Robinson Ramírez-Vélez

Aerobic exercise training during pregnancy reduces depressive symptoms in nulliparous women: a randomised trial

QUESTION Does supervised aerobic exercise during pregnancy reduce depressive symptoms in nulliparous women? DESIGN Randomised trial with concealed allocation, blinded assessors, and intention-to-treat analysis. PARTICIPANTS 80 nulliparous, pregnant women attending for prenatal care at one of three tertiary hospitals in Cali, Colombia. INTERVENTION The experimental group completed a 3-month supervised exercise program, commencing at 16 to 20 weeks of gestation. Each session included walking (10 min), aerobic exercise (30 min), stretching (10 min), and relaxation (10 min). The control group continued usual activities and performed no specific exercise. OUTCOME MEASURES The primary outcome was symptoms of depression assessed by the Center for Epidemiological Studies Depression Scale (CES-D) at baseline and immediately after the 3-month intervention. RESULTS 74 women completed the study. After the 3-month intervention, the experimental group reduced their depressive symptoms on the CES-D questionnaire by 4 points (95% CI 1 to 7) more than the control group. CONCLUSIONS A supervised 3-month program of primarily aerobic exercise during pregnancy reduces depressive symptoms. TRIAL REGISTRATION NCT00872365.

Effects of supervised exercise on cancer-related fatigue in breast cancer survivors: a systematic review and meta-analysis

BackgroundCancer-related fatigue (CRF) is the most common and distressing symptom in breast cancer survivors. Approximately 40% to 80% of cancer patients undergoing active treatment suffer from CRF. Exercise improves overall quality of life and CRF; however, the specific effects of the training modalities are not well understood.MethodsThis study aimed to determine the pooled effects of supervised exercise interventions on CRF in breast cancer survivors. We searched PubMed/MEDLINE, EMBASE, Scopus, CENTRAL and CINAHL databases between December 2013 and January 2014 without language restrictions. Risk of bias and methodological quality were evaluated using the PEDro score. Pooled effects were calculated with a random-effects model according to the DerSimonian and Laird method. Heterogeneity was evaluated with the I2 test.ResultsNine high-quality studies (n = 1156) were finally included. Supervised aerobic exercise was statistically more effective than conventional care in improving CRF among breast cancer survivors (SMD = −0.51, 95%CI −0.81 to −0.21), with high statistical heterogeneity (P = 0.001; I2 = 75%). Similar effects were found for resistance training on CRF (SMD = −0.41, 95%CI −0.76 to −0.05; P = 0.02; I2 = 64%). Meta-regression analysis revealed that exercise volume parameters are closely related with the effect estimates on CRF. Egger’s test suggested moderate evidence of publication bias (P = 0.04).ConclusionsSupervised exercise reduces CRF and must be implemented in breast cancer rehabilitation settings. High-volume exercises are safe and effective in improving CRF and overall quality of life in women with breast cancer. Further research is encouraged.Trial RegistrationCRD42014007223

The Impact of the FIFA 11+ Training Program on Injury Prevention in Football Players: A Systematic Review

The FIFA 11+ is a simple, and easy to implement, sports injury prevention program comprising a warm up of 10 conditioning exercises. The aim of this systematic review was to evaluate the impact of the FIFA 11+ on injury incidence, compliance and cost effectiveness when implemented among football players. MEDLINE, EMBASE and Scopus databases were searched using the search terms “FIFA 11+”, “football”, “soccer”, “injury prevention”, and “The 11”. The titles and abstracts were screened by two independent reviewers and the data were filtered by one reviewer using a standardized extraction form and thereafter checked by another one. The risk of bias and the methodological quality of the studies were evaluated through the PEDro score and Critical Appraisal Skills Programme (CASP). A total of 911 studies were identified, of which 12 met the inclusion criteria of the review. The FIFA 11+ has demonstrated how a simple exercise program completed as part of warm-up can decrease the incidence of injuries in amateur football players. In general, considerable reductions in the number of injured players, ranging between 30% and 70%, have been observed among the teams that implemented the FIFA 11+. In addition, players with high compliance to the FIFA 11+ program had an estimated risk reduction of all injuries by 35% and show significant improvements in components of neuromuscular and motor performance when participating in structured warm-up sessions at least 1.5 times/week. Most studies had high methodological quality and a low risk of bias. Given the large number of people who play football at amateur level and the detrimental impact of sports injuries on a personal and societal level, the FIFA 11+ can be considered as a fundamental tool to minimize the risks of participation in a sport with substantial health benefits.

