Publications by authors named "Carol Ewing Garber"

53 Publications

Is there an effective dose of aerobic exercise associated with better executive function in youth with attention deficit hyperactivity disorder?

Child Neuropsychol 2021 Oct 28:1-28. Epub 2021 Oct 28.

Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, USA.

Attention-deficit/hyperactivity disorder (ADHD) is the most prevalent neurodevelopmental disorder in children, and it's linked to a higher risk of academic failure, interpersonal issues, mental illness, and criminality. Despite several of the comparative and detailed reviews on the effects of ADHD interventions on core symptoms, there is no data summarizing the effects of aerobic exercise (AE) on executive functions (EFs). Therefore, this study aimed to systematically review and determine the relationship between AE (acute and chronic) dosage and EFs (attention, inhibition, set-shifting, and working memory) in youth with ADHD. The consideration of how AE dosage impacts aspects of EFs has not been investigated in detail previously. The study adhered to PRISMA guideline. Sixdatabases were searched without any date restrictions, up to February 2021, for articles relating to AE interventions to influence EFs in youth with ADHD18 years old. Quality assessment of the reviewed papers was addressed. Thirteen studies met the inclusion criteria. Improvements in all aspects of EFs were reported after children with ADHD engaged in acute AE lasting 20-30 minutes with at least moderate intensity (65% ≤ 80% HR).Furthermore, chronic exercise that lasts at least 45 minutes and in the range of moderate tohigh intensity (i.e., 60% ≤ 75% HR), 3 days/week for 6-12, elicits additional benefits in inhibition and set-shifting.Different dosage of AE might differently influence aspects of EFs; however, this finding rests on preliminary evidence at this stage and thus should be treated with caution.It is necessary to establish suitable interventions with regard to the dosage of AE types to improve EFs in young people with ADHD.
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http://dx.doi.org/10.1080/09297049.2021.1992378DOI Listing
October 2021

Effectiveness of the POWER Program in Improving Physical Activity and Executive Function in Fifth Grade Students.

J Sch Health 2021 07 18;91(7):574-583. Epub 2021 May 18.

Applied Physiology Teachers College, Columbia University, 525 W. 120th Street, Box 93, New York, NY, 10027.

Background: High volumes of school-based sedentary time may impact academic achievement and executive function negatively. This study evaluated a multimodal classroom program's (POWER) effect on fifth graders' physical activity (PA) and executive function.

Methods: Six 5th grade classes (3 = intervention [POW]; 3 = waitlist control [CONT]) in 2 diverse New Jersey schools participated. Data were collected before, during, and post-intervention. PA was assessed via accelerometer, executive function by NIH Toolbox, and academic achievement via standardized math tests. The POW principal, teachers, and select students participated in follow-up interviews. Group comparisons were made by multivariate repeated-measures ANOVA and linear regression.

Results: PA decreased in both groups over time, but POW's post-intervention class-time PA was significantly higher than CONT's. POW's NIH Toolbox score increased 3 percentiles more than CONT's. Intervention fidelity was associated with significantly higher scores for one NIH Toolbox test. Student math test scores increased significantly for both schools, but there was no significant main effect for group. POW's feedback was positive, with the principal reporting fewer disciplinary referrals and teachers and students conveying positive growth.

Conclusions: Overall, POW's positive changes and the favorable reception of POWER support POWER'S ability to improve children's socioemotional and physical health.
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http://dx.doi.org/10.1111/josh.13035DOI Listing
July 2021

Associations Between Habitual Sedentary Behavior and Endothelial Cell Health.

Transl J Am Coll Sports Med 2020 ;5(12)

Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, 622 W. 168 Street, New York, NY, 10032, United States.

Endothelial dysfunction is a mechanism that may explain the link between prolonged sedentary time and cardiovascular disease. However, the relation between habitual sedentary behavior (SED) and endothelial function has yet to be explored.

Purpose-: The purpose of this study was to examine the association of accelerometer-measured SED with markers of endothelial cell health.

Methods-: Healthy adult participants (n=83; 43.4% male; 25.5 ± 5.8 years old) were examined. SED was measured for 7-days by accelerometer. Endothelial function measures included endothelium-dependent vasodilation (EDV); endothelial microparticles (EMPs) [CD62E+ and CD31+/CD42- EMPs]; and endothelial progenitor cells (EPCs) [CD34+/CD133+/KDR+ and CD34+/KDR+EPCs]. Participants were classified as having low or high SED based on a median split.

Results-: Participants in the low and high SED group spent a mean ± SD of 8.6 ± 1.1 and 11.1 ± 1.0 h/day in SED, respectively. No significant differences between the low and high SED groups were detected in mean [95% confidence interval (CI)] EDV (2.51 [2.21-2.81] vs. 2.36 [2.07-2.64], =0.50), EMPs (CD62E+: 6.70 [6.55-6.84] vs. 6.56 [6.42-6.69], =0.20; CD31+/CD42‒: 6.26 [6.10-6.42] vs. 6.18 [6.03-6.33], =0.50), or EPCs (CD34+/KDR+: 11.91 [9.23-14.48]×10 vs. 14.87 [12.41-17.32]×10, =0.13); CD34+/CD133+/KDR+: 1.84 [1.28-2.39]×10 vs. 2.17 [1.64-2.70]×10, =0.43).

Conclusions-: Among healthy adults, habitual SED was not associated with markers of endothelial cell health.
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http://dx.doi.org/10.1249/tjx.0000000000000138DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8087243PMC
January 2020

Diminished muscle oxygen uptake and fatigue in spinal muscular atrophy.

Ann Clin Transl Neurol 2021 05 31;8(5):1086-1095. Epub 2021 Mar 31.

Department of Neurology, Columbia University Irving Medical Center, New York, New York, USA.

Objective: To estimate muscle oxygen uptake and quantify fatigue during exercise in ambulatory individuals with spinal muscular atrophy (SMA) and healthy controls.

