BACKGROUND: The SPHERe (Supervised Pulmonary Hypertension Exercise Rehabilitation) trial is a multi-centre, pragmatic, randomised controlled trial assessing the clinical and cost-effectiveness of supervised exercise rehabilitation with psychosocial and motivational support compared to best-practice usual care for people with pulmonary hypertension (PH). The original protocol was published in BMC Pulmonary Medicine (accessible online). We randomised our first participant in January 2020. In response to the COVID-19 pandemic, the trial was stopped in March 2020. In person delivery of the SPHERe intervention to a vulnerable population was not possible during the COVID-19 pandemic. We describe here how trial procedures and intervention delivery were adapted in response to the COVID-19 pandemic.
METHODS: Restrictions imposed by the COVID-19 pandemic on the clinically vulnerable PH population meant that trial delivery was changed from a centre-based rehabilitation programme to remotely delivered group online sessions. This led to minor alterations to the eligibility criteria. These changes followed a consultation process with stakeholders and people with PH and were approved by the funder and independent trial committees.
CONCLUSIONS: We describe the modified SPHERe trial protocol in response to restrictions imposed by the COVID-19 pandemic. SPHERe is the first randomised controlled trial to assess the clinical and cost-effectiveness of an online group rehabilitation programme for people with PH compared to usual care.
BACKGROUND: ISRCTN no. 10608766. Prospectively registered on 18th March 2019, updated 16th August 2023.

OBJECTIVE: Live-remote exercise interventions, supervised by exercise professionals in a home-based setting, could potentially enhance exercise accessibility for cancer survivors, yet research on their perspectives is limited. This study explored cancer survivors\' experience of exercise within the context of a live-remote exercise intervention, to understand factors influencing exercise engagement.
METHODS: Four online focus groups with, in total, 22 breast, prostate, and colorectal cancer survivors were conducted between March and June 2023. These individuals had participated in a 12-week live-remote exercise intervention. The semi-structured discussions were transcribed verbatim and analysed using reflexive thematic analysis with an abductive approach. The Capability, Opportunity, Motivation model of Behaviour (COM-B) served as a supportive framework.
RESULTS: Nine themes were identified and mapped onto COM-B domains (capability, opportunity, motivation). Factors influencing cancer survivors\' exercise engagement included exercise readiness following cancer treatment, bringing exercise closer, in capable hands, peer support through shared experience, life factors as hurdles or support, exercise as an integral component of cancer treatment, caring for myself and others after me, the positive impact of exercise exceeding expectations, and getting into the habit.
CONCLUSIONS: Identifying factors shaping exercise engagement, these findings emphasise live-remote\'s potential benefit in overcoming barriers and fostering participation. Supervised by professionals, it offered psychosocial and exercise support, facilitating the integration of exercise into daily life.
CONCLUSIONS: Elucidating key factors for exercise engagement within a live-remote context is essential for developing and implementing live-remote exercise interventions to ensure accessible, integrated exercise for optimal post-treatment well-being for cancer survivors.

The Pilates exercise method is applied online to various population groups. This study aimed to determine the effect of online Pilates exercises on depression, anxiety, and fear of childbirth in pregnant women. Our randomized controlled study divided participants into the online pilates group (OPG) and the control group (CG). Pilates exercises were applied to the OPG according to the American College of Obstetricians and Gynecologists guidelines, while the CG was given a home program. Assessments were made before and after the training. All measurements improved after Online Pilates (p < 0.05), while there was no change in the control group (p > 0.05). While initial measurement values were similar in both groups (p > 0.05), a statistical difference was observed in favor of OPG with a moderate effect percentage in all results after training (p < 0.05). These results revealed that eight weeks of online Pilates training could effectively reduce depression, anxiety, and fear of childbirth.Trial registration:Clinical trial registry: NCT05305716.

UNASSIGNED: Exercise-based cardiac rehabilitation (CR) is a non-pharmacological multidisciplinary programme for individuals after myocardial infarction (MI) that offers multiple health benefits. One of the greatest barriers to CR participation is the travel distance to the rehabilitation centre. Remotely monitored CR appears to be at least as effective in improving cardiovascular risk factors and exercise capacity as traditional centre-based CR. Nevertheless, the efficacy of remotely monitored CR in individuals with a recent MI has yet to be examined.
UNASSIGNED: A total of 30 individuals (8 women, 22 men) after a recent (i.e., <4 weeks) MI were randomly allocated into two groups (online home-based and gym-based groups). Both groups underwent a 26-week CR programme three times per week. All patients performed baseline and 24-week follow-up measurements where peak oxygen uptake (VO2peak), mean daily steps, distance, and calories were assessed.
UNASSIGNED: The online group showed an improvement in mean daily steps (p < 0.05) and mean daily distance (p < 0.05) at 24 weeks compared to the gym-based group. The paired-sample t-test showed that all the assessed variables were statistically (p < 0.001) improved for both groups at 24 weeks. Pearson\'s r demonstrated positive correlations between VO2peak and mean daily distance (r = 0.375), and negative correlations between VO2peak and muscle (r = -0.523) and fat masses (r = -0.460). There were no exercise-induced adverse events during the study.
UNASSIGNED: Our findings might indicate that a real-time online supervised CR exercise programme using wearable technology to monitor the haemodynamic responses in post-MI patients is equally effective as a gym-based exercise programme.

