Mental models of adherence: parallels in perceptions, values, and expectations in adherence to prescribed home exercise programs and other personal regimens.

PubMed

Rizzo, Jon; Bell, Alexandra

2018-05-09

A mental model is the collection of an individual's perceptions, values, and expectations about a particular aspect of their life, which strongly influences behaviors. This study explored orthopedic outpatients mental models of adherence to prescribed home exercise programs and how they related to mental models of adherence to other types of personal regimens. The study followed an interpretive description qualitative design. Data were collected via two semi-structured interviews. Interview One focused on participants prior experiences adhering to personal regimens. Interview Two focused on experiences adhering to their current prescribed home exercise program. Data analysis followed a constant comparative method. Findings revealed similarity in perceptions, values, and expectations that informed individuals mental models of adherence to personal regimens and prescribed home exercise programs. Perceived realized results, expected results, perceived social supports, and value of convenience characterized mental models of adherence. Parallels between mental models of adherence for prescribed home exercise and other personal regimens suggest that patients adherence behavior to prescribed routines may be influenced by adherence experiences in other aspects of their lives. By gaining insight into patients adherence experiences, values, and expectations across life domains, clinicians may tailor supports that enhance home exercise adherence. Implications for Rehabilitation A mental model is the collection of an individual's perceptions, values, and expectations about a particular aspect of their life, which is based on prior experiences and strongly influences behaviors. This study demonstrated similarity in orthopedic outpatients mental models of adherence to prescribed home exercise programs and adherence to personal regimens in other aspects of their lives. Physical therapists should inquire about patients non-medical adherence experiences, as strategies patients customarily use to adhere to other activities may inform strategies to promote prescribed home exercise adherence.

Barriers to home-based exercise program adherence with chronic low back pain: Patient expectations regarding new technologies.

PubMed

Palazzo, Clémence; Klinger, Evelyne; Dorner, Véronique; Kadri, Abdelmajid; Thierry, Olivier; Boumenir, Yasmine; Martin, William; Poiraudeau, Serge; Ville, Isabelle

2016-04-01

To assess views of patients with chronic low back pain (cLBP) concerning barriers to home-based exercise program adherence and to record expectations regarding new technologies. Qualitative study based on semi-structured interviews. A heterogeneous sample of 29 patients who performed a home-based exercise program for cLBP learned during supervised physiotherapy sessions in a tertiary care hospital. Patients were interviewed at home by the same trained interviewer. Interviews combined a funnel-shaped structure and an itinerary method. Barriers to adherence related to the exercise program (number, effectiveness, complexity and burden of exercises), the healthcare journey (breakdown between supervised sessions and home exercise, lack of follow-up and difficulties in contacting care providers), patient representations (illness and exercise perception, despondency, depression and lack of motivation), and the environment (attitudes of others, difficulties in planning exercise practice). Adherence could be enhanced by increasing the attractiveness of exercise programs, improving patient performance (following a model or providing feedback), and the feeling of being supported by care providers and other patients. Regarding new technologies, relatively younger patients favored visual and dynamic support that provided an enjoyable and challenging environment and feedback on their performance. Relatively older patients favored the possibility of being guided when doing exercises. Whatever the tool proposed, patients expected its use to be learned during a supervised session and performance regularly checked by care providers; they expected adherence to be discussed with care providers. For patients with cLBP, adherence to home-based exercise programs could be facilitated by increasing the attractiveness of the programs, improving patient performance and favoring a feeling of being supported. New technologies meet these challenges and seem attractive to patients but are not a substitute for the human relationship between patients and care providers. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Adherence to and effectiveness of an individually tailored home-based exercise program for frail older adults, driven by mobility monitoring: design of a prospective cohort study.

PubMed

Geraedts, Hilde A E; Zijlstra, Wiebren; Zhang, Wei; Bulstra, Sjoerd; Stevens, Martin

2014-06-07

With the number of older adults in society rising, frailty becomes an increasingly prevalent health condition. Regular physical activity can prevent functional decline and reduce frailty symptoms. In particular, home-based exercise programs can be beneficial in reducing frailty of older adults and fall risk, and in improving associated physiological parameters. However, adherence to home-based exercise programs is generally low among older adults. Current developments in technology can assist in enlarging adherence to home-based exercise programs. This paper presents the rationale and design of a study evaluating the adherence to and effectiveness of an individually tailored, home-based physical activity program for frail older adults driven by mobility monitoring through a necklace-worn physical activity sensor and remote feedback using a tablet PC. Fifty transitionally frail community-dwelling older adults will join a 6-month home-based physical activity program in which exercises are provided in the form of exercise videos on a tablet PC and daily activity is monitored by means of a necklace-worn motion sensor. Participants exercise 5 times a week. Exercises are built up in levels and are individually tailored in consultation with a coach through weekly telephone contact. The physical activity program driven by mobility monitoring through a necklace-worn sensor and remote feedback using a tablet PC is an innovative method for physical activity stimulation in frail older adults. We hypothesize that, if participants are sufficiently adherent, the program will result in higher daily physical activity and higher strength and balance assessed by physical tests compared to baseline. If adherence to and effectiveness of the program is considered sufficient, the next step would be to evaluate the effectiveness with a randomised controlled trial. The knowledge gained in this study can be used to develop and fine-tune the application of innovative technology in home-based exercise programs. Nederlands Trial Register (NTR); trial number 4265. The study was prospectively registered (registration date 14/11/2013).

Parent and Child Perceptions of a Self-Regulated, Home-Based Exercise Program for Children with Cystic Fibrosis

PubMed Central

Happ, Mary Beth; Hoffman, Leslie A.; Higgins, Linda W.; DiVirgilio, Dana; Orenstein, David M.

2014-01-01

Background Despite recognized benefits, many children with cystic fibrosis (CF) do not consistently participate in physical activities. There is little empirical literature regarding the feelings and attitudes of children with CF toward exercise programs, parental roles in exercise, or factors influencing exercise experiences during research participation. Objectives To describe the exercise experiences of children with CF and their parents during participation in a six-month program of self-regulated, home-based exercise. Methods This qualitative descriptive study nested within a randomized controlled trial of a self-regulated, home-based exercise program used serial semi-structured interviews conducted individually at two and six months with 11 purposively selected children with CF and their parent(s). Results Six boys and five girls, ages 10–16, and parents (nine mothers, four fathers) participated in a total of 44 interviews. Five major thematic categories describing child and parent perceptions and experience of the bicycle exercise program were identified in the transcripts: (a) motivators; (b) barriers; (c) effort/work; (d) exercise routine; (e) sustaining exercise. Research participation, parent-family participation, health benefits, and the child’s personality traits were primary motivators. Competing activities, priorities and responsibilities were the major barriers to implementing the exercise program as prescribed. Motivation waned and the novelty wore off for several (approximately half) parent-child dyads, who planned to decrease or stop the exercise program after the study ended. Discussion We identified motivators and barriers to a self-regulated, home-based exercise program for children with CF that can be addressed in planning future exercise interventions to maximize the health benefits for children with CF and the feasibility and acceptability to the children and their families. PMID:23995464

Parent and child perceptions of a self-regulated, home-based exercise program for children with cystic fibrosis.

PubMed

Happ, Mary Beth; Hoffman, Leslie A; Higgins, Linda W; Divirgilio, Dana; DiVirgilio, Dana; Orenstein, David M

2013-01-01

Despite recognized benefits, many children with cystic fibrosis (CF) do not consistently participate in physical activities. There is little empirical literature regarding the feelings and attitudes of children with CF toward exercise programs, parental roles in exercise, or factors influencing exercise experiences during research participation. The aim of this study is to describe the exercise experiences of children with CF and their parents during participation in a 6-month program of self-regulated, home-based exercise. This qualitative descriptive study was nested within a randomized controlled trial of a self-regulated, home-based exercise program and used serial semistructured interviews conducted individually at 2 and 6 months with 11 purposively selected children with CF and their parent(s). Six boys and five girls, ages 10-16 years, and parents(nine mothers, four fathers) participated in a total of 44 interviews. Five major thematic categories describing child and parent perceptions and experience of the bicycle exercise program were identified in the transcripts: (a) motivators, (b) barriers, (c) effort/work, (d) exercise routine, and (e) sustaining exercise. Research participation, parent-family participation, health benefits, and the child's personality traits were the primary motivators. Competing activities, priorities, and responsibilities were the major barriers in implementing the exercise program as prescribed. Motivation waned, and the novelty wore off for several (approximately half) parent-child dyads, who planned to decrease or stop the exercise program after the study ended. We identified motivators and barriers to a self-regulated, home-based exercise program for children with CF that can be addressed in planning future exercise interventions to maximize the health benefits for children with CF and the feasibility and acceptability to the children and their families.

Increased self-efficacy: the experience of high-intensity exercise of nursing home residents with dementia - a qualitative study.

PubMed

Olsen, Cecilie Fromholt; Telenius, Elisabeth Wiken; Engedal, Knut; Bergland, Astrid

2015-09-14

There has been increasing interest in the use of non-pharmacological interventions, such as physical exercise, to improve the well-being of nursing home residents with dementia. For reasons regarding disease symptoms, persons with dementia might find it difficult to participate in exercise programs. Therefore, it is important to find ways to successfully promote regular exercise for patients in residential care. Several quantitative studies have established the positive effects of exercise on biopsychosocial factors, such as self-efficacy in older people; however, little is known regarding the qualitative aspects of participating in an exercise program among older people with dementia. From the perspective of residents, we explored the experiences of participating in a high-intensity functional exercise program among nursing home residents with dementia. The participants were eight elderly people with mild-to-moderate dementia. We conducted semi-structured interviews one week after they had finished a 10-week supervised high-intensity exercise program. We analyzed the data using an inductive content analysis. Five overreaching and interrelated themes emerged from the interviews: "Pushing the limits," "Being invested in," "Relationships facilitate exercise participation," "Exercise revives the body, increases independence and improves self-esteem" and "Physical activity is a basic human necessity--use it or lose it!" The results were interpreted in light of Bandura's self-efficacy theory. The exercise program seemed to improve self-efficacy through several mechanisms. By being involved, "being invested in" and having something expected of them, the participants gained a sense of empowerment in their everyday lives. The importance of social influences related to the exercise instructor and the exercise group was accentuated by the participants. The nursing home residents had, for the most part, positive experiences with regard to participating in the exercise program. The program seemed to increase their self-efficacy through several mechanisms. The instructor competence emerged as an important facilitating factor. The participants emphasized the importance of physical activity in the nursing home.

H-GRASP: the feasibility of an upper limb home exercise program monitored by phone for individuals post stroke

PubMed Central

Simpson, Lisa A.; Eng, Janice J.; Chan, May

2017-01-01

Abstract Purpose: To investigate the feasibility of a phone-monitored home exercise program for the upper limb following stroke. Methods: A pre-post double baseline repeated measures design was used. Participants completed an 8-week home exercise program that included behavioural strategies to promote greater use of the affected upper limb. Participants were monitored weekly by therapists over the phone. The following feasibility outcomes were collected: Process (e.g. recruitment rate); Resources (e.g. exercise adherence rate); Management (e.g. therapist monitoring) and Scientific (e.g. safety, effect sizes). Clinical outcomes included: The Chedoke Arm and Hand Inventory, Motor Activity Log, grip strength and the Canadian Occupational Performance Measure. Results: Eight individuals with stroke were recruited and six participants completed the exercise program. All but one of the six participants met the exercise target of 60 minutes/day, 6 days/week. Participants were stable across the baseline period. The following post-treatment effect sizes were observed: CAHAI (0.944, p = 0.046); MALQ (0.789, p = 0.03) grip strength (0.947, p = 0.046); COPM (0.789, p = 0.03). Improvements were maintained at three and six month follow ups. Conclusions: Community dwelling individuals with stroke may benefit from a phone-monitored upper limb home exercise program that includes behavioural strategies that promote transfer of exercise gains into daily upper limb use.Implications for RehabilitationA repetitive, task-oriented home exercise program that utilizes telephone supervision may be an effective method for the treatment of the upper limb following strokeThis program is best suited for individuals with mild to moderate level impairment and experience a sufficient level of challenge from the exercisesAn exercise program that includes behavioural strategies may promote transfer of exercise gains into greater use of the affected upper limb during daily activities PMID:27017890

The effects of therapeutic exercises on pain, muscle strength, functional capacity, balance and hemodynamic parameters in knee osteoarthritis patients: a randomized controlled study of supervised versus home exercises.

PubMed

Kuru Çolak, Tuğba; Kavlak, Bahar; Aydoğdu, Onur; Şahin, Emir; Acar, Gönül; Demirbüken, İlkşan; Sarı, Zübeyir; Çolak, İlker; Bulut, Güven; Polat, M Gülden

2017-03-01

The aim of the study was to compare the effects of low-intensity exercise programs for lower extremities, either supervised or at home, on pain, muscle strength, balance and the hemodynamic parameters of knee osteoarthritis (OA) patients. This randomized study included 78 patients with knee OA in 2 groups of supervised and home-based exercise program. Exercises were applied to the first group in the clinic as a group exercise program and were demonstrated to the second group to be performed at home. Before and after the 6-week exercise program, assessment was made of pain, quadriceps and hamstring muscle strengths, 6-min walk test (6MWT), and non-invasive hemodynamic parameters. Results of the 78 patients, 56 completed the study. Pain, muscle strength, and 6MWT scores showed significant improvements in both groups. There were also significant differences in the amount of change in pain and muscle strength (pain: p = 0.041, Rqdc: 0.009, Lqdc: 0.013, Rhms: 0.04) which indicated greater improvements in the supervised group. The balance scores of supervised group showed a significant improvement (p = 0.009). No significant change was determined in hemodynamic parameters of either group. Conclusion according to the results of this study showed that low-intensity lower extremity exercises conducted in a clinic under the supervision of a physiotherapist were more effective than home-based exercises in reducing post-activity pain levels and improving quadriceps and right hamstring muscle strength. Both the supervised and home exercise programs were seen to be effective in reducing rest pain and increasing 6 MW distance in knee osteoarthritis patients.

A home health care approach to exercise for persons with Alzheimer's disease.

PubMed

Logsdon, Rebecca G; McCurry, Susan M; Teri, Linda

2005-01-01

Regular exercise is a mainstay of preventive health care for individuals of all ages. Research with older adults has shown that exercise reduces risk of chronic illness, maintains mobility and function, enhances mood, and may even improve cognitive function. For individuals with dementia, exercise programs are particularly likely to improve health, mood, and quality of life; the challenge at this time is to make exercise accessible and enjoyable, demonstrate its benefits, and convince family caregivers of its worth for individuals with dementia. Home health providers are uniquely positioned to assist caregivers in developing and implementing a home exercise program for their care recipient with dementia. Results of a controlled critical trial conducted at the University of Washington have demonstrated the feasibility and efficacy of a home health exercise and problem solving intervention (Reducing Disability in Alzheimer's Disease, or RDAD) for decreasing physical, psychological, and behavioral disabilities associated with dementia. This article describes the RDAD program, discusses the role of home health providers in its delivery, and provides an example of its implementation.

A home-based exercise program for children with congenital heart disease following interventional cardiac catheterization: study protocol for a randomized controlled trial.

PubMed

Du, Qing; Salem, Yasser; Liu, Hao Howe; Zhou, Xuan; Chen, Sun; Chen, Nan; Yang, Xiaoyan; Liang, Juping; Sun, Kun

2017-01-23

Cardiac catheterization has opened an innovative treatment field for cardiac disease; this treatment is becoming the most popular approach for pediatric congenital heart disease (CHD) and has led to a significant growth in the number of children with cardiac catheterization. Unfortunately, based on evidence, it has been demonstrated that the majority of children with CHD are at an increased risk of "non-cardiac" problems. Effective exercise therapy could improve their functional status significantly. As studies identifying the efficacy of exercise therapy are rare in this field, the aims of this study are to (1) identify the efficacy of a home-based exercise program to improve the motor function of children with CHD with cardiac catheterization, (2) reduce parental anxiety and parenting burden, and (3) improve the quality of life for parents whose children are diagnosed with CHD with cardiac catheterization through the program. A total of 300 children who will perform a cardiac catheterization will be randomly assigned to two groups: a home-based intervention group and a control group. The home-based intervention group will carry out a home-based exercise program, and the control group will receive only home-based exercise education. Assessments will be undertaken before catheterization and at 1, 3, and 6 months after catheterization. Motor ability quotients will be assessed as the primary outcomes. The modified Ross score, cardiac function, speed of sound at the tibia, functional independence of the children, anxiety, quality of life, and caregiver burden of their parents or the main caregivers will be the secondary outcome measurements. The proposed prospective randomized controlled trial will evaluate the efficiency of a home-based exercise program for children with CHD with cardiac catheterization. We anticipate that the home-based exercise program may represent a valuable and efficient intervention for children with CHD and their families. http://www.chictr.org.cn/ on: ChiCTR-IOR-16007762 . Registered on 13 January 2016.

Can a Home-based Cardiac Physical Activity Program Improve the Physical Function Quality of Life in Children with Fontan Circulation?

PubMed

Jacobsen, Roni M; Ginde, Salil; Mussatto, Kathleen; Neubauer, Jennifer; Earing, Michael; Danduran, Michael

2016-01-01

Patients after Fontan operation for complex congenital heart disease (CHD) have decreased exercise capacity and report reduced health-related quality of life (HRQOL). Studies suggest hospital-based cardiac physical activity programs can improve HRQOL and exercise capacity in patients with CHD; however, these programs have variable adherence rates. The impact of a home-based cardiac physical activity program in Fontan survivors is unclear. This pilot study evaluated the safety, feasibility, and benefits of an innovative home-based physical activity program on HRQOL in Fontan patients. A total of 14 children, 8-12 years, with Fontan circulation enrolled in a 12-week moderate/high intensity home-based cardiac physical activity program, which included a home exercise routine and 3 formalized in-person exercise sessions at 0, 6, and 12 weeks. Subjects and parents completed validated questionnaires to assess HRQOL. The Shuttle Test Run was used to measure exercise capacity. A Fitbit Flex Activity Monitor was used to assess adherence to the home activity program. Of the 14 patients, 57% were male and 36% had a dominant left ventricle. Overall, 93% completed the program. There were no adverse events. Parents reported significant improvement in their child's overall HRQOL (P < .01), physical function (P < .01), school function (P = .01), and psychosocial function (P < .01). Patients reported no improvement in HRQOL. Exercise capacity, measured by total shuttles and exercise time in the Shuttle Test Run and calculated VO2 max, improved progressively from baseline to the 6 and 12 week follow up sessions. Monthly Fitbit data suggested adherence to the program. This 12-week home-based cardiac physical activity program is safe and feasible in preteen Fontan patients. Parent proxy-reported HRQOL and objective measures of exercise capacity significantly improved. A 6-month follow up session is scheduled to assess sustainability. A larger study is needed to determine the applicability and reproducibility of these findings in other age groups and forms of complex CHD. © 2016 Wiley Periodicals, Inc.

Benefits and costs of home-based pulmonary rehabilitation in chronic obstructive pulmonary disease - a multi-centre randomised controlled equivalence trial.

PubMed

Holland, Anne E; Mahal, Ajay; Hill, Catherine J; Lee, Annemarie L; Burge, Angela T; Moore, Rosemary; Nicolson, Caroline; O'Halloran, Paul; Cox, Narelle S; Lahham, Aroub; Ndongo, Rebecca; Bell, Emily; McDonald, Christine F

2013-09-08

Pulmonary rehabilitation is widely advocated for people with chronic obstructive pulmonary disease (COPD) to improve exercise capacity, symptoms and quality of life, however only a minority of individuals with COPD are able to participate. Travel and transport are frequently cited as barriers to uptake of centre-based programs. Other models of pulmonary rehabilitation, including home-based programs, have been proposed in order to improve access to this important treatment. Previous studies of home-based pulmonary rehabilitation in COPD have demonstrated improvement in exercise capacity and quality of life, but not all elements of the program were conducted in the home environment. It is uncertain whether a pulmonary rehabilitation program delivered in its entirety at home is cost effective and equally capable of producing benefits in exercise capacity, symptoms and quality of life as a hospital-based program. The aim of this study is to compare the costs and benefits of home-based and hospital-based pulmonary rehabilitation for people with COPD. This randomised, controlled, equivalence trial conducted at two centres will recruit 166 individuals with spirometrically confirmed COPD. Participants will be randomly allocated to hospital-based or home-based pulmonary rehabilitation. Hospital programs will follow the traditional outpatient model consisting of twice weekly supervised exercise training and education for eight weeks. Home-based programs will involve one home visit followed by seven weekly telephone calls, using a motivational interviewing approach to enhance exercise participation and facilitate self management. The primary outcome is change in 6-minute walk distance immediately following intervention. Measurements of exercise capacity, physical activity, symptoms and quality of life will be taken at baseline, immediately following the intervention and at 12 months, by a blinded assessor. Completion rates will be compared between programs. Direct healthcare costs and indirect (patient-related) costs will be measured to compare the cost-effectiveness of each program. This trial will identify whether home-based pulmonary rehabilitation can deliver equivalent benefits to centre-based pulmonary rehabilitation in a cost effective manner. The results of this study will contribute new knowledge regarding alternative models of pulmonary rehabilitation and will inform pulmonary rehabilitation guidelines for COPD.

Effects of home-based pulmonary rehabilitation with a metronome-guided walking pace in chronic obstructive pulmonary disease.

PubMed

Lee, Sung-soon; Kim, Changhwan; Jin, Young-Soo; Oh, Yeon-Mok; Lee, Sang-Do; Yang, Yun Jun; Park, Yong Bum

2013-05-01

Despite documented efficacy and recommendations, pulmonary rehabilitation (PR) in chronic obstructive pulmonary disease (COPD) has been underutilized. Home-based PR was proposed as an alternative, but there were limited data. The adequate exercise intensity was also a crucial issue. The aim of this study was to investigate the effects of home-based PR with a metronome-guided walking pace on functional exercise capacity and health-related quality of life (HRQOL) in COPD. The subjects participated in a 12-week home-based PR program. Exercise intensity was initially determined by cardiopulmonary exercise test, and was readjusted (the interval of metronome beeps was reset) according to submaximal endurance test. Six-minute walk test, pulmonary function test, cardiopulmonary exercise test, and St. George's Respiratory Questionnaire (SGRQ) were done before and after the 12-week program, and at 6 months after completion of rehabilitation. Thirty-three patients participated in the program. Six-minute walking distance was significantly increased (48.8 m; P = 0.017) and the SGRQ score was also improved (-15; P < 0.001) over the six-month follow-up period after rehabilitation. There were no significant differences in pulmonary function and peak exercise parameters. We developed an effective home-based PR program with a metronome-guided walking pace for COPD patients. This rehabilitation program may improve functional exercise capacity and HRQOL.

Evaluation of a home-based exercise program in the treatment of Alzheimer's disease: the Maximizing Independence in Dementia (MIND) study.

PubMed

Steinberg, Martin; Leoutsakos, Jeannie-Marie Sheppard; Podewils, Laura Jean; Lyketsos, C G

2009-07-01

To determine the feasibility and efficacy of a home-based exercise intervention program to improve the functional performance of patients with Alzheimer's Disease (AD). Twenty-seven home-dwelling patients with AD were randomized to either an exercise intervention program delivered by their caregivers or a home safety assessment control. Measures of functional performance (primary), cognition, neuropsychiatric symptoms, quality of life and caregiver burden (secondary) were obtained at baseline and at 6 and 12 weeks following randomization. For each outcome measure, intent-to-treat analyses using linear random effects models were performed. Feasibility and adverse events were also assessed. Adherence to the exercise program was good. On the primary outcomes (functional performance) patients in the exercise group demonstrated a trend for improved performance on measures of hand function and lower extremity strength. On secondary outcome measures, trends toward worse depression and lower quality of life ratings were noted. The physical exercise intervention developed for the study, delivered by caregivers to home-dwelling patients with AD, was feasible and was associated with a trend for improved functional performance in this group of frail patients. Given the limited efficacy to date of pharmacotherapies for AD, further study of exercise intervention, in a variety of care setting, is warranted.

The effectiveness of the use of a digital activity coaching system in addition to a two-week home-based exercise program in patients after total knee arthroplasty: study protocol for a randomized controlled trial.

PubMed

Harmelink, Karen E M; Zeegers, A V C M; Tönis, Thijs M; Hullegie, Wim; Nijhuis-van der Sanden, Maria W G; Staal, J Bart

2017-07-05

There is consistent evidence that supervised programs are not superior to home-based programs after total knee arthroplasty (TKA), especially in patients without complications. Home-based exercise programs are effective, but we hypothesize that their effectiveness can be improved by increasing the adherence to physical therapy advice to reach an adequate exercise level during the program and thereafter. Our hypothesis is that an activity coaching system (accelerometer-based activity sensor), alongside a home-based exercise program, will increase adherence to exercises and the activity level, thereby improving physical functioning and recovery. The objective of this study is to determine the effectiveness of an activity coaching system in addition to a home-based exercise program after a TKA compared to only the home-based exercise program with physical functioning as outcome. This study is a single-blind randomized controlled trial. Both the intervention (n = 55) and the control group (n = 55) receive a two-week home-based exercise program, and the intervention group receives an additional activity coaching system. This is a hand-held electronic device together with an app on a smartphone providing information and advice on exercise behavior during the day. The primary outcome is physical functioning, measured with the Timed Up and Go test (TUG) after two weeks, six weeks and three months. Secondary outcomes are 1) adherence to the activity level (activity diary); 2) physical functioning, measured with the 2-Minute Walk Test (2MWT) and the Knee Osteoarthritis Outcome Score; 3) quality of life (SF-36); 4) healthcare use up to one year postoperatively and 5) cost-effectiveness. Data are collected preoperatively, three days, two and six weeks, three months and one year postoperatively. The strengths of the study are the use of both performance-based tests and self-reported questionnaires and the personalized tailored program after TKA given by specialized physical therapists. Its weakness is the lack of blinding of the participants to treatment allocation. Outcomes are generalizable to uncomplicated patients as defined in the inclusion criteria. The trial is registered in the Dutch Trial Register ( www.trialregister.nl , NTR 5109) (March 22, 2015).

The home stroke rehabilitation and monitoring system trial: a randomized controlled trial.

PubMed

Linder, Susan M; Rosenfeldt, Anson B; Reiss, Aimee; Buchanan, Sharon; Sahu, Komal; Bay, Curtis R; Wolf, Steven L; Alberts, Jay L

2013-01-01

Because many individuals poststroke lack access to the quality and intensity of rehabilitation to improve upper extremity motor function, a home-based robotic-assisted upper extremity rehabilitation device is being paired with an individualized home exercise program. The primary aim of this project is to determine the effectiveness of robotic-assisted home therapy compared with a home exercise program on upper extremity motor recovery and health-related quality of life for stroke survivors in rural and underserved locations. The secondary aim is to explore whether initial degree of motor function of the upper limb may be a factor in predicting the extent to which patients with stroke may be responsive to a home therapy approach. We hypothesize that the home exercise program intervention, when enhanced with robotic-assisted therapy, will result in significantly better outcomes in motor function and quality of life. A total of 96 participants within six-months of a single, unilateral ischemic, or hemorrhagic stroke will be recruited in this prospective, single-blind, multisite randomized clinical trial. The primary outcome is the change in upper extremity function using the Action Research Arm Test. Secondary outcomes include changes in: upper extremity function (Wolf Motor Function Test), upper extremity impairment (upper extremity portion of the Fugl-Meyer Test), self-reported quality of life (Stroke Impact Scale), and affect (Centers for Epidemiologic Studies Depression Scale). Similar or greater improvements in upper extremity function using the combined robotic home exercise program intervention compared with home exercise program alone will be interpreted as evidence that supports the introduction of in-home technology to augment the recovery of function poststroke. © 2012 The Authors. International Journal of Stroke © 2012 World Stroke Organization.

Gym-based exercise was more costly compared with home-based exercise with telephone support when used as maintenance programs for adults with chronic health conditions: cost-effectiveness analysis of a randomised trial.

PubMed

Jansons, Paul; Robins, Lauren; O'Brien, Lisa; Haines, Terry

2018-01-01

What is the comparative cost-effectiveness of a gym-based maintenance exercise program versus a home-based maintenance program with telephone support for adults with chronic health conditions who have previously completed a short-term, supervised group exercise program? A randomised, controlled trial with blinded outcome assessment at baseline and at 3, 6, 9 and 12 months. The economic evaluation took the form of a trial-based, comparative, incremental cost-utility analysis undertaken from a societal perspective with a 12-month time horizon. People with chronic health conditions who had completed a 6-week exercise program at a community health service. One group of participants received a gym-based exercise program and health coaching for 12 months. The other group received a home-based exercise program and health coaching for 12 months with telephone follow-up for the first 10 weeks. Healthcare costs were collected from government databases and participant self-report, productivity costs from self-report, and health utility was measured using the European Quality of Life Instrument (EQ-5D-3L). Of the 105 participants included in this trial, 100 provided sufficient cost and utility measurements to enable inclusion in the economic analyses. Gym-based follow-up would cost an additional AUD491,572 from a societal perspective to gain 1 quality-adjusted life year or 1year gained in perfect health compared with the home-based approach. There was considerable uncertainty in this finding, in that there was a 37% probability that the home-based approach was both less costly and more effective than the gym-based approach. The gym-based approach was more costly than the home-based maintenance intervention with telephone support. The uncertainty of these findings suggests that if either intervention is already established in a community setting, then the other intervention is unlikely to replace it efficiently. ACTRN12610001035011. [Jansons P, Robins L, O'Brien L, Haines T (2018) Gym-based exercise was more costly compared with home-based exercise with telephone support when used as maintenance programs for adults with chronic health conditions: cost-effectiveness analysis of a randomised trial. Journal of Physiotherapy 64: 48-54]. Crown Copyright © 2017. Published by Elsevier B.V. All rights reserved.

User Experience, Actual Use, and Effectiveness of an Information Communication Technology-Supported Home Exercise Program for Pre-Frail Older Adults.

PubMed

Dekker-van Weering, Marit; Jansen-Kosterink, Stephanie; Frazer, Sanne; Vollenbroek-Hutten, Miriam

2017-01-01

The main objective of this study was to investigate the use and user experience of an Information Communication Technology-supported home exercise program when offered for independent use to pre-frail older adults. Our secondary aim was to explore whether the program improved quality of life and health status compared to a control group. A cohort multiple randomized controlled trail is being performed. Physically pre-frail older adults (65-75 years) living independently at home were included and randomly assigned to a control group or an intervention group. The intervention group received a home exercise program (strength, balance, and flexibility exercises) for a minimal duration of 12 weeks. The control group received usual care. Primary outcomes were: use of the intervention (frequency and duration), adherence to a 3-day exercise protocol and user experience [System Usability Scale (SUS); rating 1-10]. Secondary outcomes were quality of life measured with the SF12 (Physical Component Scale and Mental Component Scale) and health status (EQ-5D), assessed before the study starts and after 12 weeks of exercising. Thirty-seven independently living older adults participated in the study. Sixteen participants were allocated to the intervention group and 21 to the control group. The average score on the SUS was 84.2 (±13.3), almost reaching an excellent score. Participants rated the intervention with an 8.5. Eighty percent of the participants finished the 12 week exercise protocol. The adherence to the 3-day exercise protocol was 68%. Participants in the intervention group trained on average 2.2 times (±1.3) each week. The mean duration of login for each exercise session was 24 min. The Mental Component Scale of the SF12 was significantly higher in the intervention group compared to the control group. A trend was seen in the change over time in the health status between groups. This study provides evidence that a home-based exercise program is easy to use and has potential in improving quality of life and health status of pre-frail older adults who live at home. However, further refinement of the program is required to improve adherence and maximize the benefits and potential of exercising in the home environment. Unique Identifier: NTR5304. URL: http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=5304.

Effects of a Combined Exercise Program Using an iPad for Older Adults

PubMed Central

Lee, Juhee; Byun, Jinyee; Lee, Minkyung

2016-01-01

Objectives The purpose of this study was to examine the function, health status, and efficacy effects of a combined exercise program using an iPad among older women in Korea, a tech-savvy country. Methods The study employed a pretest and posttest experimental design with a control group. The experimental group of subjects comprised 16 female older adults and the control group comprised 10 who were aged 65 years or older. The experimental group participated in a supervised group-based exercise program and an individualized home-based exercise program that involved the use of an iPad. The combined group and home-based exercise program consisted of group exercise, which took place in a senior center for 30 minutes weekly, and a home-based iPad exercise program, which the subjects followed at least 3 times a week. The collected data were analyzed using the Statistical Analysis System (SAS ver. 9.3 TS Level 1M0) program, which utilized a chi-square test, a Fisher exact test, a t-test, and a repeated-measures ANOVA. Results The results showed that cognitive status changed significantly over time, and there was an interaction between group and time. Further, self-efficacy for exercise and outcome expectations for exercise changed significantly over time. Conclusions Exercise programs using iPad interventions may be useful for the management of cognitive functioning and the integration of functional physical abilities in older adults. PMID:27200215

A prospective pilot study to evaluate an animated home-based physical exercise program as a treatment option for patients with rheumatoid arthritis.

PubMed

Zernicke, Jan; Kedor, Claudia; Müller, Angela; Burmester, Gerd-Rüdiger; Reißhauer, Anett; Feist, Eugen

2016-08-18

Physical exercises and physiotherapy are of great importance for maintenance of joint function in patients with rheumatoid arthritis (RA). However, many RA patients complain about problems to receive prescriptions or have a lack of access to physiotherapy. Recent reports have shown positive effects of the Wii game console on physical and psychosocial conditions of patients with other underlying diseases. The primary objectives of this prospective controlled pilot study were to investigate feasibility and patients' assessment using an animated home-based exercise program. This pilot study was conducted as a single-center, cross-over trial with two treatment arms over 24 weeks. Eligibility criteria included patients with RA reaching low disease activity under therapy with a biological disease modifying anti-rheumatic drug (bDMARD). After detailed instruction, 15 patients started with a conventional home-based physical exercise program and 15 patients began with a predefined animated exercise program by using the Wii game console for 12 weeks. Afterwards, patients were crossed-over to the other treatment arm for another period of 12 weeks. Multi-methodical assessments were performed by qualitative analysis of the interview-data as well as statistical analysis of functional tests and patient reported outcomes (PRO's). Evaluation of the interviews indicated feasibility and usefulness of the chosen animated home-based exercise program. Forefoot disabilities were identified as a main limiting factor for performing some of the animated exercises. After 12 weeks, both treatment arms showed improvement of functional tests without significant differences between groups: Overall muscle strength improved for a mean value of 10 Newton (+12 %) and the mean 6-min walk test (6-MWT) distance increased for 28 meters (+5 %). This study showed that an animated home-based exercise program by using a Wii game console was feasible and beneficial for RA patients. Compared to standard physical home exercises, similar effects were observed indicating that such an animated program might be an alternative supportive option for RA patients. ClinicalTrials.gov ID: NCT02658370 (19-Jan-2016).

A physical exercise program using music-supported video-based training in older adults in nursing homes suffering from dementia: a feasibility study.

PubMed

Spildooren, Joke; Speetjens, Ite; Abrahams, Johan; Feys, Peter; Timmermans, Annick

2018-04-28

Motivation towards an exercise program is higher in a small group setting in comparison to individual therapy. Due to attentional problems, group exercises are difficult for people with Alzheimer disease (AD). This study evaluates the feasibility of a music-supported video-based group exercise program in older adults suffering from AD. Five participants with moderate AD were recruited from a nursing home. A progressive physical exercise program using a video-based training with musical accompaniment was performed and digitally recorded to investigate the adherence and performed accuracy of the exercises. The overall participation during the exercises was 84.1%. The quality of the performance was for all exercises above the cut-off scores. A music-supported video-based group exercise program is feasible in persons with AD. The participants were motivated and the expectations towards the program increased over time. Music seemed an important factor for attention in participants with AD.

Older persons' experiences of a home-based exercise program with behavioral change support.

PubMed

Arkkukangas, Marina; Sundler, Annelie J; Söderlund, Anne; Eriksson, Staffan; Johansson, Ann-Christin

2017-12-01

It is a challenge to promote exercise among older persons. Knowledge is needed regarding the maintenance of exercise aiming at preventing falls and promoting health and well-being in older persons. This descriptive study used a qualitative inductive approach to describe older persons' experiences of a fall-preventive, home-based exercise program with support for behavioral change. Semi-structured interviews were conducted with 12 elderly persons aged 75 years or older, and a qualitative content analysis was performed. Four categories emerged: facilitators of performing exercise in everyday life, the importance of support, perceived gains from exercise, and the existential aspects of exercise. With support from physiotherapists (PTs), home-based exercise can be adapted to individual circumstances in a meaningful way. Including exercises in everyday life and daily routines could support the experience of being stronger, result in better physical functioning, and give hope for an extended active life in old age.

Effect of the 6-week home-based exercise program on physical activity level and physical fitness in colorectal cancer survivors: A randomized controlled pilot study.

PubMed

Lee, Mi Kyung; Kim, Nam Kyu; Jeon, Justin Y

2018-01-01

Despite improvement in prognosis of colorectal cancer, colorectal cancer survivors often suffer from adverse effects of cancer treatment, including reduced health-related fitness level. Therefore, this study aimed to examine the feasibility and efficacy of the 6-week home-based exercise program on the level of physical activity and physical fitness in stage II to III colorectal cancer survivors. Seventy-two stage II to III colorectal cancer survivors were randomly assigned to either a home-based exercise (n = 38) or usual care (n = 34) group for 6 weeks. The goal of the home-based exercise program was to increase the level of exercise to 18 metabolic equivalent task hours per week. The primary and the secondary outcomes of this study were physical activity level and physical fitness, respectively. A total of 57 participants (79.2%) completed the trial. Intention-to-treat analysis indicated that moderate physical activity level increased significantly by 269.4 ± 260.6 minutes per week in the exercise group (mean between-group difference, 254.6 minutes; 95% confidence interval, 172.7-434.7; p < 0.001). Physical fitness measured by using the step test (-3.9 vs. 2.6, p = 0.012) and push-up test (3.0 vs. -1.2, p = 0.012) also improved significantly in the exercise group compared to the control group. The 6-week home-based mixed aerobic and resistance exercise program was feasible and effective for increasing physical activity level and physical fitness in stage II to III colorectal cancer survivors.

Benefits of home-based rocking-chair exercise for physical performance in community-dwelling elderly women: a randomized controlled trial.

PubMed

Niemelä, Kristiina; Väänänen, Ilkka; Leinonen, Raija; Laukkanen, Pia

2011-08-01

Home-based exercise is a viable alternative for older adults with difficulties in exercise opportunities outside the home. The aim of this study was to investigate the benefits of home-based rocking-chair training, and its effects on the physical performance of elderly women. Community- dwelling women (n=51) aged 73-87 years were randomly assigned to the rocking-chair group (RCG, n=26) or control group (CG, n=25) by drawing lots. Baseline and outcome measurements were hand grip strength, maximal isometric knee extension, maximal walking speed over 10 meters, rising from a chair five times, and the Berg Balance Scale (BBS). The RCG carried out a six-week rocking-chair training program at home, involving ten sessions per week, twice a day for 15 minutes per session, and ten different movements. The CG continued their usual daily lives. After three months, the RCG responded to a mail questionnaire. After the intervention, the RCG improved and the CG declined. The data showed significant interactions of group by time in the BBS score (p=0.001), maximal knee extension strength (p=0.006) and maximal walking speed (p=0.046), which indicates that the change between groups during the follow-up period was significant. Adherence to the training protocol was high (96%). After three months, the exercise program had become a regular home exercise habit for 88.5% of the subjects. Results indicate that home-based elderly women benefit from this easily implemented rocking-chair exercise program. The subjects became motivated to participate in training and continued the exercises. This is a promising alternative exercise method for maintaining physical activity and leads to improvements in physical performance.

A comparison of home-based exercise programs with and without self-manual therapy in individuals with knee osteoarthritis in community.

PubMed

Cheawthamai, Kornkamon; Vongsirinavarat, Mantana; Hiengkaew, Vimonwan; Saengrueangrob, Sasithorn

2014-07-01

The present study aimed to compare the effectiveness of the treatment programs of home-based exercise with and without self-manual therapy in individuals with knee osteoarthritis (knee OA) in community. Forty-three participants with knee OA were randomly assigned in groups. All participants received the same home-based exercise program with or without self-manual therapy over 12 weeks. Outcome measures were pain intensity, range of motions, six-minute walk test distance, the knee injury and osteoarthritis outcome score (KOOS), short-form 36 (SF-36) and satisfaction. The results showed that the self-manual therapy program significantly decreased pain at 4 weeks, increased flexion and extension at 4 and 12 weeks, and improved the KOOS in pain item and SF-36 in physical function and mental health items. The home-based exercise group showed significant increase of the six-minute walk distance at 4 and 12 weeks, improvements in the KOOS in pain and symptom items and SF-36 in the physical function and role-emotional items. Overall, the results favored a combination of self-manual therapy and home-based exercise for patients with knee OA, which apparently showed superior benefits in decreasing pain and improving active knee range of motions.

'Physical activity at home (PAAH)', evaluation of a group versus home based physical activity program in community dwelling middle aged adults: rationale and study design.

PubMed

Freene, Nicole; Waddington, Gordon; Chesworth, Wendy; Davey, Rachel; Goss, John

2011-11-24

It is well recognised that the adoption and longer term adherence to physical activity by adults to reduce the risk of chronic disease is a challenge. Interventions, such as group and home based physical activity programs, have been widely reported upon. However few studies have directly compared these interventions over the longer term to determine their adherence and effectiveness. Participant preference for home based or group interventions is important. Some evidence suggests that home based physical activity programs are preferred by middle aged adults and provide better long term physical activity adherence. Physiotherapists may also be useful in increasing physical activity adherence, with limited research on their impact. 'Physical Activity at Home' is a 2 year pragmatic randomised control trial, with a non-randomised comparison to group exercise. Middle-aged adults not interested in, or unable to attend, a group exercise program will be targeted. Sedentary community dwelling 50-65 year olds with no serious medical conditions or functional impairments will be recruited via two mail outs using the Australian federal electoral roll. The first mail out will invite participants to a 6 month community group exercise program. The second mail out will be sent to those not interested in the group exercise program inviting them to take part in a home based intervention. Eligible home based participants will be randomised into a 6 month physiotherapy-led home based physical activity program or usual care. Outcome measures will be taken at baseline, 6, 12, 18 and 24 months. The primary outcome is physical activity adherence via exercise diaries. Secondary outcomes include the Active Australia Survey, accelerometry, aerobic capacity (step test), quality of life (SF-12v2), blood pressure, waist circumference, waist-to-hip ratio and body mass index. Costs will be recorded prospectively and qualitative data will be collected. The planned 18 month follow-up post intervention will provide an indication of the effectiveness of the group and home based interventions in terms of adherence to physical activity, health benefits and cost. If the physiotherapy-led home based physical activity program is successful it could provide an alternative option for physical activity program delivery across a number of settings. Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12611000890932.

Design and development of a mobile exercise application for home care aides and older adult medicaid home and community-based clients.

PubMed

Danilovich, Margaret K; Diaz, Laura; Saberbein, Gustavo; Healey, William E; Huber, Gail; Corcos, Daniel M

2017-01-01

We describe a community-engaged approach with Medicaid home and community-based services (HCBS), home care aide (HCA), client, and physical therapist stakeholders to develop a mobile application (app) exercise intervention through focus groups and interviews. Participants desired a short exercise program with modification capabilities, goal setting, and mechanisms to track progress. Concerns regarding participation were training needs and feasibility within usual care services. Technological preferences were for simple, easy-to-use, and engaging content. The app was piloted with HCA-client dyads (n = 5) to refine the intervention and evaluate content. Engaging stakeholders in intervention development provides valuable user-feedback on both desired exercise program contents and mobile technology preferences for HCBS recipients.

Feasibility study design and methods for a home-based, square-stepping exercise program among older adults with multiple sclerosis: The SSE-MS project.