Methods: Peak aerobic capacity (VO ) and workload (W ) were measured by cardiopulmonary exercise test (CPET) in 19 ambulatory SMA patients and 16 healthy controls. Submaximal exercise (SME) at 40% W was performed for 10 minutes. Change in vastus lateralis deoxygenated hemoglobin, measured by near-infrared spectroscopy, determined muscle oxygen uptake (ΔHHb) at rest and during CPET and SME. Dual energy X-ray absorptiometry assessed fat-free mass (FFM%). Fatigue was determined by percent change in workload or distance in the first compared to the last minute of SME (Fatigue ) and six-minute walk test (Fatigue ), respectively.

Results: ΔHHb-PEAK, ΔHHb-SME, VO , W , FFM%, and 6MWT distance were lower (P < 0.001), and Fatigue and Fatigue were higher (P < 0.001) in SMA compared to controls. ΔHHb-PEAK correlated with FFM% (r = 0.50) and VO (r = 0.41) only in controls. Only in SMA, Fatigue was inversely correlated with W (r = -0.69), and Fatigue was inversely correlated with FFM% (r = -0.55) and VO (r = -0.69).

Interpretation: This study provides further support for muscle mitochondrial dysfunction in SMA patients. During exercise, we observed diminished muscle oxygen uptake but no correlation with aerobic capacity or body composition. We also observed increased fatigue which correlated with decreased aerobic capacity, workload, and body composition. Understanding the mechanisms underlying diminished muscle oxygen uptake and increased fatigue during exercise in SMA may identify additional therapeutic targets that rescue symptomatic patients and mitigate their residual disease burden.
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http://dx.doi.org/10.1002/acn3.51353DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8108417PMC
May 2021

Who Uses Wearable Activity Trackers and Why? A Comparison of Former and Current Users in the United States.

Am J Health Promot 2020 09 24;34(7):762-769. Epub 2020 Apr 24.

Teachers College, Columbia University, New York, NY, USA.

Background: There has been an explosion in the use of wearable activity trackers (WATs), but we do not fully understand who wears them and why. This study's purpose was to describe the characteristics of WAT users and to compare current and former users.

Materials And Methods: A variety of internet-based resources (eg, Craigslist, Facebook) were used to recruit current and former WAT users. Respondents completed a web-based survey, where they provided information on sociodemographic characteristics, health, physical activity behavior, and about their WAT use.

Results: Of the 2826 respondents who gave informed consent, 70.8% (n = 2002) met inclusion criteria for this analysis. Respondents ranged from 18 to 81 years old (mean 32.9 ± 12.2 standard deviation) with 73.8% women. Most were current WAT users (68.7%), and the average length of WAT use overall was 9.3 ± 9.7 months. On average, current users wore the device for 3.7 months longer than former users. Compared to current users, former users had a lower body mass index (1.2 kg/m less), reported fewer medical conditions, shared data from their device less often, and received the device as a gift more frequently.

Conclusions: Current and former users varied in their reasons for using a WAT and how they used their device. Differences identified between these groups support further exploration of associations between WAT users' profiles and their physical activity behavior.
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http://dx.doi.org/10.1177/0890117120919366DOI Listing
September 2020

An Examination of the Relationship Between Motivation, Physical Activity, and Wearable Activity Monitor Use.

J Sport Exerc Psychol 2020 Mar 9:1-8. Epub 2020 Mar 9.

Teachers College, Columbia University.

Wearable physical activity (PA) monitors are widely promoted as a means to motivate people to be more active, but the motivational profile of users has never been assessed. This study's purpose was to classify adult users by their motivational regulation scores and examine how these profiles were associated with moderate to vigorous PA (MVPA). Current users (N = 320) recruited across the United States completed a Web-based survey. Motivational regulations were measured using the Behavioral Regulation in Exercise Questionnaire, and associations with MVPA were explored using bivariate correlations. MVPA was more highly correlated with autonomous rather than controlling regulations. A cluster analysis was conducted using the respondents' motivational regulation scores. Five motivational profiles emerged from this analysis, and they differed significantly across motivation and MVPA scores. PA monitor users characterized by more autonomous motives presented with higher MVPA. As technology use increases, assessing the multidimensionality of PA monitor users' motivation may add value when researching PA behaviors.
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http://dx.doi.org/10.1123/jsep.2019-0170DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7483559PMC
March 2020

Quantifying Physical Activity in Young Children Using a Three-Dimensional Camera.

Sensors (Basel) 2020 Feb 19;20(4). Epub 2020 Feb 19.

Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY 10027, USA.

The purpose of this study was to determine the feasibility and validity of using three-dimensional (3D) video data and computer vision to estimate physical activity intensities in young children. Families with children (2-5-years-old) were invited to participate in semi-structured 20-minute play sessions that included a range of indoor play activities. During the play session, children's physical activity (PA) was recorded using a 3D camera. PA video data were analyzed via direct observation, and 3D PA video data were processed and converted into triaxial PA accelerations using computer vision. PA video data from children ( = 10) were analyzed using direct observation as the ground truth, and the Receiver Operating Characteristic Area Under the Curve (AUC) was calculated in order to determine the classification accuracy of a Classification and Regression Tree (CART) algorithm for estimating PA intensity from video data. A CART algorithm accurately estimated the proportion of time that children spent sedentary (AUC = 0.89) in light PA (AUC = 0.87) and moderate-vigorous PA (AUC = 0.92) during the play session, and there were no significant differences ( > 0.05) between the directly observed and CART-determined proportions of time spent in each activity intensity. A computer vision algorithm and 3D camera can be used to estimate the proportion of time that children spend in all activity intensities indoors.
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http://dx.doi.org/10.3390/s20041141DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7071428PMC
February 2020

Establishing a Global Standard for Wearable Devices in Sport and Fitness: Perspectives from the New England Chapter of the American College of Sports Medicine Members.