Aerobic exercise during pregnancy improves health-related quality of life: a randomised trial

QUESTION Does supervised aerobic exercise during pregnancy improve health-related quality of life in nulliparous women? DESIGN Analysis of secondary outcomes of a randomised trial with concealed allocation, blinded assessors, and intention-to-treat analysis. PARTICIPANTS 64 nulliparous, pregnant women attending for prenatal care at one of three tertiary hospitals. INTERVENTION The experimental group completed a 3-month supervised exercise program, commencing at 16 to 20 weeks of gestation. Each session included walking (10 min), aerobic exercise (30 min), stretching (10 min), and relaxation (10 min). The control group continued usual activities and performed no specific exercise. OUTCOME MEASURES The primary outcome was health-related quality of life assessed by the Colombian version of the Medical Outcome Study Short-Form Health Survey at baseline and immediately after the 3-month intervention. RESULTS Fifty women completed the study. After the 3-month intervention, the experimental group had improved their health-related quality of life more than the control group in the physical component summary of the questionnaire by 6 points (95% CI 2 to 11), the physical function domain (7 points, 95% CI 0 to 14), the bodily pain domain (7 points, 95% CI 1 to 13) and the general health domain (5 points, 95% CI 1 to 10). CONCLUSIONS A supervised 3-month program of primarily aerobic exercise during pregnancy improves health-related quality of life. TRIAL REGISTRATION NCT00741312.

Supervised exercise reduces cancer-related fatigue: a systematic review

QUESTION Does supervised physical activity reduce cancer-related fatigue? DESIGN Systematic review with meta-analysis of randomised trials. PARTICIPANTS People diagnosed with any type of cancer, without restriction to a particular stage of diagnosis or treatment. INTERVENTION Supervised physical activity interventions (eg, aerobic, resistance and stretching exercise), defined as any planned or structured body movement causing an increase in energy expenditure, designed to maintain or enhance health-related outcomes, and performed with systematic frequency, intensity and duration. OUTCOME MEASURES The primary outcome measure was fatigue. Secondary outcomes were physical and functional wellbeing assessed using the Functional Assessment of Cancer Therapy Fatigue Scale, European Organisation for Research and Treatment of Cancer Quality of Life QUESTIONnaire, Piper Fatigue Scale, Schwartz Cancer Fatigue Scale and the Multidimensional Fatigue Inventory. Methodological quality, including risk of bias of the studies, was evaluated using the PEDro Scale. RESULTS Eleven studies involving 1530 participants were included in the review. The assessment of quality showed a mean score of 6.5 (SD 1.1), indicating a low overall risk of bias. The pooled effect on fatigue, calculated as a standardised mean difference (SMD) using a random-effects model, was -1.69 (95% CI -2.99 to -0.39). Beneficial reductions in fatigue were also found with combined aerobic and resistance training with supervision (SMD=-0.41, 95% CI -0.70 to -0.13) and with combined aerobic, resistance and stretching training with supervision (SMD=-0.67, 95% CI -1.17 to -0.17). CONCLUSION Supervised physical activity interventions reduce cancer-related fatigue. These findings suggest that combined aerobic and resistance exercise regimens with or without stretching should be included as part of rehabilitation programs for people who have been diagnosed with cancer. REGISTRATION PROSPERO CRD42013005803.

Effects of Supervised Multimodal Exercise Interventions on Cancer-Related Fatigue: Systematic Review and Meta-Analysis of Randomized Controlled Trials

Objective. Cancer-related fatigue (CRF) is the most common and devastating problem in cancer patients even after successful treatment. This study aimed to determine the effects of supervised multimodal exercise interventions on cancer-related fatigue through a systematic review and meta-analysis. Design. A systematic review was conducted to determine the effectiveness of multimodal exercise interventions on CRF. Databases of PubMed, CENTRAL, EMBASE, and OVID were searched between January and March 2014 to retrieve randomized controlled trials. Risk of bias was evaluated using the PEDro scale. Results. Nine studies (n = 772) were included in both systematic review and meta-analysis. Multimodal interventions including aerobic exercise, resistance training, and stretching improved CRF symptoms (SMD = −0.23; 95% CI: −0.37 to −0.09; P = 0.001). These effects were also significant in patients undergoing chemotherapy (P < 0.0001). Nonsignificant differences were found for resistance training interventions (P = 0.30). Slight evidence of publication bias was observed (P = 0.04). The studies had a low risk of bias (PEDro scale mean score of 6.4 (standard deviation (SD) ± 1.0)). Conclusion. Supervised multimodal exercise interventions including aerobic, resistance, and stretching exercises are effective in controlling CRF. These findings suggest that these exercise protocols should be included as a crucial part of the rehabilitation programs for cancer survivors and patients during anticancer treatments.

