Objective To determine whether early and more frequent mobilization after stroke affects health-related quality of life. Methods A Very Early Rehabilitation Trial (AVERT) was an international, multicenter (56 sites), phase 3 randomized controlled trial, spanning 2006–2015. People were included if they were aged ≥18 years, presented within 24 hours of a first or recurrent stroke (ischemic or hemorrhagic), and satisfied preordained physiologic criteria. Participants were randomized to usual care alone or very early and more frequent mobilization in addition to usual care. Quality of life at 12 months was a prespecified secondary outcome, evaluated using the Assessment of Quality of Life 4D (AQoL-4D). This utility-weighted scale has scores ranging from −0.04 (worse than death) to 1 (perfect health). Participants who died were assigned an AQoL-4D score of 0. Results No significant difference in quality of life at 12 months between intervention (median 0.47, interquartile range [IQR] 0.07–0.81) and usual care (median 0.49, IQR 0.08–0.81) groups was identified (p = 0.86), nor were there any group differences across the 4 AQoL-4D domains. The same lack of group difference in quality of life was observed at 3 months. When cohort data were analyzed (both groups together), quality of life was strongly associated with acute length of stay, independence in activities of daily living, cognitive function, depressive symptoms, and anxiety symptoms (all p < 0.001). Quality of life in AVERT participants was substantially lower than population norms, and the gap increased with age. Conclusions Earlier and more frequent mobilization after stroke did not influence quality of life. Clinical trial registration anzctr.org.au; ACTRN12606000185561 Classification of evidence This study provides Class II evidence that for people with stroke, earlier and more frequent mobilization did not influence quality of life over the subsequent year.

1991 The majority of cancer survivors will at some point experience fatigue to the extent that it impairs their quality of life. While the precise etiology of this multidimensional fatigue is unknown, it is possible that low natural killer cell cytolytic activity (NKCA) may be implicated. Evidence suggests that those completing cancer treatment demonstrate low NKCA. It would be of interest to examine if the fitness status of cancer survivors potentially influences NKCA to the point that certain exercise benefits could be useful in diminishing fatigue in this population given the relationship between fatigue and NKCA. PURPOSE: The primary purpose was to examine the NKCA levels in breast cancer survivors who have received radiation therapy compared to healthy controls. The secondary purpose was to examine the relationship between NKCA and fitness levels in these groups. METHODS: Breast cancer survivors (n = 14) and healthy controls (n = 5) were measured for NKCA via a time-resolved fluorometric assay. NKCA comparisons were determined using the Mann-Whitney test. Subjects underwent fitness testing for aerobic capacity, muscular strength, and muscular endurance. NKCA and fitness status was analyzed using the Spearman Rank correlation. RESULTS: There was no statistical difference in NKCA between the cancer group and controls (0.457, p >0.05). No statistical relationship was found between NKCA and fitness in the cancer group (VO2: 0.918, p>0.05; 1-RM bench press: 0.925, p>0.05; YMCA endurance bench press: 0.370, p>0.05; crunches: 0.600, p>0.05). No statistical relationship was found between NKCA and VO2 in the control group (0.467, p>0.05), however statistically significant positive correlations were found between NKCA and YMCA endurance bench press (0.023, p<0.05), crunches (0.003, p<0.05), and the 1-RM bench press (0.003, p<0.05). CONCLUSION: In contrast to other research, our results determined that NKCA does not differ between breast cancer survivors who have had radiation therapy and healthy controls. The high correlations between NKCA and muscular strength and endurance in the healthy population may be preliminary support for further investigation into the use of strength training to improve NKCA, potentially mitigating fatigue for cancer survivors.

585 Injury to skeletal muscle from high force eccentric exercise has been shown to complicate the diagnosis of acute myocardial infarction (AMI) by release of non-specific serum protein AMI markers. Cardiac troponin I and T (cTnI and cTnT) are highly cardiospecific AMI markers not present in adult skeletal muscle. They differ in amino acid sequence for the cardiac and skeletal muscle forms. This study investigated the effects of exercise-induced muscle injury following a marathon on cTnI and cTnT profiles. cTnI and cTnT were measured in 17 participants (20-69 years) in the 1997 Pikes Peak Marathon. Parameters were measured prior to and at 0, 2, 4, and 6 hours post-race. Mean cTnI (± SD) peaked above baseline (0.265 ± 0.235 ng/mL) at 0 hours post-race(0.452 ± 0.389 ng/mL) and decreased to 0.365 ± 0.29, 0.241± 0.272, and 0.229 ± 0.252 ng/mL at 2, 4, and 6 hours post-race, respectively (p=.0003). Mean cTnT (± SD) similarly increased above baseline (0.01 ± 0 ng/mL) peaking at 0 hours post-race (0.031 ± 0.027 ng/mL). Thereafter, cTnT steadily declined to 0.025 ± 0.021, 0.021 ± 0.009, and 0.019 ± 0.011 ng/mL at 2, 4, and 6 hours post-race, respectively (p=.0001). While no post-race value exceeded levels indicative of AMI for either cTnI (> 1.5 ng/mL) or cTnT (> 0.1 ng/mL), values above baseline may suggest slight myocardial cell necrosis since changes were not associated with a dehydration effect. Since values did not exceed the AMI diagnostic criteria after extreme endurance exercise, the results from this study suggest that cTnI and cTnT are potential early indicators of AMI.