabolic equivalent increase in eCRF over a 10-yr period was associated with 7% lower risk of AF (HR, 0.93; 95% CI, 0.86–1.00). Participants with improved eCRF had 44% lower AF risk compared with those with decreased eCRF (HR, 0.56; 95% CI, 0.36–0.87). Conclusions The eCRF was inversely associated with AF, and participants with improved eCRF over a 10-yr period had less risk of AF. These findings support the hypothesis that fitness may prevent AF.

Risk Estimates for Diabetes and Hypertension with Different Physical Activity Methods Purpose To estimate risks of incident type 2 diabetes (T2D) and stage 2 and greater hypertension associated with self-reported and accelerometer-determined moderate-vigorous physical activity (MVPA) separately and adjusted for each other. Methods The sample included 2291 black and white men and women, ages 38–50 yr, in the Coronary Artery Risk Development in Young Adults (CARDIA) fitness study, conducted during the year 20 core CARDIA examination. Accelerometer-determined (Actigraph, LLC. model 7164) MVPA (MVPA-Acc), assessed at year 20, was defined as minutes per day of counts ≥2020 min−1. Self-reported MVPA (MVPA-SR) was assessed at year 20 using the CARDIA Physical Activity History. Incident T2D was ascertained at years 25 and 30 from fasting glucose, 2 h glucose tolerance test, HbA1c, or diabetes medication; incident hypertension was ascertained at those same times from measured blood pressure or use of antihypertensive medications. Modified Poisson regression models estimated relative risk (RR) of incident (years 25 and 30) T2D or hypertension, associated with middle and high tertiles of year 20 MVPA-Acc alone, year 20 MVPA-SR alone, and both, adjusted for each other, relative to bottom tertile. Results In men, MVPA-Acc, but not MVPA-SR, was associated with a 37% to 67% decreased risk of incident T2D in a dose–response relation that persisted with adjustment for BMI, Similar associations were observed in women, although the risk reduction was similar in the second and third tertiles, relative to the bottom tertile. In both men and women, MVPA-Acc was marginally associated with reduced risk of incident stage 2 and greater hypertension, but only after adjustment for BMI, whereas MVPA-SR was not associated in either sex. Conclusions Accelerometer-determined MVPA may provide more consistent risk estimates for incident diabetes than self-reported MVPA.