This thesis investigated the cost-effectiveness of a 12-month supervised aerobic walking program with or without a behavioural intervention and an educational pamphlet, compared to an unsupervised/self-directed educational pamphlet intervention, among individuals with moderate osteoarthritis (OA) of the knee. Analyses included an economic evaluation to assess the cost effectiveness of the two walking interventions from both the societal and Canadian provincial/territorial health care payer perspectives. A value of information analysis exploring the potential value of future research was also performed. Results revealed that the unsupervised/self-directed intervention was the most cost-effective approach given that it cost the least to implement and participants had higher quality-adjusted life years (QALYs). Walking, either supervised in a community setting, or unsupervised in a setting such as the home, may be a favourable non-pharmacological option for the management of OA of the knee. The thesis concludes with a policy discussion relating to the funding of non-pharmacological therapies.

PROBLEM: Expanding knowledge of how the brain responds to various exercise types may allow for investigation and development of individualized methods of concussion management. PURPOSE: Identify differences in cerebral oxygenation recovery following bouts of maximal anaerobic, resistance and aerobic exercise. METHODS: Twenty-eight active adults were recruited, each partaking in two sessions. At the first, anthropometric measures and leg press 1-RM were determined. During the second session, cerebral oxygenation and ventilatory gas exchange variables were recorded while participants completed maximal anaerobic, resistance, and aerobic tests, and for 15-minutes of recovery. RESULTS: Anaerobic (637.41s ± 330.42s) and aerobic (689.29s ± 311.05s) exercise resulted in longer durations of time to return to baseline compared to resistance (363.07s ± 366.34s). CONCLUSION: Anaerobic and aerobic exercise taking longer than resistance to return to baseline indicates prolonged activity. Expecting equivalent outcomes as concussion management tools from differing exercise methods may be misguided and requires additional research. / February 2017

Expertise and training in fine motor skills has been associated with changes in brain structure, function, and connectivity. Fewer studies have explored the neural effects of athletic activities that do not seem to rely on precise fine motor control (e.g., distance running). Here, we compared resting-state functional connectivity in a sample of adult male collegiate distance runners (n = 11; age = 21.3 +/- 2.5) and a group of healthy age matched non-athlete male controls (n = 11; age = 20.6 +/- 1.1), to test the hypothesis that expertise in sustained aerobic motor behaviors affects resting state functional connectivity in young adults. Although generally considered an automated repetitive task, locomotion, especially at an elite level, likely engages multiple cognitive actions including planning, inhibition, monitoring, attentional switching and multi-tasking, and motor control. Here, we examined connectivity in three resting-state networks that link such executive functions with motor control: the default mode network (DMN), the frontoparietal network (FPN), and the motor network (MN). We found two key patterns of significant between-group differences in connectivity that are consistent with the hypothesized cognitive demands of elite endurance running. First, enhanced connectivity between the FPN and brain regions often associated with aspects of working memory and other executive functions (frontal cortex), suggest endurance running may stress executive cognitive functions in ways that increase connectivity in associated networks. Second, we found significant anti-correlations between the DMN and regions associated with motor control (paracentral area), somatosensory functions (post-central region), and visual association abilities (occipital cortex). DMN deactivation with task-positive regions has been shown to be generally beneficial for cognitive performance, suggesting anti-correlated regions observed here are engaged during running. For all between-group differences, there were significant associations between connectivity, self-reported physical activity, and estimates of maximum aerobic capacity, suggesting a dose-response relationship between engagement in endurance running and connectivity strength. Together these results suggest that differences in experience with endurance running are associated with differences in functional brain connectivity. High intensity aerobic activity that requires sustained, repetitive locomotor and navigational skills may stress cognitive domains in ways that lead to altered brain connectivity, which in turn has implications for understanding the beneficial role of exercise for brain and cognitive function over the lifespan.

