We recently published preliminary data identifying the acute effects of single sessions of high-intensity interval exercise (HIIE) as compared to MICE [24, 25]. The data indicate that a single bout of RSTEP HIIT taxed the cardiorespiratory system significantly more than MICE, yet without untoward effects on walking, gait, cognition, mood, or enjoyment [24, 25]. Those data were collected in pwMS-wd and suggested that RSTEP HIIT may be an acceptable, safe, and tolerable stimulus for chronic exercise training [26, 27]. Before moving on to a large-scale, randomized control trial (RCT), we must identify the feasibility and initial efficacy of chronic RSTEP HIIT for maximizing implementation strategies and long-term adherence with the exercise program. The feasibility data of the RSTEP HIIT program will identify if the intervention is practical through establishing the parameters of the design and to identify any potential threats to the validity of study outcomes [28]. Future iterations of the research study and design are then informed by the process, resource, management, and science outcomes, thus increasing the credibility of the next phases of research [28,29,30,31].
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It is evident that children with the chornic diseases reviewed herein can benefit from PA and exercise interventions for the same reasons as healthy children, in addition to disease-specific benefits. Overall, exercise appears to be a safe and efficacious intervention across the chronic diseases reviewed, as long as disease specific and individual needs are carefully considered. It is important to note that the current review is a narrative review of the literature, not a systematic review. As such, there is greater potential for bias, as the quality of published data was not assessed. Thus, our practical applications for exercise should be used as a starting point in determining the use of exercise as medicine in pediatric chronic disease rather than as specific guidelines. While a position statement (endorsed by The Canadian Paediatric Society and the Canadian Academy of Sport Medicine) was created for some pediatric chronic diseases [141], there is still a lack of high quality data to make recommendations at this time. This narrative review is a necessary first step towards filling a gap in the literature in the area of exercise as medicine in pediatric chronic disease and is critical, since producing high quality data and evidence-informed recommendations may take several years.
Musculoskeletal comorbidities (MSKCs) are the most frequent cause of activity limitations in persons with cardiovascular disease (CVD) and affect as many as 70% of this population. It has been observed that over 50% of new outpatient cardiac rehabilitation participants experience some musculoskeletal pain, with back pain reported by up to 38% of cardiac rehabilitation patients. Back pain can limit performance of activities of daily living (ADLs) and reduce exercise tolerance and compliance during outpatient cardiac rehabilitation (CR). This article will describe ways to facilitate CR exercise participation in patients who have comorbid, chronic nonspecific low back pain (CNSLBP) and have been medically cleared to exercise.
Low back pain is a common musculoskeletal disorder affecting approximately 38% of new outpatient cardiac rehabilitation patients. The majority of LBP is considered chronic and nonspecific. Cardiac rehabilitation patients who have CNSLBP can obtain the same improvements in physical activity tolerance, physical function, and HRQoL as persons without CNSLBP. A comprehensive, individualized approach to developing exercise programs that accommodate patients' CNSLBP and (if present) their movement directional preferences is prudent and can enhance the benefits of participation in outpatient CR. Clinical exercise physiologists should monitor patients for new or worsening symptoms. New or worsening pain and fatigue warrant immediate exercise cessation and communication with a physician or HCP. 2ff7e9595c
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