PubMed

Sebastião, Emerson; McAuley, Edward; Shigematsu, Ryosuke; Motl, Robert W

2017-09-01

We propose a randomized controlled trial (RCT) examining the feasibility of square-stepping exercise (SSE) delivered as a home-based program for older adults with multiple sclerosis (MS). We will assess feasibility in the four domains of process, resources, management and scientific outcomes. The trial will recruit older adults (aged 60 years and older) with mild-to-moderate MS-related disability who will be randomized into intervention or attention control conditions. Participants will complete assessments before and after completion of the conditions delivered over a 12-week period. Participants in the intervention group will have biweekly meetings with an exercise trainer in the Exercise Neuroscience Research Laboratory and receive verbal and visual instruction on step patterns for the SSE program. Participants will receive a mat for home-based practice of the step patterns, an instruction manual, and a logbook and pedometer for monitoring compliance. Compliance will be further monitored through weekly scheduled Skype calls. This feasibility study will inform future phase II and III RCTs that determine the actual efficacy and effectiveness of a home-based exercise program for older adults with MS.

Range of Motion and Plantar Pressure Evaluation for the Effects of Self-Care Foot Exercises on Diabetic Patients with and Without Neuropathy.

PubMed

Cerrahoglu, Lale; Koşan, Umut; Sirin, Tuba Cerrahoglu; Ulusoy, Aslihan

2016-05-01

We aimed to investigate whether a home exercise for self-care program that consists of range of motion (ROM), stretching, and strengthening exercises could improve ROM for foot joints and plantar pressure distribution during walking in diabetic patients to prevent diabetic foot complications. Seventy-six diabetic patients were recruited (38 with neuropathy and 38 without neuropathy). Neuropathy and nonneuropathy groups were randomly divided into a home exercise group (n = 19) and a control group (n = 19). Exercise groups performed their own respective training programs for 4 weeks, whereas no training was done in the control group. Total contact area and plantar pressure under six foot areas before and after the exercise program were measured. Ankle and first metatarsophalangeal joint ROM were measured before and after the exercise program. In the exercise group, there were significant improvements in ROM for the ankle and first metatarsophalangeal joints (P < .001); static pedobarographic values showed significant reduction in right forefoot-medial pressure (P = .010); and significant decreases were seen in dynamic pedobarographic values of peak plantar pressure at the left forefoot medial (P = .007), right forefoot lateral (P = .018), left midfoot (P < .001), and right hindfoot (P = .021) after exercise. No significant positive or negative correlation was found between the neuropathy and nonneuropathy groups (P > .05). A home exercise program could be an effective preventive method for improving ROM for foot joints and plantar pressure distribution in diabetic patients independent of the presence of neuropathy.

Flexibility and Strength Measures in Children Participating in a Cardiac Rehabilitation Exercise Program.

ERIC Educational Resources Information Center

Koch, Barbara M.; And Others

1988-01-01

A 12-week structured rehabilitation program featuring warm-up exercises, increased aerobic exercise, cool down, and home-based continuation of exercise helped 12 children with surgically corrected congenital heart disease improve lower extremity strength and flexibility. (Author/CB)

Exercise training for intermittent claudication.

PubMed

McDermott, Mary M

2017-11-01

The objective of this study was to provide an overview of evidence regarding exercise therapies for patients with lower extremity peripheral artery disease (PAD). This manuscript summarizes the content of a lecture delivered as part of the 2016 Crawford Critical Issues Symposium. Multiple randomized clinical trials demonstrate that supervised treadmill exercise significantly improves treadmill walking performance in people with PAD and intermittent claudication symptoms. A meta-analysis of 25 randomized trials demonstrated a 180-meter increase in treadmill walking distance in response to supervised exercise interventions compared with a nonexercising control group. Supervised treadmill exercise has been inaccessible to many patients with PAD because of lack of medical insurance coverage. However, in 2017, the Centers for Medicare and Medicaid Services issued a decision memorandum to support health insurance coverage of 12 weeks of supervised treadmill exercise for patients with walking impairment due to PAD. Recent evidence also supports home-based walking exercise to improve walking performance in people with PAD. Effective home-exercise programs incorporate behavioral change interventions such as a remote coach, goal setting, and self-monitoring. Supervised treadmill exercise programs preferentially improve treadmill walking performance, whereas home-based walking exercise programs preferentially improve corridor walking, such as the 6-minute walk test. Clinical trial evidence also supports arm or leg ergometry exercise to improve walking endurance in people with PAD. Treadmill walking exercise appears superior to resistance training alone for improving walking endurance. Supervised treadmill exercise significantly improves treadmill walking performance in people with PAD by approximately 180 meters compared with no exercise. Recent evidence suggests that home-based exercise is also effective and preferentially improves over-ground walking performance, such as the 6-minute walk test. Copyright © 2017 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

Physiotherapy interventions for ankylosing spondylitis.

PubMed

Dagfinrud, H; Kvien, T K; Hagen, K B

2008-01-23

Ankylosing spondylitis (AS) is a chronic, inflammatory rheumatic disease. Physiotherapy is considered an important part of the overall management of AS. To summarise the available scientific evidence on the effectiveness of physiotherapy interventions in the management of AS. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, AMED, CINAHL and PEDro up to January 2007 for all relevant publications, without any language restrictions. We checked the reference lists of relevant articles and contacted the authors of included articles. We included randomised and quasi-randomised studies with AS patients and where at least one of the comparison groups received physiotherapy. The main outcomes of interest were pain, stiffness, spinal mobility, physical function and patient global assessment. Two reviewers independently selected trials for inclusion, extracted data and assessed trial quality. Investigators were contacted to obtain missing information. Eleven trials with a total of 763 participants were included in this updated review. Four trials compared individualised home exercise programs or a supervised exercise program with no intervention and reported low quality evidence for effects in spinal mobility (Relative percentage differences (RPDs) from 5-50%) and physical function (four points on a 33-point scale). Three trials compared supervised group physiotherapy with an individualised home-exercise program and reported moderate quality evidence for small differences in spinal mobility (RPDs 7.5-18%) and patient global assessment (1.46 cm) in favour of supervised group exercises. In one study, a three-week inpatient spa-exercise therapy followed by 37 weeks of weekly outpatient group physiotherapy (without spa) was compared with weekly outpatient group physiotherapy alone; there was moderate quality evidence for effects in pain (18%), physical function (24%) and patient global assessment (27%) in favour of the combined spa-exercise therapy. One study compared daily outpatient balneotherapy and an exercise program with only exercise program, and another study compared balneotherapy with fresh water therapy. None of these studies showed significant between-group differences. One study compared an experimental exercise program with a conventional program; statistically significant change scores were reported on nearly all spinal mobility measures and physical function in favour of the experimental program. The results of this review suggest that an individual home-based or supervised exercise program is better than no intervention; that supervised group physiotherapy is better than home exercises; and that combined inpatient spa-exercise therapy followed by group physiotherapy is better than group physiotherapy alone.

Experiences of older people with dementia participating in a high-intensity functional exercise program in nursing homes: "While it's tough, it's useful"

PubMed Central

Lundin-Olsson, Lillemor; Skelton, Dawn A.; Lundman, Berit; Rosendahl, Erik

2017-01-01

The objective of the study was to describe the views and experiences of participation in a high-intensity functional exercise (HIFE) program among older people with dementia in nursing homes. The study design was a qualitative interview study with 21 participants (15 women), aged 74–96, and with a Mini-Mental State Examination score of 10–23 at study start. The HIFE-program comprises exercises performed in functional weight-bearing positions and including movements used in everyday tasks. The exercise was individually designed, supervised in small groups in the nursing homes and performed during four months. Interviews were performed directly after exercise sessions and field notes about the sessions were recorded. Qualitative content analysis was used for analyses. The analysis revealed four themes: Exercise is challenging but achievable; Exercise gives pleasure and strength; Exercise evokes body memories; and Togetherness gives comfort, joy, and encouragement. The intense and tailored exercise, adapted to each participant, was perceived as challenging but achievable, and gave pleasure and improvements in mental and bodily strength. Memories of previous physical activities aroused and participants rediscovered bodily capabilities. Importance of individualized and supervised exercise in small groups was emphasized and created feelings of encouragement, safety, and coherence. The findings from the interviews reinforces the positive meaning of intense exercise to older people with moderate to severe dementia in nursing homes. The participants were able to safely adhere to and understand the necessity of the exercise. Providers of exercise should consider the aspects valued by participants, e.g. supervision, individualization, small groups, encouragement, and that exercise involved joy and rediscovery of body competencies. PMID:29149198

Experiences of older people with dementia participating in a high-intensity functional exercise program in nursing homes: "While it's tough, it's useful".

PubMed

Lindelöf, Nina; Lundin-Olsson, Lillemor; Skelton, Dawn A; Lundman, Berit; Rosendahl, Erik

2017-01-01

The objective of the study was to describe the views and experiences of participation in a high-intensity functional exercise (HIFE) program among older people with dementia in nursing homes. The study design was a qualitative interview study with 21 participants (15 women), aged 74-96, and with a Mini-Mental State Examination score of 10-23 at study start. The HIFE-program comprises exercises performed in functional weight-bearing positions and including movements used in everyday tasks. The exercise was individually designed, supervised in small groups in the nursing homes and performed during four months. Interviews were performed directly after exercise sessions and field notes about the sessions were recorded. Qualitative content analysis was used for analyses. The analysis revealed four themes: Exercise is challenging but achievable; Exercise gives pleasure and strength; Exercise evokes body memories; and Togetherness gives comfort, joy, and encouragement. The intense and tailored exercise, adapted to each participant, was perceived as challenging but achievable, and gave pleasure and improvements in mental and bodily strength. Memories of previous physical activities aroused and participants rediscovered bodily capabilities. Importance of individualized and supervised exercise in small groups was emphasized and created feelings of encouragement, safety, and coherence. The findings from the interviews reinforces the positive meaning of intense exercise to older people with moderate to severe dementia in nursing homes. The participants were able to safely adhere to and understand the necessity of the exercise. Providers of exercise should consider the aspects valued by participants, e.g. supervision, individualization, small groups, encouragement, and that exercise involved joy and rediscovery of body competencies.

Physiotherapy rehabilitation after total knee or hip replacement: an evidence-based analysis.

PubMed

2005-01-01

The objective of this health technology policy analysis was to determine, where, how, and when physiotherapy services are best delivered to optimize functional outcomes for patients after they undergo primary (first-time) total hip replacement or total knee replacement, and to determine the Ontario-specific economic impact of the best delivery strategy. The objectives of the systematic review were as follows: To determine the effectiveness of inpatient physiotherapy after discharge from an acute care hospital compared with outpatient physiotherapy delivered in either a clinic-based or home-based setting for primary total joint replacement patientsTo determine the effectiveness of outpatient physiotherapy delivered by a physiotherapist in either a clinic-based or home-based setting in addition to a home exercise program compared with a home exercise program alone for primary total joint replacement patientsTo determine the effectiveness of preoperative exercise for people who are scheduled to receive primary total knee or hip replacement surgery Total hip replacements and total knee replacements are among the most commonly performed surgical procedures in Ontario. Physiotherapy rehabilitation after first-time total hip or knee replacement surgery is accepted as the standard and essential treatment. The aim is to maximize a person's functionality and independence and minimize complications such as hip dislocation (for hip replacements), wound infection, deep vein thrombosis, and pulmonary embolism. THE THERAPY: The physiotherapy rehabilitation routine has 4 components: therapeutic exercise, transfer training, gait training, and instruction in the activities of daily living. Physiotherapy rehabilitation for people who have had total joint replacement surgery varies in where, how, and when it is delivered. In Ontario, after discharge from an acute care hospital, people who have had a primary total knee or hip replacement may receive inpatient or outpatient physiotherapy. Inpatient physiotherapy is delivered in a rehabilitation hospital or specialized hospital unit. Outpatient physiotherapy is done either in an outpatient clinic (clinic-based) or in the person's home (home-based). Home-based physiotherapy may include practising an exercise program at home with or without supplemental support from a physiotherapist. Finally, physiotherapy rehabilitation may be administered at several points after surgery, including immediately postoperatively (within the first 5 days) and in the early recovery period (within the first 3 months) after discharge. There is a growing interest in whether physiotherapy should start before surgery. A variety of practises exist, and evidence regarding the optimal pre- and post-acute course of rehabilitation to obtain the best outcomes is needed. The Medical Advisory Secretariat used its standard search strategy, which included searching the databases of Ovid MEDLINE, CINHAL, EMBASE, Cochrane Database of Systematic Reviews, and PEDro from 1995 to 2005. English-language articles including systematic reviews, randomized controlled trials (RCTs), non-RCTs, and studies with a sample size of greater than 10 patients were included. Studies had to include patients undergoing primary total hip or total knee replacement, aged 18 years of age or older, and they had to have investigated one of the following comparisons: inpatient rehabilitation versus outpatient (clinic- or home-based therapy) rehabilitation, land-based post-acute care physiotherapy delivered by a physiotherapist compared with patient self-administered exercise and a land-based exercise program before surgery. The primary outcome was postoperative physical functioning. Secondary outcomes included the patient's assessment of therapeutic effect (overall improvement), perceived pain intensity, health services utilization, treatment side effects, and adverse events The quality of the methods of the included studies was assessed using the criteria outlined in the Cochrane Musculoskeletal Injuries Group Quality Assessment Tool. After this, a summary of the biases threatening study validity was determined. Four methodological biases were considered: selection bias, performance bias, attrition bias, and detection bias. A meta-analysis was conducted when adequate data were available from 2 or more studies and where there was no statistical or clinical heterogeneity among studies. The GRADE system was used to summarize the overall quality of evidence. The search yielded 422 citations; of these, 12 were included in the review including 10 primary studies (9 RCTs, 1 non-RCT) and 2 systematic reviews. The Medical Advisory Secretariat review included 2 primary studies (N = 334) that examined the effectiveness of an inpatient physiotherapy rehabilitation program compared with an outpatient home-based physiotherapy program on functional outcomes after total knee or hip replacement surgery. One study, available only as an abstract, found no difference in functional outcome at 1 year after surgery (TKR or THR) between the treatments. The other study was an observational study that found that patients who are younger than 71 years of age on average, who do not live alone, and who do not have comorbid illnesses recover adequate function with outpatient home-based physiotherapy. However results were only measured up to 3 months after surgery, and the outcome measure they used is not considered the best one for physical functioning. Three primary studies (N = 360) were reviewed that tested the effectiveness of outpatient home-based or clinic-based physiotherapy in addition to a self-administered home exercise program, compared with a self-administered exercise program only or in addition to using another therapy (phone calls or continuous passive movement), on postoperative physical functioning after primary TKR surgery. Two of the studies reported no difference in change from baseline in flexion range of motion between those patients receiving outpatient or home-based physiotherapy and doing a home exercise program compared with patients who did a home exercise program only with or without continuous passive movement. The other study reported no difference in the Western Ontario and McMaster Osteoarthritis Index (WOMAC) scores between patients receiving clinic-based physiotherapy and practising a home exercise program and those who received monitoring phone calls and did a home exercise program after TKR surgery. The Medical Advisory Secretariat reviewed two systematic reviews evaluating the effects of preoperative exercise on postoperative physical functioning. One concluded that preoperative exercise is not effective in improving functional recovery or pain after TKR and any effects after THR could not be adequately determined. The other concluded that there was inconclusive evidence to determine the benefits of preoperative exercise on functional recovery after TKR. Because 2 primary studies were added to the published literature since the publication of these systematic reviews the Medical Advisory Secretariat revisited the question of effectiveness of a preoperative exercise program for patients scheduled for TKR ad THR surgery. The Medical Advisory Secretariat also reviewed 3 primary studies (N = 184) that tested the effectiveness of preoperative exercise beginning 4-6 weeks before surgery on postoperative outcomes after primary TKR surgery. All 3 studies reported negative findings with regard to the effectiveness of preoperative exercise to improve physical functioning after TKR surgery. However, 2 failed to show an effect of the preoperative exercise program before surgery in those patients receiving preoperative exercise. The third study did not measure functional outcome immediately before surgery in the preoperative exercise treatment group; therefore the study's authors could not document an effect of the preoperative exercise program before surgery. Regarding health services utilization, 2 of the studies did not find significant differences in either the length of the acute care hospital stay or the inpatient rehabilitation care setting between patients treated with a preoperative exercise program and those not treated. The third study did not measure health services utilization. These results must be interpreted within the limitations and the biases of each study. Negative results do not necessarily support a lack of treatment effect but may be attributed to a type II statistical error. Finally, the Medical Advisory Secretariat reviewed 2 primary studies (N = 136) that examined the effectiveness of preoperative exercise on postoperative functional outcomes after primary THR surgery. One study did not support the effectiveness of an exercise program beginning 8 weeks before surgery. However, results from the other did support the effectiveness of an exercise program 8 weeks before primary THR surgery on pain and functional outcomes 1 week before and 3 weeks after surgery. Based on the evidence, the Medical Advisory Secretariat reached the following conclusions with respect to physiotherapy rehabilitation and physical functioning 1 year after primary TKR or THR surgery: There is high-quality evidence from 1 large RCT to support the use of home-based physiotherapy instead of inpatient physiotherapy after primary THR or TKR surgery.There is low-to-moderate quality evidence from 1 large RCT to support the conclusion that receiving a monitoring phone call from a physiotherapist and practising home exercises is comparable to receiving clinic-based physiotherapy and practising home exercises for people who have had primary TKR surgery. However, results may not be generalizable to those who have had THR surgery.There is moderate evidence to suggest that an exercise program beginning 4 to 6 weeks before primary TKR surgery is not effective. (ABSTRACT TRUNCATED)

Exercising for Two. What's Safe for the Active Pregnant Woman?

ERIC Educational Resources Information Center

White, Jacqueline

1992-01-01

Clinical experience and recent research challenge the current standards of exercise duration and intensity for pregnant women. By carefully assessing patients' self-monitoring techniques, physicians can work with active women to create safe exercise programs during pregnancy. Safety guidelines for developing home exercise programs are included.…

Mobile-phone-based home exercise training program decreases systemic inflammation in COPD: a pilot study.

PubMed

Wang, Chun-Hua; Chou, Pai-Chien; Joa, Wen-Ching; Chen, Li-Fei; Sheng, Te-Fang; Ho, Shu-Chuan; Lin, Horng-Chyuan; Huang, Chien-Da; Chung, Fu-Tsai; Chung, Kian Fan; Kuo, Han-Pin

2014-08-30

Moderate-intensity exercise training improves skeletal muscle aerobic capacity and increased oxidative enzyme activity, as well as exercise tolerance in COPD patients. To investigate whether the home-based exercise training program can reduce inflammatory biomarkers in patients with COPD, twelve patients using mobile phone assistance and 14 with free walk were assessed by incremental shuttle walk test (ISWT), spirometry, strength of limb muscles, and serum C-reactive protein (CRP) and inflammatory cytokines. Patients in the mobile phone group improved their ISWT walking distance, with decrease in serum CRP after 2 months, and sustained at 6 months. Patients in the control group had no improvement. Serum IL-8 in the mobile phone group was significantly reduced at 2, 3 and 6 months after doing home exercise training compared to baseline. IL-6 and TNF-α were significantly elevated at 3 and 6 months in control group, while there were no changes in mobile phone group. The strength of limb muscles was significantly greater compared to baseline at 3 and 6 months in the mobile phone group. A mobile-phone-based system can provide an efficient home endurance exercise training program with improved exercise capacity, strength of limb muscles and a decrease in serum CRP and IL-8 in COPD patients. Decreased systemic inflammation may contribute to these clinical benefits. (Clinical trial registration No.: NCT01631019).

Design and pilot evaluation of competitive and cooperative exercise games for arm rehabilitation at home.

PubMed

Gorsic, Maja; Novak, Domen

2016-08-01

People with chronic arm impairment should exercise intensely at home after completing their clinical rehabilitation program, but frequently lack motivation. To address this issue, we present a home rehabilitation system that motivates patients by allowing them to perform arm exercises together with friends or relatives in competitive and cooperative games. Inertial sensors are used to track the patient's arm and control the game. The system was tested with seven adults with arm impairment as well as their friends or spouses. They tested four exercise games (single-player, competitive and two different cooperative games) for 3 minutes each. Of the 7 participants, 4 preferred the competitive game, 2 preferred a cooperative game, and 1 preferred to exercise alone. Competition also increased exercise intensity (measured using inertial sensors) compared to exercising alone. Though preliminary, these results indicate that competitive exercise games could improve arm rehabilitation at home for survivors of neurological and orthopedic injuries.

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Comparison of virtual reality exergaming and home exercise programs in patients with subacromial impingement syndrome and scapular dyskinesis: Short term effect.

PubMed

Pekyavas, Nihan Ozunlu; Ergun, Nevin

2017-05-01

The aim of this study was to compare the short term effects of home exercise program and virtual reality exergaming in patients with subacromial impingement syndrome (SAIS). A total of 30 patients with SAIS were randomized into two groups which are Home Exercise Program (EX Group) (mean age: 40.6 ± 11.7 years) and Virtual Reality Exergaming Program (WII Group) (mean age: 40.33 ± 13.2 years). Subjects were assessed at the first session, at the end of the treatment (6 weeks) and at 1 month follow-up. The groups were assessed and compared with Visual Analogue Scale (based on rest, activity and night pain), Neer and Hawkins Tests, Scapular Retraction Test (SRT), Scapular Assistance Test (SAT), Lateral Scapular Slide Test (LSST) and shoulder disability (Shoulder Pain and Disability Index (SPADI)). Intensity of pain was significantly decreased in both groups with the treatment (p < 0.05). The WII Group had significantly better results for all Neer test, SRT and SAT than the EX Group (p < 0.05). Virtual reality exergaming programs with these programs were found more effective than home exercise programs at short term in subjects with SAIS. Level I, Therapeutic study. Copyright © 2017 Turkish Association of Orthopaedics and Traumatology. Production and hosting by Elsevier B.V. All rights reserved.

Fall risk and incidence reduction in high risk individuals with multiple sclerosis: a pilot randomized control trial.

PubMed

Sosnoff, Jacob J; Moon, Yaejin; Wajda, Douglas A; Finlayson, Marcia L; McAuley, Edward; Peterson, Elizabeth W; Morrison, Steve; Motl, Robert W

2015-10-01

To determine the feasibility of three fall prevention programs delivered over 12 weeks among individuals with multiple sclerosis: (A) a home-based exercise program targeting physiological risk factors; (B) an educational program targeting behavioral risk factors; and (C) a combined exercise-and-education program targeting both factors. Randomized controlled trial. Home-based training with assessments at research laboratory. A total of 103 individuals inquired about the investigation. After screening, 37 individuals with multiple sclerosis who had fallen in the last year and ranged in age from 45-75 years volunteered for the investigation. A total of 34 participants completed postassessment following the 12-week intervention. Participants were randomly assigned into one of four conditions: (1) wait-list control (n = 9); (2) home-based exercise (n = 11); (3) education (n = 9); or (4) a combined exercise and education (n = 8) group. Before and after the 12-week interventions, participants underwent a fall risk assessment as determined by the physiological profile assessment and provided information on their fall prevention behaviors as indexed by the Falls Prevention Strategy Survey. Participants completed falls diaries during the three-months postintervention. A total of 34 participants completed postintervention testing. Procedures and processes were found to be feasible. Overall, fall risk scores were lower in the exercise groups (1.15 SD 1.31) compared with the non-exercise groups (2.04 SD 1.04) following the intervention (p < 0.01). There was no group difference in fall prevention behaviors (p > 0.05). Further examination of home-based exercise/education programs for reducing falls in individuals with multiple sclerosis is warranted. A total of 108 participants would be needed in a larger randomized controlled trial.ClinicalTrials.org #NCT01956227. © The Author(s) 2014.

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Sporadic inclusion body myositis: pilot study on the effects of a home exercise program on muscle function, histopathology and inflammatory reaction.

PubMed

Arnardottir, Snjolaug; Alexanderson, Helene; Lundberg, Ingrid E; Borg, Kristian

2003-01-01

To evaluate the safety and effect of a home training program on muscle function in 7 patients with sporadic inclusion body myositis. The patients performed exercise 5 days a week over a 12-week period. Safety was assessed by clinical examination, repeated muscle biopsies and serum levels of creatine kinase. Muscle strength was evaluated by clinical examination, dynamic dynamometer and by a functional index in myositis. Strength was not significantly improved after the exercise, however none of the patients deteriorated concerning muscle function. The histopathology was unchanged and there were no signs of increased muscle inflammation or of expression of cytokines and adhesion molecules in the muscle biopsies. Creatine kinase levels were unchanged. A significant decrease was found in the areas that were positively stained for EN-4 (a marker for endothelial cells) in the muscle biopsies after training. The home exercise program was considered as not harmful to the muscles regarding muscle inflammation and function. Exercise may prevent loss of muscle strength due to disease and/or inactivity.

The effects of self-directed home exercise with serial telephone contacts on physical functions and quality of life in elderly people at high risk of locomotor dysfunction.

PubMed

Aoki, Kana; Sakuma, Mayumi; Ogisho, Noriyuki; Nakamura, Kozo; Chosa, Etsuo; Endo, Naoto

2015-01-01

Exercise is essential for maintaining quality of life (QOL) in elderly individuals. However, adherence to exercise programs is low. Here, we assessed the effectiveness of a self-directed home exercise program with serial telephone contacts to encourage exercise adherence among elderly individuals at high risk of locomotor dysfunction. We recruited community-dwelling adults (ｧ65 years) in Niigata, Japan, who were targets of the long-term care prevention project for locomotor dysfunction but did not participate in the government-sponsored prevention programs. The study was conducted from November 2011 to October 2012. Participants received exercise instruction and performed exercises independently for 3 months with serial telephone contacts. The single-leg stance and five-times sit-to-stand tests were used to assess physical function. The SF-8 was used to measure health-related QOL. Ninety-seven participants were enrolled in the study, representing 2.5% of eligible people;87 completed the intervention. Scores from physical function tests were significantly improved by the intervention, as were 7 of eight SF-8 subscales. Adherence was 85.4% for the single-leg standing exercise and 82.1% for squatting. Thus, self-directed home exercise with serial telephone contacts improved physical function and health-related QOL, representing a promising model for preventing the need for long-term care due to locomotor dysfunction.

Long-term effects of a 12 weeks high-intensity functional exercise program on physical function and mental health in nursing home residents with dementia: a single blinded randomized controlled trial.

PubMed

Telenius, Elisabeth Wiken; Engedal, Knut; Bergland, Astrid

2015-12-03

Research indicates that exercise can have a positive effect on both physical and mental health in nursing home patients with dementia, however the lasting effect is rarely studied. In a previously published article we investigated the immediate effect of a 12 weeks functional exercise program on physical function and mental health in nursing home residents with dementia. In this paper we studied the long-term effect of this exercise program. We explored the differences between the exercise and control group from baseline to 6 months follow-up and during the detraining period from month 3 to 6. A single blind, randomized controlled trial was conducted and a total of 170 nursing home residents with dementia were included. The participants were randomly allocated to an intervention (n = 87) or a control group (n = 83). The intervention consisted of intensive strengthening and balance exercises in small groups twice a week for 12 weeks. The control condition was leisure activities. Thirty participants were lost between baseline and six-month follow-up. Linear mixed model analyses for repeated measurements were used to investigate the effect of exercise after detraining period. The exercise group improved their scores on Berg Balance Scale from baseline to 6 months follow-up by 2.7 points in average. The control group deteriorated in the same period and the difference between groups was statistically significant (p = 0.031). The exercise group also scored better on NPI agitation sub-score after 6 months (p = 0.045). The results demonstrate long-time positive effects of a high intensity functional exercise program on balance and indicate a positive effect on agitation, after an intervention period of 12 weeks followed by a detraining period of 12 weeks. Identifier at ClinicalTrials.gov: NCT02262104.

Eliciting older people's preferences for exercise programs: a best-worst scaling choice experiment.

PubMed

Franco, Marcia R; Howard, Kirsten; Sherrington, Catherine; Ferreira, Paulo H; Rose, John; Gomes, Juliana L; Ferreira, Manuela L

2015-01-01

What relative value do older people with a previous fall or mobility-related disability attach to different attributes of exercise? Prospective, best-worst scaling study. Two hundred and twenty community-dwelling people, aged 60 years or older, who presented with a previous fall or mobility-related disability. Online or face-to-face questionnaire. Utility values for different exercise attributes and levels. The utility levels were calculated by asking participants to select the attribute that they considered to be the best (ie, they were most likely to want to participate in programs with this attribute) and worst (ie, least likely to want to participate). The attributes included were: exercise type; time spent on exercise per day; frequency; transport type; travel time; out-of-pocket costs; reduction in the chance of falling; and improvement in the ability to undertake tasks inside and outside of home. The attributes of exercise programs with the highest utility values were: home-based exercise and no need to use transport, followed by an improvement of 60% in the ability to do daily tasks at home, no costs, and decreasing the chances of falling to 0%. The attributes with the lowest utility were travel time of 30 minutes or more and out-of-pocket costs of AUD50 per session. The type of exercise, travel time and costs are more highly valued by older people than the health benefits. These findings suggest that physical activity engagement strategies need to go beyond education about health benefits and focus on improving accessibility to exercise programs. Exercise that can be undertaken at or close to home without any cost is most likely to be taken up by older people with past falls and/or mobility-related disability. Copyright © 2014 Australian Physiotherapy Association. Published by Elsevier B.V. All rights reserved.

Home-based exercise program and fall-risk reduction in older adults with multiple sclerosis: phase 1 randomized controlled trial.

PubMed

Sosnoff, Jacob J; Finlayson, Marcia; McAuley, Edward; Morrison, Steve; Motl, Robert W

2014-03-01

To determine the feasibility, safety, and efficacy of a home-based exercise intervention targeting fall risk in older adults with multiple sclerosis. A randomized controlled pilot trial. A home-based exercise program. Participants were randomly allocated to either a home-based exercise intervention group (n = 13) or a waiting list control group (n = 14). The exercise group completed exercises targeting lower muscle strength and balance three times a week for 12 weeks. The control group continued normal activity. Fall risk (Physiological Profile Assessment scores), balance (Berg Balance Scale), and walking testing prior to and immediately following the 12-week intervention. Each outcome measure was placed in an analysis of covariance with group as the between-subject factor and baseline values as the covariate. Effect sizes were calculated. Twelve participants from the control group and ten from the exercise group completed the study. There were no related adverse events. Fall risk was found to decrease in the exercise group following the intervention (1.1 SD 1.0 vs. 0.6 SD 0.6) while there was an increase in fall risk in the control group (1.9 SD 1.5 vs. 2.2 SD 1.9). Effect sizes for most outcomes were large (η(2) > 0.15). Home-based exercise was found to be feasible, safe, and effective for reducing physiological fall risk in older adults with multiple sclerosis. Our findings support the implementation of a larger trial to reduce fall risk in persons with multiple sclerosis.

Exercise program for nursing home residents with Alzheimer's disease: a 1-year randomized, controlled trial.

PubMed

Rolland, Yves; Pillard, Fabien; Klapouszczak, Adrian; Reynish, Emma; Thomas, David; Andrieu, Sandrine; Rivière, Daniel; Vellas, Bruno

2007-02-01

To investigate the effectiveness of an exercise program in improving ability to perform activities of daily living (ADLs), physical performance, and nutritional status and decreasing behavioral disturbance and depression in patients with Alzheimer's disease (AD). Randomized, controlled trial. Five nursing homes. One hundred thirty-four ambulatory patients with mild to severe AD. Collective exercise program (1 hour, twice weekly of walk, strength, balance, and flexibility training) or routine medical care for 12 months. ADLs were assessed using the Katz Index of ADLs. Physical performance was evaluated using 6-meter walking speed, the get-up-and-go test, and the one-leg-balance test. Behavioral disturbance, depression, and nutritional status were evaluated using the Neuropsychiatric Inventory, the Montgomery and Asberg Depression Rating Scale, and the Mini-Nutritional Assessment. For each outcome measure, the mean change from baseline to 12 months was calculated using intention-to-treat analysis. ADL mean change from baseline score for exercise program patients showed a slower decline than in patients receiving routine medical care (12-month mean treatment differences: ADL=0.39, P=.02). A significant difference between the groups in favor of the exercise program was observed for 6-meter walking speed at 12 months. No effect was observed for behavioral disturbance, depression, or nutritional assessment scores. In the intervention group, adherence to the program sessions in exploratory analysis predicted change in ability to perform ADLs. No adverse effects of exercise occurred. A simple exercise program, 1 hour twice a week, led to significantly slower decline in ADL score in patients with AD living in a nursing home than routine medical care.

Effectiveness of locomotion training in a home visit preventive care project: one-group pre-intervention versus post-intervention design study.

PubMed

Ito, Shinya; Hashimoto, Mari; Aduma, Saori; Yasumura, Seiji

2015-11-01

Locomotion training in a home visit-type preventive-care program has been reported elsewhere. However, continuation of appropriate exercises in a home setting is difficult, and few reports are available on locomotion training in a home setting. The objective of this study was to evaluate the effectiveness of locomotion training over 3 months in a home visit-type preventive-care program for improvement of motor function among elderly people. Nine hundred and fifty-eight elderly people in Tendo City in Japan who were not currently attending any preventive-care program were invited to participate in the study, and 87 were enrolled. In the pre-intervention and post-intervention assessments, we administered an interview survey (the Kihon Checklist), the timed one-leg standing test with eyes open and the sit-to-stand test, at the participants' homes. The intervention involved one set of training exercises with the participants standing on each leg for 1 min and squatting five or six times. The participants were asked to repeat one set of the exercises three times a day at home. In addition, the participants were regularly asked over the telephone about their performance of the exercises. Physical strength, cognitive function, and total scores of the Kihon Checklist were significantly lower after the intervention than before. In addition, the one-leg standing test time was significantly longer after the intervention (mean ± SD, 23.9 ± 35.4) than before (15.7 ± 20.5), and the sit-to-stand test time was significantly shorter after the intervention (13.0 ± 6.2) than before (14.8 ± 8.3). Locomotion training in a home-visit preventive-care program with telephone support effectively improved the motor function of elderly people who were not currently attending any preventive-care program organized by the long-term care insurance system.

Effect of Motivation by "Instagram" on Adherence to Physical Activity among Female College Students.

PubMed

Al-Eisa, Einas; Al-Rushud, Asma; Alghadir, Ahmad; Anwer, Shahnawaz; Al-Harbi, Bashayer; Al-Sughaier, Noha; Al-Yoseef, Noha; Al-Otaibi, Reem; Al-Muhaysin, Hanadi Ali

2016-01-01

To investigate the efficacy of using "Instagram application" with a "home-exercise program" as a motivational stimulus in improving physical activity (PA) adherence levels among female college students. Fifty-eight female undergraduate students with the mean age 20.3 ± 0.96 years participated. Participants were divided into two groups: intervention and the control group; both the groups received an exercise program and the intervention group was additionally motivated by "Instagram." Adherence to PA was measured by using an adherence sheet. The Exercise Motivation Inventory (EMI-2) was used to assess the motivational factors. The most frequent motivational factors were extrinsic as assessed using the EMI-2. "Positive health" was the most frequent factor mentioned of the two types with 47% of the sample. The intervention group adhered with 17% more to the activity program compared to the control group. Moreover, 72% of the participants in the intervention and control groups found the activity program flexible enough to be performed at home; they agreed about its effectiveness on adherence (53%). The use of Instagram with the home exercise program as a motivational modality could be attractive and effective to reinforce adherence and maintain an appropriate PA level.

Changes in body weight, C-reactive protein, and total adiponectin in non-obese women after 12 months of a small-volume, home-based exercise program.

PubMed

Mediano, Mauro Felippe Felix; Neves, Fabiana Alves; Cunha, Alessandra Cordeiro de Souza Rodrigues; Souza, Erica Patricia Garcia de; Moura, Anibal Sanchez; Sichieri, Rosely

2013-01-01

Our objective was to evaluate the effects of small-volume, home-based exercise combined with slight caloric restriction on the inflammatory markers C-reactive protein and adiponectin. In total, 54 women were randomly assigned to one of two groups for exercise intervention: the control or home-based exercise groups. Weight, waist and hip circumferences, and inflammatory markers were measured at baseline and after 6 and 12 months. Women allocated to the home-based exercise group received a booklet explaining the physical exercises to be practiced at home at least 3 times per week, 40 minutes per session, at low-to-moderate intensity. All participants received dietary counseling aimed at reducing caloric intake by 100-300 calories per day, with a normal distribution of macro-nutrients (26-28% of energy as fat). Clinicaltrials.gov: NCT01206413 RESULTS: The home-based exercise group showed a significantly greater reduction in weight and body mass index at six months, but no difference between groups was observed thereafter. With regard to the inflammatory markers, a greater but non-statistically significant reduction was found for C-reactive protein in the home-based exercise group at six months; however, this difference disappeared after adjusting for weight change. No differences in adiponectin were found at the 6- or 12-month follow-up. Small-volume, home-based exercise did not promote changes in inflammatory markers independent of weight change.

Teleexercise for Persons With Spinal Cord Injury: A Mixed-Methods Feasibility Case Series.

PubMed

Lai, Byron; Rimmer, James; Barstow, Beth; Jovanov, Emil; Bickel, C Scott

2016-07-14

Spinal cord injury (SCI) results in significant loss of function below the level of injury, often leading to restricted participation in community exercise programs. To overcome commonly experienced barriers to these programs, innovations in technology hold promise for remotely delivering safe and effective bouts of exercise in the home. To test the feasibility of a remotely delivered home exercise program for individuals with SCI as determined by (1) implementation of the intervention in the home; (2) exploration of the potential intervention effects on aerobic fitness, physical activity behavior, and subjective well-being; and (3) acceptability of the program through participant self-report. Four adults with SCI (mean age 43.5 [SD 5.3] years; 3 males, 1 female; postinjury 25.8 [SD 4.3] years) completed a mixed-methods sequential design with two phases: an 8-week intervention followed by a 3-week nonintervention period. The intervention was a remotely delivered aerobic exercise training program (30-45 minutes, 3 times per week). Instrumentation included an upper body ergometer, tablet, physiological monitor, and custom application that delivered video feed to a remote trainer and monitored and recorded exercise data in real time. Implementation outcomes included adherence, rescheduled sessions, minutes of moderate exercise, and successful recording of exercise data. Pre/post-outcomes included aerobic capacity (VO 2 peak), the Physical Activity Scale for Individuals with Physical Disabilities (PASIPD), the Satisfaction with Life Scale (SWLS), and the Quality of Life Index modified for spinal cord injury (QLI-SCI). Acceptability was determined by participant perceptions of the program features and impact, assessed via qualitative interview at the end of the nonintervention phase. Participants completed all 24 intervention sessions with 100% adherence. Out of 96 scheduled training sessions for the four participants, only 8 (8%) were makeup sessions. The teleexercise system successfully recorded 85% of all exercise data. The exercise program was well tolerated by all participants. All participants described positive outcomes as a result of the intervention and stated that teleexercise circumvented commonly reported barriers to exercise participation. There were no reported adverse events and no dropouts. A teleexercise system can be a safe and feasible option to deliver home-based exercise for persons with SCI. Participants responded favorably to the intervention and valued teleexercise for its ability to overcome common barriers to exercise. Study results are promising but warrant further investigation in a larger sample. ©Byron Lai, James Rimmer, Beth Barstow, Emil Jovanov, C Scott Bickel. Originally published in JMIR Rehabilitation and Assistive Technology (http://rehab.jmir.org), 14.07.2016.

Teleexercise for Persons With Spinal Cord Injury: A Mixed-Methods Feasibility Case Series

PubMed Central

Lai, Byron; Rimmer, James; Barstow, Beth; Jovanov, Emil

2016-01-01

Background Spinal cord injury (SCI) results in significant loss of function below the level of injury, often leading to restricted participation in community exercise programs. To overcome commonly experienced barriers to these programs, innovations in technology hold promise for remotely delivering safe and effective bouts of exercise in the home. Objective To test the feasibility of a remotely delivered home exercise program for individuals with SCI as determined by (1) implementation of the intervention in the home; (2) exploration of the potential intervention effects on aerobic fitness, physical activity behavior, and subjective well-being; and (3) acceptability of the program through participant self-report. Methods Four adults with SCI (mean age 43.5 [SD 5.3] years; 3 males, 1 female; postinjury 25.8 [SD 4.3] years) completed a mixed-methods sequential design with two phases: an 8-week intervention followed by a 3-week nonintervention period. The intervention was a remotely delivered aerobic exercise training program (30-45 minutes, 3 times per week). Instrumentation included an upper body ergometer, tablet, physiological monitor, and custom application that delivered video feed to a remote trainer and monitored and recorded exercise data in real time. Implementation outcomes included adherence, rescheduled sessions, minutes of moderate exercise, and successful recording of exercise data. Pre/post-outcomes included aerobic capacity (VO2 peak), the Physical Activity Scale for Individuals with Physical Disabilities (PASIPD), the Satisfaction with Life Scale (SWLS), and the Quality of Life Index modified for spinal cord injury (QLI-SCI). Acceptability was determined by participant perceptions of the program features and impact, assessed via qualitative interview at the end of the nonintervention phase. Results Participants completed all 24 intervention sessions with 100% adherence. Out of 96 scheduled training sessions for the four participants, only 8 (8%) were makeup sessions. The teleexercise system successfully recorded 85% of all exercise data. The exercise program was well tolerated by all participants. All participants described positive outcomes as a result of the intervention and stated that teleexercise circumvented commonly reported barriers to exercise participation. There were no reported adverse events and no dropouts. Conclusion A teleexercise system can be a safe and feasible option to deliver home-based exercise for persons with SCI. Participants responded favorably to the intervention and valued teleexercise for its ability to overcome common barriers to exercise. Study results are promising but warrant further investigation in a larger sample. PMID:28582252

ICT-based system to predict and prevent falls (iStoppFalls): study protocol for an international multicenter randomized controlled trial.

PubMed

Gschwind, Yves J; Eichberg, Sabine; Marston, Hannah R; Ejupi, Andreas; Rosario, Helios de; Kroll, Michael; Drobics, Mario; Annegarn, Janneke; Wieching, Rainer; Lord, Stephen R; Aal, Konstantin; Delbaere, Kim

2014-08-20

Falls are very common, especially in adults aged 65 years and older. Within the current international European Commission's Seventh Framework Program (FP7) project 'iStoppFalls' an Information and Communication Technology (ICT) based system has been developed to regularly assess a person's risk of falling in their own home and to deliver an individual and tailored home-based exercise and education program for fall prevention. The primary aims of iStoppFalls are to assess the feasibility and acceptability of the intervention program, and its effectiveness to improve balance, muscle strength and quality of life in older people. This international, multicenter study is designed as a single-blinded, two-group randomized controlled trial. A total of 160 community-dwelling older people aged 65 years and older will be recruited in Germany (n = 60), Spain (n = 40), and Australia (n = 60) between November 2013 and May 2014. Participants in the intervention group will conduct a 16-week exercise program using the iStoppFalls system through their television set at home. Participants are encouraged to exercise for a total duration of 180 minutes per week. The training program consists of a variety of balance and strength exercises in the form of video games using exergame technology. Educational material about a healthy lifestyle will be provided to each participant. Final reassessments will be conducted after 16 weeks. The assessments include physical and cognitive tests as well as questionnaires assessing health, fear of falling, quality of life and psychosocial determinants. Falls will be followed up for six months by monthly falls calendars. We hypothesize that the regular use of this newly developed ICT-based system for fall prevention at home is feasible for older people. By using the iStoppFalls sensor-based exercise program, older people are expected to improve in balance and strength outcomes. In addition, the exercise training may have a positive impact on quality of life by reducing the risk of falls. Taken together with expected cognitive improvements, the individual approach of the iStoppFalls program may provide an effective model for fall prevention in older people who prefer to exercise at home. Australian New Zealand Clinical Trials Registry Trial ID: ACTRN12614000096651.International Standard Randomised Controlled Trial Number: ISRCTN15932647.

