Total body recumbent stepping vs treadmill walking in supervised exercise therapy: A pilot study

Background: Treadmill walking is the most commonly recommended exercise modality in supervised exercise therapy (SET) for peripheral artery disease (PAD); however, other modalities may be equally effective and more tolerable for patients. The primary aim of this single-blind, randomized pilot study was to compare the feasibility, safety, and preliminary efficacy of a treadmill walking (TM) versus a total body recumbent stepping (TBRS) exercise program for treatment of PAD. Methods: Participants ( n = 19) enrolled in a 12-week SET program and were randomized to either a TM ( n = 9) or TBRS ( n = 10) exercise group that followed current SET exercise guidelines. Feasibility, safety, and efficacy outcomes were assessed. Results: SET attendance was 86% and 71%, respectively, for TBRS and TM groups ( p = 0.07). Session exercise dose (metabolic equivalents of task [MET] minutes) (mean [SD]) for TM was 117.6 [27.4] compared to 144.7 [28.7] in the TBRS group ( p = 0.08). Study-related adverse events were nine in 236 training hours and three in 180 training hours for the TBRS and TM groups, respectively. There were no significant differences between groups for improvement in 6-minute walk distance (mean [SD]) (TM: 133.2 ft [53.5] vs TBRS: 154.8 ft [49.8]; p = 0.77) after adjusting for baseline 6-minute walk distance. Conclusion: This is the first randomized study comparing TBRS to TM exercise in SET using current SET guidelines. This pilot study showed that TBRS is a feasible and safe exercise modality in SET. This study provides preliminary efficacy of the use of TBRS exercise in SET programs following current guidelines. Larger studies should be conducted to confirm these findings.

Upper- vs. Lower-Body Exercise Performance in Female and Male Cross-Country Skiers

Purpose: To investigate the interaction between exercise modality (i.e., upper- and lower-body exercise) and sex in physiological responses and power output (PO) across the entire intensity spectrum (i.e., from low to maximal intensity).Methods: Ten male and 10 female cross-country (XC) skiers performed a stepwise incremental test to exhaustion consisting of 5 min stages with increasing workload employing upper-body poling (UP) and running (RUN) on two separate days. Mixed measures ANOVA were performed to investigate the interactions between exercise modalities (i.e., UP and RUN) and sex in physiological responses and PO across the entire exercise intensity spectrum.Results: The difference between UP and RUN (ΔUP−RUN), was not different in the female compared with the male XC skiers for peak oxygen uptake (18 ± 6 vs. 18 ± 6 mL·kg−1·min−1, p = 0.843) and peak PO (84 ± 18 vs. 91 ± 22 W, p = 0.207). At most given blood lactate and rating of perceived exertion values, ΔUP−RUN was larger in the male compared with the female skiers for oxygen uptake and PO, but these differences disappeared when the responses were expressed as % of the modality-specific peak.Conclusion: Modality-differences (i.e., ΔUP−RUN) in peak physiological responses and PO did not differ between the female and male XC skiers. This indicates that increased focus on upper-body strength and endurance training in female skiers in recent years may have closed the gap between upper- and lower-body endurance capacity compared with male XC skiers. In addition, no sex-related considerations need to be made when using relative physiological responses for intensity regulation within a specific exercise modality.

Acute Aerobic Exercise Induces Short-Term Reductions in Ambulatory Blood Pressure in Patients With Hypertension: A Systematic Review and Meta-Analysis