One of the earliest sub-clinical stages associated with atherosclerosis is endothelial dysfunction (ED), which has been shown to predict future cardiovascular events. Chronic exercise is thought to improve endothelium-dependent vasodilation; however, few studies have evaluated the effects of acute exercise on vascular function (VF). Moreover, studies evaluating ED following an exercise training program lack a standardized time frame in which to measure VF. Although most studies require subjects to abstain from exercise for 24 hours prior to any VF measure, no study to date has assessed VF longer than 24 hours after the cessation of exercise. Additionally, no studies have compared VF responses in obese and non-obese individuals following acute exercise. Purpose: Therefore, the purpose of this study was to evaluate VF, as determined by the assessment of forearm blood flow (FBF) and vascular reactivity (VR) before and up to 48 hours after a single bout of maximal exercise in obese and non-obese males. Methods: Twelve obese (37.0 ± 1.1 kg/m2) and twelve non-obese (21.9 ± 0.3 kg/m2) males volunteered to participate. FBF was assessed before and during reactive hyperemia (RH). FBF measures were obtained prior to (PRE-E), immediately after (POST-E), and at 1 (POST-1), 2 (POST-2), 24 (POST-24), and 48 (POST-48) hours after exercise. Total excess flow, calculated as the difference between baseline FBF and FBF during RH, was used as an indicator of VR. Blood samples were also obtained at each time point to evaluate the response of interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF-α), which are potential modifiers of VF. Results: Baseline FBF and FBF during RH were significantly (P < 0.05) increased in both groups POST-E before returning to baseline values by POST-1. VR was enhanced in both groups POST-E, although the magnitude of change was greater in non-obese males. VR was significantly (P < 0.05) increased in non-obese males POST-E and was not significantly (P < 0.05) reduced until POST-48. Concentrations of IL-6 and TNF-α were unchanged in response to exercise in non-obese and obese males. Conclusions: An acute bout of maximal exercise significantly increased forearm endothelium-dependent vasodilation in non-obese and obese males. Additionally, an increased reactive vasodilation was observed only in non-obese males following exercise. These results also suggest that in non-obese males, measurements used to verify improvements in VF following exercise training should be employed after a minimum of 48 hours following physical activity.