Curr Sports Med Rep 2020 Feb;19(2):45-49

Centre for Stress and Age-related Disease, School of Pharmacy and Biomolecular Sciences (PaBS), University of Brighton, Brighton, UNITED KINGDOM.

The recent explosion of wearable technology and the associated concerns prompted the International Federation of Sports Medicine (FIMS) to create a quality assurance standard for wearable devices, which provides commissioned testing of marketing claims and endorsement of commercial wearables that test favorably. An open forum as announced in the conference advertising was held at the Annual Meeting of the New England Regional Chapter of the American College of Sports Medicine (NEACSM) November 7 to 8, 2019, in Providence, Rhode Island, USA for attending NEACSM members to voice their input on the process. Herein, we report the proceedings. The round table participants perceived the quality assurance standard to be important, but identified some practical process challenges that included the broad scope and complexity of the device universe, the need for a multiphase testing pathway, and the associated fees for product evaluation. The participants also supported the evaluation of device data analysis, behavioral influences, and user experience in the overall evaluation. Looking forward, the FIMS quality assurance standard faces the challenge of balancing these broader perspectives with practical constraints of budget, facilities, time, and human resources.
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http://dx.doi.org/10.1249/JSR.0000000000000680DOI Listing
February 2020

Limitations of 6-minute walk test reference values for spinal muscular atrophy.

Muscle Nerve 2020 03 16;61(3):375-382. Epub 2020 Jan 16.

Department of Rehabilitation and Regenerative Medicine, Program in Physical Therapy, Columbia University Irving Medical Center, New York, New York.

Introduction: The 6-minute walk test (6MWT) is a well-established clinical assessment of functional endurance, validated as a measure of walking ability in spinal muscular atrophy (SMA). The current availability of disease-modifying therapies for SMA indicates a growing need for normative reference data to compare SMA patients with healthy controls.

Methods: The literature was searched in two scientific databases. Studies were evaluated and selected based on adherence to American Thoracic Society guidelines for administering the 6MWT. Reference equations from the selected studies were applied to 6MWT data collected from SMA patients to calculate and compare % predicted values.

Results: Three pediatric and six adult studies were selected for comparison. The % predicted values using the pediatric and adult equations ranged from 47.7 ± 18.2% to 67.6 ± 26.2% and 43.0 ± 17.9% to 59.5 ± 26.2%, respectively, and were significantly different (P < 0.001).

Discussion: Results suggest significant variability between % predicted values derived from published reference equations in children and adults, despite adherence to 6MWT standardization.
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http://dx.doi.org/10.1002/mus.26794DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7024648PMC
March 2020

BRICS nations and the opportunities for community physical activity interventions.

J Sport Health Sci 2019 Nov 3;8(6):509-511. Epub 2019 Aug 3.

Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY 10027, USA.

•Rapid urbanization and its environmental impact have led to challenges to health and well-being of residents in BRICS nations.•Physical activity should be a priority public health target for primary and secondary prevention because of the high prevalence of chronic diseases and cardiometabolic risk factors in BRICS nations.•BRICS nations can harness scientific evidence prospectively to promote environmental and policy supports for physical activity.•Physical activity interventions engaging the members of the community and that are culturally relevant are more likely to be effective.
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http://dx.doi.org/10.1016/j.jshs.2019.07.010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6834979PMC
November 2019

The Health Benefits of Exercise in Overweight and Obese Patients.

Curr Sports Med Rep 2019 Aug;18(8):287-291

Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY.

More than 30% of U.S. adults are obese or overweight. A program of regular physical activity is recommended as part of an effective lifestyle intervention for weight loss and weight management. However, more than 40% of adults do not engage in sufficient physical activity to realize these beneficial effects on body weight. Physicians may encounter many barriers to counseling physical activity, such as lack of knowledge or self-efficacy for counseling patients about physical activity. Obese individuals may be reluctant to exercise because of weight stigma, physique anxiety, and other factors; therefore, referral to a weight management specialist or clinical exercise physiologist can be helpful in facilitating exercise and assisting in achieving a clinically meaningful weight loss. Exercise has many benefits on physical and mental health and well-being that go well beyond weight loss, and it is for these reasons that exercise is particularly important for overweight and obese individuals.
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http://dx.doi.org/10.1249/JSR.0000000000000619DOI Listing
August 2019

Patterns of Sedentary Behavior in the First Month After Acute Coronary Syndrome.

J Am Heart Assoc 2019 08 31;8(15):e011585. Epub 2019 Jul 31.

Center for Behavioral Cardiovascular Health Columbia University Irving Medical Center New York NY.

Background Sedentary behavior is a key contributor to cardiovascular disease. Few data exist on the sedentary behavior patterns of patients with acute coronary syndrome. Methods and Results We characterized patterns of sedentary time and their correlates in 149 patients with acute coronary syndrome over the first month postdischarge, a critical period when lifestyle behaviors are formed. Sedentary time was measured by accelerometry for 28 days postdischarge. Group-based modeling at the day level was used to characterize sedentary patterns. Participants spent a mean of 9.7±2.0 hours per day sedentary during the 28 days postdischarge, with significant decreases in sedentary time observed in each consecutive week (P<0.01 for all). Three distinct sedentary patterns were identified: high (20.6% of participants), moderate (47.9%), and low (31.5%). The high and moderate sedentary groups spent a mean of 12.6±0.8 and 10.0±0.7 hours per day sedentary, respectively, and had only minimal decreases in their sedentary time (<3 minutes per day) over the 28 days. The low sedentary group spent a mean of 7.3±0.8 hours per day sedentary, with a rapid decrease in sedentary time (14 minutes per day) observed during the first week postdischarge followed by a relatively smaller decrease (≈5 minutes per day) that persisted until day 21 postdischarge. Non-Hispanic ethnicity, left ventricular ejection fraction <40%, lower physical health-related quality of life, and not having a partner were associated with an increased likelihood of being in the high sedentary group. Conclusions Survivors of acute coronary syndrome accrued high volumes of sedentary time during the first month postdischarge, with most showing little change over time. Interventions targeting reductions in sedentary time among survivors of acute coronary syndrome may be warranted, particularly for those with poor physical health and greater disease severity.
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http://dx.doi.org/10.1161/JAHA.118.011585DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6761643PMC
August 2019

Physical Activity and Cardiovascular Risk among Kidney Transplant Patients.