Chronic exercise reduces clinic and ambulatory blood pressure (BP), but the short-term effects of an acute exercise bout on ambulatory BP have not been studied widely. We reviewed the literature regarding the short-term effects of acute exercise on ambulatory BP in patients with hypertension and considered moderating factors (medication status and exercise modality/intensity) on ambulatory BP outcomes. A systematic search was conducted (PubMed, Cochrane Library, and Scopus; since inception to January 1, 2021) for crossover randomized controlled trials assessing the short-term effects of acute exercise on ambulatory BP in hypertensive individuals versus nonexercise control conditions. A meta-analysis was conducted for 24-hour, daytime, and nighttime systolic and diastolic BP. Subanalyses also were performed attending to medication status and exercise modality/intensity. Thirty-seven studies (N=822) met the inclusion criteria. A single acute exercise bout reduces 24-hour (systolic BP, −1.6 mm Hg [95% CI, −2.4 to −0.8] for all exercise modalities combined; diastolic BP, −1.0 mm Hg [95% CI, −1.5 to −0.5]), daytime (−3.1 mm Hg [95% CI, −4.1 to −2.2]; -2.0 mm Hg [95% CI, −2.8 to −1.2]), and nighttime ambulatory BP (−1.8 mm Hg [95% CI, −3.0 to −0.6]; −1.5 mm Hg [95% CI, −2.3 to −0.6]), respectively. The magnitude of the effect appears similar in medicated and nonmedicated patients. In separate analyses for exercise modalities, aerobic exercises reduce all ambulatory BP measures ( P <0.001) yet with no significant effects for resistance or combined (aerobic and resistance) exercise for any ambulatory BP measure. Vigorous aerobic exercise tends to produce the largest effects. A single bout of acute aerobic exercise, reduces ambulatory BP over 24 hours in medicated and nonmedicated hypertensive adults.

Acute Fetal Response to High-Intensity Interval Training in the Second and Third Trimesters of Pregnancy

The majority of women do not meet the recommended levels of exercise during their pregnancies, frequently due to a lack of time. High-intensity interval training offers a potential solution, providing an effective, time-efficient exercise modality. This exercise modality has not been studied in pregnancy therefore, the objective of this study was to evaluate fetal response to a high-intensity interval training resistance circuit in the late second and early third trimesters of pregnancy. Fourteen active, healthy women with uncomplicated, singleton pregnancies participated in a high-intensity interval training resistance circuit between 28+0/7 and 32+0/7 weeks. A Borg rating of perceived exertion of 15-17/20 and an estimated heart rate of 80-90% of maternal heart-rate maximum was targeted. Fetal well-being was evaluated continuously with fetal heart-rate tracings and umbilical artery Doppler velocimetry conducted pre-and post-exercise. Fetal heart rate tracings were normal throughout the exercise circuit. Post-exercise, umbilical artery end-diastolic flow was normal and significant decreases were observed in the mean systolic/diastolic ratios, pulsatility indexes and resistance indexes. Therefore, in a small cohort of active pregnant women, a high-intensity interval training resistance circuit in the late second and early third trimesters of pregnancy appears to be a safe exercise modality with no acute, adverse fetal effects but further study is required. Novelty: • High-Intensity Interval Training, at an intensity in excess of current recommendations, does not appear to be associated with any adverse fetal effects in previously active pregnant women. • High-Intensity Interval Training is an enjoyable and effective exercise modality in previously active pregnant women.

Different Endurance Exercise Modalities, Different Affective Response: A Within-Subject Study