INTRODUÇÃO - A obesidade exógena resulta de hábitos alimentares inadequados e é agravada pelo sedentarismo. Tornou-se um problema de saúde pública em nossa sociedade, afetando também os adolescentes. OBJETIVO - Criar um instrumento simples, capaz de avaliar em adolescentes o impacto de um programa de treinamento, predominantemente aeróbio, a partir da realização de atividades de moderada intensidade, com consequente melhora do condicionamento físico. MÉTODO - Realizou-se um estudo de intervenção com uma amostra de conveniência sequencial. A amostra final foi composta por 28 adolescentes de ambos os sexos, com idade entre 14 e 18 anos, estudantes, residentes na cidade de São Paulo e pacientes do ambulatório de adolescentes do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, com índice de massa corporal (IMC) acima do terceiro quartil (Q3), segundo o CDC-2000. Todos os adolescentes foram submetidos à avaliação médica e a teste ergoespirométrico em esteira (antes e após a realização dos exercícios físicos). Eles participaram de um programa de treinamento predominantemente aeróbio por um período de 24 semanas e percorriam três vezes por semana uma distância programada, durante um período de tempo de 60 minutos, em que a frequência cardíaca e a percepção de esforço foram avaliadas. O grau de esforço atingido durante o programa não ultrapassou o nível cansativo, segundo a escala de Borg. O desempenho de cada adolescente foi comparado antes e após o programa de treinamento, sob as mesmas condições. Os resultados obtidos foram analisados por meio do teste t pareado ( 5%). Os dados que não apresentaram distribuição normal foram analisados por meio do teste Wilcoxon. Os parâmetros medidos foram: IMC, VO2máx, tempo gasto para realizar o teste ergoespirométrico em esteira, velocidade máxima atingida no teste em esteira e tempo para percorrer a distância de 1 km no esforço máximo. RESULTADOS - O desempenho antes e depois do teste mostrou uma melhora no escore Z médio de IMC (1,7;1,2 P < 0,0001), VO2 máx (35,3 ; 44,2 P < 0,0001), tempo gasto para completar o teste ergoespirométrico em esteira rolante (705,4 ; 1024,3 P < 0,0001), velocidade máxima atingida durante o teste ergoespirométrico (9,6 ; 13,2 P < 0,0001) e tempo para percorrer a distância de 1 km no esforço máximo (640,9 ; 464,9 P < 0,0001). CONCLUSÕES - O treinamento aplicado mostrou-se eficaz para a redução do excesso de peso e melhorou o condicionamento aeróbio dos adolescentes. É possível montar um programa de condicionamento físico, predominantemente aeróbio, sem atingir o grau cansativo com resultados que evidenciam uma melhora significativa do condicionamento físico e do estado nutricional / INTRODUCTION - Exogenous obesity stems from inadequate dietary habits and a sedentary lifestyle. It has become a public health issue in our society today also, affecting adolescents. OBJECTIVE: To develop a simple implement for adolescents to evaluate the impact of a training program, predominantly aerobic, by way of moderate intensity physical activities, and consequently improve their physical conditioning. METHODS - A prospective study with a sequential convenience sample was carried out. The group was composed of 28 adolescents of both genders aged between 14 and 18 years old, students residents of Sao Paulo, patients at the Adolescent Ambulatory Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, and with body mass index (BMI) above the third quartile (Q3) of BMI according to CDC-2000. All of the adolescents were submitted to a medical evolution and to ergoespirometric test on a treadmill before and after the program. After that, they participated into a predominantly aerobic training program for a period of 24 weeks. They had to cover a preset distance, three times per week, for a time period of 60 minutes. Cardiac frequency and perceived exertion on the Borg scale were evaluated. The performance of each individual was compared before and after the training program under the same conditions. The results obtained were analyzed by way of the paired t test ( 5%). The cases that did not present normal distribution were analyzed through the Wilcoxon signed rank test. The parameters measured were: BMI, VO2 max., time taken to perform the ergoespirometric test on a treadmill, maximum velocity attained on the treadmill test, and time taken to cover a distance of one Km with maximum physical effort. RESULTS- The performance before and after the test showed an improvement in the mean Z score for: BMI ( 1.7 1.2 P < 0.0001 ); VO2 max ( 35.3 44.2 P< 0.0001); time taken to complete ergoespirometric test on a treadmill ( 705.4 1024.3 P< 0.0001 );maximum velocity attained during treadmill test ( 9.6 13.2 P < 0.0001 ) ; time taken to cover a distance of one km with maximum effort (640.9; - 464.9 - P<0.0001). CONCLUSIONS - The implement proposed was proven to be effective for the reduction of excess weight and improve the aerobic conditioning of the adolescents. It is possible to compile a physical conditioning program, predominantly aerobic, without attaining physical exertion and to obtain results that evidence a significant improvement of the physical conditioning and nutritional state