ICT-based system to predict and prevent falls (iStoppFalls): study protocol for an international multicenter randomized controlled trial

PubMed Central

2014-01-01

Background Falls are very common, especially in adults aged 65 years and older. Within the current international European Commission’s Seventh Framework Program (FP7) project ‘iStoppFalls’ an Information and Communication Technology (ICT) based system has been developed to regularly assess a person’s risk of falling in their own home and to deliver an individual and tailored home-based exercise and education program for fall prevention. The primary aims of iStoppFalls are to assess the feasibility and acceptability of the intervention program, and its effectiveness to improve balance, muscle strength and quality of life in older people. Methods/Design This international, multicenter study is designed as a single-blinded, two-group randomized controlled trial. A total of 160 community-dwelling older people aged 65 years and older will be recruited in Germany (n = 60), Spain (n = 40), and Australia (n = 60) between November 2013 and May 2014. Participants in the intervention group will conduct a 16-week exercise program using the iStoppFalls system through their television set at home. Participants are encouraged to exercise for a total duration of 180 minutes per week. The training program consists of a variety of balance and strength exercises in the form of video games using exergame technology. Educational material about a healthy lifestyle will be provided to each participant. Final reassessments will be conducted after 16 weeks. The assessments include physical and cognitive tests as well as questionnaires assessing health, fear of falling, quality of life and psychosocial determinants. Falls will be followed up for six months by monthly falls calendars. Discussion We hypothesize that the regular use of this newly developed ICT-based system for fall prevention at home is feasible for older people. By using the iStoppFalls sensor-based exercise program, older people are expected to improve in balance and strength outcomes. In addition, the exercise training may have a positive impact on quality of life by reducing the risk of falls. Taken together with expected cognitive improvements, the individual approach of the iStoppFalls program may provide an effective model for fall prevention in older people who prefer to exercise at home. Trial registration Australian New Zealand Clinical Trials Registry Trial ID: ACTRN12614000096651. International Standard Randomised Controlled Trial Number: ISRCTN15932647. PMID:25141850

[Results of a physical therapy program in nursing home residents: A randomized clinical trial].

PubMed

Casilda-López, Jesús; Torres-Sánchez, Irene; Garzón-Moreno, Victor Manuel; Cabrera-Martos, Irene; Valenza, Marie Carmen

2015-01-01

The maintenance of the physical functionality is a key factor in the care of the elderly. Inactive people have a higher risk of death due to diseases associated with inactivity. In addition, the maintenance of optimal levels of physical and mental activity has been suggested as a protective factor against the development and progression of chronic illnesses and disability. The objective of this study is to assess the effectiveness of an 8-week exercise program with elastic bands, on exercise capacity, walking and balance in nursing home residents. A nursing home sample was divided into two groups, intervention group (n=26) and control group (n=25). The intervention group was included in an 8-week physical activity program using elastic bands, twice a week, while the control group was took part in a walking programme. Outcome measurements were descriptive variables (anthropometric characteristics, quality of life, fatigue, fear of movement) and fundamental variables (exercise capacity, walking and balance). A significant improvement in balance and walking speed was observed after the programme. Additionally, exercise capacity improved significantly (P≤.001), and the patients showed an improvement in perceived dyspnea after the physical activity programme in the intervention group. The exercise program was safe and effective in improving dyspnea, exercise capacity, walking, and balance in elderly. Copyright © 2014 SEGG. Published by Elsevier Espana. All rights reserved.

Exercise at Home

MedlinePlus

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A home-based, carer-enhanced exercise program improves balance and falls efficacy in community-dwelling older people with dementia.

PubMed

Taylor, Morag E; Lord, Stephen R; Brodaty, Henry; Kurrle, Susan E; Hamilton, Sarah; Ramsay, Elisabeth; Webster, Lyndell; Payne, Narelle L; Close, Jacqueline C T

2017-01-01

Older people with dementia are at increased risk of physical decline and falls. Balance and mood are significant predictors of falls in this population. The aim of this study was to determine the effect of a tailored home-based exercise program in community-dwelling older people with dementia. Forty-two participants with mild to moderate dementia were recruited from routine health services. All participants were offered a six-month home-based, carer-enhanced, progressive, and individually tailored exercise program. Physical activity, quality of life, physical, and psychological assessments were administered at the beginning and end of the trial. Of 33 participants (78.6%) who completed the six-month reassessment ten (30%) reported falls and six (18%) multiple falls during the follow-up period. At reassessment, participants had better balance (sway on floor and foam), reduced concern about falls, increased planned physical activity, but worse knee extension strength and no change in depression scores. The average adherence to the prescribed exercise sessions was 45% and 22 participants (52%) were still exercising at trial completion. Those who adhered to ≥70% of prescribed sessions had significantly better balance at reassessment compared with those who adhered to <70% of sessions. This trial of a tailored home-based exercise intervention presents preliminary evidence that this intervention can improve balance, concern about falls, and planned physical activity in community-dwelling older people with dementia. Future research should determine whether exercise interventions are effective in reducing falls and elucidate strategies for enhancing uptake and adherence in this population.

HRV Analysis to Identify Stages of Home-based Telerehabilitation Exercise.

PubMed

Jeong, In Cheol; Finkelstein, Joseph

2014-01-01

Spectral analysis of heart rate variability (HRV) has been widely used to investigate activity of autonomous nervous system. Previous studies demonstrated potential of analysis of short-term sequences of heart rate data in a time domain for continuous monitoring of levels of physiological stress however the value of HRV parameters in frequency domain for monitoring cycling exercise has not been established. The goal of this study was to assess whether HRV parameters in frequency domain differ depending on a stage of cycling exercise. We compared major HRV parameters in high, low and very low frequency ranges during rest, height of exercise, and recovery during cycling exercise. Our results indicated responsiveness of frequency-domain indices to different phases of cycling exercise program and their potential in monitoring autonomic balance and stress levels as a part of a tailored home-based telerehabilitation program.

Effects of Community-Based Exercise in Children with Severe Burns: A Randomized Trial

PubMed Central

Peña, Raquel; Ramirez, Leybi L.; Crandall, Craig G.; Wolf, Steven; Herndon, David N.; Suman, Oscar E.

2015-01-01

Objective To counteract long-lasting muscle break down, muscle weakness, and poor physical fitness resulting from severe burns, we recommend a 12-week in-hospital exercise training rehabilitation program. Unfortunately, this in-hospital training program requires time away from home, family, school or work). This study was undertaken to evaluate an alternative exercise rehabilitation strategy involving a 12-week community-based exercise training rehabilitation program (COMBEX) carried out at or near the patient and caretaker’s home. Study Design and Participants Pediatric patients (7–18 years) with ≥ 30% of the total body surface area (TBSA) burns were randomized to participate in COMBEX (N=12) or an outpatient exercise program (EX) at the hospital (N=22). Both programs were started after hospital discharge and consisted of 12 weeks of progressive resistive and aerobic exercise. COMBEX was performed in community fitness centers near the patients’ home. Endpoints were assessed at discharge (pre-exercise) and after the 12-week program. Primary endpoints were lean body mass (dual energy x-ray absorptiometry), muscle strength (isokinetic dynamometry), and peak aerobic capacity (indirect calorimetry). Results Demographics, length of hospitalization, and TBSA burned were comparable between groups (p>0.05). Both groups exhibited a significant (p≤0.01 for all) increase (mean ± SEM) in lean muscle mass (EX: 6.9 ± 1.7%; COMBEX: 6.5 ± 1.1%), muscle strength (EX: 67.1 ± 7.0%; COMBEX: 49.9 ± 6.8%), and peak aerobic capacity (EX: 35.5 ± 4.0%; COMBEX: 46.9 ± 7.7%). Furthermore, the magnitude of these increases were not different between groups (P>0.12). Conclusions Both EX and COMBEX are efficacious in improving lean mass, strength, and cardiopulmonary capacity in severely burned children. PMID:26643401

Translating Behavior Change Principles Into a Blended Exercise Intervention for Older Adults: Design Study.

PubMed

Mehra, Sumit; Visser, Bart; Dadema, Tessa; van den Helder, Jantine; Engelbert, Raoul Hh; Weijs, Peter Jm; Kröse, Ben Ja

2018-05-02

Physical activity can prevent or delay age-related impairments and prolong the ability of older adults to live independently. Community-based programs typically offer classes where older adults can exercise only once a week under the guidance of an instructor. The health benefits of such programs vary. Exercise frequency and the duration of the program play a key role in realizing effectiveness. An auxiliary home-based exercise program can provide older adults the opportunity to exercise more regularly over a prolonged period of time in the convenience of their own homes. Furthermore, mobile electronic devices can be used to motivate and remotely guide older adults to exercise in a safe manner. Such a blended intervention, where technology is combined with personal guidance, needs to incorporate behavior change principles to ensure effectiveness. The aim of this study was to identify theory-based components of a blended intervention that supports older adults to exercise at home. The Medical Research Council framework was used to develop the blended intervention. Insights from focus group, expert panels, and literature were combined into leading design considerations. A client-server system had been developed that combined a tablet app with a database in the cloud and a Web-based dashboard that can be used by a personal coach to remotely monitor and guide older adults. The app contains several components that facilitate behavior change-an interactive module for goal setting, the ability to draw up a personal training schedule from a library containing over 50 exercise videos, progress monitoring, and possibilities to receive remote feedback and guidance of a personal coach. An evidence-based blended intervention was designed to promote physical activity among older adults. The underlying design choices were underpinned by behavior change techniques that are rooted in self-regulation. Key components of the tablet-supported intervention were a tailored program that accommodates individual needs, demonstrations of functional exercises, monitoring, and remote feedback. The blended approach combines the convenience of a home-based exercise program for older adults with the strengths of mobile health and personal guidance. ©Sumit Mehra, Bart Visser, Tessa Dadema, Jantine van den Helder, Raoul HH Engelbert, Peter JM Weijs, Ben JA Kröse. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 02.05.2018.

Satisfaction and Experience With a Supervised Home-Based Real-Time Videoconferencing Telerehabilitation Exercise Program in People with Chronic Obstructive Pulmonary Disease (COPD)

PubMed Central

TSAI, LING LING Y.; MCNAMARA, RENAE J.; DENNIS, SARAH M.; MODDEL, CHLOE; ALISON, JENNIFER A.; MCKENZIE, DAVID K.; MCKEOUGH, ZOE J.

2016-01-01

Telerehabilitation, consisting of supervised home-based exercise training via real-time videoconferencing, is an alternative method to deliver pulmonary rehabilitation with potential to improve access. The aims were to determine the level of satisfaction and experience of an eight-week supervised home-based telerehabilitation exercise program using real-time videoconferencing in people with COPD. Quantitative measures were the Client Satisfaction Questionnaire-8 (CSQ-8) and a purpose-designed satisfaction survey. A qualitative component was conducted using semi-structured interviews. Nineteen participants (mean (SD) age 73 (8) years, forced expiratory volume in 1 second (FEV1) 60 (23) % predicted) showed a high level of satisfaction in the CSQ-8 score and 100% of participants reported a high level of satisfaction with the quality of exercise sessions delivered using real-time videoconferencing in participant satisfaction survey. Eleven participants undertook semi-structured interviews. Key themes in four areas relating to the telerehabilitation service emerged: positive virtual interaction through technology; health benefits; and satisfaction with the convenience and use of equipment. Participants were highly satisfied with the telerehabilitation exercise program delivered via videoconferencing. PMID:28775799

A learning-based agent for home neurorehabilitation.

PubMed

Lydakis, Andreas; Meng, Yuanliang; Munroe, Christopher; Wu, Yi-Ning; Begum, Momotaz

2017-07-01

This paper presents the iterative development of an artificially intelligent system to promote home-based neurorehabilitation. Although proper, structured practice of rehabilitation exercises at home is the key to successful recovery of motor functions, there is no home-program out there which can monitor a patient's exercise-related activities and provide corrective feedback in real time. To this end, we designed a Learning from Demonstration (LfD) based home-rehabilitation framework that combines advanced robot learning algorithms with commercially available wearable technologies. The proposed system uses exercise-related motion information and electromyography signals (EMG) of a patient to train a Markov Decision Process (MDP). The trained MDP model can enable an agent to serve as a coach for a patient. On a system level, this is the first initiative, to the best of our knowledge, to employ LfD in an health-care application to enable lay users to program an intelligent system. From a rehabilitation research perspective, this is a completely novel initiative to employ machine learning to provide interactive corrective feedback to a patient in home settings.

Sleep quality and depression of nursing home older adults in wheelchairs after exercises.

PubMed

Chen, Kuei-Min; Huang, Hsin-Ting; Cheng, Yin-Yin; Li, Chun-Huw; Chang, Ya-Hui

2015-01-01

Sleep disturbances and depression are costly and potentially disabling conditions that affect a considerable proportion of older adults. The purpose of this study was to test the effectiveness of 6 months of elastic band exercises on sleep quality and depression of wheelchair-bound older adults in nursing homes. One hundred twenty-seven older adults from 10 nursing homes participated in this cluster randomized controlled trial, and 114 completed the study. Participants were randomly assigned to two groups: experimental group (five nursing homes, n = 59) and control group (five nursing homes, n = 55). A 40-minute wheelchair-bound senior elastic band exercise program was implemented 3 times per week for 6 months. Sleep quality and depression of the participants were examined at baseline, after 3 months, and at the end of the 6-month study. Participants in the experimental group had longer sleep durations, better habitual sleep efficiencies, and less depression than the control group at 3 months of the study and maintained them throughout the rest of the 6-month study. Nursing home directors could recruit volunteers to learn the program and lead the elderly residents in wheelchairs in practicing the wheelchair-bound senior elastic band exercises regularly in the facilities. Copyright © 2015 Elsevier Inc. All rights reserved.

Compliance and safety of a novel home exercise program for patients with high-grade brain tumors, a prospective observational study.

PubMed

Baima, Jennifer; Omer, Zehra B; Varlotto, John; Yunus, Shakeeb

2017-09-01

The purpose of this study is to evaluate compliance with and safety of a novel independent home exercise program for patients with high-grade brain tumors. We designed this program around the preferences and individual capabilities of this population as well as the potential barriers to exercise in cancer patients. Demographics were collected to better understand those that persisted with exercise. Subjects with high-grade brain tumor received one-time training that included watching an exercise video and live demonstration of resistance band exercises, a balance exercise, and recommendations for walking. Subjects were instructed to do the exercises every day for 1 month. Main outcome measures were percentage of subjects who exercised throughout the month, frequency of exercising, demographic factors, quality of life scores (assessed by FACT-BR), and self report of adverse events. Fourteen of the 15 (93%) subjects started the exercises during the course of the month. Nine of the fifteen (60%) continued the exercises throughout the month. Three additional subjects would have continued to exercise if formal or supervised rehabilitation had been offered. Among the subjects who continued the exercises regularly, higher frequency of exercising was significantly associated with living as married (p = 0.033), annual income >$50,000 (p = 0.047), scores of physical well-being (p = 0.047), and brain cancer specific well-being (p = 0.054) subscales. Among those who exercised frequently, there was also a trend towards increase in total FACT-BR scores (p = 0.059). The subjects who scored higher on the social well-being subscale of the FACT-BR at baseline self-reported a higher likelihood to continue the exercises after 1 month of participation in the study (p = 0.018). No adverse events were reported. Our small group of subjects with high-grade brain tumors demonstrated compliance with and safety of a novel independent strength and balance exercise program in the home setting. Higher frequency of exercising was associated with life quality parameters as well as marriage and income.

Physiotherapy home exercise program for haemophiliacs.

PubMed

Pierstorff, K; Seuser, A; Weinspach, S; Laws, H-J

2011-05-01

Regular physiotherapy can improve the stability and flexibility of joints and decrease the bleeding risk in patients with haemophilia. To reduce the appointments for the patients and to make exercising a part of daily live, an individualized home exercise program (HEP) was designed. Retrospectively the number of bleedings during the HEP was compared to number of bleedings before. 8 patients aged between 4 and 16 years with haemophilia A were evaluated. At start and after 13 month patients had a motion analysis via topographic ultrasound. According to the results and clinical findings an individualized HEP was created. Standardised scores for clinical evaluation and the patient based evaluation of exercises were designed. At every appointment exercises were individually adjusted. Patients exercised in median 1.7 times a week. No training related bleeds occurred. 7 of 8 patients showed reduced joint and/or muscle bleeds (p<0.02). Clinical scores raised slightly in every patient. However the second motion analysis of squat and gait showed a worsening in 7 of 8 patients (p>0.05). A HEP can help to advance in physical fitness and coordination and may reduce bleeding tendency, but needs to be accomplished regularly. Patients are interested but the motivation to exercise at home is low. Disorders measured by motion analysis seem not to be sufficiently influenced by our surrogate training program. © Georg Thieme Verlag KG Stuttgart · New York.

Effect of Home Exercise Program Performance in Patients with Osteoarthritis of the Knee or the Spine on the Visual Analog Scale after Discharge from Physical Therapy

ERIC Educational Resources Information Center

Chen, Hamilton; Onishi, Kentaro

2012-01-01

The aim of our study was to assess the effect of the frequency of home exercise program (HEP) performance on pain [10-point visual analog scale (VAS)] in patients with osteoarthritis of the spine or knee after more than 6 months discharge from physical therapy (PT). We performed a retrospective chart review of 48 adult patients with a clinical…

Effectiveness of a home-based strengthening program for elderly males in Italy. A preliminary study.

PubMed

Capodaglio, P; Facioli, M; Burroni, E; Giordano, A; Ferri, A; Scaglioni, G

2002-02-01

The practice of regular physical exercise has been shown to be effective in slowing the age-related progressive functional deterioration. Most exercise trials have been conducted with supervised training programs. The purpose of this study was to investigate the effectiveness of a 4-month home-based strength training on strength, function and personal satisfaction. Ten elderly men (mean age 68.5 years) were enrolled for home-based training one month after completing a 4-month supervised program; 12 age-matched men served as the control group. Subjects were asked to perform 3 sessions a week consisting of six resistance exercises with elastic bands involving the major muscle groups of the upper and lower limbs. We had calculated the correlation between the elongation and resistance of the elastic bands. The subjects were instructed to keep a diary reporting the execution of the session. We measured dynamic concentric strength of the muscle groups involved in the resistance exercises and maximal isometric strength of the knee extensors and elbow flexors before and after the 4-month home training. The Satisfaction Profile (SAT-P) questionnaire was administered before and one month after the completion of the training program for assessing personal satisfaction. The final to baseline comparison showed a non-significant decrease in mean isometric maximal strength values for knee extensors and elbow flexors in the control group, while the exercise group significantly (p=0.001) improved the average baseline values. Maximal dynamic concentric strength values decreased significantly in the control group, while significant improvements were observed in the exercising subjects. The SAT-P questionnaire did not show any difference in either group from baseline. The adherence-to-protocol rate based on self-report was 78%. Home training with elastic bands appears to be an effective low-cost modality of maintaining strength and function in an elderly population.

Insulin resistance influences weight loss in non-obese women who followed a home-based exercise program and slight caloric restriction.

PubMed

Mediano, Mauro Felippe Felix; Sichieri, Rosely

2011-06-01

This study aimed to evaluate the influence of insulin resistance status on weight changes in non-obese women who followed a home-based exercise program and slight caloric restriction over a period of 12 months. Middle-aged (25-45 year), non-obese (body mass index of 23-29.9 kg/m(2)) women were randomly assigned to control (CG) or home-based exercise group (HB). The HB group received a booklet explaining the physical exercises to be practiced at home at least three times per week (40 min/session). Both groups were required to follow a small energy restriction of 100-300 calories per day. For the analysis, women were stratified in two groups according to baseline insulin sensitivity: NIR (non-insulin resistant; n = 121) and IR (insulin resistant; n = 64). Women classified as IR at baseline had greater weight loss after 12 months of follow-up (-1.6 kg vs. -1.1 kg; p = 0.01), and HB exercise helped to reduce weight only among NIR women (-1.5 vs. -0.7; p = 0.04); no differences were observed between intervention groups for IR women (-1.5 vs. -1.7; p = 0.24). There were no differences between IR and NIR groups for lipid profile after adjustment for weight changes. Insulin resistance facilitated weight loss, and home-based exercise promoted greater weight loss only in non-insulin resistance women. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Building Health Promotion into the Job of Home Care Aides: Transformation of the Workplace Health Environment

PubMed Central

Muramatsu, Naoko; Yin, Lijuan; Lin, Ting-Ti

2017-01-01

Home care aides (HCAs), predominantly women, constitute one of the fastest growing occupations in the United States. HCAs work in clients’ homes that lack typical workplace resources and benefits. This mixed-methods study examined how HCAs’ work environment was transformed by a pilot workplace health promotion program that targeted clients as well as workers. The intervention started with training HCAs to deliver a gentle physical activity program to their older clients in a Medicaid-funded home care program. Older HCAs aged 50+ reported increased time doing the types of physical activity that they delivered to their clients (stretching or strengthening exercise) (p = 0.027). Almost all (98%) HCAs were satisfied with the program. These quantitative results were corroborated by qualitative data from open-ended survey questions and focus groups. HCAs described how they exercised with clients and how the psychosocial work environment changed with the program. Building physical activity into HCAs’ job is feasible and can effectively promote HCAs’ health, especially among older HCAs. PMID:28379207

Building Health Promotion into the Job of Home Care Aides: Transformation of the Workplace Health Environment.

PubMed

Muramatsu, Naoko; Yin, Lijuan; Lin, Ting-Ti

2017-04-05

Home care aides (HCAs), predominantly women, constitute one of the fastest growing occupations in the United States. HCAs work in clients' homes that lack typical workplace resources and benefits. This mixed-methods study examined how HCAs' work environment was transformed by a pilot workplace health promotion program that targeted clients as well as workers. The intervention started with training HCAs to deliver a gentle physical activity program to their older clients in a Medicaid-funded home care program. Older HCAs aged 50+ reported increased time doing the types of physical activity that they delivered to their clients (stretching or strengthening exercise) ( p = 0.027). Almost all (98%) HCAs were satisfied with the program. These quantitative results were corroborated by qualitative data from open-ended survey questions and focus groups. HCAs described how they exercised with clients and how the psychosocial work environment changed with the program. Building physical activity into HCAs' job is feasible and can effectively promote HCAs' health, especially among older HCAs.

Does self-efficacy mediate functional change in older adults participating in an exercise program after hip fracture? A randomized controlled trial.

PubMed

Chang, Feng-Hang; Latham, Nancy K; Ni, Pengsheng; Jette, Alan M

2015-06-01

To examine whether self-efficacy mediated the effect of the Home-based Post-Hip Fracture Rehabilitation program on activity limitations in older adults after hip fracture and whether the mediating effect was different between sex and age groups. Randomized controlled trial. Community. Participants with hip fracture (N=232; mean age ± SD, 79±9.4y) were randomly assigned to intervention (n=120, 51.7%) and attention control (n=112, 48.3%) groups. The 6-month intervention, the Home-based Post-Hip Fracture Rehabilitation, is a functionally oriented, home-based exercise program. Data were collected at baseline, postintervention (6mo), and follow-up (9mo). Activity Measure for Post-Acute Care. The mediating effect of the Home-based Post-Hip Fracture Rehabilitation program on Basic Mobility function through self-efficacy for exercise was significant at 9 months (βindirect=.21). Similarly, the mediating effect of the intervention on Daily Activity function through self-efficacy for exercise was significant at 9 months (βindirect=.49). In subgroup analyses, the mediating effect was significant at 9 months in the younger group (age, ≤79y) in comparison to the older group and was significant in women in comparison to men. Self-efficacy may play a partial mediating role in the effect on some longer-term functional outcomes in the Home-based Post-Hip Fracture Rehabilitation intervention. The results suggest that program components that target self-efficacy should be incorporated in future hip fracture rehabilitation interventions. Age and sex of the targeted participants may also need to be considered when developing interventions. Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

24 CFR 50.17 - Decision points for projects.

Code of Federal Regulations, 2013 CFR

2013-04-01

... (including sections 202 and 811), nursing homes, hospitals, group practice facilities and manufactured home... Disposition. Multifamily structures, college housing, nursing homes, manufactured homes and parks, group.... (e) HUD programs subject to 24 CFR part 58. For cases in which HUD exercises environmental...

24 CFR 50.17 - Decision points for projects.

Code of Federal Regulations, 2014 CFR

2014-04-01

... (including sections 202 and 811), nursing homes, hospitals, group practice facilities and manufactured home... Disposition. Multifamily structures, college housing, nursing homes, manufactured homes and parks, group.... (e) HUD programs subject to 24 CFR part 58. For cases in which HUD exercises environmental...

24 CFR 50.17 - Decision points for projects.

Code of Federal Regulations, 2011 CFR

2011-04-01

... (including sections 202 and 811), nursing homes, hospitals, group practice facilities and manufactured home... Disposition. Multifamily structures, college housing, nursing homes, manufactured homes and parks, group.... (e) HUD programs subject to 24 CFR part 58. For cases in which HUD exercises environmental...

Effect of home-based exercise intervention on fasting insulin and Adipocytokines in colorectal cancer survivors: a randomized controlled trial.

PubMed

Lee, Mi Kyung; Kim, Ji-Young; Kim, Dong-Il; Kang, Dong-Woo; Park, Ji-Hye; Ahn, Ki-Yong; In Yang, Hyuk; Lee, Dong Hoon; Roh, Yun Ho; Lee, Ji-Won; Chu, Sang-Hui; Meyerhardt, Jeffrey A; Jones, Lee W; Kim, Nam-Kyu; Jeon, Justin Y

2017-11-01

Elevated circulating insulin is associated with increased risk of recurrence and cancer mortality in early-stage colorectal cancer (CRC). We conducted a randomized controlled trial to determine the effect of a 12-week home-based exercise program on fasting insulin, adipocytokines, and physical function in CRC survivors. One hundred and twenty-three stage II-III CRC patients were randomly assigned to either a home-based exercise (n=62) or standard care control group (n=61) for 12weeks. Home-based exercise consisted of aerobic and resistance training, with a goal of obtaining ≥18 metabolic equivalent task (MET)-h/wk. Participants in the exercise group were instructed to participate in >18MET-h/wk. of aerobic and resistance exercise while the participants in the control group were asked to maintain their usual daily activity. The primary outcome was fasting insulin levels. Secondary outcomes were adiponectin, TNF-α levels and 6min walk distance from baseline to post-intervention. After the 12-weeks, moderate-vigorous physical activity participation increased from 9.1±14.7MET-h/wk. to 26.6±21.7MET-h/wk. in the exercise group, with no change in the control group (p<0.01 for group and time interaction). Circulating insulin level decreased by 1μU/ml (6.0±3.9 vs. 5.0±3.5, p=0.009) in the exercise group with no change in the control group (p=0.022 for group and time interaction). A similar trend was observed in TNF-α (p=0.030 for group and time interaction). Six minute walk distance increased by 25.2m in the exercise group with no change in the control group (p=0.061 for group and time interaction). The 12week home-based exercise program increased level of physical activity and decreased circulating insulin levels in CRC survivors. Copyright © 2017 Elsevier Inc. All rights reserved.

Combined aerobic and resistance exercise program improves task performance in patients with heart failure.

PubMed

Gary, Rebecca A; Cress, M Elaine; Higgins, Melinda K; Smith, Andrew L; Dunbar, Sandra B

2011-09-01

To assess the effects of a home-based aerobic and resistance training program on the physical function of adults with New York Heart Association (NYHA) class II and III patients and systolic heart failure (HF). Randomized controlled trial. Home based. Stable patients (N=24; mean age, 60 ± 10 y; left ventricular ejection fraction, 25% ± 9%; 50% white; 50% women) with New York Heart Association (NYHA) classes II and III (NYHA class III, 58%) systolic heart failure (HF). A 12-week progressive home-based program of moderate-intensity aerobic and resistance exercise. Attention control wait list participants performed light stretching and flexibility exercises. A 10-item performance-based physical function measure, the Continuous Scale Physical Functional Performance test (CS-PFP10), was the major outcome variable and included specific physical activities measured in time to complete a task, weight carried during a task, and distance walked. Other measures included muscle strength, HRQOL (Minnesota Living With Heart Failure Questionnaire, Epworth Sleepiness Scale), functional capacity (Duke Activity Status Index), and disease severity (brain natriuretic peptide) levels. After the exercise intervention, 9 of 10 specific task activities were performed more rapidly, with increased weight carried by exercise participants compared with the attention control wait list group. Exercise participants also showed significant improvements in CS-PFP10 total score (P<.025), upper and lower muscle strength, and HRQOL (P<.001) compared with the attention control wait list group. Adherence rates were 83% and 99% for the aerobic and resistance training, respectively. Patients with stable HF who participate in a moderate-intensity combined aerobic and resistance exercise program may improve performance of routine physical activities of daily living by using a home-based exercise approach. Performance-based measures such as the CS-PFP10 may provide additional insights into physical function in patients with HF that more commonly used exercise tests may not identify. Early detection of subtle changes that may signal declining physical function that are amenable to intervention potentially may slow further loss of function in this patient population. Copyright © 2011 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Formal Physical Therapy May Not Be Necessary After Unicompartmental Knee Arthroplasty: A Randomized Clinical Trial.

PubMed

Fillingham, Yale A; Darrith, Brian; Lonner, Jess H; Culvern, Chris; Crizer, Meredith; Della Valle, Craig J

2018-02-21

The purpose of this randomized clinical trial was to compare formal outpatient physical therapy (PT) and unsupervised home exercises after unicompartmental knee arthroplasty (UKA). Fifty-two patients were randomized to 6 weeks of outpatient PT or an unsupervised home exercise program after UKA. The primary outcome was change in range of motion at 6 weeks with secondary outcomes including total arc of motion, Knee Society Score, Knee Injury and Osteoarthritis Outcome Score Jr, Lower Extremity Functional Scale, and Veterans Rands-12 score. Twenty-five patients received outpatient PT, 22 patients the self-directed exercise program, while 3 patients deviated from the protocol, 1 patient withdrew, and 1 patient was lost to follow-up. There was no difference in the change of range of motion (P = .43) or total arc of motion at 6 weeks (P = .17) between the groups and likewise no significant differences were found in any of the secondary outcomes. Two patients who crossed over from the unsupervised home exercise program to formal outpatient PT within the first 2 weeks postoperatively required a manipulation under anesthesia. Our results suggest self-directed exercises may be appropriate for most patients following UKA. However, there is a subset of patients who may benefit from formal PT. Copyright © 2018 Elsevier Inc. All rights reserved.

Comparing minimally supervised home-based and closely supervised gym-based exercise programs in weight reduction and insulin resistance after bariatric surgery: A randomized clinical trial.

PubMed

Kaviani, Sara; Dadgostar, Haleh; Mazaherinezhad, Ali; Adib, Hanie; Solaymani-Dodaran, Masoud; Soheilipour, Fahimeh; Hakiminezhad, Mahdi

2017-01-01

Background: Effectiveness of various exercise protocols in weight reduction after bariatric surgery has not been sufficiently explored in the literature. Thus, in the present study, we aimed at comparing the effect of minimally supervised home-based and closely supervised gym-based exercise programs on weight reduction and insulin resistance after bariatric surgery. Methods: Females undergoing gastric bypass surgery were invited to participate in an exercise program and were randomly allocated into 2 groups using a random number generator in Excel. They were either offered a minimally supervised home-based (MSHB) or closely supervised gym-based (CSGB) exercise program. The CSGB protocol constitutes 2 weekly training sessions under ACSM guidelines. In the MSHB protocol, the participants received a notebook containing a list of recommended aerobic and resistance exercises, a log to record their activity, and a schedule of follow-up phone calls and clinic visits. Both groups received a pedometer. We measured their weight, BMI, lipid profile, FBS, and insulin level at baseline and at 20 weeks after the exercises, the results of which were compared using t test or Mann-Whitney U test at the end of the study. All the processes were observed by 1 senior resident in sport medicine. Results: A total of 80 patients were recruited who were all able to complete our study (MSHB= 38 and CSGB= 42). The baseline comparison revealed that the 2 groups were similar. The mean change (reduction) in BMI was slightly better in CSGB (8.61 95% CI 7.76-9.45) compared with the MSHB (5.18 95% CI 3.91-6.46); p< 0.01. However, the 2 groups did not have a statistically significant difference in the amount of change in the other factors including FBS and Homa.ir. Conclusion: As we expected a non-inferiority result, our results showed that both MSHB and CSGB exercise methods are somewhat equally effective in improving lipid profile and insulin resistance in the 2 groups, but a slightly better effect on BMI was observed in CSGB group. With considerably lower costs of minimally supervised home- based exercise programs, both methods should be considered when there is lack of adequate funding.

A home-based exercise program to improve function, fatigue, and sleep quality in patients with Stage IV lung and colorectal cancer: a randomized controlled trial.

PubMed

Cheville, Andrea L; Kollasch, Jenny; Vandenberg, Justin; Shen, Tiffany; Grothey, Axel; Gamble, Gail; Basford, Jeffrey R

2013-05-01

Exercise benefits patients with cancer, but studies of home-based approaches, particularly among those with Stage IV disease, remain small and exploratory. To conduct an adequately powered trial of a home-based exercise intervention that can be facilely integrated into established delivery and reimbursement structures. Sixty-six adults with Stage IV lung or colorectal cancer were randomized, in an eight-week trial, to usual care or incremental walking and home-based strength training. The exercising participants were instructed during a single physiotherapy visit and subsequently exercised four days or more per week; training and step-count goals were advanced during bimonthly telephone calls. The primary outcome measure was mobility assessed with the Ambulatory Post Acute Care Basic Mobility Short Form. Secondary outcomes included ratings of pain and sleep quality as well as the ability to perform daily activities (Ambulatory Post Acute Care Daily Activities Short Form), quality of life (Functional Assessment of Cancer Therapy-General), and fatigue (Functional Assessment of Cancer Therapy-Fatigue). Three participants dropped out and seven died (five in the intervention and two in the control group, P=0.28). At Week 8, the intervention group reported improved mobility (P=0.01), fatigue (P=0.02), and sleep quality (P=0.05) compared with the usual care group, but did not differ on the other measures. A home-based exercise program seems capable of improving the mobility, fatigue, and sleep quality of patients with Stage IV lung and colorectal cancer. Copyright © 2013. Published by Elsevier Inc.

Home-based aerobic conditioning for management of symptoms of fibromyalgia: a pilot study.

PubMed

Harden, R Norman; Song, Sharon; Fasen, Jo; Saltz, Samuel L; Nampiaparampil, Devi; Vo, Andrew; Revivo, Gadi

2012-06-01

This pilot study was designed to evaluate the impact of a home-based aerobic conditioning program on symptoms of fibromyalgia and determine if changes in symptoms were related to quantitative changes in aerobic conditioning (VO(2) max). Twenty-six sedentary individuals diagnosed with fibromyalgia syndrome participated in an individualized 12-week home-based aerobic exercise program with the goal of daily aerobic exercise of 30 minutes at 80% of estimated maximum heart rate. The aerobic conditioning took place in the participants' homes, outdoors, or at local fitness clubs at the discretion of the individual under the supervision of a physical therapist. Patients were evaluated at baseline and completion for physiological level of aerobic conditioning (VO(2) max), pain ratings, pain disability, depression, and stress. In this pilot study subjects who successfully completed the 12-week exercise program demonstrated an increase in aerobic conditioning, a trend toward decrease in pain measured by the McGill Pain Questionnaire-Short Form and a weak trend toward improvements in visual analog scale, depression, and perceived stress. Patients who were unable or unwilling to complete this aerobic conditioning program reported significantly greater pain and perceived disability (and a trend toward more depression) at baseline than those who completed the program. Patients suffering from fibromyalgia who can participate in an aerobic conditioning program may experience physiological and psychological benefits, perhaps with improvement in symptoms of fibromyalgia, specifically pain ratings. More definitive trials are needed, and this pilot demonstrates the feasibility of the quantitative VO2 max method. Subjects who experience significant perceived disability and negative affective symptoms are not likely to maintain a home-based conditioning program, and may need a more comprehensive interdisciplinary program offering greater psychological and social support. Wiley Periodicals, Inc.

Effect of Motivation by “Instagram” on Adherence to Physical Activity among Female College Students

PubMed Central

Al-Eisa, Einas; Al-Rushud, Asma; Alghadir, Ahmad; Al-Harbi, Bashayer; Al-Sughaier, Noha; Al-Yoseef, Noha; Al-Otaibi, Reem; Al-Muhaysin, Hanadi Ali

2016-01-01

Objective. To investigate the efficacy of using “Instagram application” with a “home-exercise program” as a motivational stimulus in improving physical activity (PA) adherence levels among female college students. Methods. Fifty-eight female undergraduate students with the mean age 20.3 ± 0.96 years participated. Participants were divided into two groups: intervention and the control group; both the groups received an exercise program and the intervention group was additionally motivated by “Instagram.” Adherence to PA was measured by using an adherence sheet. The Exercise Motivation Inventory (EMI-2) was used to assess the motivational factors. Results. The most frequent motivational factors were extrinsic as assessed using the EMI-2. “Positive health” was the most frequent factor mentioned of the two types with 47% of the sample. The intervention group adhered with 17% more to the activity program compared to the control group. Moreover, 72% of the participants in the intervention and control groups found the activity program flexible enough to be performed at home; they agreed about its effectiveness on adherence (53%). Conclusions. The use of Instagram with the home exercise program as a motivational modality could be attractive and effective to reinforce adherence and maintain an appropriate PA level. PMID:27034927

Comparing conventional physical therapy rehabilitation with neuromuscular electrical stimulation after TKA.

PubMed

Levine, Michael; McElroy, Karen; Stakich, Valerie; Cicco, Jodie

2013-03-01

Rehabilitation following total knee arthroplasty (TKA) is a costly, cumbersome, and often painful process. Physical therapy contributes to the successful outcome of TKA but can be expensive. Alternative methods of obtaining good functional results that help minimize costs are desirable. Neuromuscular electrical stimulation (NMES) is a potential option. Neuromuscular electrical stimulation has been shown to increase quadriceps muscle strength and activation following TKA. Functional scores also improve following TKA when NMES is added to conventional therapy protocols vs therapy alone. The authors hypothesized that rehabilitation managed by a physical therapist would not result in a functional advantage for patients undergoing TKA when compared with NMES and an unsupervised at-home range of motion exercise program and that patient satisfaction would not differ between the 2 groups. Seventy patients were randomized into a postoperative protocol of conventional physical therapy with a licensed therapist, including range of motion exercises and strengthening exercises, or into a program of NMES and range of motion exercises performed at home without therapist supervision. Noninferiority of the NMES program was obtained 6 weeks postoperatively (Knee Society pain/function scores, Western Ontario and McMaster Universities Osteoarthritis Index, flexion). Noninferiority was shown 6 months postoperatively for all parameters. The results suggest that rehabilitation managed by a physical therapist results in no functional advantage or difference in patient satisfaction when compared with NMES and an unsupervised at-home range of motion program. Neuromuscular electrical stimulation and unsupervised at-home range of motion exercises may provide an option for reducing the cost of the postoperative TKA recovery process without compromising quadriceps strength or patient satisfaction. Copyright 2013, SLACK Incorporated.

A Home-Based Exercise Program Driven by Tablet Application and Mobility Monitoring for Frail Older Adults: Feasibility and Practical Implications.

PubMed

Geraedts, Hilde A E; Zijlstra, Wiebren; Zhang, Wei; Spoorenberg, Sophie L W; Báez, Marcos; Far, Iman Khaghani; Baldus, Heribert; Stevens, Martin

2017-02-02

Stimulation of a physically active lifestyle among older adults is essential to health and well-being. The objective of this study was to evaluate the feasibility and user opinion of a home-based exercise program supported by a sensor and tablet application for frail older adults. Community-dwelling older adults (aged ≥70 y) living in The Netherlands were recruited in 2014. Participants exercised 3 months with and 3 months without supervision from a remote coach. Feasibility was operationalized as adherence to exercise (percentage of 5 exercise bouts per week completed) and to wearing the sensor (with 70% defined as sufficient adherence) and the number of problems reported. User opinion was measured with a questionnaire addressing ease of use of the technology and opinion on the program. Twenty-one of 40 enrolled participants completed the trial. Adherence overall was 60.9% (average of 3 bouts per week). Adherence among completers (69.2%) was significantly higher than adherence among dropouts (49.9%). Adherence was sufficient among completers during the 3 months of supervision (75.8%). Adherence to wearing the sensor was 66.7% and was significantly higher among completers than among dropouts (75.7% vs 54.2%). The rate of incidents was significantly lower among completers than among dropouts (0.4 vs 1.2 incidents per participant per week). Connectivity-related incidents were prominent. On a scale of 1 to 5, completers gave ratings of 4.3 (after 3 months) and 4.2 (after 6 months). A home-based exercise program using novel technology seems feasible when participants are given a stable internet connection. This program shows promise for stimulating physical activity among older frail adults, especially if it offers regular coaching.

Changes in physical fitness of a home-based physical exercise program in childhood obesity: A quasi-experimental uncontrolled study.

PubMed

Lisón, Juan Francisco; Bruñó-Soler, Alejandro; Torró, Isabel; Segura-Ortí, Eva; Alvarez-Pitti, Julio

2017-06-01

Few studies have evaluated the changes in physical fitness (PF) of obese children and adolescents of a physical activity program for the treatment of obesity, and even fewer have explored the modality of home-based physical exercise. The objective of this study is to evaluate the changes in PF and body composition (BC) of a home-based physical exercise for treating childhood obesity. Thirty-three overweight/obese children and adolescents participated for six months in a home-based intervention that combined aerobics and muscular strength exercises. The results were compared, before and after the intervention, for the different PF components (VO2 max , abdominal muscle resistance strength, and lower body explosive strength) and BC (body mass index Z-score (BMI-Z), percentage of body fat, and fat-free mass) variables. A significant reduction was observed in the percentage of body fat (4.7%) and the BMI- Z score (.23), and there was an increase in the fat-free mass of 2.9 kg ( p < .001). In addition, the VO2 max showed a significant increase ( p < .05). The results of the different strength tests also showed significant improvements ( p < .05). Our findings support the effectiveness of this program improving not only BC but also PF. However, our results should be interpreted with caution due to lack of control group.

An elastic band exercise program for older adults using wheelchairs in Taiwan nursing homes: a cluster randomized trial.

PubMed

Chen, Kuei-Min; Li, Chun-Huw; Chang, Ya-Hui; Huang, Hsin-Ting; Cheng, Yin-Yin

2015-01-01

The number of older adults using wheelchairs in nursing homes is over 50% of that population, and many of them use wheelchairs due to muscle weakness in the lower extremities. Muscles of older adults are trainable, and progressive resistance exercises using elastic bands can increase muscle strength in older adults. To test the effectiveness of six-month Wheelchair-bound Senior Elastic Band exercises on the functional fitness of older adults in nursing homes. Cluster randomized trial. Ten nursing homes, southern Taiwan. 127 participants were recruited, and 114 of them completed the study. Inclusion criteria were: (1) aged 65 and over, (2) using wheelchairs for mobility, (3) living in the facility for at least three months, (4) cognitively intact, and (5) heavily or moderate dependency in their activities of daily living. The mean age of the participants was 79.15 (7.03) years, and 98.20% of them had chronic illnesses. Participants were randomly assigned to the experimental (five nursing homes, n=59) or the control (five nursing homes, n=55) group based on the nursing homes where they stayed. A 40-min Wheelchair-bound Senior Elastic Band exercise program was implemented three times per week for six months for the experimental group participants. The functional fitness (activities of daily living, lung capacity, body flexibilities, muscle power and endurance) of the participants was examined at baseline, after three months, and at the end of the six months study. The mixed-design, two-way analysis of variance was used to detect the interaction effects, and one-way repeated measures analysis of variance and analysis of covariance were performed to analyze the within-group and between-group differences. At the end of the six-month study, the Wheelchair-bound Senior Elastic Band group had better performances in all of the functional fitness indicators than the control group (all p<0.05). The Wheelchair-bound Senior Elastic Band exercises significantly improved the functional fitness of the older adults in wheelchairs. It is suggested that the program be incorporated as a part of daily activities for nursing home older adults in wheelchairs. Copyright © 2014 Elsevier Ltd. All rights reserved.

Feasibility of a Customized, In-Home, Game-Based Stroke Exercise Program Using the Microsoft Kinect® Sensor.