Med Sci Sports Exerc 2019 06;51(6):1154-1161

Department of Family Medicine, Warren Alpert Medical School of Brown University, Providence, RI.

Purpose: Research examining the relationship between physical activity (PA) and cardiovascular disease (CVD) risk factors among kidney transplant recipients (KTR) is limited. Accordingly, we sought to 1) describe the levels of PA in KTR and 2) analyze the associations between PA levels and CVD risk factors in KTR.

Methods: Baseline data from KTR participants in a large multiethnic, multicenter trial (the Folic Acid for Vascular Outcome Reduction in Transplantation) were examined. PA was categorized in tertiles (low, moderate, and high) derived from a modified PA summary score from the Yale Physical Activity Survey. CVD risk factors were examined across levels of PA by ANOVA, Kruskal-Wallis rank test, and hierarchical multiple regression.

Results: The 4034 participants were 37% female (mean ± SD = 51.9 ± 9.4 yr of age, 75% White, 97% with stage 2T-4T chronic kidney disease, and 20% with prevalent CVD. Participants in the "high" PA tertile reported more vigorous PA and walking, compared with participants in moderate and low tertiles (both P < 0.001). No differences were observed in daily household, occupational, or sedentary activities across PA tertiles. More participants in the "low" PA tertile were overweight/obese, had a history of prevalent diabetes, and/or had CVD compared with more active participants (all P < 0.001). Hierarchical modeling revealed that younger age (P = 0.002), cadaveric donor source (P = 0.006), shorter transplant vintage (P = 0.025), lower pulse pressure (P < 0.001), and no history of diabetes (P < 0.001) were associated with higher PA scores.

Conclusion: The most active KTR engaged in more intentional exercise. Lower levels of PA were positively associated with more CVD risk factors. Higher PA levels were associated with younger age and with more positive KTR outcomes.
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http://dx.doi.org/10.1249/MSS.0000000000001886DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6522300PMC
June 2019

Interactive Dyadic Physical Activity and Spatial Proximity Patterns in 2-Year-Olds and Their Parents.

Children (Basel) 2018 Dec 11;5(12). Epub 2018 Dec 11.

Department of Biobehavioral Sciences, Columbia University Teachers College, New York, NY 10027, USA.

This study aimed to characterize daily physical activity (PA) behaviors in 2-year-old girls and boys and their parents, with and without an objective measure of dyadic spatial proximity. Urban-dwelling parent⁻toddler dyads ( = 110) wore accelerometers for 7 days, and parents completed a sociodemographic questionnaire. Accelerometers were initialized to collect PA and Bluetooth-based proximity data. After applying wear-time algorithms, = 65 dyads were further analyzed using a dyadic analysis statistical methodology. Toddler⁻parent sedentary and light PA time were respectively interdependent, conditional on child sex and child-parent proximity, but moderate⁻vigorous physical activity (MVPA) time was not. Toddlers were significantly more active on weekdays and weekends than their parents, and no differences were found in daily PA volumes between girls and boys. In dyads with proximity data ( = 34), analyses of joint (i.e., proximal and mutual) PA time showed that girls participated in significantly more joint PA with their mothers than boys. Children who engaged in ≥60 min of MVPA/day participated in ~2 h of joint PA/day, on average, while children with <60 min of MVPA/day engaged in ~30 min less joint-PA time with their mothers. Boys and girls who participated in higher daily MVPA volumes engaged in joint PA with their mothers across greater relative distances, as compared to less active boys who engaged in joint PA at closer relative distances to their mothers. Toddlers who engaged in ≥60 min of daily MVPA participated in joint PA with their mothers at greater relative distances and for longer durations than less active children. Further research on the dyadic activity⁻proximity relationship is needed across early childhood development.
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http://dx.doi.org/10.3390/children5120167DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6306825PMC
December 2018

Factors associated with objectively measured exercise participation after hospitalization for acute coronary syndrome.

Int J Cardiol 2019 Jan 28;275:1-5. Epub 2018 Sep 28.

Center for Behavioral Cardiovascular Health, Columbia University Medical Center, 622 West 168 Street, PH 9, New York, NY 10032, USA.

Background: Guidelines recommend exercise for secondary prevention of acute coronary syndrome (ACS), however adherence to guidelines is low. A paucity of data examining factors associated with objectively-measured exercise post-discharge in ACS survivors exists. The purpose of this study was to identify factors associated with exercise during the 5 weeks after ACS discharge.

Methods: A sample of 151 ACS patients treated at a university hospital were enrolled into an observational cohort study and wore an accelerometer for 35 days post-discharge. Days on which participants accumulated ≥30 min of moderate-to-vigorous physical activity in bouts ≥10 min were considered exercise days. Participants were categorized as non-exercisers (0 exercise days) or exercisers (≥1 exercise day). A multi-variable logistic regression model was used to examine the association between exercise and socio-demographics, depression, SF-12 physical and mental health scores, disease severity, length of hospitalization, and percutaneous coronary intervention.

Results: 39.7% of participants were non-exercisers. Factors associated with non-exercise were age (OR: 1.11; 95% CI: 1.06-1.17, p < 0.001), female sex (OR: 2.76; 95% CI: 1.10-6.95, p = 0.031), and lower SF-12 physical health score (OR: 0.94; 95% CI: 0.90-0.98, p = 0.005).