INTRODUÇÃO - A obesidade exógena resulta de hábitos alimentares inadequados e é agravada pelo sedentarismo. Tornou-se um problema de saúde pública em nossa sociedade, afetando também os adolescentes. OBJETIVO - Criar um instrumento simples, capaz de avaliar em adolescentes o impacto de um programa de treinamento, predominantemente aeróbio, a partir da realização de atividades de moderada intensidade, com consequente melhora do condicionamento físico. MÉTODO - Realizou-se um estudo de intervenção com uma amostra de conveniência sequencial. A amostra final foi composta por 28 adolescentes de ambos os sexos, com idade entre 14 e 18 anos, estudantes, residentes na cidade de São Paulo e pacientes do ambulatório de adolescentes do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, com índice de massa corporal (IMC) acima do terceiro quartil (Q3), segundo o CDC-2000. Todos os adolescentes foram submetidos à avaliação médica e a teste ergoespirométrico em esteira (antes e após a realização dos exercícios físicos). Eles participaram de um programa de treinamento predominantemente aeróbio por um período de 24 semanas e percorriam três vezes por semana uma distância programada, durante um período de tempo de 60 minutos, em que a frequência cardíaca e a percepção de esforço foram avaliadas. O grau de esforço atingido durante o programa não ultrapassou o nível cansativo, segundo a escala de Borg. O desempenho de cada adolescente foi comparado antes e após o programa de treinamento, sob as mesmas condições. Os resultados obtidos foram analisados por meio do teste t pareado ( 5%). Os dados que não apresentaram distribuição normal foram analisados por meio do teste Wilcoxon. Os parâmetros medidos foram: IMC, VO2máx, tempo gasto para realizar o teste ergoespirométrico em esteira, velocidade máxima atingida no teste em esteira e tempo para percorrer a distância de 1 km no esforço máximo. RESULTADOS - O desempenho antes e depois do teste mostrou uma melhora no escore Z médio de IMC (1,7;1,2 P < 0,0001), VO2 máx (35,3 ; 44,2 P < 0,0001), tempo gasto para completar o teste ergoespirométrico em esteira rolante (705,4 ; 1024,3 P < 0,0001), velocidade máxima atingida durante o teste ergoespirométrico (9,6 ; 13,2 P < 0,0001) e tempo para percorrer a distância de 1 km no esforço máximo (640,9 ; 464,9 P < 0,0001). CONCLUSÕES - O treinamento aplicado mostrou-se eficaz para a redução do excesso de peso e melhorou o condicionamento aeróbio dos adolescentes. É possível montar um programa de condicionamento físico, predominantemente aeróbio, sem atingir o grau cansativo com resultados que evidenciam uma melhora significativa do condicionamento físico e do estado nutricional / INTRODUCTION - Exogenous obesity stems from inadequate dietary habits and a sedentary lifestyle. It has become a public health issue in our society today also, affecting adolescents. OBJECTIVE: To develop a simple implement for adolescents to evaluate the impact of a training program, predominantly aerobic, by way of moderate intensity physical activities, and consequently improve their physical conditioning. METHODS - A prospective study with a sequential convenience sample was carried out. The group was composed of 28 adolescents of both genders aged between 14 and 18 years old, students residents of Sao Paulo, patients at the Adolescent Ambulatory Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, and with body mass index (BMI) above the third quartile (Q3) of BMI according to CDC-2000. All of the adolescents were submitted to a medical evolution and to ergoespirometric test on a treadmill before and after the program. After that, they participated into a predominantly aerobic training program for a period of 24 weeks. They had to cover a preset distance, three times per week, for a time period of 60 minutes. Cardiac frequency and perceived exertion on the Borg scale were evaluated. The performance of each individual was compared before and after the training program under the same conditions. The results obtained were analyzed by way of the paired t test ( 5%). The cases that did not present normal distribution were analyzed through the Wilcoxon signed rank test. The parameters measured were: BMI, VO2 max., time taken to perform the ergoespirometric test on a treadmill, maximum velocity attained on the treadmill test, and time taken to cover a distance of one Km with maximum physical effort. RESULTS- The performance before and after the test showed an improvement in the mean Z score for: BMI ( 1.7 1.2 P < 0.0001 ); VO2 max ( 35.3 44.2 P< 0.0001); time taken to complete ergoespirometric test on a treadmill ( 705.4 1024.3 P< 0.0001 );maximum velocity attained during treadmill test ( 9.6 13.2 P < 0.0001 ) ; time taken to cover a distance of one km with maximum effort (640.9; - 464.9 - P<0.0001). CONCLUSIONS - The implement proposed was proven to be effective for the reduction of excess weight and improve the aerobic conditioning of the adolescents. It is possible to compile a physical conditioning program, predominantly aerobic, without attaining physical exertion and to obtain results that evidence a significant improvement of the physical conditioning and nutritional state

This thesis investigated the cost-effectiveness of a 12-month supervised aerobic walking program with or without a behavioural intervention and an educational pamphlet, compared to an unsupervised/self-directed educational pamphlet intervention, among individuals with moderate osteoarthritis (OA) of the knee. Analyses included an economic evaluation to assess the cost effectiveness of the two walking interventions from both the societal and Canadian provincial/territorial health care payer perspectives. A value of information analysis exploring the potential value of future research was also performed. Results revealed that the unsupervised/self-directed intervention was the most cost-effective approach given that it cost the least to implement and participants had higher quality-adjusted life years (QALYs). Walking, either supervised in a community setting, or unsupervised in a setting such as the home, may be a favourable non-pharmacological option for the management of OA of the knee. The thesis concludes with a policy discussion relating to the funding of non-pharmacological therapies.