PubMed

Proffitt, Rachel; Lange, Belinda

2015-01-01

The objective of this study was to determine the feasibility of a 6-week, game-based, in-home telerehabilitation exercise program using the Microsoft Kinect® for individuals with chronic stroke. Four participants with chronic stroke completed the intervention based on games designed with the customized Mystic Isle software. The games were tailored to each participant's specific rehabilitation needs to facilitate the attainment of individualized goals determined through the Canadian Occupational Performance Measure. Likert scale questionnaires assessed the feasibility and utility of the game-based intervention. Supplementary clinical outcome data were collected. All participants played the games with moderately high enjoyment. Participant feedback helped identify barriers to use (especially, limited free time) and possible improvements. An in-home, customized, virtual reality game intervention to provide rehabilitative exercises for persons with chronic stroke is practicable. However, future studies are necessary to determine the intervention's impact on participant function, activity, and involvement.

[Effects of an inpatient pulmonary rehabilitation program on dyspnea, exercise capacity, and health related quality of life for patients with chronic lung disease].

PubMed

Lee, Chang Kwan

2007-04-01

The purpose of this study was to examine the effects of an inpatient pulmonary rehabilitation program on dyspnea, exercise capacity, and health related quality of life in inpatients with chronic lung disease. This quasi experimental study was designed with a nonequivalent control group pre-post test time series. Twenty three patients were assigned to the experimental group and nineteen to the control group. The inpatient pulmonary rehabilitation program was composed of upper and lower extremity exercise, breathing retraining, inspiratory muscle training, education, relaxation and telephone contacts. This program consisted of 4 sessions with inpatients and 4 weeks at home after discharge. The control group was given a home based pulmonary rehabilitation program at the time of discharge. The outcomes were measured by the Borg score, 6MWD and the Chronic Respiratory Disease Questionnaire(CRQ). There was a statistically significant difference in dyspnea between the experimental group and control group, but not among time sequence, or interaction between groups and time sequence. Also significant improvements in exercise capacity and health related quality of life were found only in the experimental group. An Inpatient pulmonary rehabilitation program may be a useful intervention to reduce dyspnea, and increase exercise capacity and health related quality of life for chronic lung disease patients.

Fall Prevention for Older Adults Receiving Home Healthcare.

PubMed

Bamgbade, Sarah; Dearmon, Valorie

2016-02-01

Falls pose a significant risk for community-dwelling older adults. Fall-related injuries increase healthcare costs related to hospitalization, diagnostic procedures, and/or surgeries. This article describes a quality improvement project to reduce falls in older adults receiving home healthcare services. The fall prevention program incorporated best practices for fall reduction, including fall risk assessment, medication review/management, home hazard and safety assessment, staff and patient fall prevention education, and an individualized home-based exercise program. The program was implemented and evaluated during a 6-month time frame. Fewer falls occurred post implementation of the falls prevention program with no major injuries.

A practical guide to exercise training for heart failure patients.

PubMed

Smart, Neil; Fang, Zhi You; Marwick, Thomas H

2003-02-01

Exercise training has been shown to improve exercise capacity in patients with heart failure. We sought to examine the optimal strategy of exercise training for patients with heart failure. Review of the published data on the characteristics of the training program, with comparison of physiologic markers of exercise capacity in heart failure patients and healthy individuals and comparison of the change in these characteristics after an exercise training program. Many factors, including the duration, supervision, and venue of exercise training; the volume of working muscle; the delivery mode (eg, continuous vs. intermittent exercise), training intensity; and the concurrent effects of medical treatments may influence the results of exercise training in heart failure. Starting in an individually prescribed and safely monitored hospital-based program, followed by progression to an ongoing and progressive home program of exercise appears to be the best solution to the barriers of anxiety, adherence, and "ease of access" encountered by the heart failure patient. Various exercise training programs have been shown to improve exercise capacity and symptom status in heart failure, but these improvements may only be preserved with an ongoing maintenance program.

Manual for guided home exercises for osteoarthritis of the knee.

PubMed

Carvalho, Nilza Aparecida de Almeida; Bittar, Simoni Teixeira; Pinto, Flávia Ribeiro de Souza; Ferreira, Mônica; Sitta, Robson Roberto

2010-06-01

Physiotherapy is one of the most important components of therapy for osteoarthritis of the knee. The objective of this prospective case series was to assess the efficiency of a guidance manual for patients with osteoarthritis of the knee in relation to pain, range of movement , muscle strength and function, active goniometry, manual strength test and function. Thirty-eight adults with osteoarthritis of the knee (>or= 45 years old) who were referred to the physiotherapy service at the university hospital (Santa Casa de Misericórdia de São Paulo) were studied. Patients received guidance for the practice of specific physical exercises and a manual with instructions on how to perform the exercises at home. They were evaluated for pain, range of movement, muscle strength and function. These evaluations were performed before they received the manual and three months later. Patients were seen monthly regarding improvements in their exercising abilities. The program was effective for improving muscle strength, controlling pain, maintaining range of movement of the knee joint, and reducing functional incapacity. A review of the literature showed that there are numerous clinical benefits to the regular practice of physical therapy exercises by patients with osteoarthritis of the knee(s) in a program with appropriate guidance. This study shows that this guidance can be attained at home with the use of a proper manual. Even when performed at home without constant supervision, the use of the printed manual for orientation makes the exercises for osteoarthritis of the knee beneficial.

Long Term Home-Based Exercise is Effective to Reduce Blood Pressure in Low Income Brazilian Hypertensive Patients: A Controlled Trial.

PubMed

Farinatti, Paulo; Monteiro, Walace D; Oliveira, Ricardo B

2016-12-01

Home-based exercise programs may increase adherence to physical activity among groups with poor access to exercise facilities. However, their effectiveness to lower blood pressure of hypertensive patients remains undefined. This controlled clinical trial investigated the influence of a home-based exercise program upon blood pressure, blood metabolic profile, and physical fitness in a Brazilian cohort of low income patients diagnosed with hypertension. Twenty-nine patients (22 women, age: 53 ± 11 years) underwent 16 months of home-based exercise, including 30 min of moderate intensity walking and stretching exercises. Fourteen patients (9 women, age: 48 ± 5 years) composed a non-exercise control group. Primary outcomes were assessed each two months. Body mass (3.6 ± 0.2 kg; P = 0.03) and sum of skinfolds (3.0 ± 1.2 cm; P = 0.04) increased in controls vs. baseline. Mean compliance to home-based exercise was 83 ± 7 %, which induced significant improvements from baseline vs. controls in body mass (-5.4 ± 2.0 kg; P = 0.04), body fat (-4.7 ± 0.3 %; P = 0.03), waist circumference (-6.1 ± 1.2 cm; P = 0.03), sum of skinfolds (-14.8 ± 3.7; P = 0.02); aerobic efficiency reflected by slopes of relationships between heart rate and workload (-0.05 ± 0.01; P = 0.05), trunk flexibility (7.8 ± 1.7 cm; P = 0.02), HDL (1.8 ± 0.9 mg/dL; P = 0.04), triglycerides (-12.3 ± 1.0 mg/dL; P = 0.03), and glucose (-6.9 ± 2.9 mg/dL; P = 0.05). Systolic and diastolic BP decreased until the sixth month of intervention vs. baseline and controls, remaining stable at lower levels thereafter (systolic blood pressure: -4.5 ± 0.3 mmHg; P = 0.03; diastolic blood pressure: -2.5 ± 0.6 mmHg; P = 0.05). Low income hypertensive patients complied with a long-term home-based exercise program, which was effective for improving their functional capacity, blood metabolic profile, and blood pressure.

Implementation of exercise training programs in a hemodialysis unit: effects on physical performance.

PubMed

Bulckaen, Massimo; Capitanini, Alessandro; Lange, Sara; Caciula, Andrea; Giuntoli, Franco; Cupisti, Adamasco

2011-01-01

Exercise training is beneficial for hemodialysis patients, but it should be tailored to individual abilities and willingness to participate. This study evaluated the effects of different 6-month programs of physical activity in 18 patients of a single hemodialysis unit. Before and after a 12-month control period (T0), and following 3 (T3) and 6 (T6) months of training, the patients underwent the 6-minute walk test (6MWT) and constant treadmill test at 3 km/hour speed and 10% grade; spontaneous physical activity was assessed by pedometers. All patients trained for coordination, flexibility and muscular strengthening for 30 minutes within the first 2 hours of hemodialysis sessions: 9 patients underwent home exercise walking training (advised walking group [AWG]); the other 9 patients underwent the advised home training program plus an additional supervised gym training session, twice weekly (supervised walking group [SWG]). In both AWG and SWG, no changes occurred during the control period (232 ± 204 m and 248 ± 187 m at T0). In contrast, endurance performance at treadmill increased at T3 and T6 in the AWG (377 ± 272 m and 615 ± 413 m; p<0.01) and in the SWG (424 ± 272 m and 890 ± 364 m; p<0.001). No unwanted side effects occurred. This study shows that physical exercise programs can safely increase physical performance in hemodialysis patients. The training program should be continued for at least 6 months to increase muscle strength and endurance. Intradialytic exercise and home-based, pedometer-based regimens may be a useful and easy approach, whereas supervised programs can give additional benefits in motivated, selected patients.

Open Source Virtual Worlds and Low Cost Sensors for Physical Rehab of Patients with Chronic Diseases

NASA Astrophysics Data System (ADS)

Romero, Salvador J.; Fernandez-Luque, Luis; Sevillano, José L.; Vognild, Lars

For patients with chronic diseases, exercise is a key part of rehab to deal better with their illness. Some of them do rehabilitation at home with telemedicine systems. However, keeping to their exercising program is challenging and many abandon the rehabilitation. We postulate that information technologies for socializing and serious games can encourage patients to keep doing physical exercise and rehab. In this paper we present Virtual Valley, a low cost telemedicine system for home exercising, based on open source virtual worlds and utilizing popular low cost motion controllers (e.g. Wii Remote) and medical sensors. Virtual Valley allows patient to socialize, learn, and play group based serious games while exercising.

[Impact of exercise on the body composition and aerobic capacity of elderly with obesity through three models of intervention].

PubMed

Prieto, Jose Antonio; Del Valle, Miguel; Nistal, Paloma; Méndez, David; Abelairas-Gómez, Cristian; Barcala-Furelos, Roberto

2014-12-17

The objective of this study was to analyze the influence of aerobic exercise on body composition and aerobic capacity of a sample of older, sedentary adults with obesity rates by three different models of intervention (recommendation, prescription at home and monitoring). A total of 76 older adults with a mean age 67.1+/-1.2 years, sedentary, with a BMI> 30 kg/ m2 were randomized in to four groups: Control (CON) recommendation (REC), prescription home (PRES) and monitoring in a sports center (MON). The same program of aerobic exercise for groups of home and sports center for 24 weeks, 3 days a week was developed. It was determined before and after the intervention BMI, Waist- Hip-index (ICC), the% fat ( Σ folds) and aerobic capacity (T6M) throughout the sample. MON and PRES groups showed significant improvements in the ICC, Σ folds and T 6M variables, not the case in BMI. However the MON group presented significant differences from group PRES between-group analysis (p <0.001). The recommendation did not get positive effects. Monitoring is the most effective exercise programs in adults with obesity methodology. However the exercise prescription at home since early intervention is an important approach for people with physical and/ or psychological reasons such as obesity cannot access the sports centers to participate in activities led by a monitor. Unknowns of aerobic exercise are cleared in the home that are of great impact for social policies regarding the health of the elderly population. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

Factors That Influence the Efficacy of Stretching Programs for Patients With Hypomobility

PubMed Central

Jacobs, Cale A.; Sciascia, Aaron D.

2011-01-01

Context: Passive stretching exercise protocols, as part of outpatient treatment or home exercise programs, are used to improve hypomobility. Despite the cosmopolitan use of stretching exercises, little is known about the forces being applied to the joint during these routine treatments. Type of Study: Clinical review. Evidence Acquisition: Articles were identified using MEDLINE and Google Scholar databases, with searches initially limited to those articles published after 1995. Seminal articles that were referenced were also included. Results: Many factors contribute to the clinical success of a stretching program, including the frequency, intensity, and duration of the stretching exercises, as well as patient- and joint-specific factors. Conclusions: The goal of a stretching protocol is to maximize total end-range time both in the clinic and at home. Higher intensity, prolonged, and frequent stretching (10- to 15-minute bouts, 3 to 6 times per day) used as an adjunct to high-grade mobilizations may be beneficial for certain hypomobility conditions. PMID:23016052

Feasibility of interactive biking exercise system for telemanagement in elderly.

PubMed

Finkelstein, Joseph; Jeong, In Cheol

2013-01-01

Inexpensive cycling equipment is widely available for home exercise however its use is hampered by lack of tools supporting real-time monitoring of cycling exercise in elderly and coordination with a clinical care team. To address these barriers, we developed a low-cost mobile system aimed at facilitating safe and effective home-based cycling exercise. The system used a miniature wireless 3-axis accelerometer that transmitted the cycling acceleration data to a tablet PC that was integrated with a multi-component disease management system. An exercise dashboard was presented to a patient allowing real-time graphical visualization of exercise progress. The system was programmed to alert patients when exercise intensity exceeded the levels recommended by the patient care providers and to exchange information with a central server. The feasibility of the system was assessed by testing the accuracy of cycling speed monitoring and reliability of alerts generated by the system. Our results demonstrated high validity of the system both for upper and lower extremity exercise monitoring as well as reliable data transmission between home unit and central server.

Delivery and Outcomes of a Yearlong Home Exercise Program After Hip Fracture

PubMed Central

Orwig, Denise L.; Hochberg, Marc; Yu-Yahiro, Janet; Resnick, Barbara; Hawkes, William G.; Shardell, Michelle; Hebel, J. Richard; Colvin, Perry; Miller, Ram R.; Golden, Justine; Zimmerman, Sheryl; Magaziner, Jay

2011-01-01

Background Hip fracture affects more than 1.6 million persons worldwide and causes substantial changes in body composition, function, and strength. Usual care (UC) has not successfully restored function to most patients, and prior research has not identified an effective restorative program. Our objective was to determine whether a yearlong home-based exercise program initiated following UC could be administered to older patients with hip fracture and improve outcomes. Methods A randomized controlled trial of 180 community dwelling female patients with hip fracture, 65 years and older, randomly assigned to intervention (n=91) or UC (n=89). Patients were recruited within 15 days of fracture from 3 Baltimore-area hospitals from November 1998 through September 2004. Follow-up assessments were conducted at 2, 6, and 12 months after fracture. The Exercise Plus Program was administered by exercise trainers that included supervised and independently performed aerobic and resistive exercises with increasing intensity. Main outcome measures included bone mineral density of the contralateral femoral neck. Other outcomes included time spent and kilocalories expended in physical activity using the Yale Physical Activity Scale, muscle mass and strength, fat mass, activities of daily living, and physical and psychosocial functioning. The effect of intervention for each outcome was estimated by the difference in outcome trajectories 2 to 12 months after fracture. Results More than 80% of participants received trainer visits, with the majority receiving more than 3 quarters (79%) of protocol visits. The intervention group reported more time spent in exercise activity during follow-up (P<.05). Overall, small effect sizes of 0 to 0.2 standard deviations were seen for bone mineral density measures, and no significant patterns of time-specific between-group differences were observed for the remaining outcome measures. Conclusion Patients with hip fracture who participate in a yearlong, in-home exercise program will increase activity level compared with those in UC; however, no significant changes in other targeted outcomes were detected. PMID:21357809

Benefits of home-based multidisciplinary exercise and supportive care in inoperable non-small cell lung cancer - protocol for a phase II randomised controlled trial.

PubMed

Edbrooke, Lara; Aranda, Sanchia; Granger, Catherine L; McDonald, Christine F; Krishnasamy, Mei; Mileshkin, Linda; Irving, Louis; Braat, Sabine; Clark, Ross A; Gordon, Ian; Denehy, Linda

2017-09-29

Lung cancer is one of the most commonly diagnosed cancers, and is a leading cause of cancer mortality world-wide. Due to lack of early specific symptoms, the majority of patients present with advanced, inoperable disease and five-year relative survival across all stages of non-small cell lung cancer (NSCLC) is 14%. People with lung cancer also report higher levels of symptom distress than those with other forms of cancer. Several benefits for survival and patient reported outcomes are reported from physical activity and exercise in other tumour groups. We report the protocol for a study investigating the benefits of exercise, behaviour change and symptom self-management for patients with recently diagnosed, inoperable, NSCLC. This multi-site, parallel-group, assessor-blinded randomised controlled trial, powered for superiority, aims to assess functional and patient-reported outcomes of a multi-disciplinary, home-based exercise and supportive care program for people commencing treatment. Ninety-two participants are being recruited from three tertiary-care hospitals in Melbourne, Australia. Following baseline testing, participants are randomised using concealed allocation, to receive either: a) 8 weeks of home-based exercise (comprising an individualised endurance and resistance exercise program and behaviour change coaching) and nurse-delivered symptom self-management intervention or b) usual care. The primary outcome is the between-group difference in the change in functional exercise capacity (six-minute walk distance) from baseline to post-program assessment. Secondary outcomes include: objective and self-reported physical activity levels, physical activity self-efficacy, behavioural regulation of motivation to exercise and resilience, muscle strength (quadriceps and grip), health-related quality of life, anxiety and depression and symptom interference. There is a lack of evidence regarding the benefit of exercise intervention for people with NSCLC, particularly in those with inoperable disease receiving treatment. This trial will contribute to evidence currently being generated in national and international trials by implementing and evaluating a home-based program including three components not yet combined in previous research, for people with inoperable NSCLC receiving active treatment and involving longer-term follow-up of outcomes. This trial is ongoing and currently recruiting. This trial was prospectively registered on the Australian New Zealand Clinical Trials Registry ( ACTRN12614001268639 : (4/12/14).

Does an 8-week home-based exercise program affect physical capacity, quality of life, sick leave, and use of psychotropic drugs in patients with pulmonary embolism? Study protocol for a multicenter randomized clinical trial.

PubMed

Rolving, Nanna; Brocki, Barbara C; Mikkelsen, Hanne R; Ravn, Pernille; Bloch-Nielsen, Jannie Rhod; Frost, Lars

2017-05-30

The existing evidence base in pulmonary embolism (PE) is primarily focused on diagnostic methods, medical treatment, and prognosis. Only a few studies have investigated how everyday life is affected by PE, although many patients are negatively affected both physically and emotionally after hospital discharge. Currently, no documented rehabilitation options are available for these patients. We aim to examine whether an 8-week home-based exercise intervention can influence physical capacity, quality of life, sick leave, and use of psychotropic drugs in patients medically treated for PE. One hundred forty patients with incident first-time PE will be recruited in five hospitals. After inclusion, patients will be randomly allocated to either the control group, receiving usual care, or the intervention group, who will be exposed to an 8-week home-based exercise program in addition to usual care. The intervention includes an initial individual exercise planning session with a physiotherapist, leading to a recommended exercise program of a minimum of three weekly training sessions of 30-60 minutes' duration. The patients have regular telephone contact with the physiotherapist during the 8-week program. At the time of inclusion, after 2 months, and after 6 months, the patients' physical capacity is measured using the Incremental Shuttle Walk test. Furthermore the patients' quality of life, sick leave, and use of psychotropic drugs is measured using self-reported questionnaires. In both randomization arms, all follow-up measurements and visits will take place at the hospital from which the patient was discharged. Levels of eligibility, consent, adherence, and retention will be used as indicators of study feasibility. We expect that the home-based exercise program will improve the physical capacity and quality of life for the patients in the intervention group. The study will furthermore contribute significantly to the limited knowledge about the optimal rehabilitation of PE patients, and may thereby form the basis of future recommendations in this field. ClinicalTrials.gov, NCT02684721 . Registered on 20 January 2016.

The efficacy of three-dimensional Schroth exercises in adolescent idiopathic scoliosis: a randomised controlled clinical trial.

PubMed

Kuru, Tuğba; Yeldan, İpek; Dereli, E Elçin; Özdinçler, Arzu R; Dikici, Fatih; Çolak, İlker

2016-02-01

To compare the efficacy of three-dimensional (3D) Schroth exercises in patients with adolescent idiopathic scoliosis. A randomised-controlled study. An outpatient exercise-unit and in a home setting. Fifty-one patients with adolescent idiopathic scoliosis. Forty-five patients with adolescent idiopathic scoliosis meeting the inclusion criteria were divided into three groups. Schroth's 3D exercises were applied to the first group in the clinic and were given as a home program for the second group; the third group was the control. Scoliosis angle (Cobb method), angle of rotation (scoliometer), waist asymmetry (waist - elbow distance), maximum hump height of the patients and quality of life (QoL) (SRS-23) were assessed pre-treatment and, at the 6(th), 12(th) and 24(th) weeks. The Cobb (-2.53°; P=0.003) and rotation angles (-4.23°; P=0.000) significantly decreased, which indicated an improvement in the clinic exercise group compared to the other groups. The gibbosity (-68.66mm; P=0.000) and waist asymmetry improved only in the clinic exercise group, whereas the results of the other groups worsened. QoL did not change significantly in either group. According to the results of this study the Schroth exercise program applied in the clinic under physiotherapist supervision was superior to the home exercise and control groups; additionally, we observed that scoliosis progressed in the control group, which received no treatment. © The Author(s) 2015.

Individualized home-based exercise programs for older people to reduce falls and improve physical performance: A systematic review and meta-analysis.

PubMed

Hill, Keith D; Hunter, Susan W; Batchelor, Frances A; Cavalheri, Vinicius; Burton, Elissa

2015-09-01

There is considerable diversity in the types of exercise programs investigated to reduce falls in older people. The purpose of this paper was to review the effectiveness of individualized (tailored) home-based exercise programs in reducing falls and improving physical performance among older people living in the community. A systematic review and meta-analysis was conducted of randomized or quasi-randomized trials that utilized an individualized home-based exercise program with at least one falls outcome measure reported. Single intervention exercise studies, and multifactorial interventions where results for an exercise intervention were reported independently were included. Two researchers independently rated the quality of each included study. Of 16,871 papers identified from six databases, 12 met all inclusion criteria (11 randomized trials and a pragmatic trial). Study quality overall was high. Sample sizes ranged from 40 to 981, participants had an average age 80.1 years, and although the majority of studies targeted the general older population, several studies included clinical groups as their target (Parkinson's disease, Alzheimer's disease, and hip fracture). The meta-analysis results for the five studies reporting number of fallers found no significant effect of the intervention (RR [95% CI]=0.93 [0.72-1.21]), although when a sensitivity analysis was performed with one study of participants recently discharged from hospital removed, this result was significant (RR [95% CI] = 0.84 [0.72-0.99]). The meta-analysis also found that intervention led to significant improvements in physical activity, balance, mobility and muscle strength. There were no significant differences for measures of injurious falls or fractures. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Design of the Physical exercise during Adjuvant Chemotherapy Effectiveness Study (PACES): a randomized controlled trial to evaluate effectiveness and cost-effectiveness of physical exercise in improving physical fitness and reducing fatigue.

PubMed

van Waart, Hanna; Stuiver, Martijn M; van Harten, Wim H; Sonke, Gabe S; Aaronson, Neil K

2010-12-07

Cancer chemotherapy is frequently associated with a decline in general physical condition, exercise tolerance, and muscle strength and with an increase in fatigue. While accumulating evidence suggests that physical activity and exercise interventions during chemotherapy treatment may contribute to maintaining cardiorespiratory fitness and strength, the results of studies conducted to date have not been consistent. Additional research is needed to determine the optimal intensity of exercise training programs in general and in particular the relative effectiveness of supervised, outpatient (hospital- or physical therapy practice-based) versus home-based programs. This multicenter, prospective, randomized trial will evaluate the effectiveness of a low to moderate intensity, home-based, self-management physical activity program, and a high intensity, structured, supervised exercise program, in maintaining or enhancing physical fitness (cardiorespiratory fitness and muscle strength), in minimizing fatigue and in enhancing the health-related quality of life (HRQoL). Patients receiving adjuvant chemotherapy for breast or colon cancer (n = 360) are being recruited from twelve hospitals in the Netherlands, and randomly allocated to one of the two treatment groups or to a 'usual care' control group. Performance-based and self-reported outcomes are assessed at baseline, at the end of chemotherapy and at six month follow-up. This large, multicenter, randomized clinical trial will provide additional empirical evidence regarding the effectiveness of physical exercise during adjuvant chemotherapy in enhancing physical fitness, minimizing fatigue, and maintaining or enhancing patients' quality of life. If demonstrated to be effective, exercise intervention programs will be a welcome addition to the standard program of care offered to patients with cancer receiving chemotherapy. This study is registered at the Netherlands Trial Register (NTR 2159).

Ankle sprains: combination of manual therapy and supervised exercise leads to better recovery.

PubMed

2013-01-01

Ankle sprains often occur when running, walking on uneven ground, or jumping. Usually, people are told to rest, elevate the foot, apply ice, and use an elastic wrap to reduce swelling. This treatment is typically followed by exercises that can be performed at home. Although the pain and swelling usually improve quickly, more than 70% of people who sprain their ankles continue to have problems with them and up to 80% will sprain their ankles again. This suggests that it is important to better care for ankle sprains. One option is manual therapy, where the therapist moves the ankle and surrounding joints to help restore normal joint movement. A research report published in the July 2013 issue of JOSPT examines and compares the outcomes of a home exercise program with a more involved treatment program that includes manual therapy and supervised exercises.

A prehabilitation program for physically frail community-living older persons.

PubMed

Gill, Thomas M; Baker, Dorothy I; Gottschalk, Margaret; Gahbauer, Evelyne A; Charpentier, Peter A; de Regt, Paul T; Wallace, Sarah J

2003-03-01

To describe the development and implementation of a preventive, home-based physical therapy program (PREHAB) and to provide evidence for the safety and interrater reliability of the PREHAB protocol. Demonstration study. General community. Ninety-four physically frail, community-living persons, aged 75 years or older, who were randomized to the PREHAB program in a clinical trial. The PREHAB program built on the physical therapy component of 2 previous home-based protocols. A total of 223 assessment items were linked to 28 possible interventions, including progressive balance and conditioning exercises, by using detailed algorithms and decisions rules that were automated on notebook computers. The percentages of participants who were eligible for and who completed each intervention, the extent of progress noted in the balance and conditioning exercises, adherence to the training program, and adverse events. Participants who completed the PREHAB program and those who ended it prematurely received an average of 9.7 and 7.2 interventions during an average of 14.9 and 9.5 home visits, respectively. With few exceptions, the completion rate and interrater reliability for the specific interventions were high. Despite high self-reported adherence to the training program, the majority of participants did not advance beyond the initial Thera-Band level for the upper- and lower-extremity conditioning exercises, and only about a third advanced to the highest 2 levels of the balance exercises. Adverse events were no more common in the PREHAB group than in the educational control group. Our results support the feasibility and safety of the PREHAB program, but also show the special challenges and pitfalls of such a strategy when it is implemented among persons of advanced age and physical frailty. Copyright 2003 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

The design of a purpose-built exergame for fall prediction and prevention for older people.

PubMed

Marston, Hannah R; Woodbury, Ashley; Gschwind, Yves J; Kroll, Michael; Fink, Denis; Eichberg, Sabine; Kreiner, Karl; Ejupi, Andreas; Annegarn, Janneke; de Rosario, Helios; Wienholtz, Arno; Wieching, Rainer; Delbaere, Kim

2015-01-01

Falls in older people represent a major age-related health challenge facing our society. Novel methods for delivery of falls prevention programs are required to increase effectiveness and adherence to these programs while containing costs. The primary aim of the Information and Communications Technology-based System to Predict and Prevent Falls (iStoppFalls) project was to develop innovative home-based technologies for continuous monitoring and exercise-based prevention of falls in community-dwelling older people. The aim of this paper is to describe the components of the iStoppFalls system. The system comprised of 1) a TV, 2) a PC, 3) the Microsoft Kinect, 4) a wearable sensor and 5) an assessment and training software as the main components. The iStoppFalls system implements existing technologies to deliver a tailored home-based exercise and education program aimed at reducing fall risk in older people. A risk assessment tool was designed to identify fall risk factors. The content and progression rules of the iStoppFalls exergames were developed from evidence-based fall prevention interventions targeting muscle strength and balance in older people. The iStoppFalls fall prevention program, used in conjunction with the multifactorial fall risk assessment tool, aims to provide a comprehensive and individualised, yet novel fall risk assessment and prevention program that is feasible for widespread use to prevent falls and fall-related injuries. This work provides a new approach to engage older people in home-based exercise programs to complement or provide a potentially motivational alternative to traditional exercise to reduce the risk of falling.

Effect of aquatic exercise on ankylosing spondylitis: a randomized controlled trial.

PubMed

Dundar, U; Solak, O; Toktas, H; Demirdal, U S; Subasi, V; Kavuncu, V; Evcik, D

2014-11-01

Ankylosing spondylitis (AS) is a chronic systemic inflammatory disease that affects mainly the axial skeleton and causes significant pain and disability. Aquatic (water-based) exercise may have a beneficial effect in various musculoskeletal conditions. The aim of this study was to compare the effectiveness of aquatic exercise interventions with land-based exercises (home-based exercise) in the treatment of AS. Patients with AS were randomly assigned to receive either home-based exercise or aquatic exercise treatment protocol. Home-based exercise program was demonstrated by a physiotherapist on one occasion and then, exercise manual booklet was given to all patients in this group. Aquatic exercise program consisted of 20 sessions, 5× per week for 4 weeks in a swimming pool at 32-33 °C. All the patients in both groups were assessed for pain, spinal mobility, disease activity, disability, and quality of life. Evaluations were performed before treatment (week 0) and after treatment (week 4 and week 12). The baseline and mean values of the percentage changes calculated for both groups were compared using independent sample t test. Paired t test was used for comparison of pre- and posttreatment values within groups. A total of 69 patients with AS were included in this study. We observed significant improvements for all parameters [pain score (VAS) visual analog scale, lumbar flexion/extension, modified Schober test, chest expansion, bath AS functional index, bath AS metrology index, bath AS disease activity index, and short form-36 (SF-36)] in both groups after treatment at week 4 and week 12 (p < 0.05). Comparison of the percentage changes of parameters both at week 4 and week 12 relative to pretreatment values showed that improvement in VAS (p < 0.001) and bodily pain (p < 0.001), general health (p < 0.001), vitality (p < 0.001), social functioning (p < 0.001), role limitations due to emotional problems (p < 0.001), and general mental health (p < 0.001) subparts of SF-36 were better in aquatic exercise group. It is concluded that a water-based exercises produced better improvement in pain score and quality of life of the patients with AS compared with home-based exercise.

Manual for guided home exercises for osteoarthritis of the knee

PubMed Central

de Almeida Carvalho, Nilza Aparecida; Bittar, Simoni Teixeira; de Souza Pinto, Flávia Ribeiro; Ferreira, Mônica; Sitta, Robson Roberto

2010-01-01

INTRODUCTION: Physiotherapy is one of the most important components of therapy for osteoarthritis of the knee. The objective of this prospective case series was to assess the efficiency of a guidance manual for patients with osteoarthritis of the knee in relation to pain, range of movement , muscle strength and function, active goniometry, manual strength test and function. METHODS: Thirty-eight adults with osteoarthritis of the knee (≥ 45 years old) who were referred to the physiotherapy service at the university hospital (Santa Casa de Misericórdia de São Paulo) were studied. Patients received guidance for the practice of specific physical exercises and a manual with instructions on how to perform the exercises at home. They were evaluated for pain, range of movement, muscle strength and function. These evaluations were performed before they received the manual and three months later. Patients were seen monthly regarding improvements in their exercising abilities. RESULTS: The program was effective for improving muscle strength, controlling pain, maintaining range of movement of the knee joint, and reducing functional incapacity. DISCUSSION: A review of the literature showed that there are numerous clinical benefits to the regular practice of physical therapy exercises by patients with osteoarthritis of the knee(s) in a program with appropriate guidance. This study shows that this guidance can be attained at home with the use of a proper manual. CONCLUSIONS: Even when performed at home without constant supervision, the use of the printed manual for orientation makes the exercises for osteoarthritis of the knee beneficial. PMID:20835554

The process associated with motivation of a home-based Wii Fit exercise program among sedentary African American women with systemic lupus erythematosus.

PubMed

Yuen, Hon K; Breland, Hazel L; Vogtle, Laura K; Holthaus, Katy; Kamen, Diane L; Sword, David

2013-01-01

To explore the process associated with the motivation for playing Wii Fit among patients with systemic lupus erythematosus (SLE). Individual in-depth semi-structured telephone interviews were conducted with 14 sedentary African American women with SLE to explore their experiences and reflect on their motivation for playing Wii Fit after completing a 10-week home-based Wii Fit exercise program. Interviews were audio-recorded, transcribed verbatim, and analyzed using the constant comparative method to identify categories related to participants' motivation. Three authors independently sorted, organized and coded transcript text into categories, then combined the categories into themes and subthemes. In addition to the two themes (Ethical principal of keeping a commitment, and Don't want to let anyone down) generic to home-based exercise trials, we identified five themes (Enjoyment, Health Benefits, Sense of Accomplishment, Convenience, and Personalized) that revealed why the participants were motivated to play the Wii Fit. Enjoyment had three subthemes: Interactive, Challenging, and Competitive with an embedded social element. However, several participants commented they were not able to do many activities, master certain games, or figure out how to play some; as a result, they were bored with the limited selection of activities that they could do. The motivational elements of the Wii Fit may contribute to improved exercise motivation and adherence in select sedentary African American women with SLE. Results provide a better understanding on the important elements to incorporate in the development of sustainable home-based exercise programs with interactive health video games for this population. Copyright © 2013 Elsevier Inc. All rights reserved.

Developing strategies to be added to the protocol for antenatal care: an exercise and birth preparation program.

PubMed

Miquelutti, Maria Amélia; Cecatti, José Guilherme; Makuch, Maria Yolanda

2015-04-01

To describe the implementation process of a birth preparation program, the activities in the protocol for physical and birth preparation exercises, and the educational activities that have been evaluated regarding effectiveness and women's satisfaction. The birth preparation program described was developed with the following objectives: to prevent lumbopelvic pain, urinary incontinence and anxiety; to encourage the practice of physical activity during pregnancy and of positions and exercises for non-pharmacological pain relief during labor; and to discuss information that would help women to have autonomy during labor. The program comprised the following activities: supervised physical exercise, relaxation exercises, and educational activities (explanations of lumbopelvic pain prevention, pelvic floor function, labor and delivery, and which non-pharmacological pain relief to use during labor) provided regularly after prenatal consultations. These activities were held monthly, starting when the women joined the program at 18-24 weeks of pregnancy and continuing until 30 weeks of pregnancy, fortnightly thereafter from 31 to 36 weeks of pregnancy, and then weekly from the 37th week until delivery. Information and printed materials regarding the physical exercises to be performed at home were provided. Clinicaltrials.gov: NCT01155804. The program was an innovative type of intervention that systematized birth preparation activities that were organized to encompass aspects related both to pregnancy and to labor and that included physical, educational and home-based activities. The detailed description of the protocol used may serve as a basis for further studies and also for the implementation of birth preparation programs within the healthcare system in different settings.

A New Adaptive Home-based Exercise Technology among Older Adults Living in Nursing Home: A Pilot Study on Feasibility, Acceptability and Physical Performance.

PubMed

Valiani, V; Lauzé, M; Martel, D; Pahor, M; Manini, T M; Anton, S; Aubertin-Leheudre, M

2017-01-01

To explore the feasibility and acceptability of a new home-based exercise technology among older adults and to evaluate its efficacy on physical performance measures. Longitudinal clinical trial. Oak Hammock at the University of Florida, a nursing home located in Gainesville, Florida. Twelve pre-disabled older adults (≥75 years) living in a nursing home with a Short Physical Performance Battery (SPPB) score between 6 and 9 and no diagnosis of dementia. Thirty minutes of light intensity exercise (aerobic, strength and balance) two times per week for four weeks using a home-based physical activity technology called Jintronix. Feasibility and acceptability were assessed through a 9-item self-administered questionnaire and by exploring the percentage of quality of movements and time performing exercise which was calculated automatically by Jintronix technology. Physical performance measures were assessed through the SPPB score at baseline, after 4 weeks of intervention and after 3 months from the completion of the intervention. Twelve older adults (80.5±4.2 years old) performed light intensity exercise with Jintronix for a total of 51.9±7.9 minutes per week. Participants reached 87% score of quality of movements in strength and balance exercises, a global appreciation score of 91.7% and a global difficulty score of 36%. Compared to baseline, there was a significant improvement in SPPB score at the end of the intervention and at 3 months following the completion of the exercise program (0.67±0.98 and 1.08±0.99 respectively, p-value <0.05). Jintronix technology is feasible and acceptable among pre-disabled older adults without dementia living in nursing home and is beneficial in improving their physical performance.

Feasibility of a Customized, In-Home, Game-Based Stroke Exercise Program Using the Microsoft Kinect® Sensor

PubMed Central

PROFFITT, RACHEL; LANGE, BELINDA

2015-01-01

The objective of this study was to determine the feasibility of a 6-week, game-based, in-home telerehabilitation exercise program using the Microsoft Kinect® for individuals with chronic stroke. Four participants with chronic stroke completed the intervention based on games designed with the customized Mystic Isle software. The games were tailored to each participant’s specific rehabilitation needs to facilitate the attainment of individualized goals determined through the Canadian Occupational Performance Measure. Likert scale questionnaires assessed the feasibility and utility of the game-based intervention. Supplementary clinical outcome data were collected. All participants played the games with moderately high enjoyment. Participant feedback helped identify barriers to use (especially, limited free time) and possible improvements. An in-home, customized, virtual reality game intervention to provide rehabilitative exercises for persons with chronic stroke is practicable. However, future studies are necessary to determine the intervention’s impact on participant function, activity, and involvement. PMID:27563384

Chronic Pain and Exercise Therapy.

ERIC Educational Resources Information Center

Raithel, Kathryn Simmons

1989-01-01

Aerobic and resistance exercise are currently prescribed by physicians to treat chronic pain. However, patient fitness level must improve before he/she feels better. Pain management programs help patients become more active so they can function at work and home. (SM)

Herniated Cervical Disc

MedlinePlus

... doctor, with the help of a nurse or physical therapist, may also begin education and training on specific exercises to strengthen your neck. These exercises may be performed at home or you may visit a physical therapist for a more specific program to meet ...

Feasibility study: Effect of hand resistance exercise on handwriting in Parkinson's disease and essential tremor.

PubMed

Bryant, Mon S; Workman, Craig D; Jamal, Fariha; Meng, Hao; Jackson, George R

A single group, repeated measures design was used. Tremor can lead to impaired hand function in patients with Parkinson's disease (PD) and essential tremor (ET). Difficulty with handwriting is a common complaint in these patients suffering from hand tremors. The effect of hand resistance exercise on handwriting is unknown. To explore the influence of 6 weeks of home-based hand resistance exercise on handwriting in individuals with PD and ET. Nine individuals with PD and 9 with ET participated in the study. The average age was 65.3 (6.0) years with an average disease duration of 7.8 years. Participants were instructed to perform a home-based, hand and arm resistance exercise program 3 times a week for 6 weeks. Samples of the area of handwriting and maximal grip strength were measured at baseline and after 6 weeks of exercise. The area of the handwriting sample and maximal grip strength measured before and after 6 weeks were compared. Mean grip strength of the participants with PD improved after 6 weeks of hand resistance exercise (P = .031), but grip strength did not change in ET (P = .091). The size of the handwriting samples (words and sentences) did not change after exercise in either participants with PD or ET. Micrographia in patients with PD and macrographia in patients with ET represent complex fine motor skills. More research is needed to understand what therapies could be effective in modifying the size and quality of handwriting. The purpose of this feasibility study was to explore the influence of home-based wrist resistance exercise on handwriting in individuals with PD and ET. Despite small gains in grip strength, the size of the handwriting samples (words and sentences) did not change for patients with PD or ET following a 6-week home-based hand resistance exercise program. Published by Elsevier Inc.

Long-term evaluation of home-based pulmonary rehabilitation in patients with COPD.

PubMed

Grosbois, Jean Marie; Gicquello, Alice; Langlois, Carole; Le Rouzic, Olivier; Bart, Frédéric; Wallaert, Benoit; Chenivesse, Cécile

2015-01-01

Personalized, global pulmonary rehabilitation (PR) management of patients with COPD is effective, regardless of the place in which this rehabilitation is provided. The objective of this retrospective observational study was to study the long-term outcome of exercise capacity and quality of life during management of patients with COPD treated by home-based PR. Home-based PR was administered to 211 patients with COPD (mean age, 62.3±11.1 years; mean forced expiratory volume in 1 second, 41.5%±17.7%). Home-based PR was chosen because of the distance of the patient's home from the PR center and the patient's preference. Each patient was individually managed by a team member once a week for 8 weeks with unsupervised continuation of physical exercises on the other days of the week according to an individual action plan. Exercise conditioning, therapeutic patient education, and self-management were included in the PR program. The home assessment comprised evaluation of the patient's exercise capacity by a 6-minute stepper test, Timed Up and Go test, ten times sit-to-stand test, Hospital Anxiety and Depression score, and quality of life (Visual Simplified Respiratory Questionnaire, VQ11, Maugeri Respiratory Failure 28). No incidents or accidents were observed during the course of home-based PR. The 6-minute stepper test was significantly improved after completion of the program, at 6 months and 12 months, whereas the Timed Up and Go and ten times sit-to-stand test were improved after PR and at 6 months but not at 12 months. Hospital Anxiety and Depression and quality of life scores improved after PR, and this improvement persisted at 6 months and 12 months. Home-based PR for unselected patients with COPD is effective in the short term, and this effectiveness is maintained in the medium term (6 months) and long term (12 months). Home-based PR is an alternative to outpatient management provided all activities, such as exercise conditioning, therapeutic education, and self-management are performed.

Long-term evaluation of home-based pulmonary rehabilitation in patients with COPD

PubMed Central

Grosbois, Jean Marie; Gicquello, Alice; Langlois, Carole; Le Rouzic, Olivier; Bart, Frédéric; Wallaert, Benoit; Chenivesse, Cécile

2015-01-01

Introduction Personalized, global pulmonary rehabilitation (PR) management of patients with COPD is effective, regardless of the place in which this rehabilitation is provided. The objective of this retrospective observational study was to study the long-term outcome of exercise capacity and quality of life during management of patients with COPD treated by home-based PR. Methods Home-based PR was administered to 211 patients with COPD (mean age, 62.3±11.1 years; mean forced expiratory volume in 1 second, 41.5%±17.7%). Home-based PR was chosen because of the distance of the patient’s home from the PR center and the patient’s preference. Each patient was individually managed by a team member once a week for 8 weeks with unsupervised continuation of physical exercises on the other days of the week according to an individual action plan. Exercise conditioning, therapeutic patient education, and self-management were included in the PR program. The home assessment comprised evaluation of the patient’s exercise capacity by a 6-minute stepper test, Timed Up and Go test, ten times sit-to-stand test, Hospital Anxiety and Depression score, and quality of life (Visual Simplified Respiratory Questionnaire, VQ11, Maugeri Respiratory Failure 28). Results No incidents or accidents were observed during the course of home-based PR. The 6-minute stepper test was significantly improved after completion of the program, at 6 months and 12 months, whereas the Timed Up and Go and ten times sit-to-stand test were improved after PR and at 6 months but not at 12 months. Hospital Anxiety and Depression and quality of life scores improved after PR, and this improvement persisted at 6 months and 12 months. Conclusion Home-based PR for unselected patients with COPD is effective in the short term, and this effectiveness is maintained in the medium term (6 months) and long term (12 months). Home-based PR is an alternative to outpatient management provided all activities, such as exercise conditioning, therapeutic education, and self-management are performed. PMID:26445534

Home-based versus center-based aerobic exercise on cardiopulmonary performance, physical function, quality of life and quality of sleep of overweight patients with chronic kidney disease.