Conclusion: In ACS patients in whom exercise participation was objectively measured for 5 weeks post-discharge, demographic and poor physical health factors were associated with non-exercise. These findings identify populations (e.g. older adults, women) at especially high risk for being physically inactive in whom more intense intervention may be warranted.
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http://dx.doi.org/10.1016/j.ijcard.2018.09.080DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6289665PMC
January 2019

Benefits of exercise therapy in Charcot-Marie-Tooth disease.

Lancet Child Adolesc Health 2017 Oct 27;1(2):82-83. Epub 2017 Jul 27.

Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, USA.

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http://dx.doi.org/10.1016/S2352-4642(17)30037-8DOI Listing
October 2017

How Do Physical Activity and Health Vary Among Younger, Middle-Aged, and Older Adults With and Without Disability?

J Aging Phys Act 2019 04 20;27(2):234-241. Epub 2019 Jan 20.

Physical activity (PA) and health were compared in younger (YA; 18-44 years), middle-aged (MA; 45-64 years), and older (OA; ≥65 years) adults with disability (PWD), functional limitation (PFL), or without disability (PWoD). Disability occurred in YA (PWD: 2.3%; PFL: 14.3%), MA (PWD: 8.5%; PFL: 23.8%), and OA (PWD: 14.9%; PFL: 26.6%). Not meeting aerobic/muscle-strengthening PA recommendations was frequent in YA (PWD: 50.7%; PFL: 42.5%; PWoD: 35.8%), MA (PWD: 56.7%; PFL: 44.0%; PWoD: 35.6%), and OA (PWD: 57.8%; PFL: 44.1%; PWoD: 33.1%). Among PWD, YA and MA met muscle, strengthening recommendations more frequently than did OA; PFL did more aerobic PA than PWD. The presence of chronic diseases, female gender, White race, lower education, and less income were associated with being PWD or PFL. Those with greater PA were less likely to be PWD or PFL. Results suggest increasing public health efforts to promote healthy lifestyles in MA and OA.
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http://dx.doi.org/10.1123/japa.2017-0215DOI Listing
April 2019

Effects of Theory-Based Behavioral Interventions on Physical Activity Among Overweight and Obese Female Cancer Survivors: A Systematic Review of Randomized Controlled Trials.

Integr Cancer Ther 2018 06 27;17(2):226-236. Epub 2017 Oct 27.

2 Columbia University, New York, NY, USA.

Purpose: To determine whether theory-based physical activity (PA) interventions for overweight and obese female cancer survivors lead to increased PA and improved health.

Methods: This systematic review examined randomized controlled trials analyzing the impact of theory-based PA interventions on overweight and obese female cancer survivors through December 2016. Searches of 5 electronic databases revealed 10 articles that included 1351 participants who met the inclusion criteria.

Results: Participants were primarily non-Hispanic white (74%-100%) breast or endometrial cancer survivors. Intervention characteristics and PA assessment tools varied greatly. Adherence (68%-99%) and retention (79%-100%) were relatively high. Social cognitive theory was utilized as the theoretical construct in 9 of the 10 studies. Home-based interventions led to small improvements in PA (Cohen's d range = 0.25-0.31), whereas home-based plus center-based interventions led to moderate to large improvements (Cohen's d range = 0.45-1.02). Only three of the studies assessed psychosocial behavioral processes associated with PA, and the results were mixed. Health-related outcomes included improvements in aerobic fitness (Cohen's d = 0.32-1.1 in 5 studies), large absolute decreases in waist circumferences (>6 cm in 3 of 5 studies; Cohen's d = -0.31 to -1.02), and no change in inflammatory biomarkers (in 2 studies). Only one serious adverse event (pelvic stress fracture) was attributed to the interventions.

Conclusions: Theory-based PA interventions are safe and feasible for overweight and obese female cancer survivors. Interventions that include a center-based component showed moderate to large effect sizes for PA. Future studies should evaluate behavioral variables and more health-related clinical outcomes.
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http://dx.doi.org/10.1177/1534735417734911DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6041897PMC
June 2018

A Review of Current Literature on Vital Sign Assessment of Physical Activity in Primary Care.

J Nurs Scholarsh 2018 01 25;50(1):65-73. Epub 2017 Oct 25.

Professor and Chair, Department of Behavioral Sciences, Teachers College, Columbia University, New York, NY, USA.

Purpose: To conduct an integrated review of the performance and implementation of two physical activity (PA) assessment tools, the exercise vital sign (EVS) and the physical activity vital sign (PAVS), in U.S. primary care practice.

Design: An integrative review following Whittemore and Knafl's methodology.

Methods: Medline and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases were searched. Search terms were "exercise vital sign" OR "physical activity vital sign" AND "primary care". Additional inclusion criteria were studies conducted in the United States, published in English, in primary care, between 2010 and 2016.

Results: Nine studies met inclusion criteria. Five studies reported validity data of the EVS tool, while four studies reported data from the PAVS tool. Compared with the accelerometer, the EVS tool overestimated moderate-vigorous PA, while the PAVS tool demonstrated moderate agreement in identifying those not meeting national PA guidelines. The EVS tool was successfully implemented in large, integrated practices utilizing electronic health record systems. PA documentation increased compared to non-EVS practices. The predictive ability of the PAVS tool for clinical outcomes was shown. Studies of PA assessment tool use in children were not found.

Conclusions: Preliminary evidence on the validity of both the EVS and PAVS tools support cautious use of each as a screening tool in primary care. There were no data on reliability, with limited data on tool use in diverse populations or settings. Data in children, older adults, and diverse population subgroups were lacking.

Clinical Relevance: Two brief exercise vital signs tools have each shown some initial validity for use by primary care clinicians as measures to identify patients not meeting PA guidelines.
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http://dx.doi.org/10.1111/jnu.12351DOI Listing
January 2018

Association Between Physical Activity, Depression, and Diabetes in Urban-Dwelling People Living with HIV.