Affect experienced during an exercise session is supposed to predict future exercise behavior. However, empirical evidence reveals high variability in affective response to different exercise modalities. Thus, the purpose of the present study was to compare acute affective response and its variation during three different endurance exercise modalities: (a) moderate-intensity continuous exercise (MICE), (b) vigorous-intensity continuous exercise (VICE), and (c) high-intensity interval exercise (HIIE). Using the dual-mode theory as a theoretical framework, cognitive and interoceptive factors were considered as potential predictors of in-task affective response. In a within-subject design, 40 insufficiently active healthy participants (aged from 20 to 40 years) attended three sessions per exercise modality on a cycle ergometer. Affective valence (measured by the Feeling Scale), two cognitive factors (perceived competence and awareness of interoceptive cues), and one interoceptive factor (heart rate) were assessed before, during, and after each exercise session. Mixed models with three levels (subject, exercise session, and time point) revealed more positive affective valence during MICE compared with VICE (p &lt; 0.001) and HIIE (p &lt; 0.01), while there was no significant difference between the latter two. Levene's test results showed the highest variability of in-task affective valence during VICE (ps &lt; 0.01). Regarding the course across the session, MICE was associated with a constant slight increase in affective valence from pre- to post-exercise (p &lt; 0.05), whereas VICE and HIIE caused a decline in pleasure, followed by an affective rebound immediately after exercise termination (ps &lt; 0.01). The highest importance of cognitive and interoceptive factors for in-task affective valence was observed in VICE (ps &lt; 0.05). The current findings provide support for the tenets of the dual-mode theory, however, indicating that there may be differences in the affect-intensity relationship between continuous and interval exercise. In conclusion, the study results concerning previously insufficiently active individuals extend the knowledge of how exercise can positively shape affective well-being depending on exercise modality and psychophysiological influences. This knowledge enables public health practitioners to design more individualized activity recommendations, thereby improving the subjective experience of exercise.

Physiological and Perceptual Responses to Self-Selected Exercise Pace on A Track Versus Treadmill

Objective: To investigate differences between a controlled and non-controlled exercise modality when walking and running at self-selected pace. Methods: Male and female participants (N=30, 21.07±0.88 years of age) engaged in four sessions testing V̇O2max, one-mile walk and run on an indoor track, and one-mile walk and run on a laboratory treadmill. With a significance level set at p<0.05, the following results were found. Results: Walking and running heart rate and rating of perceived exertion were significantly higher on the treadmill compared to the track (p<0.05). However, energy expenditure showed no significant difference between exercise modality (p=0.611). Treadmill exercise resulted in higher V̇O2 values for males during both walk and run pace (p=0.041 and p=0.002, respectively). Conclusions: Exercise programming is an individualized process which should consider differences among modalities, settings, and affective responses. We observed an increased perceived effort during treadmill exercise while maintaining similar energy expenditure. The provisions of autonomy and individuality may decrease perceived effort while maintaining energy expenditure, thus providing positive affective responses promoting adherence. With these differences between modalities in mind, exercise professionals should consider appropriate adjustments to intensity when targeting specific adaptations. These adjustments may also influence adherence to a prescribed program.

Maximal Fat Oxidation: Comparison between Treadmill, Elliptical and Rowing Exercises

Fat oxidation during exercise is associated with cardio-metabolic benefits, but the extent of which whole-body exercise modality elicits the greatest fat oxidation remains unclear. We investigated the effects of treadmill, elliptical and rowing exercise on fat oxidation in healthy individuals. Nine healthy males participated in three, peak oxygen consumption tests, on a treadmill, elliptical and rowing ergometer. Indirect calorimetry was used to assess maximal oxygen consumption (V̇O2peak), maximal fat oxidation (MFO) rates, and the exercise intensity MFO occurred (Fatmax). Mixed venous blood was collected to assess lactate and blood gases concentrations. While V̇O2peak was similar between exercise modalities, MFO rates were higher on the treadmill (mean ± SD; 0.61 ± 0.06 g·min-1) compared to both the elliptical (0.41 ± 0.08 g·min-1, p = 0.022) and the rower (0.40 ± 0.08 g·min-1, p = 0.017). Fatmax values were also significantly higher on the treadmill (56.0 ± 6.2 %V̇O2peak) compared to both the elliptical (36.8 ± 5.4 %V̇O2peak, p = 0.049) and rower (31.6 ± 5.0 %V̇O2peak, p = 0.021). Post-exercise blood lactate concentrations were also significantly lower following treadmill exercise (p = 0.021). Exercising on a treadmill maximizes fat oxidation to a greater extent than elliptical and rowing exercises, and remains an important exercise modality to improve fat oxidation, and consequently, cardio-metabolic health.