PubMed

Aoike, Danilo Takashi; Baria, Flavia; Kamimura, Maria Ayako; Ammirati, Adriano; Cuppari, Lilian

2018-02-01

The association between chronic kidney disease (CKD) and obesity can decrease the patients' cardiopulmonary capacity, physical functioning and quality of life. The search for effective and practical alternative methods of exercise to engage patients in training programs is of great importance. Therefore, we aimed to compare the effects of home-based versus center-based aerobic exercise on the cardiopulmonary and functional capacities, quality of life and quality of sleep of overweight non-dialysis-dependent patients with CKD (NDD-CKD). Forty sedentary overweight patients CKD stages 3 and 4 were randomly assigned to an exercise group [home-based group (n = 12) or center-based exercise group (n = 13)] or to a control group (n = 15) that did not perform any exercise. Cardiopulmonary exercise test, functional capacity tests, quality of life, quality of sleep and clinical parameters were assessed at baseline, 12 and 24 weeks. The VO 2peak and all cardiopulmonary parameters evaluated were similarly improved (p < 0.05) after 12 and 24 weeks in both exercise groups. The functional capacity tests improved during the follow-up in the home-based group (p < 0.05) and reached values similar to those obtained in the center-based group. The benefits achieved in both exercise groups were also reflected in improvement of quality of life and sleep (p < 0.05). No differences were observed between the exercise groups, and no changes in any of the parameters investigated were found in the control group. Home-based aerobic training was as effective as center-based training in improving the physical and functional capabilities, quality of life and sleep in overweight NDD-CKD patients.

Effect of total knee replacement surgery and postoperative 12 month home exercise program on gait parameters.

PubMed

Heikkilä, A; Sevander-Kreus, N; Häkkinen, A; Vuorenmaa, M; Salo, Petr; Konsta, P; Ylinen, J

2017-03-01

To evaluate the effects of surgery and a postoperative progressive home exercise program on gait parameters among individuals operated with total knee arthroplasty. Single blinded randomized controlled trial. 108 patients (84 females, 24 males, mean age 69 years). Patients were equally randomized into an exercise group (EG) and control group (CG). The 12-months progressive home exercise program starting two months postoperatively was compared to usual care. Gait analysis was performed using the Gaitrite electronic walkway system. In addition, knee extension and flexion strength were measured by a dynamometer preoperatively, and pain on visual analog scale (VAS) at two months and 14 months postoperatively. At the 12-month follow-up, maximal gait velocity (p=0.006), cadence (p=0.003) and stance time (p=0.039) showed a greater increase among EG than CG. All the other gait parameters improved among both groups, but with not statistically discernible difference between groups. Weak correlations were found between changes in maximal gait velocity and the knee extension (r=-0.31, p=0.002), flexion strength (r=0.28, p=0.004) and pain during loading (r=-0.27, p=0.005) values. The intervention produced statistically significant changes in maximal gait velocity, cadence and stance times in the exercise group compared to controls. Although the average change was small it is of importance that biggest changes occurred in those with low performance. Copyright © 2017 Elsevier B.V. All rights reserved.

Identifying Feasible Physical Activity Programs for Long-Term Care Homes in the Ontario Context

PubMed Central

Shakeel, Saad; Newhouse, Ian; Malik, Ali; Heckman, George

2015-01-01

Background Structured exercise programs for frail institutionalized seniors have shown improvement in physical, functional, and psychological health of this population. However, the ‘feasibility’ of implementation of such programs in real settings is seldom discussed. The purpose of this systematic review was to gauge feasibility of exercise and falls prevention programs from the perspective of long-term care homes in Ontario, given the recent changes in funding for publically funded physiotherapy services. Method Six electronic databases were searched by two independent researchers for randomized controlled trials that targeted long-term care residents and included exercise as an independent component of the intervention. Results A total of 39 studies were included in this review. A majority of these interventions were led by physiotherapist(s), carried out three times per week for 30–45 minutes per session. However, a few group-based interventions that were led by long-term care staff, volunteers, or trained non-exercise specialists were identified that also required minimal equipment. Conclusion This systematic review has identified ‘feasible’ physical activity and falls prevention programs that required minimal investment in staff and equipment, and demonstrated positive outcomes. Implementation of such programs represents cost-effective means of providing long-term care residents with meaningful gains in physical, psychological, and social health. PMID:26180563

The effect of sensor-based exercise at home on functional performance associated with fall risk in older people - a comparison of two exergame interventions.

PubMed

Gschwind, Yves J; Schoene, Daniel; Lord, Stephen R; Ejupi, Andreas; Valenzuela, Trinidad; Aal, Konstantin; Woodbury, Ashley; Delbaere, Kim

2015-01-01

There is good evidence that balance challenging exercises can reduce falls in older people. However, older people often find it difficult to incorporate such programs in their daily life. Videogame technology has been proposed to promote enjoyable, balance-challenging exercise. As part of a larger analysis, we compared feasibility and efficacy of two exergame interventions: step-mat-training (SMT) and Microsoft-Kinect® (KIN) exergames. 148 community-dwelling people, aged 65+ years participated in two exergame studies in Sydney, Australia (KIN: n = 57, SMT: n = 91). Both interventions were delivered as unsupervised exercise programs in participants' homes for 16 weeks. Assessment measures included overall physiological fall risk, muscle strength, finger-press reaction time, proprioception, vision, balance and executive functioning. For participants allocated to the intervention arms, the median time played each week was 17 min (IQR 32) for KIN and 48 min (IQR 94) for SMT. Compared to the control group, SMT participants improved their fall risk score (p = 0.036), proprioception (p = 0.015), reaction time (p = 0.003), sit-to-stand performance (p = 0.011) and executive functioning (p = 0.001), while KIN participants improved their muscle strength (p = 0.032) and vision (p = 0.010), and showed a trend towards improved fall risk scores (p = 0.057). The findings suggest that it is feasible for older people to conduct an unsupervised exercise program at home using exergames. Both interventions reduced fall risk and SMT additionally improved specific cognitive functions. However, further refinement of the systems is required to improve adherence and maximise the benefits of exergames to deliver fall prevention programs in older people's homes. ACTRN12613000671763 (Step Mat Training RCT) ACTRN12614000096651 (MS Kinect RCT).

Home-based hand rehabilitation after chronic stroke: Randomized, controlled single-blind trial comparing the MusicGlove with a conventional exercise program.

PubMed

Zondervan, Daniel K; Friedman, Nizan; Chang, Enoch; Zhao, Xing; Augsburger, Renee; Reinkensmeyer, David J; Cramer, Steven C

2016-01-01

Individuals with chronic stroke have limited options for hand rehabilitation at home. Here, we sought to determine the feasibility and efficacy of home-based MusicGlove therapy. Seventeen participants with moderate hand impairment in the chronic phase of stroke were randomized to 3 wk of home-based exercise with either the MusicGlove or conventional tabletop exercises. The primary outcome measure was the change in the Box and Blocks test score from baseline to 1 mo posttreatment. Both groups significantly improved their Box and Blocks test score, but no significant difference was found between groups. The MusicGlove group did exhibit significantly greater improvements than the conventional exercise group in motor activity log quality of movement and amount of use scores 1 mo posttherapy (p = 0.007 and p = 0.04, respectively). Participants significantly increased their use of MusicGlove over time, completing 466 gripping movements per day on average at study end. MusicGlove therapy was not superior to conventional tabletop exercises for the primary end point but was nevertheless feasible and led to a significantly greater increase in self-reported functional use and quality of movement of the impaired hand than conventional home exercises. ClinicalTrials.gov; "Influence of Timing on Motor Learning"; NCT01769326; https://clinicaltrials.gov/ct2/show/NCT01769326.

Predictive factors of adherence to frequency and duration components in home exercise programs for neck and low back pain: an observational study

PubMed Central

2009-01-01

Background Evidence suggests that to facilitate physical activity sedentary people may adhere to one component of exercise prescriptions (intensity, duration or frequency) without adhering to other components. Some experts have provided evidence for determinants of adherence to different components among healthy people. However, our understanding remains scarce in this area for patients with neck or low back pain. The aims of this study are to determine whether patients with neck or low back pain have different rates of adherence to exercise components of frequency per week and duration per session when prescribed with a home exercise program, and to identify if adherence to both exercise components have distinct predictive factors. Methods A cohort of one hundred eighty-four patients with chronic neck or low back pain who attended physiotherapy in eight primary care centers were studied prospectively one month after intervention. The study had three measurement periods: at baseline (measuring characteristics of patients and pain), at the end of physiotherapy intervention (measuring characteristics of the home exercise program) and a month later (measuring professional behaviors during clinical encounters, environmental factors and self-efficacy, and adherence behavior). Results Adherence to duration per session (70.9% ± 7.1) was more probable than adherence to frequency per week (60.7% ± 7.0). Self-efficacy was a relevant factor for both exercise components (p < 0.05). The total number of exercises prescribed was predictive of frequency adherence (p < 0.05). Professional behaviors have a distinct influence on exercise components. Frequency adherence is more probable if patients received clarification of their doubts (adjusted OR: 4.1; p < 0.05), and duration adherence is more probable if they are supervised during the learning of exercises (adjusted OR: 3.3; p < 0.05). Conclusion We have shown in a clinic-based study that adherence to exercise prescription frequency and duration components have distinct levels and predictive factors. We recommend additional study, and advise that differential attention be given in clinical practice to each exercise component for improving adherence. PMID:19995464

Effectiveness of an Educational Physiotherapy and Therapeutic Exercise Program in Adult Patients With Hemophilia: A Randomized Controlled Trial.

PubMed

Cuesta-Barriuso, Rubén; Torres-Ortuño, Ana; Nieto-Munuera, Joaquín; López-Pina, José Antonio

2017-05-01

To assess the efficacy of an educational physiotherapy home exercise intervention for physical improvement, pain perception, quality of life, and illness behavior in patients with hemophilic arthropathy. Single-blind randomized controlled trial. Home. Patients with hemophilia (N=20) were randomly allocated to an educational intervention group or to a control group. The educational intervention was performed every 2 weeks over a 15-week period, and home exercises were carried out once a day, 6 days a week, over the same period. Joint status was evaluated using the Gilbert scale; pain was assessed using the visual analog scale; illness behavior was evaluated using the Illness Behavior Questionnaire; and the perception of the quality of life was evaluated using the A36 Hemophilia-QoL questionnaire. We observed significant differences in the intervention group and the control group for both quality of life and illness behavior. There was no significant improvement in joint status; however, an improvement was noted in terms of perception of pain in the ankle. A physiotherapy program based on educational sessions and home exercises can improve the perception of pain in patients with hemophilic arthropathy of the ankle. It improves some variables in the perception of the quality of life and illness behavior. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

[Cardiac rehabilitation. Recent advances].

PubMed

Lellamo, Ferdinando; Volterrani, Maurizio

2010-03-01

Evidence derived from studies which support the relevance of exercise as a core component of cardiac rehabilitation programs are presented, along with the beneficial effects of exercise training in counteracting the mechanisms sustaining the atherosclerotic process and cardiovascular risk factors in the context of secundary, as well as primary, cardiovascular prevention. Practical guides to plan exercise training programs are also provided with suggestions for specific pathological conditions and advanced age. Recent advances on the benefits of exercise training in patients with heart failure are reported along with the potential of telemedicine for home rehabilitation aiming to a widespread diffusion of exercise as a cardiovascular therapy. Finally, the possible risks of exercise and practical open questions in cardiac rehabilitation are discussed.

The effectiveness of physical exercise training in pain, mobility, and psychological well-being of older persons living in nursing homes.

PubMed

Tse, Mimi M Y; Tang, Shuk Kwan; Wan, Vanessa T C; Vong, Sinfia K S

2014-12-01

Pain is common in the aging population, particularly among older residents of nursing homes. It has been found that 50% of older people living in the community have been experiencing chronic pain, and the number increased to 80% for older residents of nursing homes. Exercise is an effective non-pharmacological intervention that can reduce pain and improve physical and psychological functions. A quasi-experimental study with a pretest-posttest control group designed was conducted to evaluate the effects of a physical exercise program (PEP) on older residents of nursing homes who have chronic pain. Three-hundred-ninety-six older residents with chronic pain were recruited from 10 nursing homes run by non-governmental organizations in Hong Kong. The average age of the older residents was 85.44 ± 6.29. Five nursing homes were randomized to the experimental group with PEP (n = 225, age = 85.45 ± 6.25); the other five nursing homes were randomized to the control group without the PEP (n = 171, age = 85.44 ± 6.35). PEP was an eight-week training program given by a physiotherapist and nurses once a week. It consisted of warm-up exercises, muscle strengthening, stretching, balancing, and self-administered massage to acupressure points. At the end of each PEP session, pamphlets with pictures illustrating the "exercise of the day" were given to the older residents of nursing homes as a tool to enhance their self-management skills. The control group received no training during the eight weeks. Upon completion of the PEP, the experimental group experienced a significantly greater reduction in pain intensity from 4.19 ± 2.25 (on an 11 point scale) to 2.67 ± 2.08, as compared to the control group (p < .05). In addition, the psychological well-being (happiness, loneliness, life satisfaction, and depression) of the experimental group was significantly improved (p < .05). Copyright © 2014 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

Tai Chi-based exercise program provided via telerehabilitation compared to home visits in a post-stroke population who have returned home without intensive rehabilitation: study protocol for a randomized, non-inferiority clinical trial

PubMed Central

2014-01-01

Background The incidence of strokes in industrialized nations is on the rise, particularly in the older population. In Canada, a minority of individuals who have had a stroke actually receive intensive rehabilitation because most stroke patients do not have access to services or because their motor recovery was judged adequate to return home. Thus, there is a considerable need to organize home-based rehabilitation services for everyone who has had a stroke. To meet this demand, telerehabilitation, particularly from a service center to the patient’s home, is a promising alternative approach that can help improve access to rehabilitation services once patients are discharged home. Methods/Design This non-inferiority study will include patients who have returned home post-stroke without requiring intensive rehabilitation. To be included in the study, participants will: 1) not be referred to an Intensive Functional Rehabilitation Unit, 2) have a Rankin score of 2 or 3, and 3) have a balance problem (Berg Balance Scale score between 46 and 54). Participants will be randomly assigned to either the teletreatment group or the home visits group. Except for the delivery mode, the intervention will be the same for both groups, that is, a personalized Tai Chi-based exercise program conducted by a trained physiotherapist (45-minute session twice a week for eight consecutive weeks). The main objective of this research is to test the non-inferiority of a Tai Chi-based exercise program provided via telerehabilitation compared to the same program provided in person at home in terms of effectiveness for retraining balance in individuals who have had a stroke but do not require intensive functional rehabilitation. The main outcome of this study is balance and mobility measured with the Community Balance and Mobility Scale. Secondary outcomes include physical and psychological capacities related to balance and mobility, participants’ quality of life, satisfaction with services received, and cost-effectiveness associated with the provision of both types of services. Study/trial registration ClinicalTrials.gov: NCT01848080 PMID:24479760

Tai Chi-based exercise program provided via telerehabilitation compared to home visits in a post-stroke population who have returned home without intensive rehabilitation: study protocol for a randomized, non-inferiority clinical trial.

PubMed

Tousignant, Michel; Corriveau, Hélène; Kairy, Dahlia; Berg, Katherine; Dubois, Marie-France; Gosselin, Sylvie; Swartz, Richard H; Boulanger, Jean-Martin; Danells, Cynthia

2014-01-30

The incidence of strokes in industrialized nations is on the rise, particularly in the older population. In Canada, a minority of individuals who have had a stroke actually receive intensive rehabilitation because most stroke patients do not have access to services or because their motor recovery was judged adequate to return home. Thus, there is a considerable need to organize home-based rehabilitation services for everyone who has had a stroke. To meet this demand, telerehabilitation, particularly from a service center to the patient's home, is a promising alternative approach that can help improve access to rehabilitation services once patients are discharged home. This non-inferiority study will include patients who have returned home post-stroke without requiring intensive rehabilitation. To be included in the study, participants will: 1) not be referred to an Intensive Functional Rehabilitation Unit, 2) have a Rankin score of 2 or 3, and 3) have a balance problem (Berg Balance Scale score between 46 and 54). Participants will be randomly assigned to either the teletreatment group or the home visits group. Except for the delivery mode, the intervention will be the same for both groups, that is, a personalized Tai Chi-based exercise program conducted by a trained physiotherapist (45-minute session twice a week for eight consecutive weeks). The main objective of this research is to test the non-inferiority of a Tai Chi-based exercise program provided via telerehabilitation compared to the same program provided in person at home in terms of effectiveness for retraining balance in individuals who have had a stroke but do not require intensive functional rehabilitation. The main outcome of this study is balance and mobility measured with the Community Balance and Mobility Scale. Secondary outcomes include physical and psychological capacities related to balance and mobility, participants' quality of life, satisfaction with services received, and cost-effectiveness associated with the provision of both types of services. ClinicalTrials.gov: NCT01848080.

Home-Based Computer Gaming in Vestibular Rehabilitation of Gaze and Balance Impairment.

PubMed

Szturm, Tony; Reimer, Karen M; Hochman, Jordan

2015-06-01

Disease or damage of the vestibular sense organs cause a range of distressing symptoms and functional problems that could include loss of balance, gaze instability, disorientation, and dizziness. A novel computer-based rehabilitation system with therapeutic gaming application has been developed. This method allows different gaze and head movement exercises to be coupled to a wide range of inexpensive, commercial computer games. It can be used in standing, and thus graded balance demands using a sponge pad can be incorporated into the program. A case series pre- and postintervention study was conducted of nine adults diagnosed with peripheral vestibular dysfunction who received a 12-week home rehabilitation program. The feasibility and usability of the home computer-based therapeutic program were established. Study findings revealed that using head rotation to interact with computer games, when coupled to demanding balance conditions, resulted in significant improvements in standing balance, dynamic visual acuity, gaze control, and walking performance. Perception of dizziness as measured by the Dizziness Handicap Inventory also decreased significantly. These preliminary findings provide support that a low-cost home game-based exercise program is well suited to train standing balance and gaze control (with active and passive head motion).

Web-Based Telepresence Exercise Program for Community-Dwelling Elderly Women With a High Risk of Falling: Randomized Controlled Trial.

PubMed

Hong, Jeeyoung; Kong, Hyoun-Joong; Yoon, Hyung-Jin

2018-05-28

While physical exercise is known to help prevent falls in the elderly, bad weather and long distance between the home and place of exercise represent substantial deterrents for the elderly to join or continue attending exercise programs outside their residence. Conventional modalities for home exercise can be helpful but do not offer direct and prompt feedback to the participant, which minimizes the benefit. We aimed to develop an elderly-friendly telepresence exercise platform and to evaluate the effects of a 12-week telepresence exercise program on fall-related risk factors in community-dwelling elderly women with a high risk of falling. In total, 34 women aged 68-91 years with Fall Risk Assessment scores >14 and no medical contraindication to physical training-based therapy were recruited in person from a senior citizen center. The telepresence exercise platform included a 15-inch tablet computer, custom-made peer-to-peer video conferencing server system, and broadband Internet connectivity. The Web-based program included supervised resistance exercises performed using elastic resistance bands and balance exercise for 20-40 minutes a day, three times a week, for 12 weeks. During the telepresence exercise session, each participant in the intervention group was supervised remotely by a specialized instructor who provided feedback in real time. The women in the control group maintained their lifestyle without any intervention. Fall-related physical factors (body composition and physical function parameters) and psychological factors (Korean Falls Efficacy Scale score, Fear of Falling Questionnaire score) before and after the 12-week interventional period were examined in person by an exercise specialist blinded to the group allocation scheme. Of the 30 women enrolled, 23 completed the study. Compared to women in the control group (n=13), those in the intervention group (n=10) showed significant improvements on the scores for the chair stand test (95% confidence interval -10.45 to -5.94, P<.001), Berg Balance Scale (95% confidence interval -2.31 to -0.28, P=.02), and Fear of Falling Questionnaire (95% confidence interval 0.69-3.5, P=.01). The telepresence exercise program had positive effects on fall-related risk factors in community-dwelling elderly women with a high risk of falling. Elderly-friendly telepresence technology for home-based exercises can serve as an effective intervention to improve fall-related physical and psychological factors. Clinical Research Information Service KCT0002710; https://cris.nih.go.kr/cris/en/search/ search_result_st01.jsp?seq=11246 (Archived by WebCite at http://www.webcitation.org/6zdSUEsmb). ©Jeeyoung Hong, Hyoun-Joong Kong, Hyung-Jin Yoon. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 28.05.2018.

Uptake of a technology-assisted home-care cardiac rehabilitation program.

PubMed

Varnfield, Marlien; Karunanithi, Mohanraj K; Särelä, Antti; Garcia, Elsa; Fairfull, Anita; Oldenburg, Brian F; Walters, Darren L

2011-02-21

The prevalence of cardiovascular disease, a major cause of disease burden in Australia and other developed countries, is increasing due to a rapidly ageing population and environmental, biomedical and modifiable lifestyle factors. Although cardiac rehabilitation (CR) programs have been shown to be beneficial and effective, rates of referral, uptake and utilisation of traditional hospital or community centre programs are poor. Home-based CR programs have been shown to be as effective as centre-based programs, and recent advances in information and communication technologies (ICT) can be used to enhance the delivery of such programs. The Care Assessment Platform (CAP) is an integrated home-based CR model incorporating ICT (including a mobile phone and the internet) and providing all the core components of traditional CR (education, physical activity, exercise training, behaviour modification strategies and psychological counselling). The mobile phone given to patients has an integrated accelerometer and diary application for recording exercise and health information. A central database, with access to these data, allows mentors to assess patients' progress, assist in setting goals, revise targets and give weekly personal feedback. Mentors find the mobile-phone modalities practical and easy to use, and preliminary results show high usage rates and acceptance of ICT by participants. The provision of ICT-supported home-based CR programs may enable more patients in both metropolitan and remote settings to benefit from CR.

The development and evaluation of a program for leg-strengthening exercises and balance assessment using Kinect.

PubMed

Choi, Jin-Seung; Kang, Dong-Won; Seo, Jeong-Woo; Kim, Dae-Hyeok; Yang, Seung-Tae; Tack, Gye-Rae

2016-01-01

[Purpose] In this study, a program was developed for leg-strengthening exercises and balance assessment using Microsoft Kinect. [Subjects and Methods] The program consists of three leg-strengthening exercises (knee flexion, hip flexion, and hip extension) and the one-leg standing test (OLST). The program recognizes the correct exercise posture by comparison with the range of motion of the hip and knee joints and provides a number of correct action examples to improve training. The program measures the duration of the OLST and presents this as the balance-age. The accuracy of the program was analyzed using the data of five male adults. [Results] In terms of the motion recognition accuracy, the sensitivity and specificity were 95.3% and 100%, respectively. For the balance assessment, the time measured using the existing method with a stopwatch had an absolute error of 0.37 sec. [Conclusion] The developed program can be used to enable users to conduct leg-strengthening exercises and balance assessments at home.

Recruitment to and pilot results of the PACES randomized trial of physical exercise during adjuvant chemotherapy for colon cancer.

PubMed

van Waart, Hanna; Stuiver, Martijn M; van Harten, Wim H; Geleijn, Edwin; de Maaker-Berkhof, Marianne; Schrama, Jolanda; Geenen, Maud M; Meerum Terwogt, Jetske M; van den Heiligenberg, Simone M; Hellendoorn-van Vreeswijk, Jeannette A J H; Sonke, Gabe S; Aaronson, Neil K

2018-01-01

We report the recruitment rate, reasons for and factors influencing non-participation, and descriptive results of a randomized controlled trial of two different exercise programs for patients with colon cancer undergoing adjuvant chemotherapy. Participants were randomized to a low-intensity, home-based program (Onco-Move), a moderate- to high-intensity, combined supervised resistance and aerobic exercise program (OnTrack), or Usual Care. Non-participants provided reasons for non-participation and were asked to complete a questionnaire assessing behavioral and attitudinal variables. Trial participants completed performance-based and self-reported outcome measures prior to randomization, at the end of chemotherapy, and at the 6-month follow-up. Twenty-three of 63 referred patients agreed to participate in the trial. All 40 non-participants provided reasons for non-participation. Forty-five percent of the non-participants completed the questionnaire. Those who did not want to exercise had higher fatigue scores at baseline and a more negative attitude toward exercise. Compliance to both programs was high and no adverse events occurred. On average, the colon cancer participants were able to maintain or improve their physical fitness levels and maintain or decrease their fatigue levels during chemotherapy and follow-up. Recruitment of patients with colon cancer to a physical exercise trial during adjuvant chemotherapy proved to be difficult, underscoring the need to develop more effective strategies to increase participation rates. Both home-based and supervised programs are safe and feasible in patients with colon cancer undergoing chemotherapy. Effectiveness needs to be established in a larger trial. Netherlands Trial Register - NTR2159.

The influence of home exercise programs for patients with non-specific or specific neck pain: a systematic review of the literature.

PubMed

Zronek, Margaret; Sanker, Holly; Newcomb, Jennifer; Donaldson, Megan

2016-05-01

Systematic review of randomized controlled trials (RCT). To examine the effects of a therapeutic home exercise program (HEP) for patients with neck pain (associated with whiplash, non-specific, or specific neck pain, with or without radiculopathy, or cervicogenic headache) on pain, function, and disability. Our secondary aim was to describe the design, dosage, and adherence of the prescribed HEPs. Neck pain is a leading cause of disability that affects 22-70% of the population. Different techniques have been found effective for the treatment of neck pain. However, there is conflicting evidence to support the role of a therapeutic HEP to reduce pain, disability, and improve function and quality of life (QOL). A systematic review in accordance with the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement for reporting systematic reviews. The full-text review utilized the Maastricht-Amsterdam assessment tool to assess quality among RCTs. A total of 1927 subjects included within seven full-text articles met our specific search strategy. It was found that HEPs with a focus on strength and endurance-training exercises, as well as self- mobilization, have a positive effect when used in combination with other conservative treatments or alone. Home exercise programs that utilize either self-mobilizations within an augmented HEP to address specific spinal levels, or strengthening, and/or endurance exercise are effective at reducing neck pain, function, and disability and improving QOL. The benefit of HEPs in combination with other conservative interventions yields some benefit with a range of effect sizes.

Exploring experiences, barriers, and enablers to home- and class-based exercise in rotator cuff tendinopathy: A qualitative study.

PubMed

Sandford, Fiona M; Sanders, Thomas A B; Lewis, Jeremy S

Qualitative study. Adherence is paramount to the successful outcome of exercise-based treatment. The barriers and enablers to adherence to a home- and class-based exercise program were explored in this qualitative study. Semi-structured interviews were carried out to establish common themes relating to the participants' experiences during a year-long randomized controlled trial. Twelve participants were interviewed. The main enablers to exercise were highlighted as equipment, perceived benefit from the exercises, and longer and more intensive monitoring. Barriers included the lack of motivation, lack of equipment, and pain. Implications for practice are incorporating enablers and addressing barriers including self-discharge from classes; the importance of longer term follow-up and the benefits of adopting exercise into a well-established routine may provide potential benefits. N/A. Copyright © 2017 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.

Effect of orofacial exercises on oral aperture in adults with systemic sclerosis

PubMed Central

Yuen, Hon K.; Marlow, Nicole M.; Reed, Susan G.; Summerlin, Lisa M.; Leite, Renata S.; Mahoney, Samantha; Silver, Richard M.

2012-01-01

Purpose To examine the effect of a home orofacial exercise program on increasing oral aperture among adults with systemic sclerosis (SSc). Method Forty-eight adults with SSc were assigned randomly to the multi-faceted oral health intervention or usual dental care control group. Participants with an oral aperture of < 40 mm in the intervention group received an orofacial exercise program, which included daily manual mouth-stretching and oral augmentation exercises twice a day with a total of 6 minutes for 6 months. The outcome measure was oral aperture which was measured at baseline, 3-months, and 6-months intervals. Results A significantly larger increase in oral aperture for participants received the orofacial exercise program was found when compared to those in the usual care at 3 months (P=0.01), but not at 6 months evaluation. Participants’ adherence rate to the exercise program was low (48.9%). Conclusions The orofacial exercise program intervention for adults with SSc and microstomia did not show significant improvement at 6 months. In addition to the low exercise adherence rate, insufficient frequencies, repetitions, and durations of the orofacial exercises may contribute to these results. PMID:21951278

Muscle atrophy

MedlinePlus

... muscle atrophy may include: Burns Long-term corticosteroid therapy Malnutrition Muscular dystrophy and other diseases of the muscle Osteoarthritis Rheumatoid arthritis Home Care An exercise program ...

Pilot study comparing changes in postural control after training using a video game balance board program and 2 standard activity-based balance intervention programs.

PubMed

Pluchino, Alessandra; Lee, Sae Yong; Asfour, Shihab; Roos, Bernard A; Signorile, Joseph F

2012-07-01

To compare the impacts of Tai Chi, a standard balance exercise program, and a video game balance board program on postural control and perceived falls risk. Randomized controlled trial. Research laboratory. Independent seniors (N=40; 72.5±8.40) began the training, 27 completed. Tai Chi, a standard balance exercise program, and a video game balance board program. The following were used as measures: Timed Up & Go, One-Leg Stance, functional reach, Tinetti Performance Oriented Mobility Assessment, force plate center of pressure (COP) and time to boundary, dynamic posturography (DP), Falls Risk for Older People-Community Setting, and Falls Efficacy Scale. No significant differences were seen between groups for any outcome measures at baseline, nor were significant time or group × time differences for any field test or questionnaire. No group × time differences were seen for any COP measures; however, significant time differences were seen for total COP, 3 of 4 anterior/posterior displacement and both velocity, and 1 displacement and 1 velocity medial/lateral measure across time for the entire sample. For DP, significant improvements in the overall score (dynamic movement analysis score), and in 2 of the 3 linear and angular measures were seen for the sample. The video game balance board program, which can be performed at home, was as effective as Tai Chi and the standard balance exercise program in improving postural control and balance dictated by the force plate postural sway and DP measures. This finding may have implications for exercise adherence because the at-home nature of the intervention eliminates many obstacles to exercise training. Copyright © 2012 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

A prospective 2-site parallel intervention trial of a research-based film to increase exercise amongst older hemodialysis patients.

PubMed

Kontos, Pia; Alibhai, Shabbir M H; Miller, Karen-Lee; Brooks, Dina; Colobong, Romeo; Parsons, Trisha; Jassal, Sarbjit Vanita; Thomas, Alison; Binns, Malcolm; Naglie, Gary

2017-01-26

Evidence suggests that exercise training for hemodialysis patients positively improves morbidity and mortality outcomes, yet exercise programs remain rare and are not systematically incorporated into care. We developed a research-based film, Fit for Dialysis, designed to introduce, motivate, and sustain exercise for wellness amongst older hemodialysis patients, and exercise counseling and support by nephrologists, nurses, and family caregivers. The objective of this clinical trial is to determine whether and in what ways Fit for Dialysis improves outcomes and influences knowledge/attitudes regarding the importance of exercise for wellness in the context of end-stage renal disease. This 2-site parallel intervention trial will recruit 60 older hemodialysis patients from two urban hospitals. The trial will compare the film + a 16-week exercise program in one hospital, with a 16-week exercise-only program in another hospital. Physical fitness and activity measures will be performed at baseline, 8 and 16 weeks, and 12 weeks after the end of the program. These include the 2-min Walk Test, Grip Strength, Duke Activity Status Index, and the Timed Up-and-Go Test, as well as wearing a pedometer for one week. Throughout the 16-week exercise program, and at 12 weeks after, we will record patients' exercise using the Godin Leisure-time Exercise Questionnaire. Patients will also keep a diary of the exercise that they do at home on non-dialysis days. Qualitative interviews, conducted at baseline, 8, and 16 weeks, will explore the impact of Fit for Dialysis on the knowledge/attitudes of patients, family caregivers, and nephrology staff regarding exercise for wellness, and in what ways the film is effective in educating, motivating, or sustaining patient exercise during dialysis, at home, and in the community. This research will determine for whom Fit for Dialysis is effective, why, and under what conditions. If Fit for Dialysis is proven beneficial to patients, nephrology staff and family caregivers, research-based film as a model to support exercise promotion and adherence could be used to support the National Kidney Foundation's guideline recommendation (NKF-KDOQI) that exercise be incorporated into the care and treatment of dialysis patients. NCT02754271 (ClinicalTrials.gov), retroactively registered on April 21, 2016.

Active Video Gaming for Children with Cerebral Palsy: Does a Clinic-Based Virtual Reality Component Offer an Additive Benefit? A Pilot Study.

PubMed

Levac, Danielle; McCormick, Anna; Levin, Mindy F; Brien, Marie; Mills, Richard; Miller, Elka; Sveistrup, Heidi

2018-02-01

To compare changes in gross motor skills and functional mobility between ambulatory children with cerebral palsy who underwent a 1-week clinic-based virtual reality intervention (VR) followed by a 6-week, therapist-monitored home active video gaming (AVG) program and children who completed only the 6-week home AVG program. Pilot non-randomized controlled trial. Five children received 1 hour of VR training for 5 days followed by a 6-week home AVG program, supervised online by a physical therapist. Six children completed only the 6-week home AVG program. The Gross Motor Function Measure Challenge Module (GMFM-CM) and Six Minute Walk Test (6MWT) evaluated change. There were no significant differences between groups. The home AVG-only group demonstrated a statistically and clinically significant improvement in GMFM-CM scores following the 6-week AVG intervention (median difference 4.5 points, interquartile range [IQR] 4.75, p = 0.042). The VR + AVG group demonstrated a statistically and clinically significant decrease in 6MWT distance following the intervention (median decrease 68.2 m, IQR 39.7 m, p = 0.043). All 6MWT scores returned to baseline at 2 months post-intervention. Neither intervention improved outcomes in this small sample. Online mechanisms to support therapist-child communication for exercise progression were insufficient to individualize exercise challenge.

Adherence to Technology-Based Exercise Programs in Older Adults: A Systematic Review.

PubMed

Valenzuela, Trinidad; Okubo, Yoshiro; Woodbury, Ashley; Lord, Stephen R; Delbaere, Kim

Exercise participation and adherence in older people is often low. The integration of technology-based exercise programs may have a positive effect on adherence as they can overcome perceived barriers to exercise. Previous systematic reviews have shown preliminary evidence that technology-based exercise programs can improve physical functioning. However, there is currently no in-depth description and discussion of the potential this technology offers to improve exercise adherence in older people. This review examines the literature regarding older adults' acceptability and adherence to technology-based exercise interventions. A comprehensive systematic database search for randomized controlled trials, clinical controlled trials, and parallel group trials was performed, including MEDLINE, PsycINFO, EMBASE, CINAHL, EMB Reviews, and Cochrane Library, completed in May 2015. Trials reporting adherence to technology-based exercise programs aimed at improving physical function were included. Adherence was defined as the percentage of exercise sessions attended out of the total number of sessions prescribed. Twenty-two studies were included. The mean cohort age range was 67 to 86 years. Studies were conducted in research facilities, aged care facilities, and people's homes. Ten studies compared outcomes between technology-based and traditional exercise programs. Adherence to both types of interventions was high (median 91.25% and 83.58%, respectively). Adherence was higher for technology-based interventions than traditional interventions independent of study site, level of supervision, and delivery mode. The majority of the studies used commercially available gaming technologies, and both types of exercise interventions were mostly supervised. A lack of detailed reporting of adherence and the pilot nature of most studies did not allow computation of a comprehensive adherence rate. This systematic review provides evidence that technology offers a well-accepted method to provide older adults with engaging exercise opportunities, and adherence rates remain high in both supervised and unsupervised settings at least throughout the first 12 weeks of intervention. The higher adherence rates to technology-based interventions can be largely explained by the high reported levels of enjoyment when using these programs. However, the small sample sizes, short follow-up periods, inclusion of mostly healthy older people, and problems related to the methods used to report exercise adherence limit the generalizability of our findings. This systematic review indicates that technology-based exercise interventions have good adherence and may provide a sustainable means of promoting physical activity and preventing falls in older people. More research is required to investigate the feasibility, acceptability, and effectiveness of technology-based exercise programs undertaken by older people at home over extended trial periods.

A Randomized Controlled Trial of Home-Based Exercise for Cancer-Related Fatigue in Women during and after Chemotherapy with or without Radiation Therapy

PubMed Central

Dodd, Marylin J.; Cho, Maria H.; Miaskowski, Christine; Painter, Patricia L.; Paul, Steven M.; Cooper, Bruce A.; Duda, John; Krasnoff, Joanne; Bank, Kayee A.

2010-01-01

Background Few studies have evaluated an individualized home-based exercise prescription during and after cancer treatment. Objective The purpose was to evaluate the effectiveness of a home-based exercise training intervention, the PRO-SELF FATIGUE CONTROL PROGRAM on the management of cancer related fatigue. Interventions/Methods Participants (N=119) were randomized into one of three groups: Group 1 (EE) received the exercise prescription throughout the study; Group 2 (CE) received their exercise prescription after completing cancer treatment; Group 3 (CC) received usual care. Patients completed the Piper Fatigue Scale, General Sleep Disturbance Scale, Center for Epidemiological Studies-Depression scale, and Worst Pain Intensity Scale. Results All groups reported mild fatigue levels, sleep disturbance and mild pain, but not depression. Using multilevel regression analysis significant linear and quadratic trends were found for change in fatigue and pain (i.e., scores increased, then decreased over time). No group differences were found in the changing scores over time. A significant quadratic effect for the trajectory of sleep disturbance was found, but no group differences were detected over time. No significant time or group effects were found for depression. Conclusions Our home-based exercise intervention had no effect on fatigue or related symptoms associated with cancer treatment. The optimal timing of exercise remains to be determined. Implications for practice Clinicians need to be aware that some physical activity is better than none, and there is no harm in exercise as tolerated during cancer treatment. Further analysis is needed to examine the adherence to exercise. More frequent assessments of fatigue, sleep disturbance, depression, and pain may capture the effect of exercise. PMID:20467301

Effectiveness of home exercise on pain, function, and strength of manual wheelchair users with spinal cord injury: a high-dose shoulder program with telerehabilitation.

PubMed

Van Straaten, Meegan G; Cloud, Beth A; Morrow, Melissa M; Ludewig, Paula M; Zhao, Kristin D

2014-10-01

To test the effectiveness of a high-dose home exercise/telerehabilitation program for manual wheelchair users who have a spinal cord injury (SCI) by determining whether the intervention would reduce pain and increase function, as we hypothesized. A pre-post trial with outcomes measured at 3 time points: baseline, postintervention (12wk), and follow-up (>24 wk). Subjects performed an exercise program at their homes using telerehabilitation for therapist monitoring of technique and exercise advancement. Baseline and postintervention data were collected at a motion analysis laboratory in a tertiary medical center. A convenience sample of manual wheelchair users (N=16, 3 women; average age, 41y; average time in a wheelchair, 16y) with shoulder pain (average pain duration, 9y) and mechanical impingement signs on physical examination. A 12-week home exercise program of rotator cuff and scapular stabilization exercises was given to each participant. The program included a high dose of 3 sets of 30 repetitions, 3 times weekly, and regular physical therapist supervision via videoconferencing. Primary outcomes of pain and function were measured with the Wheelchair User's Shoulder Pain Index (WUSPI), Disabilities of Arm, Shoulder, and Hand (DASH) Index, and Shoulder Rating Questionnaire (SRQ). Secondary outcomes of strength were measured with isometric strength tests of scapulothoracic and glenohumeral muscles, and a static fatigue test of the lower trapezius. Pain was reduced and function improved after the intervention. There was a significant main effect for pain and function between the 3 time points based on the Friedman signed-ranked test, WUSPI (χ(2)2=5.10, P=.014), DASH Index (χ(2)2=5.41, P=.012), and SRQ (χ(2)2=23.71, P≤.001). Wilcoxon signed-rank tests demonstrated that isometric strength measurements of the serratus anterior and scapular retractors increased after the exercise intervention ([t=2.42, P=.04] and [t=4.67, P=.003], respectively). Muscle impulse produced by the lower trapezius during a fatigue task also improved (t=2.2, P=.02). No differences were measured in isometric strength for the lower trapezius, glenohumeral rotators, and abductors between the baseline and 12-week time points. A high-dose scapular stabilizer and rotator cuff strengthening program using telerehabilitation for supervision holds promise for shoulder pain treatment in manual wheelchair users with SCI. Additional work is needed to determine the effectiveness compared with other interventions, as well as the potential for earlier intervention to prevent development of shoulder pain. Copyright © 2014 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

A task-oriented circuit training in multiple sclerosis: a feasibility study

PubMed Central

2014-01-01

Background The aim of this study was to evaluate the safety, feasibility and preliminary effects of a high-intensity rehabilitative task-oriented circuit training (TOCT) in a sample of multiple sclerosis (MS) subjects on walking competency, mobility, fatigue and health-related quality of life (HRQoL). Methods 24 MS subjects (EDSS 4.89 ± 0.54, 17 female and 7 male, 52.58 ± 11.21 years, MS duration 15.21 ± 8.68 years) have been enrolled and randomly assigned to 2 treatment groups: (i) experimental group received 10 TOCT sessions over 2 weeks (2 hours/each session) followed by a 3 months home exercise program, whereas control group did not receive any specific rehabilitation intervention. A feasibility patient-reported questionnaire was administered after TOCT. Functional outcome measures were: walking endurance (Six Minute Walk Test), gait speed (10 Meter Walk Test), mobility (Timed Up and Go test) and balance (Dynamic Gait Index). Furthermore, self-reported questionnaire of motor fatigue (Fatigue Severity Scale), walking ability (Multiple Sclerosis Walking Scale – 12) and health-related quality of life (Multiple Sclerosis Impact Scale – 29) were included. Subjects’ assessments were delivered at baseline (T0), after TOCT (T1) and 3 months of home-based exercise program (T2). Results After TOCT subjects reported a positive global rating on the received treatment. At 3 months, we found a 58.33% of adherence to the home-exercise program. After TOCT, walking ability and health-related quality of life were improved (p < 0.05) with minor retention after 3 months. The control group showed no significant changes in any variables. Conclusions This two weeks high-intensity task-oriented circuit class training followed by a three months home-based exercise program seems feasible and safe in MS people with moderate mobility impairments; moreover it might improve walking abilities. Trial registration NCT01464749 PMID:24906545

Validation of Evidence-Based Fall Prevention Programs for Adults with Intellectual and/or Developmental Disorders: A Modified Otago Exercise Program.

PubMed

Renfro, Mindy; Bainbridge, Donna B; Smith, Matthew Lee

2016-01-01

Evidence-based fall prevention (EBFP) programs significantly decrease fall risk, falls, and fall-related injuries in community-dwelling older adults. To date, EBFP programs are only validated for use among people with normal cognition and, therefore, are not evidence-based for adults with intellectual and/or developmental disorders (IDD) such as Alzheimer's disease and related dementias, cerebral vascular accident, or traumatic brain injury. Adults with IDD experience not only a higher rate of falls than their community-dwelling, cognitively intact peers but also higher rates and earlier onset of chronic diseases, also known to increase fall risk. Adults with IDD experience many barriers to health care and health promotion programs. As the lifespan for people with IDD continues to increase, issues of aging (including falls with associated injury) are on the rise and require effective and efficient prevention. A modified group-based version of the Otago Exercise Program (OEP) was developed and implemented at a worksite employing adults with IDD in Montana. Participants were tested pre- and post-intervention using the Center for Disease Control and Prevention's (CDC) Stopping Elderly Accidents Deaths and Injuries (STEADI) tool kit. Participants participated in progressive once weekly, 1-h group exercise classes and home programs over a 7-week period. Discharge planning with consumers and caregivers included home exercise, walking, and an optional home assessment. Despite the limited number of participants ( n  = 15) and short length of participation, improvements were observed in the 30-s Chair Stand Test, 4-Stage Balance Test, and 2-Minute Walk Test. Additionally, three individuals experienced an improvement in ambulation independence. Participants reported no falls during the study period. Promising results of this preliminary project underline the need for further study of this modified OEP among adults with IDD. Future multicenter study should include more participants in diverse geographic regions with longer lengths of participation and follow-up.

Home exercise improves the quality of sleep and daytime sleepiness of elderlies: a randomized controlled trial.

