Does an individualised performance-focused swimming training program improve health, fitness and function in individuals following megaprosthesis bone replacement surgery?

Phase 1. Baseline Participants will complete a 15-week pre-participation period or baseline during which they continue with their current lifestyle, including physical activity levels, and report to The University of Queensland on a weekly basis for testing (further detail to follow). Phase 2. Introductory training Individuals who complete the pre-participation period will then participate in a 15-week low to moderate intensity health focused training program comprising four main training modalities: 1.) Land-based aerobic training, 2.) Resistance training, 3.) Neuromotor training 4.) Swimming. Modalities will be interspersed throughout the intervention and progressed on an individual basis. Training dose: The frequency, intensity, duration and activities included in each session will steadily progress over 15 weeks in order to bring participants to the point where participants are: 1.) Meeting national physical activity guidelines for health (150 minutes of moderate intensity physical activity per week including two resistance training sessions) 2.) Remediating existing deficits in lower limb strength and range of motion. 3.) Able to swim competently and safely for fitness. Training intensity will be monitored using heart rate monitors and Rating of Perceived Exertion (RPE), Prescribed target heart rate during training sessions will be between 40-70% of heart rate maximum. The prescription of frequency and duration of training sessions will be individualised based on each participant's exercise tolerance and baseline physical activity levels. As stated above, the duration and intensity of training will slowly and safely be increased until each participant is able to meet the above criteria. This phase may continue longer than 15 weeks if the participant is unable to meet these criteria within the time frame. One of the main purposes of this run-in period is to bring all participants to the same baseline physical activity level before progressing them to undertake sports performance-focused training. Phase 3. Performance-focused Swimming Training Once the above criteria are met, participants will progress on to a 15-week, swimming performance focused training program designed to enhance stroke technique, aerobic and anaerobic endurance, in-water power, race starts and swim speed. The program will be comprised of moderate to high intensity: 1.) Land-based aerobic training, 2.) Resistance training, 3.) Neuromotor training 4.) Swimming training. Modalities will be interspersed throughout the intervention and progressed on an individual basis - tailored to optimise each individuals swimming performance. Training dose During this phase of the project, participants will be training up to 4 sessions per week, the frequency, intensity and duration of each session will be prescribed based on the participant's individual exercise tolerance and fitness level. Training intensity will be monitored using heart rate monitors and Rating of Perceived Exertion (RPE) as per phase one of the study, The intensity of training in this phase will range from easy to challenging, and will aim to elicit an RPE score of between three and ten, depending on the aim of the session. Prescribed target heart rate during training sessions will be between 40-100% of heart rate maximum. the duration and intensity of training will continue to be slowly and safely increased until the participant is consistently exceeding moderate levels of physical activity i.e. completing more than 150 minutes of moderate intensity physical activity per week including two strength sessions. Phase 4. Maintenance/off-season This phase will mirror phase one, baseline. Participants will complete a 15-week off season or maintenance period during which they continue with their current lifestyle, including physical activity levels, and report to The University of Queensland on a weekly basis for testing. Exercise prescription Training programs included in both phase two and phase three of this study will be designed specifically for each individual, taking into account the training principles of specificity, progressive overload, reversibility, variety, initial values and diminishing returns. Exercise prescription will also employ the ACSM’s FITT-VP principles: Frequency, intensity, type, time, volume, pattern and progression. By employing these principles we hope to maintain participant safety, decrease injury risk and optimise participant adherence and exercise benefit. Training will utilise a combination of land and pool-based training sessions. Within the land-based sessions, a combination of resistance, flexibility, balance, proprioception and motor control training will be used. Training monitoring Throughout the intervention (during both the introductory program and the performance-focused program) adherence to the program will be logged using a training diary which is completed by the participant. This will include: frequency, intensity, duration, type of training, level of enjoyment, pain and fatigue. Semi-structured interviews will also be conducted on an 8-weekly basis to ascertain participant's perception of the program. Training delivery All training programs will be designed and administered by a combination of swimming coaches, exercise scientists and physiotherapists. As recruitment into this study will be progressive, mode of training delivery will vary. Participants may be supervised and trained one-to-one face-to-face or in small groups of no more than three individuals to one practitioner.