Engaging in regular physical activity offers a myriad of benefits, including the improvement of mental health, social well-being, and cognitive function. Unfortunately, obstacles, such as transportation constraints, time limitations, and inadequate exercise facilities, hinder the regular participation of older adults in physical activity. Online group physical activity programs present a promising solution to enhance the involvement of older adults; however, several barriers impede their effective utilization. To explore these barriers and benefits, we conducted semi-structured interviews with participants and instructors of a community-based exercise program. Thematic analysis of interviews with 12 physical activity instructors and eight program participants unveiled key hindrances, including limited awareness and accessibility of online programs, challenges in assessing performance during exercise sessions, lack of social component, and technological difficulties. On the positive side, the benefits encompass convenience, wide accessibility, and enhanced social comfort. We also deliberate on future considerations to further bolster participation in these programs.

OBJECTIVE: Physical activity and exercise are key components in the management of cystic fibrosis (CF). Completing exercise programs online may minimize the risk of cross-infection and increase access for people with CF. This study aimed to understand the perspectives of people with CF regarding intervention content for a telehealth exercise program.
METHODS: Individual semistructured qualitative interviews were conducted in adults with CF purposefully sampled for age, disease severity, and social demographics. Interviews were recorded, transcribed verbatim, and analyzed thematically by two researchers independently.
RESULTS: Participants were 23 adults with CF (14 females) aged from 21 to 60 years. Three major themes (subthemes) were generated: \"Personalizing components to an exercise program\" (customizing an exercise program to the individual person and their unique health and exercise needs, enjoyment and variety of exercise activities, accessibility and exercise fitting around competing demands or commitments), \"The importance of maintaining connections\" (challenges regarding face-to-face interactions for people with CF, accountability of scheduled exercise sessions with others, shared experiences between people with CF and specialist support from the CF care team), and \"Monitoring health and exercise\" (perception of health status and monitoring and recording exercise participation and health).
CONCLUSIONS: This study provides important information regarding the preferences of adults with CF for telehealth exercise interventions. Interventions should be tailored to the individual person with CF, include an opportunity to maintain connections with peers and the CF multidisciplinary team, and provide a method to monitor progress over time.

BACKGROUND: Online exercise interventions can improve physical outcomes. Online supervised exercise program is more effective than unsupervised exercise program.
OBJECTIVE: The aim of this study is to determine the effect of an online supervised exercise program on fasting blood glucose, body mass index (BMI), resilience and quality of life in older people with diabetes.
METHODS: This parallel group randomised controlled study included 70 older patients with Type 2 diabetes. Participants were divided into online supervised and unsupervised exercise training groups. Participants in the online-supervised exercise group were given an online-supervised exercise program 3 days a week for 6 weeks. Personal Information Form, Short Resilience Scale and Quality of Life Scale in Older People were used to collect data. In addition, fasting blood sugar BMI and values were measured.
RESULTS: According to the results of our study, while there was no significant difference between the pre-and post-training scores of the supervised and unsupervised groups on the Psychological Resilience Scale and Quality of Life Scale, it was observed that there was a significant difference in both groups according to time (p < .05). When the difference between the scores of the groups before and after the training was analysed according to time, a significant difference was observed between the online-supervised and unsupervised exercise groups (p < .05). In addition, it was seen that there was a significant difference in the fasting blood sugar and BMI results of the online-supervised exercise group according to time (p < .05).
CONCLUSIONS: Online supervised exercise program decreases fasting blood sugar and BMI, increases psychological resilience and quality of life of older patients with Type 2 diabetes.
CONCLUSIONS: Online supervised exercise program may be an additional treatment that provides benefits for older people with diabetes who cannot participate in clinical-based rehabilitation programs.