PubMed

Brandão, Glauber Sá; Gomes, Glaucia Sá Brandão Freitas; Brandão, Glaudson Sá; Callou Sampaio, Antônia A; Donner, Claudio F; Oliveira, Luis V F; Camelier, Aquiles Assunção

2018-01-01

Aging causes physiological changes which affect the quality of sleep. Supervised physical exercise is an important therapeutic resource to improve the sleep of the elderlies, however there is a low adherence to those type of programs, so it is necessary to implement an exercise program which is feasible and effective. The study aimed to test the hypothesis that a semi-supervised home exercise program, improves sleep quality and daytime sleepiness of elderlies of the community who present poor sleep quality. This was a randomized controlled trial study, conducted from May to September 2017, in Northeastern Brazil, with elderlies of the community aging 60 years old or older, sedentary, with lower scores or equal to 5 at the Pittsburgh Sleep Quality Index (PSQI) and without cognitive decline. From one hundred ninety-one potential participants twenty-eight refused to participate, therefore, one hundred thirty-one (mean age 68 ± 7 years), and 88% female, were randomly assigned to an intervention group - IG (home exercise and sleep hygiene, n  = 65) and a control group - CG (sleep hygiene only, n  = 66). Sleep assessment tools were used: PSQI, Epworth sleepiness scale (ESS) and clinical questionnaire of Berlin. The level of physical activity has been assessed by means of International Physical Activity Questionnaire adapted for the elderly (IPAQ) and Mini-Mental State Examination for cognitive decline. All participants were assessed before and after the 12-week intervention period and, also, the assessors were blind. The IG showed significant improvement in quality of sleep with a mean reduction of 4.9 ± 2.7 points in the overall PSQI ( p  < 0.01) and in all its 7 components of evaluation ( p  < 0.05), and improvement of secondary endpoint, daytime sleepiness, a decline of 2.8 ± 2.2 points in the ESS (p < 0.01). Our results suggest that semi-supervised home exercise is effective in improving the quality of sleep and self-referred daytime sleepiness of sedentary elderlies of the community who presented sleep disorders. Ensaiosclinicos.gov.br process number: RBR-3cqzfy.

Incorporating yoga into an intense physical therapy program in someone with Parkinson's disease: a case report.

PubMed

Moriello, Gabriele; Denio, Christopher; Abraham, Megan; DeFrancesco, Danielle; Townsley, Jill

2013-10-01

The purpose of this case report was to document outcomes following an intense exercise program integrating yoga with physical therapy exercise in a male with Parkinson's disease. The participant performed an intense 1½-hour program (Phase A) incorporating strengthening, balance, agility and yoga exercises twice weekly for 12 weeks. He then completed a new home exercise program developed by the researchers (Phase B) for 12 weeks. His score on the Parkinson's Disease Questionnaire improved 16 points while his score on the High Level Mobility Assessment tool improved 11 points. There were also improvements in muscle length of several lower extremity muscles, in upper and lower extremity muscle strength, in dynamic balance and he continues to work full time 29 months later. There were no improvements in thoracic posture or aerobic power. This intense program was an effective dose of exercise for someone with Parkinson's disease and allowed him to continue to participate in work, leisure, and community activities. Copyright © 2013 Elsevier Ltd. All rights reserved.

Validation of Tendril TrueHome Using Software-to-Software Comparison

DOE Office of Scientific and Technical Information (OSTI.GOV)

Maguire, Jeffrey B; Horowitz, Scott G; Moore, Nathan

This study performed comparative evaluation of EnergyPlus version 8.6 and Tendril TrueHome, two physics-based home energy simulation models, to identify differences in energy consumption predictions between the two programs and resolve discrepancies between them. EnergyPlus is considered a benchmark, best-in-class software tool for building energy simulation. This exercise sought to improve both software tools through additional evaluation/scrutiny.

Attitude toward the out-patient cardiac rehabilitation program and facilitators for maintenance of exercise behavior.

PubMed

Wong, Eliza M L; Zhong, Xue Bing; Sit, Janet W H; Chair, Sek Ying; Leung, Doris Y P; Leung, Carmen; Leung, K C

2016-09-01

This study examined the attitudes of Chinese patients with coronary heart disease (CHD) toward the outpatient cardiac rehabilitation program (OCRP), as well as their exercise behavior, intention, maintenance and related factors. A qualitative descriptive study design was used, and 22 CHD patients were recruited in Hong Kong in 2014. In-depth interviews and content analyses were conducted. The tripartite model of attitudes was adopted as research framework. Two themes were identified: (1) informant attitude (perception, affection, and practice) toward the OCRP and (2) Exercise Behavior - intention, maintenance and its related factors. Most informants showed positive perception and affection regarding the outpatient rehabilitation program, leading to regular practice of exercise in the program and at home. Peer, group dynamic, social support and Chinese culture influences on exercise behavior may serve as major facilitators to maintain exercise behavior. Positive attitude toward the OCRP enhanced the participation rate, whereas peer and social support from the family and workplace were useful to improve the maintenance of exercise behavior. Overall, this study provides insights into strategic planning for the OCRP and continual support for CHD patients in the community.

[Physical exercise versus exercise program using electrical stimulation devices for home use].

PubMed

Santos, F M; Rodrigues, R G S; Trindade-Filho, E M

2008-02-01

To evaluate the effects of electrical muscle stimulation with devices for home use on neuromuscular conditioning. The study sample comprised 20 sedentary, right-handed, voluntary women aged from 18 to 25 years in the city of Maceió, Northeastern Brazil, in 2006. Subjects were randomly divided into two groups: group A included women who underwent muscle stimulation using commercial electrical devices; group B included those women who performed physical activities with loads. The training program for both groups consisted of two weekly sessions for two months, in a total of 16 sessions. Comparisons of body weight, cirtometry, fleximetry, and muscle strength before and after exercise were determined using the paired t-test. For the comparisons between both groups, Student's t-test was used and a 5% significance level was adopted. Muscle strength subjectively assessed before and after each intervention was increased in both groups. Significant increases in muscle mass and strength were seen only in those subjects who performed voluntary physical activity. Resisted knee flexion and extension exercises effectively increased muscle mass and strength when compared to electrical stimulation at 87 Hz which did not produce a similar effect. The study results showed that electrical stimulation devices for passive physical exercising commercially available are less effective than voluntary physical exercise.

Home-based pulmonary rehabilitation in patients with chronic obstructive pulmonary disease: a randomized clinical trial

PubMed Central

Dias, Fernanda Dultra; Sampaio, Luciana Maria Malosá; da Silva, Graziela Alves; Gomes, Évelim LF Dantas; do Nascimento, Eloisa Sanches Pereira; Alves, Vera Lucia Santos; Stirbulov, Roberto; Costa, Dirceu

2013-01-01

Introduction Pulmonary rehabilitation (PR) is a multidisciplinary program of care for patients with chronic obstructive pulmonary disease (COPD) with the goal of improving the functional capacity and quality of life, as well as maintaining the clinical stability of COPD sufferers. However, not all patients are available for such a program despite discomfort with their condition. The aim of this study was to evaluate the effects of a home-based PR (HBPR) program on functional ability, quality of life, and respiratory muscle strength and endurance. Patients and methods Patients with COPD according to the Global Initiative of Chronic Obstructive Lung Disease were randomized (double-blind) into two groups. One group performed a protocol at home with aerobic and muscle strength exercises and was called the intervention group; the other group received only instructions to perform breathing and stretching exercises, characterizing it as the control group (CG). We assessed the following variables at baseline and 2 months: exercise tolerance (incremental shuttle walk test and upper limb test), respiratory muscle (strength and endurance test), and health-related quality of life (Airways Questionnaire 20). Results There were no significant changes after the intervention in either of the two groups in exercise tolerance and quality of life. However, the intervention group had improved respiratory endurance compared with the CG, while the CG presented a decrease in the load sustained by the respiratory muscles after the HBPR. Conclusion A program of HBPR with biweekly supervision (although not enough to provide significant improvements in physical capacity or quality of life) played an important role in maintaining the stability of the clinical features of patients with COPD; the patients had no worsening of symptoms during the intervention period according to the daily log. PMID:24235824

The effects of neuromuscular exercise on medial knee joint load post-arthroscopic partial medial meniscectomy: 'SCOPEX', a randomised control trial protocol.

PubMed

Hall, Michelle; Hinman, Rana S; Wrigley, Tim V; Roos, Ewa M; Hodges, Paul W; Staples, Margaret; Bennell, Kim L

2012-11-27

Meniscectomy is a risk factor for knee osteoarthritis, with increased medial joint loading a likely contributor to the development and progression of knee osteoarthritis in this group. Therefore, post-surgical rehabilitation or interventions that reduce medial knee joint loading have the potential to reduce the risk of developing or progressing osteoarthritis. The primary purpose of this randomised, assessor-blind controlled trial is to determine the effects of a home-based, physiotherapist-supervised neuromuscular exercise program on medial knee joint load during functional tasks in people who have recently undergone a partial medial meniscectomy. 62 people aged 30-50 years who have undergone an arthroscopic partial medial meniscectomy within the previous 3 to 12 months will be recruited and randomly assigned to a neuromuscular exercise or control group using concealed allocation. The neuromuscular exercise group will attend 8 supervised exercise sessions with a physiotherapist and will perform 6 exercises at home, at least 3 times per week for 12 weeks. The control group will not receive the neuromuscular training program. Blinded assessment will be performed at baseline and immediately following the 12-week intervention. The primary outcomes are change in the peak external knee adduction moment measured by 3-dimensional analysis during normal paced walking and one-leg rise. Secondary outcomes include the change in peak external knee adduction moment during fast pace walking and one-leg hop and change in the knee adduction moment impulse during walking, one-leg rise and one-leg hop, knee and hip muscle strength, electromyographic muscle activation patterns, objective measures of physical function, as well as self-reported measures of physical function and symptoms and additional biomechanical parameters. The findings from this trial will provide evidence regarding the effect of a home-based, physiotherapist-supervised neuromuscular exercise program on medial knee joint load during various tasks in people with a partial medial meniscectomy. If shown to reduce the knee adduction moment, neuromuscular exercise has the potential to prevent the onset of osteoarthritis or slow its progression in those with early disease. Australian New Zealand Clinical Trials Registry reference: ACTRN12612000542897.

The effect of a VR exercise program on falls and depression in the elderly with mild depression in the local community.

PubMed

Yang, Jong-Eun; Lee, Tac-Young; Kim, Jin-Kyung

2017-12-01

[Purpose] The purpose of this study is to explore the effect of a VR exercise program on falls and depression in the elderly with mild depression who reside in the local community. [Subjects and Methods] This study was performed by targeting 15 elderly subjects with mild depression who resided in the local community. The targeted subjects voluntarily selected 3 VR exercise programs (each lasting 10 minutes) among 4 activities, and a resting time of 5 minutes was given for an interval after each activity. The VR exercise program was performed for total 12 weeks (36 times), 3 times a week, 45 minutes per session. [Results] After exercise, scores of static balance test (anteroposterior), Falls Efficacy Scale, and the Activities-specific Balance Confidence Scale in the test subjects were improved and depression and internal stress scores were significantly decreased after the intervention. [Conclusion] It can be concluded that the VR exercise program exerts a positive effect not only on the physical factor but also on the mental factor of the elderly subjects with mild depression who reside in the local community. It is expected that based on the VR exercise program, diversified home programs for the elderly should be developed in the future.

Manual therapy intervention for a patient with a total hip arthroplasty revision.

PubMed

Howard, Paul D; Levitsky, Beth

2007-12-01

Case report. A 73-year-old active woman with a total hip arthroplasty, who later had revision surgery, developed left hip and buttock pain 2 years after the revision surgery, subsequent to lifting her foot while seated. This movement was performed so that her spouse could assist her in putting on her sock and shoe. During the first physical therapy session, the patient exhibited a forward-flexed trunk posture and difficulty weight bearing on the involved lower limb. The patient was successfully treated with manual therapy techniques and a home exercise program. The manual therapy techniques included long-axis hip distraction, lateral hip distraction, posterior-to-anterior hip joint mobilization, and a contract-relax proprioceptive neuromuscular facilitation technique. The patient's home program consisted of long-axis hip distraction, performed by her spouse, and standing lower limb pendular movements into flexion and extension. Pain scale ratings, posture and gait observations, strength, range of motion, and return to functional activities served as outcome measures. After 1 physical therapy visit, in which manual therapy techniques were utilized, the patient had a significant decrease in hip symptoms. The patient and spouse were compliant with the home exercise program and continued with physical therapy for 3 more visits, and the patient ultimately became symptom free. The patient returned to all previous activities, including household chores, cooking, and a walking program. The patient was contacted at 6 months, 1 year, and 4 years, and reported no recurrences of hip or buttock symptoms. Manual therapy techniques and home exercises described in this case report were apparently effective in eliminating symptoms and returning this patient, who had total hip arthroplasty and revision surgery 2 years earlier, to all previous functional activities after a dressing incident produced hip and buttock symptoms.

Postural adaptations to long-term training in Prader-Willi patients.

PubMed

Capodaglio, Paolo; Cimolin, Veronica; Vismara, Luca; Grugni, Graziano; Parisio, Cinzia; Sibilia, Olivia; Galli, Manuela

2011-05-15

Improving balance and reducing risk of falls is a relevant issue in Prader-Willi Syndrome (PWS). The present study aims to quantify the effect of a mixed training program on balance in patients with PWS. Eleven adult PWS patients (mean age: 33.8 ± 4.3 years; mean BMI: 43.3 ± 5.9 Kg/m2) attended a 2-week training program including balance exercises during their hospital stay. At discharge, Group 1 (6 patients) continued the same exercises at home for 6 months, while Group 2 (5 patients) quitted the program. In both groups, a low-calorie, well-balanced diet of 1.200 kcal/day was advised. They were assessed at admission (PRE), after 2 weeks (POST1) and at 6-month (POST2). The assessment consisted of a clinical examination, video recording and 60-second postural evaluation on a force platform. Range of center of pressure (CoP) displacement in the antero-posterior direction (RANGEAP index) and the medio-lateral direction (RANGEML index) and its total trajectory length were computed. At POST1, no significant changes in all of the postural parameters were observed. At completion of the home program (POST2), the postural assessment did not reveal significant modifications. No changes in BMI were observed in PWS at POST2. Our results showed that a long-term mixed, but predominantly home-based training on PWS individuals was not effective in improving balance capacity. Possible causes of the lack of effectiveness of our intervention include lack of training specificity, an inadequate dose of exercise, an underestimation of the neural and sensory component in planning rehabilitation exercise and failed body weight reduction during the training. Also, the physiology of balance instability in these patients may possibly compose a complex puzzle not affected by our exercise training, mainly targeting muscle weakness.

Postural adaptations to long-term training in Prader-Willi patients

PubMed Central

2011-01-01

Background Improving balance and reducing risk of falls is a relevant issue in Prader-Willi Syndrome (PWS). The present study aims to quantify the effect of a mixed training program on balance in patients with PWS. Methods Eleven adult PWS patients (mean age: 33.8 ± 4.3 years; mean BMI: 43.3 ± 5.9 Kg/m2) attended a 2-week training program including balance exercises during their hospital stay. At discharge, Group 1 (6 patients) continued the same exercises at home for 6 months, while Group 2 (5 patients) quitted the program. In both groups, a low-calorie, well-balanced diet of 1.200 kcal/day was advised. They were assessed at admission (PRE), after 2 weeks (POST1) and at 6-month (POST2). The assessment consisted of a clinical examination, video recording and 60-second postural evaluation on a force platform. Range of center of pressure (CoP) displacement in the antero-posterior direction (RANGEAP index) and the medio-lateral direction (RANGEML index) and its total trajectory length were computed. Results At POST1, no significant changes in all of the postural parameters were observed. At completion of the home program (POST2), the postural assessment did not reveal significant modifications. No changes in BMI were observed in PWS at POST2. Conclusions Our results showed that a long-term mixed, but predominantly home-based training on PWS individuals was not effective in improving balance capacity. Possible causes of the lack of effectiveness of our intervention include lack of training specificity, an inadequate dose of exercise, an underestimation of the neural and sensory component in planning rehabilitation exercise and failed body weight reduction during the training. Also, the physiology of balance instability in these patients may possibly compose a complex puzzle not affected by our exercise training, mainly targeting muscle weakness. PMID:21575153

Increasing Fathers' Participation in Therapeutic Intervention Programs for Exceptional Children.

ERIC Educational Resources Information Center

Revelj, Elizabeth O.

In response to a research review indicating that few programs address the father's role in early intervention and preschool programs for the young exceptional child, a three-month practicum was designed which included fathers in physical therapy sessions and in daily home exercise programming for their developmentally disabled children. Practicum…

Effectiveness of Exercise Programs in Ankylosing Spondylitis: A Meta-Analysis of Randomized Controlled Trials.

PubMed

Pécourneau, Virginie; Degboé, Yannick; Barnetche, Thomas; Cantagrel, Alain; Constantin, Arnaud; Ruyssen-Witrand, Adeline

2018-02-01

To assess the effectiveness of exercise programs on disease activity and function in ankylosing spondylitis (AS) by a systematic review and meta-analysis of randomized controlled trials (RCTs). Medline via PubMed and Cochrane Library. Reports of RCTs examining the effectiveness of exercise programs for AS published up to May 2017. Outcomes were evolution of the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Bath Ankylosing Spondylitis Functional Index (BASFI) after the completion of exercise programs. Modalities of exercise were compared and the use of biologic therapy was reported. After screening 190 abstracts, we selected 26 reports for detailed evaluation and finally investigated 8 trials that assessed a home-based exercise program (2/8), swimming (1/8), Pilates training (1/8), or supervised exercises (4/8), for a total of 331 patients with AS. Four trials included patients receiving antitumor necrosis factor therapy. All trials except one showed a decrease in BASDAI and BASFI with exercise. The weighted mean difference was -0.90 (95% confidence interval, -1.52 to -0.27; I 2 =69%; P=.005) for the BASDAI and -0.72 (95% confidence interval, -1.03 to -0.40; I 2 =0%; P<.00001) for the BASFI in favor of exercise programs. Despite the small number of patients and the heterogeneity of exercise programs in the RCTs included in this meta-analysis, its results support the potential of exercise programs to improve disease activity and body function in AS. Copyright © 2017 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

A multicomponent exercise program for institutionalized older adults.

PubMed

Justine, Maria; Hamid, Tengku Aizan

2010-10-01

This study examined the effects of a multicomponent exercise program on depression and quality of life in institutionalized older adults. A quasi-experimental pretest-posttest design was used. Participants were recruited from a publicly funded shelter home in Seremban, Negeri Sembilan Malaysia. The experimental group consisted of 23 volunteers 60 or older who performed 60 minutes of supervised exercise three times per week for 12 weeks. The control group consisted of 20 volunteers who continued with a sedentary lifestyle. At 12 weeks, the exercise group demonstrated an improvement in quality of life by 10.74% (p > 0.05) but not depression (-1.6%, p > 0.05). The control group demonstrated a decrease in both quality of life by 11.26% (p > 0.05) and level of depression by 17.7% (p > 0.05). This study suggests a multicomponent exercise program is a feasible intervention to improve quality of life in institutionalized older adults. Copyright 2010, SLACK Incorporated.

Predilection for frailty remedial strategies among black and white seniors.

PubMed

Miller, D K; Morrison, M J; Blair, S D; Miller, J P; Morley, J E

1998-04-01

Frailty prevention and remedial programs based on exercise, hormone replacement, and vitamin supplementation are becoming available for use with older patients, but success of these programs depends largely on seniors' willingness to participate. We evaluated preferences for specific aspects of these programs using a sample of 359 older persons recruited from potential delivery sites. Main effects and subgroup analyses were done. Subjects preferred stretching, chair-based, walking, and dynamic balance exercises over lifting weights, dancing, hormone and vitamin therapy; exercising alone in their own homes over exercising in groups; and vitamins over hormones. Preferences were affected to some extent by sex, race, recruitment site, and functional status. However, subjects' willingness even to consider exercise was rarely as high as the desired levels of participation set forth in Healthy People 2000. Physicians and public health authorities need to educate older persons about effective methods to prevent or treat frailty.

Attitudes and beliefs about exercise among elderly African Americans in an urban community.

PubMed Central

Lavizzo-Mourey, R.; Cox, C.; Strumpf, N.; Edwards, W. F.; Lavizzo-Mourey, R.; Stinemon, M.; Grisso, J. A.

2001-01-01

Older African Americans are less likely to exercise compared with their white counterparts. Few studies have examined the facilitating factors and barriers to exercise among older African Americans living in urban communities. This study represented the first phase of a program to develop an exercise intervention in an urban community. Qualitative research was conducted to identify culturally determined attitudes that could be useful in designing an effective exercise program. Five focus groups involving 38 persons from a variety of settings were facilitated by trained professionals. Transcripts were analyzed to identify themes and contrasts among group participants. Contrary to the expectations of the investigative team, focus-group participants: (1) uniformly preferred group exercises compared with exercising at home, (2) rejected walking as a feasible option because of safety concerns, and (3) expressed limited interest in using weights or Eastern exercises such as Tai Chi. Concepts and goals of exercise differed according to the physical capabilities of the participants. The analysis of these focus-group discussions provided valuable insights with regard to the development of our community-based exercise-intervention protocol. These findings may be important in designing effective exercise programs for older African Americans in urban settings. PMID:11800276

Using Wii Fit to reduce fatigue among African American women with systemic lupus erythematosus: a pilot study.

PubMed

Yuen, H K; Holthaus, K; Kamen, D L; Sword, D O; Breland, H L

2011-10-01

Fatigue and physical deconditioning are common, difficult to treat conditions among patients with systemic lupus erythematosus (SLE). The aim of this pilot study was to evaluate the effectiveness of a home-based exercise program using the Wii Fit system in patients with SLE. Fifteen sedentary African American women with SLE experiencing moderate to severe fatigue participated in a home exercise program using the Wii Fit 3 days a week for 30 minutes each for 10 weeks. A one-group pretest-post test design was used to evaluate the effectiveness of this program. Primary outcome measure was severity of fatigue. Secondary outcome measures were body weight, waist circumference, fatigue-related symptoms of distress, activity level, and physical fitness. At the completion of the 10-week Wii Fit exercise program, participants perceived fatigue severity as measured by the Fatigue Severity Scale to be significantly decreased (p = 0.002), and body weight and waist circumference were significantly reduced (p = 0.01). In addition, anxiety level, as measured by Hospital Anxiety and Depression Scale, and overall intensity of total pain experience, as measured by Short-form of the McGill Pain Questionnaire, were also significantly reduced (p < 0.05). Findings provide preliminary evidence that the Wii Fit motivates this population to exercise, which leads to alleviation of fatigue and reduced body weight, waist circumference, anxiety level, and overall intensity of total pain experience.

Using Wii Fit to reduce fatigue among African American women with systemic lupus erythematosus: A pilot study

PubMed Central

Yuen, Hon K.; Holthaus, Katy; Kamen, Diane L.; Sword, David; Breland, Hazel L.

2012-01-01

Fatigue and physical deconditioning are common, difficult to treat conditions among patients with systemic lupus erythematosus (SLE). The aim of this pilot study is to evaluate the effectiveness of a home-based exercise program using the Wii Fit system in patients with SLE. Fifteen sedentary African American women with SLE experiencing moderate to severe fatigue participated in a home exercise program using the Wii Fit 3 days a week for 30 minutes each for 10 weeks. A one-group pretest-posttest design was used to evaluate the effectiveness of this program. Primary outcome measure was severity of fatigue. Secondary outcome measures were body weight, waist circumference, fatigue-related symptoms of distress, activity level and physical fitness. At the completion of the 10-week Wii Fit exercise program, participants perceived fatigue severity as measured by the Fatigue Severity Scale to be significantly decreased (P=0.002), body weight and waist circumference were significantly reduced (Ps=0.01). In addition, anxiety level as measured by Hospital Anxiety and Depression Scale, and overall intensity of total pain experience as measured by Short-form of the McGill Pain Questionnaire were also significantly reduced (Ps<0.05). Findings provide preliminary support that the Wii Fit motivates this population to exercise which leads to alleviation of fatigue and reduced body weight, waist circumference, anxiety level, and overall intensity of total pain experience. PMID:21700656

The effectiveness of exercise for the management of musculoskeletal disorders and injuries of the elbow, forearm, wrist, and hand: a systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) collaboration.

PubMed

Menta, Roger; Randhawa, Kristi; Côté, Pierre; Wong, Jessica J; Yu, Hainan; Sutton, Deborah; Varatharajan, Sharanya; Southerst, Danielle; D'Angelo, Kevin; Cox, Jocelyn; Brown, Courtney; Dion, Sarah; Mior, Silvano; Stupar, Maja; Shearer, Heather M; Lindsay, Gail M; Jacobs, Craig; Taylor-Vaisey, Anne

2015-09-01

The purpose of this systematic review was to evaluate the effectiveness of exercise compared to other interventions, placebo/sham intervention, or no intervention in improving self-rated recovery, functional recovery, clinical, and/or administrative outcomes in individuals with musculoskeletal disorders and injuries of the elbow, forearm, wrist, and hand. We searched MEDLINE, EMBASE, CINAHL, PsycINFO, and the Cochrane Central Register of Controlled Trials from 1990 to 2015. Paired reviewers independently screened studies for relevance and assessed the risk of bias using the Scottish Intercollegiate Guidelines Network criteria. We synthesized the evidence using the best evidence synthesis methodology. We identified 5 studies with a low risk of bias. Our review suggests that, for patients with persistent lateral epicondylitis, (1) adding concentric or eccentric strengthening exercises to home stretching exercises provides no additional benefits; (2) a home program of either eccentric or concentric strengthening exercises leads to similar outcomes; (3) home wrist extensor strengthening exercises lead to greater short-term improvements in pain reduction compared to "wait and see"; and (4) clinic-based, supervised exercise may be more beneficial than home exercises with minimal improvements in pain and function. For hand pain of variable duration, supervised progressive strength training added to advice to continue normal physical activity provides no additional benefits. The relative effectiveness of stretching vs strengthening for the wrist extensors remains unknown for the management of persistent lateral epicondylitis. The current evidence shows that the addition of supervised progressive strength training does not provide further benefits over advice to continue normal physical activity for hand pain of variable duration. Copyright © 2015 National University of Health Sciences. Published by Elsevier Inc. All rights reserved.

[REHABILITATION OF MOBILITY AND MOTOR FUNCTION IN NURSING HOME RESIDENTS WITH DEMENTIA].

PubMed

Aizen, Efraim; Lubosky, Enna; Sobeh, Saleh; Ibrahim, Rasha; Pressburger, Dina; Oliven, Roni

2018-04-01

Few clinical trials have evaluated exercise programs developed specifically for patients with dementia in nursing home settings. To determine if a training program tailored for demented patients, can be implemented in a nursing home setting in order to improve motor performances in patients with dementia who suffered functional decline. The present intervention was conducted in wards of patients suffering from dementia in three nursing homes. Patients suffering from dementia and hospitalized in a rehabilitation hospital were the control arm. Eligible patients in the wards assigned to the intervention group (NH; n = 24) received exercise training specifically designed for patients with dementia. Patients in the rehabilitation hospital were observed as a control group (RH; n = 50) and received usual care treatment. Primary endpoints were changes in Functional Independence Measure (FIM), 5X Sit-to-Stand Test, Timed up and go test and ADL. Basic parameters were examined as predictors of positive training response. Both the nursing home residents and rehabilitation hospital patients improved significantly in both primary endpoints (change: in Functional Independence Measure, NH: +119.2 ± 30.8 % versus RH: +83.3 ± 41.9%, p < 0.001; ADL, NH: +143.5 ± 102.6% versus RH: +59.0 ± 90.2%, p < 0.001). Age was found to be a predictor of positive training response. This functional training program tailored for demented patients can be implemented in a nursing home setting to improve motor performances in patients with dementia. Such interventions should be further evaluated in larger randomized controlled trials.

Determining Whether a Dosage-Specific and Individualized Home Exercise Program With Consults Reduces Fall Risk and Falls in Community-Dwelling Older Adults With Difficulty Walking: A Randomized Control Trial.

PubMed

Gallo, Estelle; Stelmach, Maria; Frigeri, Fernanda; Ahn, Dong-Hyun

The development and implementation of effective interventions to prevent falls in older adults is a public health priority. The purpose of this study was to compare the efficacy of a new practice model, incorporating Shubert's evidence-based fall prevention recommendations, with the usual ambulatory physical therapy (PT) at Rusk Rehabilitation, to decrease fall risk among older adults living in the community. The hypotheses were (1) the proposed program would decrease participants' fall risk, (2) it would be more effective than our usual PT, and (3) the addition of 4 consults after discharge would improve compliance with a home exercise program. This was a randomized controlled trial. Sixty-nine participants who were independent community dwellers, were 65 years or older, had difficulty walking or complaints of instability, and had 1 or more risk of falls were randomly assigned into a usual care group (UCG, n = 43) or an experimental group (EG, n = 26). Both groups received PT 2 times per week for 30 minutes for 10 to 32 visits. The UCG received the usual PT delivered at Rusk. The EG was instructed in a moderate- to high-intensity home exercise program designed after completing the mini-Balance Evaluation Systems Test to assist with exercise prescription. The EG was educated on performing a recommended dosage of exercise over 6 months using a diary. The EG received 4 additional 30-minute consults every 2 to 4 weeks postdischarge to reinforce compliance. Self-report of number of falls, number of minutes of exercise per week, and performance on outcome measures (Timed Up and Go, 5-times sit-to-stand, Berg Balance Scale, and Activity Balance Confidence Scale) were monitored at evaluation, 2, 4, and 6 months. Thirty-five participants completed the study (UCG n = 22; EG n = 13). Both groups were similar at baseline on outcome measures and number of visits. Random effect model analyses demonstrated that both groups made significant reductions in fall risk over 6 months as identified by performance on outcome measures. However, the EG improved significantly more compared with the UCG over time (P < .05). Linear regression analyses showed that the EG exercised significantly more compared with the UCG at all times (P < .05). The EG exceeded the target of 115 min/wk of exercise (154 minutes, standard deviation [SD] 68.5; 170 minutes, SD 96.8; and 143 minutes, SD 68.5) at 2, 4, and 6 months, respectively. This study demonstrated that the experimental program is effective in decreasing fall risk in community-dwelling older adults and is more effective than our usual care. Moreover, it suggests that the overall experimental protocol may offer an effective strategy to foster adherence to an exercise program without the increasing number of visits. This study supports the efficacy of the experimental program in decreasing fall risk and being more effective than our usual care, as well as fostering greater compliance with an exercise regimen. It provides some preliminary evidence to support Shubert's recommendation on exercise prescription for fall prevention.

Patients' Perceptions of an Exercise Program Delivered Following Discharge From Hospital After Critical Illness (the Revive Trial).

PubMed

Ferguson, Kathryn; Bradley, Judy M; McAuley, Daniel F; Blackwood, Bronagh; O'Neill, Brenda

2017-01-01

The REVIVE randomized controlled trial (RCT) investigated the effectiveness of an individually tailored (personalized) exercise program for patients discharged from hospital after critical illness. By including qualitative methods, we aimed to explore patients' perceptions of engaging in the exercise program. Patients were recruited from general intensive care units in 6 hospitals in Northern Ireland. Patients allocated to the exercise intervention group were invited to participate in this qualitative study. Independent semistructured interviews were conducted at 6 months after randomization. Interviews were audio-recorded, transcribed, and content analysis used to explore themes arising from the data. Of 30 patients allocated to the exercise group, 21 completed the interviews. Patients provided insight into the physical and mental sequelae they experienced following critical illness. There was a strong sense of patients' need for the exercise program and its importance for their recovery following discharge home. Key facilitators of the intervention included supervision, tailoring of the exercises to personal needs, and the exercise manual. Barriers included poor mental health, existing physical limitations, and lack of motivation. Patients' views of outcome measures in the REVIVE RCT varied. Many patients were unsure about what would be the best way of measuring how the program affected their health. This qualitative study adds an important perspective on patients' attitude to an exercise intervention following recovery from critical illness, and provides insight into the potential facilitators and barriers to delivery of the program and how programs should be evolved for future trials.

Body-weight-supported treadmill rehabilitation after stroke.

PubMed

Duncan, Pamela W; Sullivan, Katherine J; Behrman, Andrea L; Azen, Stanley P; Wu, Samuel S; Nadeau, Stephen E; Dobkin, Bruce H; Rose, Dorian K; Tilson, Julie K; Cen, Steven; Hayden, Sarah K

2011-05-26

Locomotor training, including the use of body-weight support in treadmill stepping, is a physical therapy intervention used to improve recovery of the ability to walk after stroke. The effectiveness and appropriate timing of this intervention have not been established. We stratified 408 participants who had had a stroke 2 months earlier according to the extent of walking impairment--moderate (able to walk 0.4 to <0.8 m per second) or severe (able to walk <0.4 m per second)--and randomly assigned them to one of three training groups. One group received training on a treadmill with the use of body-weight support 2 months after the stroke had occurred (early locomotor training), the second group received this training 6 months after the stroke had occurred (late locomotor training), and the third group participated in an exercise program at home managed by a physical therapist 2 months after the stroke (home-exercise program). Each intervention included 36 sessions of 90 minutes each for 12 to 16 weeks. The primary outcome was the proportion of participants in each group who had an improvement in functional walking ability 1 year after the stroke. At 1 year, 52.0% of all participants had increased functional walking ability. No significant differences in improvement were found between early locomotor training and home exercise (adjusted odds ratio for the primary outcome, 0.83; 95% confidence interval [CI], 0.50 to 1.39) or between late locomotor training and home exercise (adjusted odds ratio, 1.19; 95% CI, 0.72 to 1.99). All groups had similar improvements in walking speed, motor recovery, balance, functional status, and quality of life. Neither the delay in initiating the late locomotor training nor the severity of the initial impairment affected the outcome at 1 year. Ten related serious adverse events were reported (occurring in 2.2% of participants undergoing early locomotor training, 3.5% of those undergoing late locomotor training, and 1.6% of those engaging in home exercise). As compared with the home-exercise group, each of the groups receiving locomotor training had a higher frequency of dizziness or faintness during treatment (P=0.008). Among patients with severe walking impairment, multiple falls were more common in the group receiving early locomotor training than in the other two groups (P=0.02). Locomotor training, including the use of body-weight support in stepping on a treadmill, was not shown to be superior to progressive exercise at home managed by a physical therapist. (Funded by the National Institute of Neurological Disorders and Stroke and the National Center for Medical Rehabilitation Research; LEAPS ClinicalTrials.gov number, NCT00243919.).

The effect of a multisensory exercise program on engagement, behavior, and selected physiological indexes in persons with dementia.

PubMed

Heyn, Patricia

2003-01-01

A multisensory exercise approach that evokes the stimulation and use of various senses, such as combining physical and cognitive stimuli, can assist in the management of persons with Alzheimer's disease (AD). The objective of this study was to evaluate the outcomes of a multisensory exercise program on cognitive function (engagement), behavior (mood), and physiological indices (blood pressure, resting heart rate, and weight) in 13 nursing home residents diagnosed with moderate to severe AD. A one-group pretest/post-test, quasi-experimental design was used. The program combined a variety of sensory stimulations, integrating storytelling and imaging strategies. Results showed an improvement in resting heart rate, overall mood, and in engagement of physical activity. The findings suggest that a multisensory exercise approach can be beneficial for individuals with AD.

Theory-Based Predictors of Follow-Up Exercise Behavior After A Supervised Exercise Intervention in Older Breast Cancer Survivors

PubMed Central

Loprinzi, Paul D.; Cardinal, Bradley J.; Si, Qi; Bennett, Jill A.; Winters-Stone, Kerri

2014-01-01

Purpose Supervised exercise interventions can elicit numerous positive health outcomes in older breast cancer survivors. However, to maintain these benefits, regular exercise needs to be maintained long after the supervised program. This may be difficult, as in this transitional period (i.e., time period immediately following a supervised exercise program), breast cancer survivors are in the absence of on-site direct supervision from a trained exercise specialist. The purpose of the present study was to identify key determinants of regular exercise participation during a 6-month follow-up period after a 12-month supervised exercise program among women aged 65+ years who had completed adjuvant treatment for breast cancer. Methods At the conclusion of a supervised exercise program, and 6-months later, 69 breast cancer survivors completed surveys examining their exercise behavior and key constructs from the Transtheoretical Model. Results After adjusting for weight status and physical activity at the transition point, breast cancer survivors with higher self-efficacy at the point of transition were more likely to be active 6-months after leaving the supervised exercise program (OR [95% CI]: 1.10 [1.01–1.18]). Similarly, breast cancer survivors with higher behavioral processes of change use at the point of transition were more likely to be active (OR [95% CI]: 1.13 [1.02–1.26]). Conclusion These findings suggest that self-efficacy and the behavioral processes of change, in particular, play an important role in exercise participation during the transition from a supervised to a home-based program among older breast cancer survivors. PMID:22252545

Efficacy of a cell phone-based exercise programme for COPD.

PubMed

Liu, W-T; Wang, C-H; Lin, H-C; Lin, S-M; Lee, K-Y; Lo, Y-L; Hung, S-H; Chang, Y-M; Chung, K F; Kuo, H-P

2008-09-01

The application of a supervised endurance exercise training programme in a home setting offering convenience and prolonged effects is a challenge. In total, 48 patients were initially assessed by the incremental shuttle walk test (ISWT), spirometry and the Short Form-12 (SF-12) quality-of-life questionnaire, and then every 4 weeks for 3 months thereafter and again after 1 yr. During the first 3 months, 24 patients in the cell phone group were asked to perform daily endurance walking at 80% of their maximal capacity by following the tempo of music from a program installed on a cell phone. The level of endurance walking at home was readjusted monthly according to the result of ISWT. In the control group, 24 patients received the same protocol and were verbally asked to take daily walking exercise at home. Patients in the cell phone group significantly improved their ISWT distance and duration of endurance walking after 8 weeks. The improvements in ISWT distance, inspiratory capacity and SF-12 scoring at 12 weeks persisted until the end of the study, with less acute exacerbations and hospitalisations. In the present pilot study, the cell phone-based system provides an efficient, home endurance exercise training programme with good compliance and clinical outcomes in patients with moderate-to-severe chronic obstructive pulmonary disease.

[Effectiveness of an illustrated home exercise guide on promoting urinary continence during pregnancy: a pragmatic randomized clinical trial].

PubMed

de Assis, Liamara Cavalcante; Bernardes, João Marcos; Barbosa, Angélica Mércia Pascon; Santini, Ana Carolina Monteiro; Vianna, Luana Schneider; Dias, Adriano

2015-10-01

To evaluate the effectiveness of an illustrated home exercise guide targeting the pelvic floor muscles in promoting urinary continence during pregnancy. A randomized clinical trial was performed with 87 participants, evaluated six times during pregnancy and divided into three groups: Gsup, supervised; Gobs, not supervised, and Gref, women who did not perform the home exercises program. A miction diary and perineometry were used to evaluate urinary incontinence (primary outcome) and pelvic floor muscle strength (secondary outcome), respectively. The Kruskal-Wallis test with post hoc Dunn's and chi-square and Z tests with Bonferroni correction were used for continuous variables and proportions, respectively, with the level of significance set at 5%. At the end of the study, 6.9% of pregnant women in the Gsup and Gobs had urinary incontinence, while 96.6% of Gref women were incontinent. Regarding pelvic floor muscle function, Gsup and Gobs had mean contractions of 10 and 8.9 cmH2O, respectively, while Gref had a value of 4.7 cmH2O. Both results were significant. An illustrated home exercise guide targeting the pelvic floor muscles is effective in promoting urinary continence during pregnancy, even without permanent supervision. clinicaltrials.gov Registry--NCT00740428.

Telephone Coaching to Enhance a Home-Based Physical Activity Program for Knee Osteoarthritis: A Randomized Clinical Trial.

PubMed

Bennell, Kim L; Campbell, Penny K; Egerton, Thorlene; Metcalf, Ben; Kasza, Jessica; Forbes, Andrew; Bills, Caroline; Gale, Janette; Harris, Anthony; Kolt, Gregory S; Bunker, Stephen J; Hunter, David J; Brand, Caroline A; Hinman, Rana S

2017-01-01

To investigate whether simultaneous telephone coaching improves the clinical effectiveness of a physiotherapist-prescribed home-based physical activity program for knee osteoarthritis (OA). A total of 168 inactive adults ages ≥50 years with knee pain on a numeric rating scale ≥4 (NRS; range 0-10) and knee OA were recruited from the community and randomly assigned to a physiotherapy (PT) and coaching group (n = 84) or PT-only (n = 84) group. All participants received five 30-minute consultations with a physiotherapist over 6 months for education, home exercise, and physical activity advice. PT+coaching participants also received 6-12 telephone coaching sessions by clinicians trained in behavioral-change support for exercise and physical activity. Primary outcomes were pain (NRS) and physical function (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC; score range 0-68]) at 6 months. Secondary outcomes were these same measures at 12 and 18 months, as well as physical activity, exercise adherence, other pain and function measures, and quality of life. Analyses were intent-to-treat with multiple imputation for missing data. A total of 142 (85%), 136 (81%), and 128 (76%) participants completed 6-, 12-, and 18-month measurements, respectively. The change in NRS pain (mean difference 0.4 unit [95% confidence interval (95% CI) -0.4, 1.3]) and in WOMAC function (1.8 [95% CI -1.9, 5.5]) did not differ between groups at 6 months, with both groups showing clinically relevant improvements. Some secondary outcomes related to physical activity and exercise behavior favored PT+coaching at 6 months but generally not at 12 or 18 months. There were no between-group differences in most other outcomes. The addition of simultaneous telephone coaching did not augment the pain and function benefits of a physiotherapist-prescribed home-based physical activity program. © 2016, American College of Rheumatology.

Achievement in Large-Scale National Numeracy Assessment: An Ecological Study of Motivation and Student, Home, and School Predictors

ERIC Educational Resources Information Center

Martin, Andrew J.; Lazendic, Goran

2018-01-01

With the rise of large-scale academic assessment programs around the world, there is a need to better understand the factors predicting students' achievement in these assessment exercises. This investigation into national numeracy assessment drew on ecological and transactional conceptualizing involving student, student/home, and school factors.…

Can a tailored exercise and home hazard reduction program reduce the rate of falls in community dwelling older people with cognitive impairment: protocol paper for the i-FOCIS randomised controlled trial.

PubMed

Close, Jacqueline C T; Wesson, Jacqueline; Sherrington, Catherine; Hill, Keith D; Kurrle, Sue; Lord, Stephen R; Brodaty, Henry; Howard, Kirsten; Gitlin, Laura N; O'Rourke, Sandra D; Clemson, Lindy

2014-08-15

The rate of falls in community dwelling older people with cognitive impairment (CI) is twice that of a cognitively intact population, with almost two thirds of people with CI falling annually. Studies indicate that exercise involving balance and/or a home hazard reduction program are effective in preventing falls in cognitively intact older people. However the potential benefit of these interventions in reducing falls in people with CI has not been established.This randomised controlled trial will determine whether a tailored exercise and home hazard reduction program can reduce the rate of falls in community dwelling older people with CI. We will determine whether the intervention has beneficial effects on a range of physical and psychological outcome measures as well as quality of life of participants and their carers. A health economic analysis examining the cost and potential benefits of the program will also be undertaken. Three hundred and sixty people aged 65 years or older living in the community with CI will be recruited to participate in the trial. Each will have an identifiable carer with a minimum of 3.5 hours of face to face contact each week.Participants will undergo an assessment at baseline with retests at 6 and 12 months. Participants allocated to the intervention group will participate in an exercise and home hazard reduction program tailored to their cognitive and physical abilities.The primary outcome measure will be the rate of falls which will be measured using monthly falls calendars. Secondary outcome measures will include the risk of falling, quality of life, measures of physical and cognitive function, fear of falling and planned and unplanned use of health services. Carers will be followed up to determine carer burden, coping strategies and quality of life. The study will determine the impact of this tailored intervention in reducing the rate of falls in community dwelling older people with CI as well as the cost-effectiveness and adherence to the program. The results will have direct implications for the design and implementation of interventions for this high-risk group of older people. The protocol for this study is registered with the Australian New Zealand Clinical Trials Registry - ACTRN12614000603617.

Unique Positioning for Using Elastic Resistance Band in Providing Strengthening Exercise to the Muscles Surrounding the Ankle

PubMed Central

Bandy, William D.