J Assoc Nurses AIDS Care 2017 Nov - Dec;28(6):838-848. Epub 2017 Jun 29.

Physical activity (PA) may improve physical and mental health in people living with HIV (PLWH). However, the associations between PA participation and physical and mental health problems of PLWH in urban settings remain largely unknown. Our objective was to determine the relationships between PA and physical and mental health in urban-dwelling PLWH. There were 289 adult PLWH who responded to an electronic survey including questions on PA and current physical and mental health. The associations between physical and mental health and PA were investigated using linear and logistic regression. A large proportion of participants met recommended volumes of PA. Eighty-three percent of respondents reported symptoms of severe mental distress. Diabetes mellitus was associated with a lower total volume of PA (p = .035). Similarly, depression was negatively associated with muscle-strengthening exercise participation (p = .030). Sufficient amounts of aerobic activity and/or muscle strengthening exercise are associated with better physical and mental health.
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http://dx.doi.org/10.1016/j.jana.2017.06.015DOI Listing
December 2017

Physical activity-related differences in body mass index and patient-reported quality of life in socioculturally diverse endometrial cancer survivors.

Support Care Cancer 2017 07 16;25(7):2169-2177. Epub 2017 Feb 16.

Division of Gynecologic Oncology, Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center, 111 East 210th Street, Bronx, NY, 10467, USA.

Purpose: The purpose of this study was to describe physical activity-related differences in body composition, quality of life, and behavioral variables among a socioculturally diverse sample of endometrial cancer survivors.

Methods: Ambulatory, English-speaking endometrial cancer survivors (6 months to 5 years post-treatment), who were residents of Bronx, NY, were recruited to complete questionnaires about physical activity (PA), quality of life (QoL), and psychosocial characteristics. Body weight and height were obtained from medical records to determine body mass index (BMI). ANOVA and independent sample t tests were used to determine differences between racial/ethnic groups and active versus insufficiently active, respectively.

Results: Sixty-two participants enrolled in the study. Recruitment rate was 7% for mailed questionnaires and 92% in clinic. Mean age was 63 ± 10 years. Sixty-five percent of the sample was obese (mean BMI: 34.2 ± 8.6 kg·m). BMI was significantly higher in non-Hispanic black women (37.8 ± 10.2 kg·m) than non-Hispanic white women (31.2 ± 7.8 kg·m; d = 0.73, p = 0.05). Forty-seven percent reported being physically active, with no differences by race/ethnicity. Physically active endometrial cancer survivors had higher QoL scores (d = 0.57, p = 0.02). There was a moderate effect size for BMI for the active (32.4 ± 5.6 kg·m) compared to the insufficiently active group (35.7 ± 10.2 kg·m; d = 0.40, p = 0.06). Walking self-efficacy was a significant predictor of physical activity (χ = 13.5, p = 0.02).

Conclusions: Physically active endometrial cancer survivors reported higher QoL, lower BMI, and more positive walking self-efficacy. These data suggest that a physically active lifestyle has a benefit in socioculturally diverse endometrial cancer survivors.
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http://dx.doi.org/10.1007/s00520-017-3622-yDOI Listing
July 2017

Single-Blind, Randomized, Controlled Clinical Trial of Exercise in Ambulatory Spinal Muscular Atrophy: Why are the Results Negative?

J Neuromuscul Dis 2015 Oct;2(4):463-470

Department of Neurology, Columbia University Medical Center, New York, NY, USA.

Background: The benefits of exercise on long-term health and well-being are well established. The possible benefits of exercise in Spinal Muscular Atrophy (SMA) have not been explored in a controlled clinical trial format.

Objective: To assess the effects of exercise on measures of function, strength, and exercise capacity in ambulatory SMA patients.

Methods: Fourteen participants, ages 10-48 years, were randomized to control and exercise cohorts after a 1 month lead-in period. The exercise group received 6 months of intervention. Thereafter, both groups received the intervention for the remaining 12 months. Participants were monitored for a total of 19 months. Exercise included individualized home-based cycling and strengthening. The primary outcome measure was distance walked during the six-minute walk test (6MWT). Secondary outcomes included strength, function, exercise capacity, quality of life and fatigue.

Results: Twelve participants completed the first 7 months of the study, and 9 completed all 19 months. At baseline, the groups were similar on all clinical variables. There were no group changes at any time point in the 6MWT, fatigue, or function. Percent-predicted VO2 max improved 4.9% in all participants in 6 months (p = 0.036) (n = 10).

Conclusion: Daily exercise is safe in ambulatory SMA and should be encouraged. We did not uncover any deleterious effects on strength, function, or fatigue. Our study documented a reduction in oxidative capacity and a blunted conditioning response to exercise possibly representing an important insight into underlying pathophysiological mechanisms. These findings also may be linked causally to mitochondrial depletion in SMA and warrant further study.
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http://dx.doi.org/10.3233/JND-150101DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5240606PMC
October 2015

Six-minute walk test is reliable and valid in spinal muscular atrophy.

Muscle Nerve 2016 11 13;54(5):836-842. Epub 2016 May 13.

Department of Neurology, Columbia University Medical Center, New York, New York, USA.

Introduction: The Six-Minute Walk Test (6MWT) was adopted as a clinical outcome measure for ambulatory spinal muscular atrophy (SMA). However, a systematic review of measurement properties reported significant variation among chronic pediatric conditions. Our purpose was to assess the reliability/validity of the 6MWT in SMA.

Methods: Thirty participants performed assessments, including the 6MWT, strength, and function. Reproducibility was evaluated by intraclass correlation coefficients. Criterion/convergent validity were determined using Pearson correlation coefficients.

Results: Test-retest reliability was excellent. The 6MWT was associated positively with peak oxygen uptake, Hammersmith Functional Motor Scale Expanded (HFMSE), lower extremity manual muscle testing, knee flexion hand-held dynamometry, and inversely with 10-m walk/run. The 6MWT discriminates between disease severity, unlike the HFMSE.

