BACKGROUND The STEP for MS trial was designed and delivered by a team of medical and rehabilitation professionals with a key player being the exercise professional (EP). Our purpose is to showcase the role of the EP and methods for standardized, safe and effective exercise and behavior change intervention. DESIGN Site principal investigators who designed the intervention and implementation plan were physical medicine and rehabilitation doctors, physical therapists and kinesiologists with expertise in MS and exercise programming. The interventional EP were site staff members with varied backgrounds in delivering exercise programming to people with MS. Professional titles include personal trainer, exercise specialist, clinical exercise physiologist, graduate teaching assistant, research associate, clinical integration and research coordinator. Interventionalists had little to no prior experience using the theory-based behavior change strategies employed in the trial. METHODS To accommodate differences in EP backgrounds and expertise, standardized training on behavior change principles and exercise prescription was required. Weekly booster meetings were held via Zoom to discuss participant progress, challenges and identify solutions and modifications to the intervention while maintaining trial fidelity. Supporting materials like exercise training manuals, scripts, newsletters, logbooks and calendars were used by EPs to deliver the intervention. EPs deployed their unique skills and training to provide guidance on exercise program progression, exercise technique modification and behavior change strategies to participants. EPs and participants mutually decided on the trajectory of exercise progression based on experiences during the first 2 standardized weeks. The trajectories differed in the rate of progression with all participants meeting the exercise guidelines of 30 minutes of aerobic exercise and 5–10 strength exercises consisting of 1–2 sets, 10–15 repetitions targeting lower body, upper body, and core musculature 2 days a week, by week 10 of the program. Outcome measures were transcribed by EPs in a research database. CONCLUSION There was a varied skillset among principal investigators and interventionalists in the STEP for MS trial which provided a well-rounded intervention to people with MS. Standardized training, trial-issued supporting materials and weekly booster meetings enabled successful and standardized program implementation across 8 sites.

Background Cardiorespiratory function measured as peak volume of oxygen consumption (Vo2peak) predicts all-cause mortality and dictates exercise prescription for cancer survivors (CS). It is imperative that Vo2peak values are reliable, as using inaccurate values may invalidate the exercise program and is unsafe. The Bruce treadmill protocol is commonly used for Vo2peak testing but may not be accurate for CS because of its higher intensity. A cancer-specific treadmill (CANCER) protocol and corresponding prediction equations has been validated, yet the Bruce protocol is most used, also using estimation equations. It is unknown if the Bruce protocol is appropriate for CS. The purpose of this study was to determine whether the Bruce protocol prediction equations provide accurate estimations of Vo2peak for CS by comparing it against Vo2peak values from the CANCER protocol using gas analysis (CANCERmet) and prediction equations (CANCERest). Methods Forty-seven subjects completed both CANCER and Bruce protocols 1 week apart in randomized order. Actual and predicted Vo2peak from CANCERmet and CANCERest, respectively, were compared to estimated Vo2peak from the Bruce. Results Vo2peak values were significantly lower in CANCERmet and CANCERest compared to the Bruce (P < 0.05); however, peak heart rate, systolic blood pressure, and rate pressure product were significantly higher using the CANCER protocol (P < 0.05). Conclusion The Bruce protocol and corresponding Vo2peak prediction equations do not appear accurate for CS, as Vo2peak is significantly overpredicted, despite yielding lower physiological values of maximal exertion. The CANCER treadmill protocol should remain the gold standard for assessing cardiorespiratory function in CS.

Resistance exercise alone or in conjunction with caffeine increases heart rate and blood pressure in resistance-trained women. While acute resistance exercise has been shown to increase measures of left ventricular workload, the addition of caffeine on these responses is unknown. PURPOSE: To evaluate alterations in left ventricular workload at rest, following acute caffeine supplementation or placebo, as well as during recovery from a fatiguing bout of resistance exercise in resistance-trained women. METHODS: Eleven resistance-trained women (Mean±SD: Age: 24 ± 4yrs) participated in a counterbalanced, double blind, placebo-controlled, crossover-design study. Each participant drank 4mg/kg of caffeine mixed with water. Applanation tonometry was used to measure left ventricular workload at rest (Rest1), 45 minutes after caffeine ingestion (Rest2), immediately postresistance exercise (Post 1), and 10 minutes post-resistance exercise (Post2). The acute bout of resistance exercise consisted of two sets at 75% 1-repetition maximum (1RM) for 10 repetitions, and one set at 70%1RM with repetitions to failure on the squat and bench press. Two minutes of rest were given between sets and exercises. A 2x4 two-way analysis of variance (ANOVA) was used to assess the effects of condition with a repeated measure of time. RESULTS: There were significant main effects of time for wasted left ventricular energy (Rest1

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