BACKGROUND: Regular exercise is beneficial for people with Multiple Sclerosis (MS), regardless of disability level. The previously reported differential effect of COVID-19-related lockdowns on exercise levels in this population remains unexplained. We examined effects of lockdowns on exercise in Australians with MS according to disability levels, lockdown severity and health technology use.
METHODS: A cross-sectional survey of people with MS in Australia (22 April-23 September 2021) collected demographic and clinical information as well as exercise patterns before and during lockdowns. Mann-Whitney was used to compare ordinal data and Likelihood Ratio to compare dichotomous data.
RESULTS: 151 people completed the survey. 72.2% had mild disability and 25.2% moderate disability. Extended lockdowns were associated with significantly decreased sedentary behaviour (31.5% to 25.9%) but also with decreased exercise frequency in frequent exercisers (≥3 times/week; 53.7% to 22.2%). The latter occurred significantly more in those with mild disability (-22.7%) than with moderate disability (-3.5%). More people with mild disability walked for exercise pre-pandemic (LR 8.6, p=.004) and during lockdowns (LR 6.6, p=.010). Walking during lockdowns was positively associated with working from home. People with moderate disability were more likely to engage in home exercise both pre-pandemic (LR 5.5, p=.019) and during lockdown (LR 5.2, p=.023). Engagement in home exercise rose for both groups during lockdowns and was facilitated by on-line exercise classes.
CONCLUSIONS: Lockdowns differentially affected exercise patterns according to disability level. The proportion of people achieving exercise recommendations decreased more in those with mild but not moderate disability. Incidental physical activity was disproportionately impacted in people with moderate disability.

Despite the clear benefits of physical activity in healthy ageing, engagement in regular physical activity among community-dwelling older adults remains low, with common barriers including exertional discomfort, concerns with falling, and access difficulties. The recent rise of the use of technology and the internet among older adults presents an opportunity to engage with older people online to promote increased physical activity. This study aims to determine the feasibility and acceptability of training volunteers to deliver online group exercises for older adults attending community social clubs.
This was a pre-post mixed-methods study. Older adults aged ≥ 65 years attending community social clubs who provided written consent and were not actively participating in exercise classes took part in the feasibility study. Older adults, volunteers, and staff were interviewed to determine the acceptability of the intervention. The intervention was a once weekly volunteer-led online group seated strength exercises using resistance bands. The duration of the intervention was 6 months. The primary outcome measures were the feasibility of the intervention (determined by the number of volunteers recruited, trained, and retained, participant recruitment and intervention adherence) and its acceptability to key stakeholders. Secondary outcome measures included physical activity levels (Community Health Model Activities Programme for Seniors (CHAMPS) questionnaire), modified Barthel Index, Health-related quality of life (EQ-5D-5L), frailty (PRISMA-7) and sarcopenia (SARC-F), at baseline and 6 months.
Nineteen volunteers were recruited, 15 (78.9%) completed training and 9 (47.3%) were retained after 1 year (mean age 68 years). Thirty older adults (mean age 77 years, 27 female) participated, attending 54% (IQR 37-67) of exercise sessions. Participants had no significant changes in secondary outcome measures, with a trend towards improvement in physical activity levels (physical activity in minutes per week at baseline was 1770 min, and 1909 min at six months, p = 0.13). Twenty volunteers, older adults, and staff were interviewed and found the intervention acceptable. The seated exercises were perceived as safe, manageable, and enjoyable.
Trained volunteers can safely deliver online group exercise for community-dwelling older adults which was acceptable to older adults, volunteers, and club staff.
NCT04672200.

UNASSIGNED: With the onset of the COVID-19 pandemic, many exercise programs moved online. The purpose of this study was to examine the extent to which older adults\' social identification with other exercise program members contributed to their psychological flourishing and exercise program adherence.
UNASSIGNED: The study represented a secondary analysis of data derived from the Seniors COVID-19 Pandemic and Exercise (SCOPE) Trial, in which older adults were randomized to a waitlist control condition or one of two online (personal v group) exercise programs. Only data from participants in the trial intervention conditions (N = 162; Mage = 73.52 years; SD = 5.61) were utilized in this secondary analysis. We assessed psychological flourishing and social identification at baseline and every two weeks, as well as program adherence over each 2-week block, for 12 weeks.
UNASSIGNED: Based on stepwise multilevel modeling the results revealed that older adults\' social identification with others in their respective exercise program had a direct effect on psychological flourishing (ΔR2Unique Marginal = 0.063, p < .001) and program adherence (ΔR2Unique Marginal = 0.014, p = .03).
UNASSIGNED: The results highlight the value of bolstering older adults\' social identification with others in an online exercise program to support adherence and well-being.