Conclusions: This study documents measurement properties of reproducibility, positive criterion validity, and convergent validity with established clinical assessments and reaffirms the value of the 6MWT as a pivotal outcome measure in SMA clinical trials. Muscle Nerve 54: 836-842, 2016.
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http://dx.doi.org/10.1002/mus.25120DOI Listing
November 2016

Feasibility of a physical activity intervention for obese, socioculturally diverse endometrial cancer survivors.

Gynecol Oncol 2016 Aug 4;142(2):304-10. Epub 2016 Jun 4.

Department of Obstetrics & Gynecology and Women's Health, Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467, USA; Albert Einstein Cancer Center, Albert Einstein College of Medicine, 1300 Morris Park Avenue Bronx, NY 10461, USA. Electronic address:

Purpose: Determine the feasibility of a 12-week physical activity intervention for obese, socioculturally diverse endometrial cancer survivors and to evaluate whether the intervention improves physical activity behavior, physical function, waist circumference, and quality of life.

Methods: Obese endometrial cancer survivors from Bronx, NY were assigned to either a 12-week physical activity intervention of behavioral counseling, physical activity and home-based walking (n=25), or wait-list control group (n=15). Mixed-design ANOVA (2 groups×2 time points) were analyzed to determine differences between the intervention and the control for the Yale Physical Activity Survey, six-minute walk test, 30-second chair stand test, waist circumference, and Functional Assessment of Cancer Therapy-Endometrial questionnaire. Data are presented as mean±standard deviation.

Results: The sample was diverse (38% non-Hispanic black, 38% Hispanic, 19% non-Hispanic white). Mean Body Mass Index was 37.3±6.5kg·m(-2). Although recruitment rate was low (20% of 140 contacted), 15 of 25 participants in the intervention group attended 75-100% of scheduled sessions. Participants reported walking 118±79min/week at home. There were large effect sizes for the improvements in the six-minute walk test (22±17m vs. 1±22m, d=1.10), waist circumference (-5.3±5.3cm vs. 2.6±6.7cm, d=-1.32), quality of life (10±12 vs. -1±11, d=0.86) and walking self-efficacy (24±30% vs. 1±55%, d=0.87) compared to the control group.

Conclusions: The intervention appeared feasible in this population. The results show promising effects on several outcomes that should be confirmed in a larger randomized control trial, with more robust recruitment strategies.
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http://dx.doi.org/10.1016/j.ygyno.2016.05.034DOI Listing
August 2016

Updating ACSM's Recommendations for Exercise Preparticipation Health Screening.

Med Sci Sports Exerc 2015 Nov;47(11):2473-9

1Department of Kinesiology, University of Rhode Island, Kingston, RI; 2Department of Preventive Cardiology, Beaumont Health Center, Royal Oak, MI; 3Department of Cardiology, Hartford Hospital, Hartford, CT; 4Teachers College, Columbia University, New York, NY; 5No affiliation; 6Division of Mathematics and Sciences, North Carolina Wesleyan College, Rocky Mount, NC; and 7Department of Kinesiology, University of Connecticut, Storrs, CT.

The purpose of the American College of Sports Medicine's (ACSM) exercise preparticipation health screening process is to identify individuals who may be at elevated risk for exercise-related sudden cardiac death and/or acute myocardial infarction. Recent studies have suggested that using the current ACSM exercise preparticipation health screening guidelines can result in excessive physician referrals, possibly creating a barrier to exercise participation. In addition, there is considerable evidence that exercise is safe for most people and has many associated health and fitness benefits; exercise-related cardiovascular events are often preceded by warning signs/symptoms; and the cardiovascular risks associated with exercise lessen as individuals become more physically active/fit. Consequently, a scientific roundtable was convened by the ACSM in June 2014 to evaluate the current exercise preparticipation health screening recommendations. The roundtable proposed a new evidence-informed model for exercise preparticipation health screening on the basis of three factors: 1) the individual's current level of physical activity, 2) presence of signs or symptoms and/or known cardiovascular, metabolic, or renal disease, and 3) desired exercise intensity, as these variables have been identified as risk modulators of exercise-related cardiovascular events. Identifying cardiovascular disease risk factors remains an important objective of overall disease prevention and management, but risk factor profiling is no longer included in the exercise preparticipation health screening process. The new ACSM exercise preparticipation health screening recommendations reduce possible unnecessary barriers to adopting and maintaining a regular exercise program, a lifestyle of habitual physical activity, or both, and thereby emphasize the important public health message that regular physical activity is important for all individuals.
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http://dx.doi.org/10.1249/MSS.0000000000000664DOI Listing
November 2015

Physical activity for an ethnically diverse sample of endometrial cancer survivors: a needs assessment and pilot intervention.

J Gynecol Oncol 2015 Apr;26(2):141-7

Division of Gynecologic Oncology, Department of Obstetrics & Gynecology and Women's Health, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.

Objective: To determine the physical activity (PA) behavior, needs and preferences for underserved, ethnically diverse women with a history of endometrial cancer (EC).

Methods: Women with a history of EC (41 non-Hispanic black, 40 non-Hispanic white, and 18 Hispanic) completed a needs assessment during their regular follow-up appointments at Montefiore Medical Center in Bronx, NY, USA. An 8-week pilot PA intervention based on the results of the needs assessment was conducted with 5 EC survivors.

Results: Mean body mass index (BMI) among the 99 respondents was 34.1±7.6 kg/m², and 66% did not exercise regularly. Self-described weight status was significantly lower than actual BMI category (p<0.001). Of the 86% who were interested in joining an exercise program, 95% were willing to attend at least once weekly. The primary motivations were improving health, losing weight, and feeling better physically. Despite the high interest in participation, volunteer rate was very low (8%). However, adherence to the 8-week pilot PA intervention was high (83%), and there were no adverse events. Body weight decreased in all pilot participants.