Reliability of Health-Related Physical Fitness Tests among Colombian Children and Adolescents : The FUPRECOL Study

Substantial evidence indicates that youth physical fitness levels are an important marker of lifestyle and cardio-metabolic health profiles and predict future risk of chronic diseases. The reliability physical fitness tests have not been explored in Latino-American youth population. This study’s aim was to examine the reliability of health-related physical fitness tests that were used in the Colombian health promotion “Fuprecol study”. Participants were 229 Colombian youth (boys n = 124 and girls n = 105) aged 9 to 17.9 years old. Five components of health-related physical fitness were measured: 1) morphological component: height, weight, body mass index (BMI), waist circumference, triceps skinfold, subscapular skinfold, and body fat (%) via impedance; 2) musculoskeletal component: handgrip and standing long jump test; 3) motor component: speed/agility test (4x10 m shuttle run); 4) flexibility component (hamstring and lumbar extensibility, sit-and-reach test); 5) cardiorespiratory component: 20-meter shuttle-run test (SRT) to estimate maximal oxygen consumption. The tests were performed two times, 1 week apart on the same day of the week, except for the SRT which was performed only once. Intra-observer technical errors of measurement (TEMs) and inter-rater (reliability) were assessed in the morphological component. Reliability for the Musculoskeletal, motor and cardiorespiratory fitness components was examined using Bland–Altman tests. For the morphological component, TEMs were small and reliability was greater than 95% of all cases. For the musculoskeletal, motor, flexibility and cardiorespiratory components, we found adequate reliability patterns in terms of systematic errors (bias) and random error (95% limits of agreement). When the fitness assessments were performed twice, the systematic error was nearly 0 for all tests, except for the sit and reach (mean difference: -1.03% [95% CI = -4.35% to -2.28%]. The results from this study indicate that the “Fuprecol study” health-related physical fitness battery, administered by physical education teachers, was reliable for measuring health-related components of fitness in children and adolescents aged 9–17.9 years old in a school setting in Colombia.

Influence of regular aerobic exercise on endothelium-dependent vasodilation and cardiorespiratory fitness in pregnant women

Aim:  To evaluate the effect of regular aerobic exercise on the endothelial function and cardiorespiratory fitness in pregnant women.

Normative reference values for the 20 m shuttle‐run test in a population‐based sample of school‐aged youth in Bogota, Colombia: the FUPRECOL study

Our aim was to determine the normative reference values of cardiorespiratory fitness (CRF) and to establish the proportion of subjects with low CRF suggestive of future cardio‐metabolic risk.

Effect of Exercise Training on Enos Expression, NO Production and Oxygen Metabolism in Human Placenta

Objective To determine the effects of combined aerobic and resistance exercise training during the second half of pregnancy on endothelial NOS expression (eNOS), nitric oxide (NO) production and oxygen metabolism in human placenta. Methods The study included 20 nulliparous in gestational week 16–20, attending prenatal care at three tertiary hospitals in Colombia who were randomly assigned into one of two groups: The exercise group (n = 10) took part in an exercise session three times a week for 12 weeks which consisted of: aerobic exercise at an intensity of 55–75% of their maximum heart rate for 60 min and 25 mins. Resistance exercise included 5 exercise groups circuit training (50 repetitions of each) using barbells (1–3 kg/exercise) and low-to-medium resistance bands. The control group (n = 10) undertook their usual physical activity. Mitochondrial and cytosol fractions were isolated from human placental tissue by differential centrifugation. A spectrophotometric assay was used to measure NO production in cytosolic samples from placental tissue and Western Blot technique to determine eNOS expression. Mitochondrial superoxide levels and hydrogen peroxide were measured to determine oxygen metabolism. Results Combined aerobic and resistance exercise training during pregnancy leads to a 2-fold increase in eNOS expression and 4-fold increase in NO production in placental cytosol (p = 0.05). Mitochondrial superoxide levels and hydrogen peroxide production rate were decreased by 8% and 37% respectively in the placental mitochondria of exercising women (p = 0.05). Conclusion Regular exercise training during the second half of pregnancy increases eNOS expression and NO production and decreases reactive oxygen species generation in human placenta. Collectively, these data demonstrate that chronic exercise increases eNOS/NO production, presumably by increasing endothelial shear stress. This adaptation may contribute to the beneficial effects of exercise on the vascular and antioxidant system and in turn reduce the risk of preeclampsia, diabetes or hypertension during pregnancy.