2007-01-01

Ankle sprains are among the most common injuries incurred by participants in athletics. Conservative management of the patient after an ankle sprain includes a comprehensive rehabilitation program of which the resistance exercises are a part and are frequently advised by the clinician, many times as part of a home exercise program. The purpose of this Clinical Suggestion is to present a unique method of using elastic resistance band to provide strengthening activities to the inverters, ever-tors, plantarflexors, and dorsiflexors of the ankle. The method is unique, as well as convenient and efficient, as it allows the subject to perform all four exercises with a minimum of change in position, while staying seated in a chair. PMID:21522203

Improved Functional Performance in Individuals With Dementia After a Moderate-Intensity Home-Based Exercise Program: A Randomized Controlled Trial.

PubMed

Dawson, Nicole; Judge, Katherine S; Gerhart, Hayden

2017-03-01

Individuals with dementia (IWDs) experience difficulties across cognitive and functional domains. Nonpharmacological interventions aimed at reducing disability are greatly needed. Exercise is a low-cost and easily implemented approach, but investigation has yielded mixed evidence to date. The purpose of the current study was to evaluate a novel and innovative moderate-intensity functional exercise intervention for IWDs, which was developed using principles from exercise science along with a Strength-Based Approach, consisting of 24 home-based sessions. A randomized, controlled intervention trial with a 2-group pretest and posttest design was used with a sample of 23 community-dwelling IWDs (intervention group: n = 13; comparison group: n = 10). Average age of participants was 73.9 years (standard deviation, 9.1) with mild to moderate cognitive impairment (Mini-Mental State Examination, Mean = 20.8; standard deviation, 5.0). A 99.0% attendance rate indicated high adherence to the moderate-intensity exercise program. Efficacy was examined using multiple linear regression. Group assignment significantly predicted performance in key outcome measures, with IWDs from the intervention group improving in lower extremity strength (B = 5.92, t = 3.26, P = .004), balance (B = 4.04, t = 4.13, P = .001), and fast gait speed (B = .32, t = 2.61, P = .02). These findings indicated IWDs are able to participate in and benefit from a moderate-intensity functional exercise program, consisting of strength and balance activities. The current intervention used a Strength-Based Approach to facilitate implementation of exercise activities that could be completed by the sample. Therefore, integration of these techniques into mainstream clinical practice and research should be feasible with this patient population. Future research directions and implications of these findings also are discussed.

Sport therapy for hypertension: why, how, and how much?

PubMed

Manfredini, Fabio; Malagoni, Anna M; Mandini, Simona; Boari, Benedetta; Felisatti, Michele; Zamboni, Paolo; Manfredini, Roberto

2009-01-01

Exercise may prevent or reduce the effects of metabolic and cardiovascular diseases, including arterial hypertension. Both acute and chronic exercise, alone or combined with lifestyle modifications, decrease blood pressure and avoid or reduce the need for pharmacologic therapy in patients with hypertension. The hypotensive effect of exercise is observed in a large percentage of subjects, with differences due to age, sex, race, health conditions, parental history, and genetic factors. Exercise regulates autonomic nervous system activity, increases shear stress, improves nitric oxide production in endothelial cells and its bioavailability for vascular smooth muscle, up-regulates antioxidant enzymes. Endurance training is primarily effective, and resistance training can be combined with it. Low-to-moderate intensity training in sedentary patients with hypertension is necessary, and tailored programs make exercise safe and effective also in special populations. Supervised or home-based exercise programs allow a nonpharmacological reduction of hypertension and reduce risk factors, with possible beneficial effects on cardiovascular morbidity.

Randomized Controlled Trial Comparing Orthosis Augmented by Either Stretching or Stretching and Strengthening for Stage II Tibialis Posterior Tendon Dysfunction.

PubMed

Houck, Jeff; Neville, Christopher; Tome, Josh; Flemister, Adolph

2015-09-01

The value of strengthening and stretching exercises combined with orthosis treatment in a home-based program has not been evaluated. The purpose of this study was to compare the effects of augmenting orthosis treatment with either stretching or a combination of stretching and strengthening in participants with stage II tibialis posterior tendon dysfunction (TPTD). Participants included 39 patients with stage II TPTD who were recruited from a medical center and then randomly assigned to a strengthening or stretching treatment group. Excluding 3 dropouts, there were 19 participants in the strengthening group and 17 in the stretching group. The stretching treatment consisted of a prefabricated orthosis used in conjunction with stretching exercises. The strengthening treatment consisted of a prefabricated orthosis used in conjunction with the stretching and strengthening exercises. The main outcome measures were self-report (ie, Foot Function Index and Short Musculoskeletal Function Assessment) and isometric deep posterior compartment strength. Two-way analysis of variance was used to test for differences between groups at 6 and 12 weeks after starting the exercise programs. Both groups significantly improved in pain and function over the 12-week trial period. The self-report measures showed minimal differences between the treatment groups. There were no differences in isometric deep posterior compartment strength. A moderate-intensity, home-based exercise program was minimally effective in augmenting orthosis wear alone in participants with stage II TPTD. Level I, prospective randomized study. © The Author(s) 2015.

Feasibility of a Caregiver Assisted Exercise Program for Preterm Infants

PubMed Central

Gravem, Dana; Lakes, Kimberley; Rich, Julia; Hayes, Gillian; Cooper, Dan; Olshansky, Ellen

2013-01-01

Purpose Mounting evidence shows that low birth weight and prematurity are related to serious health problems in adulthood, including increased body fat, decreased fitness, poor bone mineralization, pulmonary problems, and cardiovascular disease. There is data to suggest that increasing physical activity in preterm infants will have effects on short term muscle mass and fat mass, but we also hypothesized that increasing physical activity early in life can lead to improved health outcomes in adulthood. Because few studies have addressed the augmentation of physical activity in premature babies, the objective of this study was to evaluate the feasibility of whether caregivers (mostly mothers) can learn from nurses and other health care providers to implement a program of assisted infant exercise following discharge. Study Design and Methods Ten caregivers of preterm infants were taught by nurses, along with occupational therapists and other health care providers, to perform assisted infant exercise and instructed to conduct the exercises daily for approximately three weeks. The researchers made home visits and conducted qualitative interviews to understand the caregivers’ (mostly mothers’) experiences with this exercise protocol. Quantitative data included a caregiver’s daily log of the exercises completed to measure adherence as well as videotaped caregiver sessions, which were used to record errors as a measure of proficiency in the exercise technique. Results On average, the caregivers completed a daily log on 92% of the days enrolled in the study and reported performing the exercises on 93% of the days recorded. Caregivers made an average of 1.8 errors on two tests (with a maximum of 23 or 35 items on each, respectively) when demonstrating proficiency in the exercise technique. All caregivers described the exercises as beneficial for their infants, and many reported that these interventions fostered increased bonding with their babies. Nearly all reported feeling “scared” of hurting their babies during the first few days of home exercise, but stated that fears were alleviated by practice in the home and further teaching and learning. Clinical Implications Caregivers were willing and able to do the exercises correctly, and they expressed a belief that the intervention had positive effects on their babies and on caregiver-infant interactions. These findings have important implications for nursing practice because nurses are in key positions to teach and encourage caregivers to practice these exercises with their newborn babies. PMID:23618941

One day access to a running wheel reduces self-administration of d-methamphetamine, MDMA and Methylone

PubMed Central

Aarde, Shawn M.; Miller, Michelle L.; Creehan, Kevin M.; Vandewater, Sophia A.; Taffe, Michael A.

2015-01-01

Background Exercise influences drug craving and consumption in humans and drug self-administration in laboratory animals, but the effects can be variable. Improved understanding of how exercise affects drug intake or craving would enhance applications of exercise programs to human drug users attempting cessation. Methods Rats were trained in the intravenous self-administration (IVSA) of d-methamphetamine (METH; 0.05 mg/kg/inf), 3,4-methylenedioxymethamphetamine (MDMA; 0.5 mg/kg/inf) or methylone (0.5 mg/kg/inf). Once IVSA was established, the effect of ~22 hrs of wheel access in the home cage on subsequent drug taking was assessed in a two cohort crossover design. Results Provision of home cage wheel access during the day prior to IVSA sessions significantly decreased the self-administration of METH, MDMA and methylone. At the individual level, there was no correlation between the amount a rat used the wheel and the size of the individual’s decrease in drug intake. Conclusions Wheel access can reduce self-administration of a variety of psychomotor stimulants. It does so immediately, i.e., without a need for weeks of exercise prior to drug access. This study therefore indicates that future mechanistic investigations should focus on acute effects of exercise. In sum, the results predict that exercise programs can be used to decrease stimulant drug use in individuals even with no exercise history and an established drug taking pattern. PMID:25863714

Exercise in Patients on Dialysis: A Multicenter, Randomized Clinical Trial

PubMed Central

Manfredini, Fabio; Mallamaci, Francesca; D’Arrigo, Graziella; Baggetta, Rossella; Bolignano, Davide; Torino, Claudia; Lamberti, Nicola; Bertoli, Silvio; Ciurlino, Daniele; Rocca-Rey, Lisa; Barillà, Antonio; Battaglia, Yuri; Rapanà, Renato Mario; Zuccalà, Alessandro; Bonanno, Graziella; Fatuzzo, Pasquale; Rapisarda, Francesco; Rastelli, Stefania; Fabrizi, Fabrizio; Messa, Piergiorgio; De Paola, Luciano; Lombardi, Luigi; Cupisti, Adamasco; Fuiano, Giorgio; Lucisano, Gaetano; Summaria, Chiara; Felisatti, Michele; Pozzato, Enrico; Malagoni, Anna Maria; Castellino, Pietro; Aucella, Filippo; Abd ElHafeez, Samar; Provenzano, Pasquale Fabio; Tripepi, Giovanni; Catizone, Luigi

2017-01-01

Previous studies have suggested the benefits of physical exercise for patients on dialysis. We conducted the Exercise Introduction to Enhance Performance in Dialysis trial, a 6-month randomized, multicenter trial to test whether a simple, personalized walking exercise program at home, managed by dialysis staff, improves functional status in adult patients on dialysis. The main study outcomes included change in physical performance at 6 months, assessed by the 6-minute walking test and the five times sit-to-stand test, and in quality of life, assessed by the Kidney Disease Quality of Life Short Form (KDQOL-SF) questionnaire. We randomized 296 patients to normal physical activity (control; n=145) or walking exercise (n=151); 227 patients (exercise n=104; control n=123) repeated the 6-month evaluations. The distance covered during the 6-minute walking test improved in the exercise group (mean distance±SD: baseline, 328±96 m; 6 months, 367±113 m) but not in the control group (baseline, 321±107 m; 6 months, 324±116 m; P<0.001 between groups). Similarly, the five times sit-to-stand test time improved in the exercise group (mean time±SD: baseline, 20.5±6.0 seconds; 6 months, 18.2±5.7 seconds) but not in the control group (baseline, 20.9±5.8 seconds; 6 months, 20.2±6.4 seconds; P=0.001 between groups). The cognitive function score (P=0.04) and quality of social interaction score (P=0.01) in the kidney disease component of the KDQOL-SF improved significantly in the exercise arm compared with the control arm. Hence, a simple, personalized, home-based, low-intensity exercise program managed by dialysis staff may improve physical performance and quality of life in patients on dialysis. PMID:27909047

The effects of a Pilates-based exercise rehabilitation program on functional outcome and fall risk reduction in an aging adult status-post traumatic hip fracture due to a fall.

PubMed

Stivala, Adam; Hartley, Greg

2014-01-01

Currently, little information describing the relationship of Pilates-based strength and stability exercises with fall risk in the geriatric population exists. The purpose of this report was to examine the impact of a Pilates-based rehabilitation (PBR) program on reducing fall risk in an aging adult status postfall with resulting hip fracture and open reduction and internal fixation. The patient was an 84-year-old woman admitted to a skilled nursing facility (SNF) after a right hip fracture resulting from a fall at home. The patient's relevant medical history included frequent falls due to loss of balance, a previous left hip fracture with resultant arthroplasty, and a stroke roughly 20 years prior. The patient received physical therapy and occupational therapy 6 days per week for 26 days in an SNF. The physical therapy intervention consisted of gait and transfer training, neuromuscular reeducation, and an adjunct of specialized PBR exercises for the following impairments: decreased core strength and awareness and poor dynamic stabilization during functional activities. The patient demonstrated increases in lower extremity strength and active range of motion, ambulation distance and speed, and transfer ability. The patient was able to return home and live with her husband while requiring only incidental assistance with activities of daily living. She was able to independently ambulate around her home with her rolling walker. Her fall risk was also reduced from initial evaluation based on several fall risk assessments, including the Four Square Step Test, the Berg Balance Scale, and the Timed Up and Go. This case illustrates the benefit of integrating PBR exercises into a standard SNF rehabilitation program, which may contribute to decreased fall risk.

Home-Based Exercise Program Improves Balance and Fear of Falling in Community-Dwelling Older Adults with Mild Alzheimer's Disease: A Pilot Study.

PubMed

Padala, Kalpana P; Padala, Prasad R; Lensing, Shelly Y; Dennis, Richard A; Bopp, Melinda M; Roberson, Paula K; Sullivan, Dennis H

2017-01-01

Balance problems are common in older adults with Alzheimer's disease (AD). The objective was to study the effects of a Wii-Fit interactive video-game-led physical exercise program to a walking program on measures of balance in older adults with mild AD. A prospective randomized controlled parallel-group trial (Wii-Fit versus walking) was conducted in thirty community-dwelling older adults (73±6.2 years) with mild AD. Home-based exercises were performed under caregiver supervision for 8 weeks. Primary (Berg Balance Scale, BBS) and secondary outcomes (fear of falls and quality of life) were measured at baseline, 8 weeks (end of intervention), and 16 weeks (8-weeks post-intervention). At 8 weeks, there was a significantly greater improvement (average inter-group difference [95% CI]) in the Wii-Fit group compared to the walking group in BBS (4.8 [3.3-6.2], p < 0.001), after adjusting for baseline. This improvement was sustained at 16 weeks (3.5 [2.0-5.0], p < 0.001). Analyses of the secondary outcome measures indicated that there was a significantly greater improvement in the Wii-Fit group compared to walking group in Activity-specific Balance Confidence scale (6.5 [3.6-9.4], p < 0.001) and Falls Efficacy Scale (-4.8 [-7.6 to -2.0], p = 0.002) at 8 weeks. However, this effect was not sustained at 16 weeks. Quality of life improved in both groups at 8 weeks; however, there were no inter-group differences (p = 0.445). Home-based, caregiver-supervised Wii-Fit exercises improve balance and may reduce fear of falling in community-dwelling older adults with mild AD.

A Post-Hospital Home Exercise Program Improved Mobility but Increased Falls in Older People: A Randomised Controlled Trial

PubMed Central

Sherrington, Catherine; Lord, Stephen R.; Vogler, Constance M.; Close, Jacqueline C. T.; Howard, Kirsten; Dean, Catherine M.; Heller, Gillian Z.; Clemson, Lindy; O'Rourke, Sandra D.; Ramsay, Elisabeth; Barraclough, Elizabeth; Herbert, Robert D.; Cumming, Robert G.

2014-01-01

Background Home exercise can prevent falls in the general older community but its impact in people recently discharged from hospital is not known. The study aimed to investigate the effects of a home-based exercise program on falls and mobility among people recently discharged from hospital. Methods and Findings This randomised controlled trial (ACTRN12607000563460) was conducted among 340 older people. Intervention group participants (n = 171) were asked to exercise at home for 15–20 minutes up to 6 times weekly for 12 months. The control group (n = 169) received usual care. Primary outcomes were rate of falls (assessed over 12 months using monthly calendars), performance-based mobility (Lower Extremity Summary Performance Score, range 0–3, at baseline and 12 months, assessor unaware of group allocation) and self-reported ease of mobility task performance (range 0–40, assessed with 12 monthly questionaries). Participants had an average age of 81.2 years (SD 8.0) and 70% had fallen in the past year. Complete primary outcome data were obtained for at least 92% of randomised participants. Participants in the intervention group reported more falls than the control group (177 falls versus 123 falls) during the 12-month study period and this difference was statistically significant (incidence rate ratio 1.43, 95% CI 1.07 to 1.93, p = 0.017). At 12-months, performance-based mobility had improved significantly more in the intervention group than in the control group (between-group difference adjusted for baseline performance 0.13, 95% CI 0.04 to 0.21, p = 0.004). Self-reported ease in undertaking mobility tasks over the 12-month period was not significantly different between the groups (0.49, 95% CI −0.91 to 1.90, p = 0.488). Conclusions An individualised home exercise prescription significantly improved performance-based mobility but significantly increased the rate of falls in older people recently discharged from hospital. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12607000563460 PMID:25180702

Exercise program improved subjective dry eye symptoms for office workers.

PubMed

Sano, Kokoro; Kawashima, Motoko; Takechi, Sayuri; Mimura, Masaru; Tsubota, Kazuo

2018-01-01

We investigated the benefits of a cognitive behavior therapy-based exercise program to reduce the dry eye symptoms of office workers. We recruited 11 office workers with dry eye symptoms, aged 31-64 years, who voluntarily participated in group health guidance at a manufacturing company. Participants learned about the role of physical activity and exercise in enhancing wellness and performed an exercise program at home 3 days per week for 10 weeks. We estimated the indexes of body composition, dry eye symptoms, and psychological distress using the Dry Eye-Related Quality of Life Score and the World Health Organization's Subjective Well-Being Inventory questionnaires pre- and postintervention. The 10-week exercise program and the questionnaires were completed by 48.1% (39 of 81) of the participants. Body composition did not change pre- and postintervention. However, the average of the Dry Eye-Related Quality of Life Score scores in participants with subjective dry eye significantly improved after the intervention. Moreover, the World Health Organization's Subjective Well-Being Inventory positive well-being score tended to increase after the intervention. In this study, we showed that a 10-week exercise program improved subjective dry eye symptoms of healthy office workers. Our study suggests that a cognitive behavior therapy-based exercise program can play an important role in the treatment of patients with dry eye disease.

Randomized controlled trial of a comprehensive home environment-focused weight loss program for adults

PubMed Central

Gorin, Amy A.; Raynor, Hollie A.; Fava, Joseph; Maguire, Kimberly; Robichaud, Erica; Trautvetter, Jennifer; Crane, Melissa; Wing, Rena R.

2012-01-01

Objective Behavioral weight loss programs (BWL) provide limited instruction on how to change the environmental context of weight-regulating behaviors, perhaps contributing to regain. Drawing on social ecological models, this trial evaluated a comprehensive weight loss program that targeted both an individual’s behavior and their physical and social home environment. Methods Overweight and obese adults (N=201; 48.9±10.5 years; 78.1% women) were randomized to BWL or to BWL plus home environment changes (BWL+H). Groups met weekly for 6 months and bi-monthly for 12 months. BWL+H participants were given items to facilitate healthy choices in their homes (e.g., exercise equipment, portion plates) and attended treatment with a household partner. Weight loss at 6 and 18 months was the primary outcome. Results BWL+H changed many aspects of the home environment and produced better 6 month weight losses than BWL (p=.017). At 18 months, no weight loss differences were observed (p=.19) and rates of regain were equivalent (p=.30). Treatment response was moderated by gender (6 month p=.01; 18 month p=.006). Women lost more weight in BWL+H than BWL at 6 and 18 months, whereas men in BWL lost more weight than those in BWL+H at 18 months. Partners, regardless of gender, lost more weight in BWL+H than BWL at both time points (ps<.0001). Conclusion The home food and exercise environment is malleable and targeting this microenvironment appears to improve initial weight loss, and in women, 18-month outcomes. Research is needed to understand this gender difference and to develop home-focused strategies with more powerful and sustained weight loss effects. PMID:22309885

Exercise motivation and adherence in cancer survivors after participation in a randomized controlled trial: an attribution theory perspective.

PubMed

Courneya, Kerry S; Friedenreich, Christine M; Sela, Rami A; Quinney, H Arthur; Rhodes, Ryan E; Jones, Lee W

2004-01-01

The purpose of this study was to examine postprogram exercise motivation and adherence in cancer survivors who participated in the Group Psychotherapy and Home-Based Physical Exercise (GROUP-HOPE; Courneya, Friedenreich, Sela, Quinney, & Rhodes, 2002) trial. At the completion of the GROUP-HOPE trial, 46 of 51 (90%) participants in the exercise group completed measures of attribution theory constructs. A 5-week follow-up self-report of exercise was then completed by 30 (65%) participants. Correlational analyses indicated that program exercise, perceived success, expected success, and affective reactions were strong predictors of postprogram exercise. In multivariate stepwise regression analyses, program exercise and perceived success were the strongest predictors of postprogram exercise. Additionally, perceived success was more important than objective success in understanding the attribution process, and it interacted with personal control to influence expected success and negative affect. Finally, postprogram quality of life and changes in physical fitness were correlates of perceived success. We concluded that attribution theory may have utility for understanding postprogram exercise motivation and adherence in cancer survivors.

The Impact of a 35-Week Long-Term Exercise Therapy on Psychosocial Health of Children With Benign Epilepsy.

PubMed

Eom, Soyong; Lee, Mi Kyung; Park, Ji-Hye; Lee, Dongpyo; Kang, Hoon-Chul; Lee, Joon Soo; Jeon, Justin Y; Kim, Heung Dong

2016-07-01

The purpose of this study was to evaluate the feasibility of a 35-week exercise program and its efficacy on neurocognitive and psychological variables in children with benign epilepsy with centrotemporal spikes. Ten children with benign epilepsy with centrotemporal spikes (aged 8 to 12 years) completed a 35-week exercise program consisting of supervised sport activities for 5 weeks and home-based exercise program for 30 weeks. The children and their parents participated in neurocognitive and psychological evaluations including measures of attention, executive function, behaviors, and quality of life at baseline and postexercise follow-up at the 35th week. At postintervention evaluation, significant improvements were seen relative to baseline in neurocognitive domains such as psychomotor speed, sustained attention, divided attention, and inhibition-disinhibition ability, and in psychological domains including internalizing behavior problems, general health, and general quality of life. Long-term exercise intervention may have benefits for some aspects of neurocognitive and psychological function in children with benign epilepsy. © The Author(s) 2016.

The effects of neuromuscular exercise on medial knee joint load post-arthroscopic partial medial meniscectomy: ‘SCOPEX’ a randomised control trial protocol

PubMed Central

2012-01-01

Background Meniscectomy is a risk factor for knee osteoarthritis, with increased medial joint loading a likely contributor to the development and progression of knee osteoarthritis in this group. Therefore, post-surgical rehabilitation or interventions that reduce medial knee joint loading have the potential to reduce the risk of developing or progressing osteoarthritis. The primary purpose of this randomised, assessor-blind controlled trial is to determine the effects of a home-based, physiotherapist-supervised neuromuscular exercise program on medial knee joint load during functional tasks in people who have recently undergone a partial medial meniscectomy. Methods/design 62 people aged 30–50 years who have undergone an arthroscopic partial medial meniscectomy within the previous 3 to 12 months will be recruited and randomly assigned to a neuromuscular exercise or control group using concealed allocation. The neuromuscular exercise group will attend 8 supervised exercise sessions with a physiotherapist and will perform 6 exercises at home, at least 3 times per week for 12 weeks. The control group will not receive the neuromuscular training program. Blinded assessment will be performed at baseline and immediately following the 12-week intervention. The primary outcomes are change in the peak external knee adduction moment measured by 3-dimensional analysis during normal paced walking and one-leg rise. Secondary outcomes include the change in peak external knee adduction moment during fast pace walking and one-leg hop and change in the knee adduction moment impulse during walking, one-leg rise and one-leg hop, knee and hip muscle strength, electromyographic muscle activation patterns, objective measures of physical function, as well as self-reported measures of physical function and symptoms and additional biomechanical parameters. Discussion The findings from this trial will provide evidence regarding the effect of a home-based, physiotherapist-supervised neuromuscular exercise program on medial knee joint load during various tasks in people with a partial medial meniscectomy. If shown to reduce the knee adduction moment, neuromuscular exercise has the potential to prevent the onset of osteoarthritis or slow its progression in those with early disease. Trial Registration Australian New Zealand Clinical Trials Registry reference: ACTRN12612000542897 PMID:23181415

Daughters and Mothers Exercising Together (DAMET): Effects of Home- and University-Based Interventions on Physical Activity Behavior and Family Relations

ERIC Educational Resources Information Center

Ransdell, Lynda B.; Eastep, Eric; Taylor, Alison; Oakland, Darcie; Schmidt, Jenny; Moyer-Mileur, Laurie; Shultz, Barry

2003-01-01

This study compared two interventions in terms of impact on physical activity participation and mother-daughter relations. Previously sedentary mothers and daughters (N = 34) were randomly assigned to a 12-week university-or home-based physical activity group. Program activities were designed using focus group information, aspects of the social…

Effect of a rehabilitation-based chronic disease management program targeting severe COPD exacerbations on readmission patterns.

PubMed

Lalmolda, C; Coll-Fernández, R; Martínez, N; Baré, M; Teixidó Colet, M; Epelde, F; Monsó, E

2017-01-01

Pulmonary rehabilitation (PR) is recommended after a severe COPD exacerbation, but its short- and long-term effects on health care utilization have not been fully established. The aims of this study were to evaluate patient compliance with a chronic disease management (CDM) program incorporating home-based exercise training as the main component after a severe COPD exacerbation and to determine its effects on health care utilization in the following year. COPD patients with a severe exacerbation were included in a case-cohort study at admission. An intervention group participated in a nurse-supervised CDM program during the 2 months after discharge, comprising of home-based PR with exercise components directly supervised by a physiotherapist, while the remaining patients followed usual care. Nineteen of the twenty-one participants (90.5%) were compliant with the CDM program and were compared with 29 usual-care patients. Compliance with the program was associated with statistically significant reductions in admissions due to respiratory disease in the following year (median [interquartile range]: 0 [0-1] vs 1 [0-2.5]; P =0.022) and in days of admission (0 [0-7] vs 7 [0-12]; P =0.034), and multiple linear regression analysis confirmed the protective effect of the CDM program (β coefficient -0.785, P =0.014, and R 2 =0.219). A CDM program incorporating exercise training for COPD patients without limiting comorbidities after a severe exacerbation achieves high compliance and reduces admissions in the year following after the intervention.

Fall Risk-Relevant Functional Mobility Outcomes in Dementia Following Dyadic Tai Chi Exercise

PubMed Central

Yao, Lan; Giordani, Bruno J.; Algase, Donna L.; You, Mei; Alexander, Neil B.

2012-01-01

Whether persons with dementia benefit from fall prevention exercise is unclear. Applying the Positive Emotion-Motivated Tai Chi protocol, preliminary findings concerning adherence and effects of a dyadic Tai Chi exercise program on persons with Alzheimer’s disease (AD) are reported. Using pre/ posttest design, 22 community-dwelling AD-caregiver dyads participated in the program. Fall-risk-relevant functional mobility was measured using Unipedal Stance Time (UST) and Timed Up and Go (TUG) tests. Results showed that 19/22 (86.4%) AD patients completed the 16-week program and final assessment; 16/19 dyads (84.2%) completed the prescribed home program as reported by caregivers. UST adjusted mean improved from 4.0 to 5.1 (Week 4, p < .05) and 5.6 (Week 16, p < .05); TUG improved from 13.2 to 11.6 (Week 4, p < .05) and 11.6 (Week 16, p > .05) post intervention. Retaining dementia patients in an exercise intervention remains challenging. The dyadic Tai Chi approach appears to succeed in keeping AD-caregiver dyads exercising and safe. PMID:22517441

Fall risk-relevant functional mobility outcomes in dementia following dyadic tai chi exercise.

PubMed

Yao, Lan; Giordani, Bruno J; Algase, Donna L; You, Mei; Alexander, Neil B

2013-03-01

Whether persons with dementia benefit from fall prevention exercise is unclear. Applying the Positive Emotion-Motivated Tai Chi protocol, preliminary findings concerning adherence and effects of a dyadic Tai Chi exercise program on persons with Alzheimer's disease (AD) are reported. Using pre/posttest design, 22 community-dwelling AD-caregiver dyads participated in the program. Fall-risk-relevant functional mobility was measured using Unipedal Stance Time (UST) and Timed Up and Go (TUG) tests. Results showed that 19/22 (86.4%) AD patients completed the 16-week program and final assessment; 16/19 dyads (84.2%) completed the prescribed home program as reported by caregivers. UST adjusted mean improved from 4.0 to 5.1 (Week 4, p < .05) and 5.6 (Week 16, p < .05); TUG improved from 13.2 to 11.6 (Week 4, p < .05) and 11.6 (Week 16, p > .05) post intervention. Retaining dementia patients in an exercise intervention remains challenging. The dyadic Tai Chi approach appears to succeed in keeping AD-caregiver dyads exercising and safe.

Patients' mental models and adherence to outpatient physical therapy home exercise programs.

PubMed

Rizzo, Jon

2015-05-01

Within physical therapy, patient adherence usually relates to attending appointments, following advice, and/or undertaking prescribed exercise. Similar to findings for general medical adherence, patient adherence to physical therapy home exercise programs (HEP) is estimated between 35 and 72%. Adherence to HEPs is a multifactorial and poorly understood phenomenon, with no consensus regarding a common theoretical framework that best guides empirical or clinical efforts. Mental models, a construct used to explain behavior and decision-making in the social sciences, may serve as this framework. Mental models comprise an individual's tacit thoughts about how the world works. They include assumptions about new experiences and expectations for the future based on implicit comparisons between current and past experiences. Mental models play an important role in decision-making and guiding actions. This professional theoretical article discusses empirical research demonstrating relationships among mental models, prior experience, and adherence decisions in medical and physical therapy contexts. Specific issues related to mental models and physical therapy patient adherence are discussed, including the importance of articulation of patients' mental models, assessment of patients' mental models that relate to exercise program adherence, discrepancy between patient and provider mental models, and revision of patients' mental models in ways that enhance adherence. The article concludes with practical implications for physical therapists and recommendations for further research to better understand the role of mental models in physical therapy patient adherence behavior.

Superfund record of decision (EPA Region 10): Mountain Home Air Force Base, Site 8, Fire Training Area 8, Operable Unit 4, Elmore County, Mountain Home, ID. (First remedial action), June 1992. Final report

DOE Office of Scientific and Technical Information (OSTI.GOV)

Not Available

1992-06-16

The 7-acre Mountain Home Air Force Base (AFB) site was a fire department training area located in Mountain Home, Elmore County, Idaho. From 1962 to 1975, the Mountain Home Air Force Base used the site for fire department training exercises. Each exercise began by saturating the bermed training area with water, followed directly by applying 250 to 500 gallons of fuel. The flames were extinguished with Aqueous Film Forming Foam (AFFF), or prior to 1972, with a water-based protein foam. The training session was completed with a post-exercise ignition of the residual fuel in a bermed area. The USAF investigationsmore » identified solvents and petroleum, oil, lubricant (POL) wastes in the soil. Under the Installation Restoration Program (IRP), the USAF conducted a record search, drilling, and sampling of soil borings to bedrock, the installation of monitoring wells, and hand auger samples. The ROD provided a final remedy for onsite soil as OU4. Because contaminants were found at such low concentrations, the soil was covered by crushed asphalt and has little potential to impact ecological receptors. The soil posed low risks for humans at the site and no remediation was necessary.« less

Effects of the stages of change model-based education and motivational interview on exercise behavior in diabetic women.

PubMed

Sekerci, Yasemin Gümüs; Kitis, Yeter

2018-05-08

In this study, we examined the effects of exercise education and a motivational interview program, based on the stages of change model (SCM), on stage of change, using cognitive and behavioral methods, perceived benefits and barriers and self-confidence in Turkish women with diabetes. This intervention study was carried out in 2015 on 55 women selected from a family health centers' population. An exercise guide was prepared based on the SCM for the intervention group. The intervention group was followed seven times at 1-month intervals via home visits, and exercise education and the motivational interview program were conducted to identify changes in behavior. The control group received no intervention. Data were collected from both groups using a personal description form, Exercise Stages of Change Scale, Exercise Processes of Change Scale, Exercise Decisional Balance Scale, and Exercise Self-Efficacy Scale. After the exercise program, each group was re-subjected to the same scales. We used a chi-square test and independent and paired sample t-tests to analyze the data. The stages of change, using cognitive and behavioral methods, perceived benefits and self-confidence for exercise in the intervention group significantly improved compared with that in the control group (p < .05). In the intervention group, 81.5% of the participants started exercising. The exercise education and motivational interview program based on SCM positively affected stages of change, using cognitive and behavioral methods, perceived benefits, perceived barriers, and self-confidence for exercise behavior in women with diabetes. We conclude that the education and motivational interview program based on SCM are effective in promoting exercise habit.

Gender differences in home-based cardiac rehabilitation of post-percutaneous coronary intervention patients.

PubMed

Kim, Yong Hwan; So, Wi-Young

2018-04-20

Cardiac rehabilitation (CR) is a structured program for the prevention of secondary cardiovascular disease (CVD) and related diseases, such as hypertension, diabetes, and obesity. This study aimed to investigate whether there are gender differences after 9 months of home-based cardiac rehabilitation program in post-percutaneous coronary intervention patients. A total of 114 (58.29 ± 10.33 years) men and 30 (60.90 ± 9.32 years) women were enrolled in the CR program. The program included three visits: initial, 4th month (follow-up), and 9th month (final) visits at a CR center. The CR program included exercise and nutrition counseling. In nutrition counseling, a professional nutritionist educated the patients on how to organize the menu, incorporating an optimal caloric, low-salt, and low-cholesterol diet. Exercise was performed 30 min per session for more than 3 days per week with a target heart rate within 40-75% of the peak heart rate-resting heart rate (VO 2 reserve; VO 2 R) during intense exercise, which was based on ECG treadmill test. After 9 months, there was no significant difference in terms of dropout rate between men and women (p < 0.05). No significant changes were found in the anthropometric and lipid profiles in women, whereas the HDL-cholesterol (HDL-C) was significantly increased to 6.8% (p = 0.005) in men. The findings of our study showed that there was no difference in the CR participation rate between men and women. Moreover, there was an increase in HDL-C levels and an improvement in cardiorespiratory endurance, strength, and agility in men, whereas no significant difference in most risk factors and fitness variables was found in women. Thus, the 9-month home-based CR program was more effective for fitness in men, but only the HDL-C showed positive improvement among the cardiovascular risk factors. In women, 6-min walk and timed up and go were effective exercises.

Efficacy of Hip Strengthening Exercises Compared With Leg Strengthening Exercises on Knee Pain, Function, and Quality of Life in Patients With Knee Osteoarthritis.

PubMed

Lun, Victor; Marsh, Andrew; Bray, Robert; Lindsay, David; Wiley, Preston

2015-11-01

The purpose of this study was to compare the efficacy of hip and leg strengthening exercise programs on knee pain, function, and quality of life (QOL) of patients with knee osteoarthritis (KOA). Single-Blinded Randomized Clinical Trial. Patients with KOA. Male and female subjects were recruited from patients referred to the University of Calgary Sport Medicine Center and from newspaper advertisements. Thirty-seven and 35 patients with KOA were randomly assigned to either a 12-week hip or leg strengthening exercise program, respectively. Both exercise programs consisted of strengthening and flexibility exercises, which were completed 3 to 5 days a week. The first 3 weeks of exercise were supervised and the remaining 9 weeks consisted of at-home exercise. Knee Injury and Osteoarthritis Score (KOOS) and Western Ontario McMaster Arthritis Index (WOMAC) questionnaires, 6-minute walk test, hip and knee range of motion (ROM), and hip and leg muscle strength. Statistically and clinically significant improvements in the KOOS and WOMAC pain subscale scores were observed in both the hip and leg strengthening programs. There was no statistical difference in the change in scores observed between the 2 groups. Equal improvements in the KOOS and WOMAC function and QOL subscales were observed for both programs. There was no change in hip and knee ROM or hip and leg strength in either group. Isolated hip and leg strengthening exercise programs seem to similarly improve knee pain, function, and QOL in patients with KOA. The results of this study show that both hip and leg strengthening exercises improve pain and QOL in patients with KOA and should be incorporated into the exercise prescription of patients with KOA.

The Effects of an Exercise Program on Anxiety Levels and Metabolic Functions in Patients With Anxiety Disorders.

PubMed

Ma, Wei-Fen; Wu, Po-Lun; Su, Chia-Hsien; Yang, Tzu-Ching

2017-05-01

The purpose of this study was to evaluate the effects of a home-based (HB) exercise program on anxiety levels and metabolic functions in patients with anxiety disorders in Taiwan. Purposive sampling was used to recruit 86 participants for this randomized, experimental study. Participants were asked to complete a pretest before the 3-month exercise program, a posttest at 1 week, and a follow-up test at 3 months after the exercise program. Study measures included four Self-Report Scales and biophysical assessments to collect and assess personal data, lifestyle behaviors, anxiety levels, and metabolic control functions. Of the 86 study participants, 83 completed the posttest and the 3-month follow-up test, including 41 in the experimental group and 42 in the control group. Participants in the experimental group showed significant improvements in body mass index, high-density lipoprotein cholesterol levels, and the level of moderate exercise after the program relative to the control group, as analyzed by generalized estimating equations mixed-model repeated measures. State and trait anxiety levels were also significantly improved from pretest to follow-up test in the experimental group. Finally, the prevalence of metabolic syndrome declined for participants in the experimental group. The HB exercise program produced positive effects on the metabolic indicators and anxiety levels of Taiwanese adults with anxiety disorders. Health providers should consider using similar HB exercise programs to help improve the mental and physical health of patients with anxiety disorders in their communities.

Results of a feasibility randomised controlled study of the guidelines for exercise in multiple sclerosis project.

PubMed

Learmonth, Yvonne C; Adamson, Brynn C; Kinnett-Hopkins, Dominique; Bohri, Maria; Motl, Robert W

2017-03-01

There is increasing recognition that exercise is an efficacious strategy for managing many consequences of multiple sclerosis (MS), yet persons with MS are not engaging in sufficient exercise for accruing health benefits. Poor exercise uptake might be associated with the design of previous research. We conducted a randomised controlled trial (RCT) for examining the feasibility of a 4-month home-based, exercise-training program designed based on recent physical activity guidelines for MS and supplemented by behavioural strategies for compliance. Feasibility was assessed in the domains of process (e.g., recruitment), resource (e.g., monetary costs), management (e.g., personnel time requirements) and scientific outcomes (e.g., treatment effect). We recruited persons with mild-to-moderate MS who were randomised into an intervention or wait-list control condition. Intervention participants received a pedometer, elastic resistance bands, DVD, training manual, calendars, log-book, video coaching calls and newsletters. Participants in both conditions completed home-based assessments before and after the 4-month period. Ninety-nine persons with MS were assessed for eligibility, and 57 were randomised. Fifty-one persons completed the study (90%). Total costs of the study were US $5331.03. Personnel time to conduct the study totaled 263h. Participants in the intervention group complied fully with 71% of all exercise sessions. There was a moderate increase in self-reported exercise behaviour of the intervention participants as measured by the Godin Leisure-Time Exercise Questionnaire (d≥0.5). The results support the feasibility and acceptability of a home-based exercise intervention based on physical activity guidelines and supplemented with behavioural strategies for adults with mild-to-moderate MS. Copyright © 2016 Elsevier Inc. All rights reserved.

Effect of a Home-Based Exercise Program on Functional Recovery Following Rehabilitation After Hip Fracture A Randomized Clinical Trial

PubMed Central

Latham, Nancy K.; Harris, Bette Ann; Bean, Jonathan F.; Heeren, Timothy; Goodyear, Christine; Zawacki, Stacey; Heislein, Diane M.; Mustafa, Jabed; Pardasaney, Poonam; Giorgetti, Marie; Holt, Nicole; Goehring, Lori; Jette, Alan M.

2015-01-01

IMPORTANCE For many older people, long-term functional limitations persist after a hip fracture. The efficacy of a home exercise program with minimal supervision after formal hip fracture rehabilitation ends has not been established. OBJECTIVE To determine whether a home exercise program with minimal contact with a physical therapist improved function after formal hip fracture rehabilitation ended. DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial conducted from September 2008 to October 2012 in the homes of 232 functionally limited older adults who had completed traditional rehabilitation after a hip fracture. INTERVENTIONS The intervention group (n = 120) received functionally oriented exercises (such as standing from a chair, climbing a step) taught by a physical therapist and performed independently by the participants in their homes for 6 months. The attention control group (n = 112) received in-home and telephone-based cardiovascular nutrition education. MAIN OUTCOMES AND MEASURES Physical function assessed at baseline, 6 months (ie, at completion of the intervention), and 9 months by blinded assessors. The primary outcome was change in function at 6 months measured by the Short Physical Performance Battery (SPPB; range 0-12, higher score indicates better function) and the Activity Measure for Post-Acute Care (AM-PAC) mobility and daily activity (range, 23-85 and 9-101, higher score indicates better function). RESULTS Among the 232 randomized patients, 195 were followed up at 6 months and included in the primary analysis. The intervention group (n=100) showed significant improvement relative to the control group (n=95) in functional mobility (mean SPPB scores for intervention group: 6.2 [SD, 2.7] at baseline, 7.2 [SD, 3] at 6 months; control group: 6.0 [SD, 2.8] at baseline, 6.2 [SD, 3] at 6 months; and between-group differences: 0.8 [95% CI, 0.4 to 1.2], P < .001; mean AM-PAC mobility scores for intervention group: 56.2 [SD, 7.3] at baseline, 58.1 [SD, 7.9] at 6 months; control group: 56 [SD, 7.1] at baseline, 56.6 [SD, 8.1] at 6 months; and between-group difference, 1.3 [95% CI, 0.2 to 2.4], P = .03; and mean AM-PAC daily activity scores for intervention group: 57.4 [SD, 13.7] at baseline, 61.3 [SD, 15.7] at 6 months; control group: 58.2 [SD, 15.2] at baseline, 58.6 [SD, 15.3] at 6 months; and between-group difference, 3.5 [95% CI, 0.9 to 6.0], P = .03). In multiple imputation analyses, between-group differences remained significant for SPPB and AM-PAC daily activity, but not for mobility. Significant between-group differences persisted at 9 months for all functional measures with and without imputation. CONCLUSIONS AND RELEVANCE Among patients who had completed standard rehabilitation after hip fracture, the use of a home-based functionally oriented exercise program resulted in modest improvement in physical function at 6 months after randomization. The clinical importance of these findings remains to be determined. PMID:24549550

Effect of a home-based exercise program on functional recovery following rehabilitation after hip fracture: a randomized clinical trial.

PubMed

Latham, Nancy K; Harris, Bette Ann; Bean, Jonathan F; Heeren, Timothy; Goodyear, Christine; Zawacki, Stacey; Heislein, Diane M; Mustafa, Jabed; Pardasaney, Poonam; Giorgetti, Marie; Holt, Nicole; Goehring, Lori; Jette, Alan M

2014-02-19

For many older people, long-term functional limitations persist after a hip fracture. The efficacy of a home exercise program with minimal supervision after formal hip fracture rehabilitation ends has not been established. To determine whether a home exercise program with minimal contact with a physical therapist improved function after formal hip fracture rehabilitation ended. Randomized clinical trial conducted from September 2008 to October 2012 in the homes of 232 functionally limited older adults who had completed traditional rehabilitation after a hip fracture. The intervention group (n = 120) received functionally oriented exercises (such as standing from a chair, climbing a step) taught by a physical therapist and performed independently by the participants in their homes for 6 months. The attention control group (n = 112) received in-home and telephone-based cardiovascular nutrition education. Physical function assessed at baseline, 6 months (ie, at completion of the intervention), and 9 months by blinded assessors. The primary outcome was change in function at 6 months measured by the Short Physical Performance Battery (SPPB; range 0-12, higher score indicates better function) and the Activity Measure for Post-Acute Care (AM-PAC) mobility and daily activity (range, 23-85 and 9-101, higher score indicates better function). Among the 232 randomized patients, 195 were followed up at 6 months and included in the primary analysis. The intervention group (n=100) showed significant improvement relative to the control group (n=95) in functional mobility (mean SPPB scores for intervention group: 6.2 [SD, 2.7] at baseline, 7.2 [SD, 3] at 6 months; control group: 6.0 [SD, 2.8] at baseline, 6.2 [SD, 3] at 6 months; and between-group differences: 0.8 [95% CI, 0.4 to 1.2], P < .001; mean AM-PAC mobility scores for intervention group: 56.2 [SD, 7.3] at baseline, 58.1 [SD, 7.9] at 6 months; control group: 56 [SD, 7.1] at baseline, 56.6 [SD, 8.1] at 6 months; and between-group difference, 1.3 [95% CI, 0.2 to 2.4], P = .03; and mean AM-PAC daily activity scores for intervention group: 57.4 [SD, 13.7] at baseline, 61.3 [SD, 15.7] at 6 months; control group: 58.2 [SD, 15.2] at baseline, 58.6 [SD, 15.3] at 6 months; and between-group difference, 3.5 [95% CI, 0.9 to 6.0], P = .03). In multiple imputation analyses, between-group differences remained significant for SPPB and AM-PAC daily activity, but not for mobility. Significant between-group differences persisted at 9 months for all functional measures with and without imputation. Among patients who had completed standard rehabilitation after hip fracture, the use of a home-based functionally oriented exercise program resulted in modest improvement in physical function at 6 months after randomization. The clinical importance of these findings remains to be determined. clinicaltrials.gov Identifier: NCT00592813.