Conclusion: These data show that ethnically diverse EC survivors have a great need for, and are highly interested in, PA interventions. However, greater care needs to be taken to assess and identify barriers to increase participation in such programs.
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http://dx.doi.org/10.3802/jgo.2015.26.2.141DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4397230PMC
April 2015

The effect of a cadence retraining protocol on running biomechanics and efficiency: a pilot study.

J Sports Sci 2015 4;33(7):724-31. Epub 2014 Nov 4.

a Kinesiology , University of Massachusetts Amherst , Amherst , MA , USA.

Many studies have documented the association between mechanical deviations from normal and the presence or risk of injury. Some runners attempt to change mechanics by increasing running cadence. Previous work documented that increasing running cadence reduces deviations in mechanics tied to injury. The long-term effect of a cadence retraining intervention on running mechanics and energy expenditure is unknown. This study aimed to determine if increasing running cadence by 10% decreases running efficiency and changes kinematics and kinetics to make them less similar to those associated with injury. Additionally, this study aimed to determine if, after 6 weeks of cadence retraining, there would be carryover in kinematic and kinetic changes from an increased cadence state to a runner's preferred running cadence without decreased running efficiency. We measured oxygen uptake, kinematic and kinetic data on six uninjured participants before and after a 6-week intervention. Increasing cadence did not result in decreased running efficiency but did result in decreases in stride length, hip adduction angle and hip abductor moment. Carryover was observed in runners' post-intervention preferred running form as decreased hip adduction angle and vertical loading rate.
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http://dx.doi.org/10.1080/02640414.2014.962573DOI Listing
November 2015

Walking economy during cued versus non-cued self-selected treadmill walking in persons with Parkinson's disease.

J Parkinsons Dis 2014 ;4(4):705-16

Teacher's College, Columbia University, NY, USA.

Background: Gait impairments related to Parkinson's disease (PD) include variable step length and decreased walking velocity, which may result in poorer walking economy. Auditory cueing is a common method used to improve gait mechanics in PD that has been shown to worsen walking economy at set treadmill walking speeds. It is unknown if auditory cueing has the same effects on walking economy at self-selected treadmill walking speeds.

Objectives: To determine if auditory cueing will affect walking economy at self-selected treadmill walking speeds and at speeds slightly faster and slower than self-selected.

Methods: Twenty-two participants with moderate PD performed three, 6-minute bouts of treadmill walking at three speeds (self-selected and ± 0.22 m·sec-1). One session used cueing and the other without cueing. Energy expenditure was measured and walking economy was calculated (energy expenditure/power).

Results: Poorer walking economy and higher energy expenditure occurred during cued walking at a self-selected and a slightly faster walking speed, but there was no apparent difference at the slightly slower speed.

Conclusion: These results suggest that potential gait benefits of auditory cueing may come at an energy cost and poorer walking economy for persons with PD at least at some treadmill walking speeds.
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http://dx.doi.org/10.3233/JPD-140445DOI Listing
August 2015

Performance of the timed "up & go" test in spinal muscular atrophy.

Muscle Nerve 2014 Aug 12;50(2):273-7. Epub 2014 May 12.

Department of Neurology, Columbia University Medical Center, 180 Fort Washington Avenue, 5th Floor, New York, New York, 10032, USA.

Introduction: The timed "up & go" (TUG) test is a quick measure of balance and mobility. TUG scores correlate with clinical, functional, and strength assessment and decline linearly over time. Reliability and validity have not been tested in spinal muscular atrophy (SMA).

Methods: Fifteen ambulatory SMA participants performed TUG testing and strength, functional, and clinical assessments. Intraclass correlation coefficients quantified test-retest reliability. Convergent validity was determined using Pearson correlation coefficients.

Results: Test-retest reliability was excellent for all participants. TUG was associated significantly with total leg and knee flexor strength, as well as the Hammersmith Functional Motor Scale Expanded, the 10-meter walk/run, and 6-minute walk tests. TUG findings were not associated with knee extensor strength, pulmonary function, or fatigue.

Conclusions: In SMA, the TUG test is easily administered, reliable, and correlates with established outcome measures. TUG testing is a potentially useful outcome measure for clinical trials and a measure of disability in ambulatory patients with SMA.
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http://dx.doi.org/10.1002/mus.24153DOI Listing
August 2014

A Randomized, Controlled Clinical Trial of Exercise in Patients with Spinal Muscular Atrophy: Methods and Baseline Characteristics.

J Neuromuscul Dis 2014;1(2):151-161

Department of Neurology, Columbia University Medical Center, NY, USA.

Background: Spinal Muscular Atrophy (SMA) is a recessively-inherited neuromuscular disease characterized by weakness and muscle atrophy. Although anecdotal benefits from exercise have been noted, and despite promising pre-clinical and pilot reports, the effect of exercise has not been addressed in a controlled trial in SMA.

Objective: To assess the effects of exercise on measures of function, strength, and exercise capacity in ambulatory SMA patients.

Methods/design: An evaluator-blinded, randomized, controlled trial of aerobic and strengthening exercise in 14 ambulatory SMA patients aged 8-50 years. Patients will be randomized to either the exercise or control arm after the 1 month lead in period. During the first 6-months, the exercise group will receive the intervention while the other group serves as a control. After those 6 months, both groups will receive the intervention. The last 6-months of the study are designed to mimic real-world conditions where all participants are encouraged to continue on their own. Participants will be monitored throughout this 19 month study and will have in-person visits every three months. The primary outcome measure is the change in the total distance walked over 6-months on the six minute walk test (6MWT). Secondary outcome measures include maximal oxygen uptake (VO2 max), functional and strength assessments, pulmonary function, fatigue, and quality of life.

Discussion: The result of this prospective, single blinded, randomized and controlled clinical trial of exercise on an established functional outcome measure will have impact on clinical practice by providing important guidance to clinical management of SMA patients.
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January 2014
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