To assess relative reliability and measurement error of the Graded Cycling Test (GCT) with the Talk Test (TT) for patients with cardiac disease. Patients (N = 64; women, n = 30) with ischemic heart disease performed the GCT with the TT twice in 1 day. Every minute the patient recited a text passage of 30 words. The question "Are you still able to speak comfortably?" was then answered: "Yes" (TT+), "Not sure" (TT±), or "No" (TT-). Two physiotherapists (PTs) rated when the speaking ability was affected by ventilation. Relative reliability: intraclass correlation coefficient (ICC)2.1 and absolute reliability: standard error of measurement with 95% CI (SEM95) and smallest real difference (SRD) were calculated. Intraclass correlation coefficient values of 0.90, 0.91, and 0.90 were observed for TT+, TT±, and TT-, respectively. Physiotherapist ICCs ranged between 0.81 and 0.88. SEM95 ranged between 17.2 and 18.3 watts (W), with corresponding SRD values between 24.4 and 25.9 W for the patient ratings. The PT ratings ranged between 15.8 and 21.4 W (SEM95) and between 22.3 and 30.3 W (SRD). The TT, combined with the GCT, was well tolerated by patients with cardiac disease in clinical settings with small measurement error and an excellent relative reliability. These results apply to both patient-rated and PT-rated TT.

PURPOSE: To evaluate clinical assessment outcome of cardiac rehabilitation, a simple and reliable submaximal exercise test, not based on heart rate, is warranted. The Talk Test (TT) has been found to correlate well with the ventilatory threshold, and excellent reliability was observed for TT combined with the Graded Cycling Test (GCT-TT) in cardiac patients. The purpose was to investigate responsiveness of GCT-TT in cardiac rehabilitation patients. METHODS: Patients (n = 93) referred to 8 weeks of cardiac rehabilitation were included. Pre- and posttests were performed using GCT-TT. Mean test changes in watts (W) were compared with the standard error of measurement (SEM₉₅) for groups and the smallest real difference (SRD) for individuals. Minimal clinically important difference was assessed by comparing patient perceived changes in physical fitness with the test changes. RESULTS: A statistically significant improvement of GCT-TT was observed; 18.1 ± 21.1 W (mean ± SD) (P < .001). This was close to the previously observed SEM₉₅ of 18.3 W. Thirty-six percent of the patients exceeded SRD (2 test stages). The subgroup with a perceived “major change” improved 28.8 ± 20.7 W compared with the groups reporting “some” (P < .001) and “no or minor” change (P = .002). A change of 30 W (equivalent to 2 stages ≈ 1 metabolic equivalent task [MET]) in the present test protocol is suggested as the minimal clinically important difference. CONCLUSIONS: GCT-TT was responsive to changes of power output for these patients, and these changes were generally in agreement with patient perceived changes in physical fitness.

Exercise is a cornerstone in diabetes care; however, adherence is low and sustaining physical activity remains a challenge. Patient-centered diabetes self-management education and support are recommended; however, sparse literature exists on how to design exercise interventions that improve self-management in individuals with complications of type 2 diabetes mellitus (T2D). We aimed to gain insights into needs, barriers, and motivation based on experiences with exercise participation among individuals with T2D and complications to adjust and develop new types of tailored, supervised exercise classes in specialized care at three hospitals in Denmark. In keeping with a constructivist research paradigm, a qualitative hermeneutic approach using focus group interviews was applied to explore perspectives among different participants in terms of disease severity. Seven interviews with 30 participants (aged 49–88) representing seven different exercise classes, were conducted over three years. Reflective thematic analysis was used. Four themes were generated: People like us, Getting started with exercise, Game changers, and Moving forward. An overarching theme ‘The transformation of motivation when exercising in a safe and kind environment’ links the themes together, resembling the participants’ development of physical literacy encompassing motivation, confidence, physical competence as well as an ability to value physical activity. Supportive patient-centered exercise classes promoted a transformation of motivation grounded in the development of physical literacy among participants in specialized diabetes care. However, participants were concerned with continuing to exercise on their own after the intervention, as they experienced a lack of continuous, supervised exercise opportunities in local communities.

Purpose: Workplace health interventions with exercise have positive effects on musculoskeletal pain and well-being at work, however, effectiveness is questioned due to low adherence. In hospitals participation is challenged by shiftwork and unpredictable workload. Our aim was to investigate the feasibility of exercise during working hours in an acute hospital, herein to estimate the health impact to guide management decisions on implementation. Methods: A clinical trial in a public hospital, offering staff supervised group-based individualized exercise with combined aerobic and strength training during working hours twice weekly for 20 weeks. Delivery, acceptance, and adherence were investigated. Subjective outcomes were social capital, well-being, quality of life, and musculoskeletal pain were assessed. Objective outcomes were blood pressure, body composition, and cardiorespiratory fitness. Results: Twenty-three percent of the employees ( n = 617) accepted participation (92% female, median age was 50 years, 38% nurses). Adherence was 29% with no difference between employees with clinical versus non-clinical functions . Non-clinicians participated during working hours, while clinicians participated outside of working hours in 50% (IQR 5–87) of the sessions. Positive changes were seen in systolic and diastolic blood pressure (decreased 2.0 [0.9; 2.2] and 0.9 [0.1; 1.7] mmHG, respectively), aerobic capacity 2.3 ml/O2/min/kg [1.7; 2.9], and in waist-hip ratio, social capital, well-being, quality of life, and musculoskeletal pain. Conclusion: Exercise during working hours in an acute hospital staff was feasible, but strategies to increase acceptance and adherence are necessary for a successful implementation. Despite low adherence, the intervention was associated with improvements of physical and mental health. Registration: The study protocol has been uploaded on www.clinicaltrials.gov (NCT04988724).

Aims: We investigated long-term changes of patient-reported outcomes after a supervised exercise intervention in individuals with type 2 diabetes (T2D). Methods: In an intervention study without a control group, follow-up assessments were performed 12 months after initiating 12 weeks of physical exercise in individuals with T2D at intermediate or high risk of complications. Primary outcomes were health-related quality of life assessed with EQ-5D-5L, empowerment with Diabetes Empowerment Scale-Short Form, and self-reported physical activity with the Physical Activity Scale. Secondary outcomes were physical function (30-s chair-stand test) and working capacity (Aastrand or Graded Cycling Test). Results: 153 participants completed follow-up (35% women, age (mean +/- SD) 67 +/- 11 years, body mass index 33.1 +/- 5.9 kg/m2, glycated haemoglobin A1c 7.8 +/- 3.7%). No changes were reported in health-related quality of life (index score p = 0.444, visual analogue scale p = 0.270), empowerment (p = 0.232), and moderate intensity physical activity (p = 0.917). Vigorous intensity physical activity decreased (mean (95% CI) -25.5 (-37.14; -13.94) min/day, p < 0.001). Physical function increased (p < 0.001) and working capacity decreased (Aastrand p = 0.002, Graded Cycling Test p = 0.039). Conclusions: Health-related quality of life, empowerment, and self-reported moderate intensity physical activity time remained elevated at the long-term follow-up after a supervised exercise intervention.