Increasing evidence supports the use of physical activity for modifying brain activity and overall neurological health (Hillman et al, 2008). Specifically, aerobic exercise appears to improve cognitive efficacy with regards to decisional oddball tasks shown through the P300, whose amplitude and latency is augmented (Magnié et al., 2000). Furthermore, the effects of an acute bout of aerobic exercise on cardiovascular function are well established and are sustained following exercise cessation. Based on these findings, we proposed that (1) an acute bout of exercise may modulate movement-related cortical excitability within motor areas and (2) that transient effects would be sustained as long as heart rate (HR) remained elevated. Subjects (n=23) were placed in a soundproof booth and instructed to perform a self-paced unimanual ballistic wrist extension every 3-6 seconds of the right wrist while holding a moveable handle. The motion involved a brisk contraction followed by relaxation and positional reset, collected continuously for approximately 8 minutes. Electroencephalography was used to measure movement-related cortical activity of the Bereitschaftspotential (BP) time-locked to onset of muscle activity associated with movement. The BP is a slow negative self-paced movement related cortical potential that precedes movement by approximately 1500ms. Current work commonly separates the BP into 3 main components early, late, and re-afferent Potentials. The early BP is representative of motor preparation of supplementary motor area (SMA) activity while the late component is representative of motor execution from primary motor cortex (M1). Early and late components are often distinguished by a a characteristic change in slope; where the early BP is a slow negative rise and the late components a steeper negative deflection beginning approximately 500ms prior to movement onset. Broken down further the late component consists of a portion of negative slope before giving rise to a peak approximately 100ms after movement onset known as the motor potential (MP). Following baseline measures, subjects performed 20 minutes of aerobic exercise at a moderate intensity (70% of age-predicted maximum heart rate) on a recumbent cycle ergometer. After the cessation of exercise, BP measures were recorded at two time points: immediately post-exercise (Post) and following a return to iv baseline HR (Post[Rest]) and two additional measures separated by 15 minutes each (Post[Rest2] and Post[Rest3]) which was, on average, 45 minutes after the cessation of exercise. Electromyography (EMG) was employed over the extensor carpi radialis muscle belly to describe muscle burst activity and onset characteristics. Results determined that Early but not Late BP was influenced by aerobic exercise. This early movement related cortical adaptation is indicative of enhanced processing within supplementary motor area. Moreover, this effect was sustained for up to an hour and 15 minutes following exercise cessation. This data is suggestive that aerobic exercise influences on motor related cortical excitability is not driven by an aerobic exercise effect and is more indicative of a delayed neurotransmitter effect.

The benefits of brief-duration, early exercise programs in stroke have been shown, but the effects of longer-duration aerobic training early after stroke have not been examined. The purpose of this study was to determine the effects of an early aerobic exercise program that extended beyond inpatient into outpatient rehabilitation on aerobic capacity, walking parameters (walking distance, speed, and symmetry), health-related quality of life, and balance. Patients in the subacute phase after stroke (n = 15) with mild to moderate impairment received aerobic exercise in addition to conventional rehabilitation. The study participants demonstrated significant improvement in aerobic and walking capacity, peak work rate, quality of life, balance, and gait velocity from baseline to midpoint. However, no difference was found between midpoint and final. This early aerobic exercise program following stroke significantly improved aerobic capacity, walking ability, quality of life and balance during the inpatient period although no further improvement was observed during the outpatient period.

The benefits of brief-duration, early exercise programs in stroke have been shown, but the effects of longer-duration aerobic training early after stroke have not been examined. The purpose of this study was to determine the effects of an early aerobic exercise program that extended beyond inpatient into outpatient rehabilitation on aerobic capacity, walking parameters (walking distance, speed, and symmetry), health-related quality of life, and balance. Patients in the subacute phase after stroke (n = 15) with mild to moderate impairment received aerobic exercise in addition to conventional rehabilitation. The study participants demonstrated significant improvement in aerobic and walking capacity, peak work rate, quality of life, balance, and gait velocity from baseline to midpoint. However, no difference was found between midpoint and final. This early aerobic exercise program following stroke significantly improved aerobic capacity, walking ability, quality of life and balance during the inpatient period although no further improvement was observed during the outpatient period.