Postoperative treatment of metacarpal fractures-Classical physical therapy compared with a home exercise program.

PubMed

Gülke, Joachim; Leopold, Barbara; Grözinger, Daniel; Drews, Björn; Paschke, Stephan; Wachter, Nikolaus J

Prospective cohort randomized controlled trial. Is either a home exercise (HE) program or traditional physical therapy (PT) more effective in the postoperative management of metacarpal fractures? Sixty patients suffering from nonthumb metacarpal fractures who received mobilization-stable open reduction and internal fixation were included. All patients were prospectively randomized into either the PT group or the HE group. Follow-up examinations at 2, 6 and 12 weeks postoperatively. After 2 weeks, the range of motion (ROM) in both groups was still severely reduced. Twelve weeks after surgery the ROM improved to 245° (PT) and 256° (HE). Grip strength after 6 weeks was 68% (PT) and 71% (HE) when compared to the non-injured hand, improving to 91% (PT) and 93% (HE) after 12 weeks. Study results show that both HE program and traditional PT are effective in the postoperative management of metacarpal fractures. II. Copyright © 2017 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.

Development of a home-based training program for post-ward geriatric rehabilitation patients with cognitive impairment: study protocol of a randomized-controlled trail.

PubMed

Bongartz, Martin; Kiss, Rainer; Ullrich, Phoebe; Eckert, Tobias; Bauer, Jürgen; Hauer, Klaus

2017-09-12

Geriatric patients with cognitive impairment (CI) show an increased risk for a negative rehabilitation outcome and reduced functional recovery following inpatient rehabilitation. Despite this obvious demand, evidence-based training programs at the transition from rehabilitation to the home environments are lacking. The aim of this study is to evaluate the efficacy of a feasible and cost-effective home-based training program to improve motor performance and to promote physical activity, specifically-tailored for post-ward geriatric patients with CI. A sample of 101 geriatric patients with mild to moderate stage CI following ward-based rehabilitation will be recruited for a blinded, randomized controlled trial with two arms. The intervention group will conduct a 12 week home-based training, consisting of (1) Exercises to improve strength/power, and postural control; (2) Individual walking trails to enhance physical activity; (3) Implementation of patient-specific motivational strategies to promote behavioral changes. The control group will conduct 12 weeks of unspecific flexibility exercise. Both groups will complete a baseline measurement before starting the program, at the end of the intervention, and after 24 weeks for follow-up. Sensor-based as well as questionnaire-based measures will be applied to comprehensively assess intervention effects. Primary outcomes document motor performance, assessed by the Short Physical Performance Battery, and level of physical activity (PA), as assessed by duration of active episodes (i.e., sum of standing and walking). Secondary outcomes include various medical, psycho-social, various PA and motor outcomes, including sensor-based assessment as well as cost effectiveness. Our study is among the first to provide home-based training in geriatric patients with CI at the transition from a rehabilitation unit to the home environment. The program offers several unique approaches, e.g., a comprehensive and innovative assessment strategy and the integration of individually-tailored motivational strategies. We expect the program to be safe and feasible in geriatric patients with CI with the potential to enhance the sustainability of geriatric rehabilitation programs in patients with CI. International Standard Randomized Controlled Trial (# ISRCTN82378327 ). Registered: August 10, 2015.

Does attending an exercise class with a spouse improve long-term exercise adherence among people aged 65 years and older: a 6-month prospective follow-up study.

PubMed

Osuka, Yosuke; Jung, Songee; Kim, Taeho; Okubo, Yoshiro; Kim, Eunbi; Tanaka, Kiyoji

2017-07-31

Family support can help older adults better adhere to exercise routine, but it remains unclear whether an exercise program targeting older married couples would have stronger effects on exercise adherence than would a program for individuals. The purpose of this study was to determine the effects of an exercise program on the exercise adherence of older married couples over a 24-week follow-up period. Thirty-four older married couples and 59 older adults participated in this study as couple and non-couple groups (CG and NCG, respectively). All participants attended an 8-week supervised program (once a week and a home-based exercise program comprising walking and strength exercises) and then participated in a follow-up measurement (24 weeks after post-intervention measurement). Exercise adherence was prospectively measured via an exercise habituation diary during the follow-up period-specifically, we asked them to record practice rates for walking (≥2 days/week) and strength exercises (≥6 items for 2 days/week). A multivariate logistic regression analysis was conducted to obtain the CG's odds ratios (ORs) and 95% confidence intervals (CIs) for adherence to walking and strength exercise adjusted for potential confounders (with NCG as the reference). Although the adherence rate of walking exercise in the CG was significantly higher than that in the NCG (29.2%; P < 0.001), there was no significant difference in the adherence rate of strength exercise between the two groups (P = 0.199). The multivariate logistic regression analysis showed that CG had significantly higher odds of adherence to walking exercise compared with the NCG (3.68 [1.57-8.60]). However, the odds of adherence to strength exercise did not significantly differ between the two groups (1.30 [0.52-3.26]). These results suggest that an exercise program targeting older married couples may be a useful strategy for maintaining walking adherence, even six months after the supervised program has ceased. A blinded randomized controlled trial will be needed to confirm this conclusion. Retrospectively registered. UMIN Clinical Trials Registry (Registered: 02/11/16) UMIN000024689 .

Does a physical activity program in the nursing home impact on depressive symptoms? A generalized linear mixed-model approach.

PubMed

Diegelmann, Mona; Jansen, Carl-Philipp; Wahl, Hans-Werner; Schilling, Oliver K; Schnabel, Eva-Luisa; Hauer, Klaus

2018-06-01

Physical activity (PA) may counteract depressive symptoms in nursing home (NH) residents considering biological, psychological, and person-environment transactional pathways. Empirical results, however, have remained inconsistent. Addressing potential shortcomings of previous research, we examined the effect of a whole-ecology PA intervention program on NH residents' depressive symptoms using generalized linear mixed-models (GLMMs). We used longitudinal data from residents of two German NHs who were included without any pre-selection regarding physical and mental functioning (n = 163, M age = 83.1, 53-100 years; 72% female) and assessed on four occasions each three months apart. Residents willing to participate received a 12-week PA training program. Afterwards, the training was implemented in weekly activity schedules by NH staff. We ran GLMMs to account for the highly skewed depressive symptoms outcome measure (12-item Geriatric Depression Scale-Residential) by using gamma distribution. Exercising (n = 78) and non-exercising residents (n = 85) showed a comparable level of depressive symptoms at pretest. For exercising residents, depressive symptoms stabilized between pre-, posttest, and at follow-up, whereas an increase was observed for non-exercising residents. The intervention group's stabilization in depressive symptoms was maintained at follow-up, but increased further for non-exercising residents. Implementing an innovative PA intervention appears to be a promising approach to prevent the increase of NH residents' depressive symptoms. At the data-analytical level, GLMMs seem to be a promising tool for intervention research at large, because all longitudinally available data points and non-normality of outcome data can be considered.

Formal Physical Therapy After Total Hip Arthroplasty Is Not Required: A Randomized Controlled Trial.

PubMed

Austin, Matthew S; Urbani, Brian T; Fleischman, Andrew N; Fernando, Navin D; Purtill, James J; Hozack, William J; Parvizi, Javad; Rothman, Richard H

2017-04-19

The value of formal physical therapy after total hip arthroplasty is unknown. With substantial changes that have occurred in surgical and anesthesia techniques, self-directed therapy may be efficacious in restoring function to patients undergoing total hip arthroplasty. We conducted a single-center, randomized trial of 120 patients undergoing primary, unilateral total hip arthroplasty who were eligible for direct home discharge. The experimental group followed a self-directed home exercise program for 10 weeks. The control group received the standard protocol for physical therapy that included in-home visits with a physical therapist for the first 2 weeks followed by formal outpatient physical therapy for 8 weeks. Functional outcomes were measured using validated instruments including the Harris hip score (HHS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the Short Form-36 Health Survey (SF-36) preoperatively, at 1 month postoperatively, and at 6 to 12 months postoperatively. Of 120 randomized patients, 108 were included in the final analysis. Ten patients (19%) were randomized to unsupervised home exercise and 20 patients (37%) were randomized to formal outpatient therapy crossed over between groups. There was no significant difference in any of the measured functional outcomes between patients receiving formal therapy (n = 54) and those participating in unsupervised home exercise (n = 54) at any time point (HHS, p = 0.82; WOMAC, p = 0.80; and SF-36 physical health, p = 0.90). This randomized trial suggests that unsupervised home exercise is both safe and efficacious for a majority of patients undergoing total hip arthroplasty, and formal physical therapy may not be required. Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Exercise program design considerations for head and neck cancer survivors.

PubMed

Midgley, Adrian W; Lowe, Derek; Levy, Andrew R; Mepani, Vishal; Rogers, Simon N

2018-01-01

The present study aimed to establish exercise preferences, barriers, and perceived benefits among head and neck cancer survivors, as well as their level of interest in participating in an exercise program. Patients treated for primary squamous cell carcinoma of the head and neck between 2010 and 2014 were identified from the hospital database and sent a postal questionnaire pack to establish exercise preferences, barriers, perceived benefits, current physical activity levels, and quality of life. A postal reminder was sent to non-responders 4 weeks later. The survey comprised 1021 eligible patients of which 437 (43%) responded [74% male, median (interquartile range) age, 66 (60-73) years]. Of the respondents, 30% said 'Yes' they would be interested in participating in an exercise program and 34% said 'Maybe'. The most common exercise preferences were a frequency of three times per week, moderate-intensity, and 15-29 min per bout. The most popular exercise types were walking (68%), flexibility exercises (35%), water activites/swimming (33%), cycling (31%), and weight machines (19%). Home (55%), outdoors (46%) and health club/gym (33%) were the most common preferred choices for where to regularly exercise. Percieved exercise benefits relating to improved physical attributes were commonly cited, whereas potential social and work-related benefits were less well-acknowledged. The most commonly cited exercise barriers were dry mouth or throat (40%), fatigue (37%), shortness of breath (30%), muscle weakness (28%) difficulty swallowing (25%), and shoulder weakness and pain (24%). The present findings inform the design of exercise programs for head and neck cancer survivors.

Integrating Pilates Exercise into an Exercise Program for 65+ Year-Old Women to Reduce Falls

PubMed Central

Irez, Gonul Babayigit; Ozdemir, Recep Ali; Evin, Ruya; Irez, Salih Gokhan; Korkusuz, Feza

2011-01-01

The purpose of this study was to determine if Pilates exercise could improve dynamic balance, flexibility, reaction time and muscle strength in order to reduce the number of falls among older women. 60 female volunteers over the age of 65 from a residential home in Ankara participated in this study. Participants joined a 12-week series of 1-hour Pilates sessions three times per week. Dynamic balance, flexibility, reaction time and muscle strength were measured before and after the program. The number of falls before and during the 12-week period was also recorded. Dynamic balance, flexibility, reaction time and muscle strength improved (p < 0. 05) in the exercise group when compared to the non-exercise group. In conclusion, Pilates exercises are effective in improving dynamic balance, flexibility, reaction time, and muscle strength as well as decreasing the propensity to fall in older women. Key points Pilates-based exercises improve dynamic balance, reaction time and muscle strength in the elderly. Pilates exercise may reduce the number of falls in elderly women by increasing these fitness parameters. PMID:24149302

Health and social support services in older adults recently discharged from hospital: service utilisation and costs and exploration of the impact of a home-exercise intervention.

PubMed

Farag, I; Howard, K; O'Rourke, S; Ferreira, M L; Lord, S R; Close, J C T; Vogler, C; Dean, C M; Cumming, R G; Sherrington, C

2016-04-18

Admission to hospital can lead to persistent deterioration in physical functioning, particularly for the more vulnerable older population. As a result of this physical deterioration, older people who have been recently discharged from hospital may be particularly high users of health and social support services. Quantify usage and costs of services in older adults after hospitalisation and explore the impact of a home-exercise intervention on service usage. The present study was a secondary analysis of data from a randomised controlled trial (ACTRN12607000563460). The trial involved 340 participants aged 60 years and over with recent hospitalisation. Service use and costs were compared between intervention (12 months of home-exercise prescribed in 10 visits from a physiotherapist) and control groups. 33 % of participants were re-admitted to hospital, 100 % consulted a General Medical Practitioner and 63 % used social services. 56 % of costs were associated with hospital admission and 22 % with social services. There was reduction in General Medical Practitioner services provided in the home in the intervention group (IRR 0.23, CI 0.1 to 0.545, p < 0.01) but no significant between-group difference in service use or in costs for other service categories. There appears to be substantial hospital and social service use and costs in this population of older people. No significant impact of a home-based exercise program was evident on service use or costs. Australian and New Zealand Clinical Trial Registry ACTRN12607000563460 >TrialSearch.

Gravity-independent constant force resistive exercise unit

NASA Technical Reports Server (NTRS)

Colosky, Jr., Paul E. (Inventor); Ruttley, Tara M. (Inventor)

2004-01-01

This invention describes a novel gravity-independent exercise unit designed for use in microgravity, or on the ground, as a means by which to counter muscle atrophy and bone degradation due to disuse or underuse. Modular resistive packs comprising constant torque springs provide constant force opposing the withdrawal of an exercise cable from the device. In addition to uses within the space program, the compact resistive packs of the CFREU allow the unit to be small enough for easy use as a home gym for personal use, or as a supplement for rehabilitation programs. Resistive packs may be changed conveniently out of the CFREU according to the desired exercise regimen. Thus, the resistive packs replace the need for expensive, heavy, and bulky traditional weight plates. The CFREU may be employed by hospitals, rehabilitation and physical therapy clinics, and other related professional businesses.

Findings from a strength-based moderate-intensity exercise interventions for individuals with dementia (innovative practice).

PubMed

Dawson, Nicole; Gerhart, Hayden; Judge, Katherine S

2017-01-01

Limited evidence exists regarding exercise interventions with individuals with dementia, which is often due to heterogeneity of methodology and outcomes being assessed. This led to the development and evaluation of a moderate-intensity home-based functional exercise program guided by theories from exercise science and the Strength-Based Approach. Data indicated excellent treatment adherence (99.04%) along with high levels of acceptability and feasibility in this sample (age 76.63 years (9.84); Mini Mental State Exam 18.87 (6.40)). This article informs future practice by highlighting the merits of a Strength-Based Approach in research examining exercise and physical rehabilitation to improve adherence and compliance with individuals with dementia.

Home-based treadmill training improved seminal quality in adults with type 2 diabetes.

PubMed

Rosety-Rodriguez, M; Rosety, J M; Fornieles, G; Rosety, M A; Diaz, A J; Rosety, I; Rodríguez-Pareja, A; Rosety, M; Ordonez, F J; Elosegui, S

2014-11-01

This was the first study conducted to determine the influence of home-based treadmill training on seminal quality in adults with type 2 diabetes. Sixty sedentary adults with type 2 diabetes volunteered for the current study. Thirty were randomly allocated to the intervention group and performed a a 14-week, home-based, treadmill training program, 3 sessions per week, consisting of a warm-up (10-15min), 40min treadmill exercise at a work intensity of 55-70% of peak heart rate (increasing by 2.5% each two weeks) measured during a maximal treadmill test, and cooling-down (5-10min). The control group included 30, age and BMI matched adults with type 2 diabetes who did not take part in any training program. Seminal quality analysis included semen volume, sperm concentration, motility and normal morphologic features. Furthermore, total antioxidant status (TAS) as well as glutathione peroxidase (GPX) activity were assessed in seminal plasma. This protocol was approved by an Institutional Ethics Committee. The home-based treadmill training significantly increased sperm concentration as well as percentages of total sperm motility and normal spermatozoa. Furthermore, TAS and GPX activity were increased after the completion of the training program. No significant changes in any of the measured variables were found in the control group. Home-based treadmill training improved seminal quality in adults with type 2 diabetes. A secondary finding was that seminal antioxidant defense system was significantly increased after being exercised. Copyright © 2013 AEU. Published by Elsevier Espana. All rights reserved.

Elastic Band Exercises Improved Activities of Daily Living and Functional Fitness of Wheelchair-bound Older Adults with Cognitive Impairment: A Cluster Randomized Controlled Trial.

PubMed

Chen, Meng-Chun; Chen, Kuei-Min; Chang, Chu-Lin; Chang, Ya-Hui; Cheng, Yin-Yin; Huang, Hsin-Ting

2016-11-01

The purpose of this study was to test the effects of a 6-month Wheelchair-bound Senior Elastic Band (WSEB) exercise program on the activities of daily living (ADL) and functional fitness of wheelchair-bound older adults with cognitive impairment. Cluster randomized controlled trial was used. A convenience sample of 138 wheelchair-bound older adults with cognitive impairment were recruited from 8 nursing homes in southern Taiwan and were randomly assigned based on the nursing homes they lived to the experimental (4 nursing homes; n = 73) or the control group (4 nursing homes; n = 65). The experimental group performed WSEB exercises 3 times per week and 40 minutes per session for 6 months. The ADL and functional fitness (cardiopulmonary function, body flexibility, range of joint motion, and muscle strength and endurance) were examined at baseline, 3 months, and the end of 6-month study. The ADL and functional fitness indicators of participants in the experimental group showed significant improvements compared to the control group (all P < 0.05). The WSEB exercises have positive benefits for the ADL and functional fitness of wheelchair-bound older adults with cognitive impairment. It is suggested that WSEB exercises be included as a routine activity in nursing homes. Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCMECME OBJECTIVES:: Upon completion of this article the reader should be able to: (1) Understand the risk factors for functional decline in older adults with dementia; (2) Articulate the benefits of structured activities and exercises in the older adult with dementia; and (3) Incorporate elastic band exercises into the treatment plan of wheelchair bound older adults with dementia. AdvancedACCREDITATION:: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Association of Academic Physiatrists designates this activity for a maximum of 1.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

[Effects of a fall prevention program on falls in frail elders living at home in rural communities].

PubMed

Yoo, Jae-Soon; Jeon, Mi Yang; Kim, Chul-Gyu

2013-10-01

This study was conducted to determine the effects of a fall prevention program on falls, physical function, psychological function, and home environmental safety in frail elders living at home in rural communities. The design of this study was a nonequivalent control group pre posttest design. The study was conducted from July to November, 2012 with 30 participants in the experimental group and 30 in the control group. Participants were registered at the public health center of E County. The prevention program on falls consisted of laughter therapy, exercise, foot care and education. The program was provided once a week for 8 weeks and each session lasted 80 minutes. The risk score for falls and depression in the experimental group decreased significantly compared with scores for the control group. Compliance with prevention behavior related to falls, knowledge score on falls, safety scores of home environment, physical balance, muscle strength of lower extremities, and self-efficacy for fall prevention significantly increased in the experimental group compared with the control group. These results suggest that the prevention program on falls is effective for the prevention of falls in frail elders living at home.

12,13-diHOME: An Exercise-Induced Lipokine that Increases Skeletal Muscle Fatty Acid Uptake.

PubMed

Stanford, Kristin I; Lynes, Matthew D; Takahashi, Hirokazu; Baer, Lisa A; Arts, Peter J; May, Francis J; Lehnig, Adam C; Middelbeek, Roeland J W; Richard, Jeffrey J; So, Kawai; Chen, Emily Y; Gao, Fei; Narain, Niven R; Distefano, Giovanna; Shettigar, Vikram K; Hirshman, Michael F; Ziolo, Mark T; Kiebish, Michael A; Tseng, Yu-Hua; Coen, Paul M; Goodyear, Laurie J

2018-05-01

Circulating factors released from tissues during exercise have been hypothesized to mediate some of the health benefits of regular physical activity. Lipokines are circulating lipid species that have recently been reported to affect metabolism in response to cold. Here, lipidomics analysis revealed that a bout of moderate-intensity exercise causes a pronounced increase in the circulating lipid 12,13-dihydroxy-9Z-octadecenoic acid (12,13-diHOME) in male, female, young, old, sedentary, and active human subjects. In mice, both a single bout of exercise and exercise training increased circulating 12,13-diHOME and surgical removal of brown adipose tissue (BAT) negated the increase in 12,13-diHOME, suggesting that BAT is the tissue source for exercise-stimulated 12,13-diHOME. Acute 12,13-diHOME treatment of mice in vivo increased skeletal muscle fatty acid uptake and oxidation, but not glucose uptake. These data reveal that lipokines are novel exercise-stimulated circulating factors that may contribute to the metabolic changes that occur with physical exercise. Copyright © 2018 Elsevier Inc. All rights reserved.

Study protocol: EXERcise and cognition in sedentary adults with early-ONset dementia (EXERCISE-ON).

PubMed

Hooghiemstra, Astrid M; Eggermont, Laura H P; Scheltens, Philip; van der Flier, Wiesje M; Bakker, Jet; de Greef, Mathieu H G; Koppe, Peter A; Scherder, Erik J A

2012-08-16

Although the development of early-onset dementia is a radical and invalidating experience for both patient and family there are hardly any non-pharmacological studies that focus on this group of patients. One type of a non-pharmacological intervention that appears to have a beneficial effect on cognition in older persons without dementia and older persons at risk for dementia is exercise. In view of their younger age early-onset dementia patients may be well able to participate in an exercise program. The main aim of the EXERCISE-ON study is to assess whether exercise slows down the progressive course of the symptoms of dementia. One hundred and fifty patients with early-onset dementia are recruited. After completion of the baseline measurements, participants living within a 50 kilometre radius to one of the rehabilitation centres are randomly assigned to either an aerobic exercise program in a rehabilitation centre or a flexibility and relaxation program in a rehabilitation centre. Both programs are applied three times a week during 3 months. Participants living outside the 50 kilometre radius are included in a feasibility study where participants join in a daily physical activity program set at home making use of pedometers. Measurements take place at baseline (entry of the study), after three months (end of the exercise program) and after six months (follow-up). Primary outcomes are cognitive functioning; psychomotor speed and executive functioning; (instrumental) activities of daily living, and quality of life. Secondary outcomes include physical, neuropsychological, and rest-activity rhythm measures. The EXERCISE-ON study is the first study to offer exercise programs to patients with early-onset dementia. We expect this study to supply evidence regarding the effects of exercise on the symptoms of early-onset dementia, influencing quality of life. The present study is registered within The Netherlands National Trial Register (ref: NTR2124).

Study protocol: EXERcise and Cognition In Sedentary adults with Early-ONset dementia (EXERCISE-ON)

PubMed Central

2012-01-01

Background Although the development of early-onset dementia is a radical and invalidating experience for both patient and family there are hardly any non-pharmacological studies that focus on this group of patients. One type of a non-pharmacological intervention that appears to have a beneficial effect on cognition in older persons without dementia and older persons at risk for dementia is exercise. In view of their younger age early-onset dementia patients may be well able to participate in an exercise program. The main aim of the EXERCISE-ON study is to assess whether exercise slows down the progressive course of the symptoms of dementia. Methods/Design One hundred and fifty patients with early-onset dementia are recruited. After completion of the baseline measurements, participants living within a 50 kilometre radius to one of the rehabilitation centres are randomly assigned to either an aerobic exercise program in a rehabilitation centre or a flexibility and relaxation program in a rehabilitation centre. Both programs are applied three times a week during 3 months. Participants living outside the 50 kilometre radius are included in a feasibility study where participants join in a daily physical activity program set at home making use of pedometers. Measurements take place at baseline (entry of the study), after three months (end of the exercise program) and after six months (follow-up). Primary outcomes are cognitive functioning; psychomotor speed and executive functioning; (instrumental) activities of daily living, and quality of life. Secondary outcomes include physical, neuropsychological, and rest-activity rhythm measures. Discussion The EXERCISE-ON study is the first study to offer exercise programs to patients with early-onset dementia. We expect this study to supply evidence regarding the effects of exercise on the symptoms of early-onset dementia, influencing quality of life. Trial registration The present study is registered within The Netherlands National Trial Register (ref: NTR2124) PMID:22897903

Home exercise programmes supported by video and automated reminders compared with standard paper-based home exercise programmes in patients with stroke: a randomized controlled trial.

PubMed

Emmerson, Kellie B; Harding, Katherine E; Taylor, Nicholas F

2017-08-01

To determine whether patients with stroke receiving rehabilitation for upper limb deficits using smart technology (video and reminder functions) demonstrate greater adherence to prescribed home exercise programmes and better functional outcomes when compared with traditional paper-based exercise prescription. Randomized controlled trial comparing upper limb home exercise programmes supported by video and automated reminders on smart technology, with standard paper-based home exercise programmes. A community rehabilitation programme within a large metropolitan health service. Patients with stroke with upper limb deficits, referred for outpatient rehabilitation. Participants were randomly assigned to the control (paper-based home exercise programme) or intervention group (home exercise programme filmed on an electronic tablet, with an automated reminder). Both groups completed their prescribed home exercise programme for four weeks. The primary outcome was adherence using a self-reported log book. Secondary outcomes were change in upper limb function and patient satisfaction. A total of 62 participants were allocated to the intervention ( n = 30) and control groups ( n = 32). There were no differences between the groups for measures of adherence (mean difference 2%, 95% CI -12 to 17) or change in the Wolf Motor Function Test log transformed time (mean difference 0.02 seconds, 95% CI -0.1 to 0.1). There were no between-group differences in how participants found instructions ( p = 0.452), whether they remembered to do their exercises ( p = 0.485), or whether they enjoyed doing their exercises ( p = 0.864). The use of smart technology was not superior to standard paper-based home exercise programmes for patients recovering from stroke. This trial design was registered prospectively with the Australian and New Zealand Clinical Trials Register, ID: ACTRN 12613000786796. http://www.anzctr.org.au/trialSearch.aspx.

Does a Wii-based exercise program enhance balance control of independently functioning older adults? A systematic review.

PubMed

Laufer, Yocheved; Dar, Gali; Kodesh, Einat

2014-01-01

Exercise programs that challenge an individual's balance have been shown to reduce the risk of falls among older adults. Virtual reality computer-based technology that provides the user with opportunities to interact with virtual objects is used extensively for entertainment. There is a growing interest in the potential of virtual reality-based interventions for balance training in older adults. This work comprises a systematic review of the literature to determine the effects of intervention programs utilizing the Nintendo Wii console on balance control and functional performance in independently functioning older adults. STUDIES WERE OBTAINED BY SEARCHING THE FOLLOWING DATABASES: PubMed, CINAHL, PEDro, EMBASE, SPORTdiscus, and Google Scholar, followed by a hand search of bibliographic references of the included studies. Included were randomized controlled trials written in English in which Nintendo Wii Fit was used to enhance standing balance performance in older adults and compared with an alternative exercise treatment, placebo, or no treatment. Seven relevant studies were retrieved. The four studies examining the effect of Wii-based exercise compared with no exercise reported positive effects on at least one outcome measure related to balance performance in older adults. Studies comparing Wii-based training with alternative exercise programs generally indicated that the balance improvements achieved by Wii-based training are comparable with those achieved by other exercise programs. The review indicates that Wii-based exercise programs may serve as an alternative to more conventional forms of exercise aimed at improving balance control. However, due to the great variability between studies in terms of the intervention protocols and outcome measures, as well as methodological limitations, definitive recommendations as to optimal treatment protocols and the potential of such an intervention as a safe and effective home-based treatment cannot be made at this point.

Cerebral Palsy Not Necessary: Maxi-Move. Do It Yourself for Parents with Movement Delayed Children under Eight.

ERIC Educational Resources Information Center

Lotz, H. Winky

Written for parents to use in the home environment, this illustrated handbook describes the Maxi-Move program, an intensive one-year program of exercise for children of one to eight years of age, who have cerebral palsy. The program does not use physical therapy, patterning, or specific movement goals, but focuses on having fun, creating…

Efficacy of home-based non-pharmacological interventions for treating depression: a systematic review and network meta-analysis of randomised controlled trials

PubMed Central

Sukhato, Kanokporn; Lotrakul, Manote; Dellow, Alan; Ittasakul, Pichai; Thakkinstian, Ammarin; Anothaisintawee, Thunyarat

2017-01-01

Objectives To systematically review and compare the efficacy of all available home-based non-pharmacological treatments of depression. Design Systematic review and network meta-analysis of randomised controlled trials. Data sources Medline, Scopus and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases were searched since inceptions to 7 August 2016. Eligibility criteria Randomised controlled trials comparing the efficacy of home-based non-pharmacological interventions with usual care of patients with depression were included in the review. Main outcomes Depression symptom scores and disease remission rates at the end of treatment. Results Seventeen studies were included in the review. Home-based non-pharmacological interventions were categorised as (1) home-based psychological intervention, (2) home-based exercise intervention, (3) combined home-based psychological intervention with exercise intervention and (4) complementary medicine. Complementary medicine approaches were excluded from the meta-analysis due to heterogeneity. The standardised mean differences of post-treatment depression symptom scores between usual care groups and home-based psychological intervention, home-based exercise intervention and combined home-based psychological intervention with exercise intervention were −0.57 (95% CI −0.84 to −0.31), −1.03 (95% CI −2.89 to 0.82) and −0.78 (95% CI −1.09 to −0.47), respectively. These results suggest that only home-based psychological intervention and combined home-based psychological intervention with exercise intervention could significantly decrease depression scores. Compared with usual care groups, the disease remission rate was also significantly higher for home-based psychological intervention (pooled risk ratio=1.53; 95% CI 1.19 to 1.98) and combined home-based psychological intervention with exercise intervention (pooled risk ratio=3.47; 95% CI 2.11 to 5.70). Of all the studied interventions, combined home-based psychological intervention with exercise intervention had the highest probability of resulting in disease remission. Conclusion Our study confirms the efficacy of home-based psychological intervention and combined home-based psychological intervention with exercise intervention in the treatment of depression. Combined home-based psychological intervention and exercise intervention was the best treatment and should be considered for inclusion in clinical guidelines for managing depression. PMID:28706086

A study of exercise modality and physical self-esteem in breast cancer survivors.

PubMed

Musanti, Rita

2012-02-01

This study, theoretically based on the Exercise Self-Esteem Model, EXSEM, examined effects of exercise modality on physical and global self-esteem (PSE, GSE) in breast cancer survivors. The EXSEM posits GSE at the apex with PSE feeding into GSE. PSE has three subdomains: physical condition (PC), attractive body (AB), and physical strength (PS). The goals were to compare the effect of combination modality versus single-modality exercise on PSE and GSE and to explore the relationship between exercise modality and the subdomains of PSE. Survivors were randomly allocated to flexibility (F), aerobic (A), resistance (R), or aerobic plus resistance (AR), 12-wk, individualized, home-based exercise program. Pre/posttesting included submaximal treadmill test, six-repetition maximum chest press and leg press, YMCA bench press, shoulder/hip flexibility, and bioelectric impedance analysis body composition. Esteem measures were the Physical Self-Perception Profile and the Rosenberg Self-Esteem Scale. Forty-two women completed the study (F = 12, A = 10, R = 9, and AR = 11). Fitness improvements congruent with exercise modality were seen in all groups. PSE and GSE outcomes did not reveal a greater effect from the combination modality program, AR, compared with the single-modality programs A and R. The relationships between the single-modality groups and the subdomains of PC, PS, and AB were supported in the R group (PS and AB increased) and were partially supported in the A group (PC, not AB, increased). A single-modality R program significantly improved all domains of PSE, and participation in the A program improved the PC subdomain. The combination exercise program did not enhance PSE greater than the single-modality programs. EXSEM was a useful framework for exploring esteem in breast cancer survivors.

Low-frequency group exercise improved the motor functions of community-dwelling elderly people in a rural area when combined with home exercise with self-monitoring

PubMed Central

Matsubayashi, Yoshito; Asakawa, Yasuyoshi; Yamaguchi, Haruyasu

2016-01-01

[Purpose] This study examined whether low-frequency group exercise improved the motor functions of community-dwelling elderly people in a rural area when combined with home exercise with self-monitoring. [Subjects] The subjects were community-dwelling elderly people in a rural area of Japan. [Methods] One group (n = 50) performed group exercise combined with home exercise with self-monitoring. Another group (n = 37) performed group exercise only. Low-frequency group exercise (warm-up, exercises for motor functions, and cool-down) was performed in seven 40 to 70-minute sessions over 9 weeks by both groups. Five items of motor functions were assessed before and after the intervention. [Results] Significant interactions were observed between groups and assessment times for all motor functions. Improvements in motor functions were significantly greater in the group that performed group exercise combined with home exercise with self-monitoring than in the group that performed group exercise only. Post-hoc comparisons revealed significant differences in 3 items of motor functions. No significant improvements were observed in motor functions in the group that performed group exercise only. [Conclusions] Group exercise combined with home exercise with self-monitoring improved motor functions in the setting of low-frequency group exercise for community-dwelling elderly people in a rural area. PMID:27065520

Physical therapy approaches to reduce fall and fracture risk among older adults.

PubMed

Karinkanta, Saija; Piirtola, Maarit; Sievänen, Harri; Uusi-Rasi, Kirsti; Kannus, Pekka

2010-07-01

Falls and fall-related injuries, such as fractures, are a growing problem among older adults, often causing longstanding pain, functional impairments, reduced quality of life and excess health-care costs and mortality. These problems have led to a variety of single component or multicomponent intervention strategies to prevent falls and subsequent injuries. The most effective physical therapy approach for the prevention of falls and fractures in community-dwelling older adults is regular multicomponent exercise; a combination of balance and strength training has shown the most success. Home-hazard assessment and modification, as well as assistive devices, such as canes and walkers, might be useful for older people at a high risk of falls. Hip protectors are effective in nursing home residents and potentially among other high-risk individuals. In addition, use of anti-slip shoe devices in icy conditions seems beneficial for older people walking outdoors. To be effective, multifactorial preventive programs should include an exercise component accompanied by individually tailored measures focused on high-risk populations. In this Review, we focus on evidence-based physical therapy approaches, including exercise, vibration training and improvements of safety at home and during periods of mobility. Additionally, the benefits of multifaceted interventions, which include risk factor assessment, dietary supplements, elements of physical therapy and exercise, are addressed.

Efficacy of a Student-Led, Community-Based, Multifactorial Fall Prevention Program: Stay in Balance.

PubMed

Der Ananian, Cheryl A; Mitros, Melanie; Buman, Matthew Paul

2017-01-01

Falls are a major public health concern in older adults. Recent fall prevention guidelines recommend the use of multifactorial fall prevention programs (FPPs) that include exercise for community-dwelling older adults; however, the availability of sustainable, community-based FPPs is limited. We conducted a 24-week quasi-experimental study to evaluate the efficacy of a community-based, multifactorial FPP [Stay in Balance (SIB)] on dynamic and functional balance and muscular strength. The SIB program was delivered by allied health students and included a health education program focused on fall risk factors and a progressive exercise program emphasizing lower-extremity strength and balance. All participants initially received the 12-week SIB program, and participants were non-randomly assigned at baseline to either continue the SIB exercise program at home or as a center-based program for an additional 12 weeks. Adults aged 60 and older ( n  = 69) who were at-risk of falling (fall history or 2+ fall risk factors) were recruited to participate. Mixed effects repeated measures using Statistical Application Software Proc Mixed were used to examine group, time, and group-by-time effects on dynamic balance (8-Foot Up and Go), functional balance (Berg Balance Scale), and muscular strength (30 s chair stands and 30 s arm curls). Non-normally distributed outcome variables were log-transformed. After adjusting for age, gender, and body mass index, 8-Foot Up and Go scores, improved significantly over time [ F (2,173)  = 8.92, p  = 0.0; T0 - T2 diff = 1.2 (1.0)]. Berg Balance Scores [ F (2,173)  = 29.0, p  < 0.0001; T0 - T2 diff = 4.96 (0.72)], chair stands [ F (2,171)  = 10.17, p  < 0.0001; T0 - T2 diff = 3.1 (0.7)], and arm curls [ F (2,171)  = 12.7, p  < 0.02; T0 - T2 diff = 2.7 (0.6)] also all improved significantly over time. There were no significant group-by-time effects observed for any of the outcomes. The SIB program improved dynamic and functional balance and muscular strength in older adults at-risk for falling. Our findings indicate continuing home-based strength and balance exercises at home after completion of a center-based FPP program may be an effective and feasible way to maintain improvements in balance and strength parameters.

Exercise in Patients on Dialysis: A Multicenter, Randomized Clinical Trial.

PubMed

Manfredini, Fabio; Mallamaci, Francesca; D'Arrigo, Graziella; Baggetta, Rossella; Bolignano, Davide; Torino, Claudia; Lamberti, Nicola; Bertoli, Silvio; Ciurlino, Daniele; Rocca-Rey, Lisa; Barillà, Antonio; Battaglia, Yuri; Rapanà, Renato Mario; Zuccalà, Alessandro; Bonanno, Graziella; Fatuzzo, Pasquale; Rapisarda, Francesco; Rastelli, Stefania; Fabrizi, Fabrizio; Messa, Piergiorgio; De Paola, Luciano; Lombardi, Luigi; Cupisti, Adamasco; Fuiano, Giorgio; Lucisano, Gaetano; Summaria, Chiara; Felisatti, Michele; Pozzato, Enrico; Malagoni, Anna Maria; Castellino, Pietro; Aucella, Filippo; Abd ElHafeez, Samar; Provenzano, Pasquale Fabio; Tripepi, Giovanni; Catizone, Luigi; Zoccali, Carmine

2017-04-01

Previous studies have suggested the benefits of physical exercise for patients on dialysis. We conducted the Exercise Introduction to Enhance Performance in Dialysis trial, a 6-month randomized, multicenter trial to test whether a simple, personalized walking exercise program at home, managed by dialysis staff, improves functional status in adult patients on dialysis. The main study outcomes included change in physical performance at 6 months, assessed by the 6-minute walking test and the five times sit-to-stand test, and in quality of life, assessed by the Kidney Disease Quality of Life Short Form (KDQOL-SF) questionnaire. We randomized 296 patients to normal physical activity (control; n =145) or walking exercise ( n =151); 227 patients (exercise n =104; control n =123) repeated the 6-month evaluations. The distance covered during the 6-minute walking test improved in the exercise group (mean distance±SD: baseline, 328±96 m; 6 months, 367±113 m) but not in the control group (baseline, 321±107 m; 6 months, 324±116 m; P <0.001 between groups). Similarly, the five times sit-to-stand test time improved in the exercise group (mean time±SD: baseline, 20.5±6.0 seconds; 6 months, 18.2±5.7 seconds) but not in the control group (baseline, 20.9±5.8 seconds; 6 months, 20.2±6.4 seconds; P =0.001 between groups). The cognitive function score ( P =0.04) and quality of social interaction score ( P =0.01) in the kidney disease component of the KDQOL-SF improved significantly in the exercise arm compared with the control arm. Hence, a simple, personalized, home-based, low-intensity exercise program managed by dialysis staff may improve physical performance and quality of life in patients on dialysis. Copyright © 2017 by the American Society of Nephrology.

Effectiveness and feasibility of early physical rehabilitation programs for geriatric hospitalized patients: a systematic review

PubMed Central

2013-01-01

Background Old adults admitted to the hospital are at severe risk of functional loss during hospitalization. Early in-hospital physical rehabilitation programs appear to prevent functional loss in geriatric patients. The first aim of this review was to investigate the effect of early physical rehabilitation programs on physical functioning among geriatric patients acutely admitted to the hospital. The second aim was to evaluate the feasibility of early physical rehabilitation programs. Methods Two searches, one for physical functioning and one for feasibility, were conducted in PubMed, CINAHL, and EMBASE. Additional studies were identified through reference and citation tracking. To be included articles had to report on in-hospital early physical rehabilitation of patients aged 65 years and older with an outcome measure of physical functioning. Studies were excluded when the treatment was performed on specialized units other than geriatric units. Randomized controlled trials were included to examine the effect of early physical rehabilitation on physical functioning, length of stay and discharge destination. To investigate feasibility also non randomized controlled trials were added. Results Fifteen articles, reporting on 13 studies, described the effect on physical functioning. The early physical rehabilitation programs were classified in multidisciplinary programs with an exercise component and usual care with an exercise component. Multidisciplinary programs focussed more on facilitating discharge home and independent ADL, whereas exercise programs aimed at improving functional outcomes. At time of discharge patients who had participated in a multidisciplinary program or exercise program improved more on physical functional tests and were less likely to be discharged to a nursing home compared to patients receiving only usual care. In addition, multidisciplinary programs reduced the length of hospital stay significantly. Follow-up interventions improved physical functioning after discharge. The feasibility search yielded four articles. The feasibility results showed that early physical rehabilitation for acutely hospitalized old adults was safe. Adherence rates differed between studies and the recruitment of patients was sometimes challenging. Conclusions Early physical rehabilitation care for acutely hospitalized old adults leads to functional benefits and can be safely executed. Further research is needed to specifically quantify the physical component in early physical rehabilitation programs. PMID:24112948

Effectiveness and feasibility of early physical rehabilitation programs for geriatric hospitalized patients: a systematic review.

PubMed

Kosse, Nienke M; Dutmer, Alisa L; Dasenbrock, Lena; Bauer, Jürgen M; Lamoth, Claudine J C

2013-10-10

Old adults admitted to the hospital are at severe risk of functional loss during hospitalization. Early in-hospital physical rehabilitation programs appear to prevent functional loss in geriatric patients. The first aim of this review was to investigate the effect of early physical rehabilitation programs on physical functioning among geriatric patients acutely admitted to the hospital. The second aim was to evaluate the feasibility of early physical rehabilitation programs. Two searches, one for physical functioning and one for feasibility, were conducted in PubMed, CINAHL, and EMBASE. Additional studies were identified through reference and citation tracking. To be included articles had to report on in-hospital early physical rehabilitation of patients aged 65 years and older with an outcome measure of physical functioning. Studies were excluded when the treatment was performed on specialized units other than geriatric units. Randomized controlled trials were included to examine the effect of early physical rehabilitation on physical functioning, length of stay and discharge destination. To investigate feasibility also non randomized controlled trials were added. Fifteen articles, reporting on 13 studies, described the effect on physical functioning. The early physical rehabilitation programs were classified in multidisciplinary programs with an exercise component and usual care with an exercise component. Multidisciplinary programs focussed more on facilitating discharge home and independent ADL, whereas exercise programs aimed at improving functional outcomes. At time of discharge patients who had participated in a multidisciplinary program or exercise program improved more on physical functional tests and were less likely to be discharged to a nursing home compared to patients receiving only usual care. In addition, multidisciplinary programs reduced the length of hospital stay significantly. Follow-up interventions improved physical functioning after discharge. The feasibility search yielded four articles. The feasibility results showed that early physical rehabilitation for acutely hospitalized old adults was safe. Adherence rates differed between studies and the recruitment of patients was sometimes challenging. Early physical rehabilitation care for acutely hospitalized old adults leads to functional benefits and can be safely executed. Further research is needed to specifically quantify the physical component in early physical rehabilitation programs.

Evaluating the effectiveness of home exercise programmes using an online exercise prescription tool in children with cerebral palsy: protocol for a randomised controlled trial

PubMed Central

Williams, Sian A; Gucciardi, Daniel F; Bear, Natasha; Gibson, Noula

2018-01-01

Introduction Children with cerebral palsy (CP) and other neurodevelopmental disabilities often receive a home programme of exercises to assist in reaching their therapy goals. Adherence to exercise programmes is necessary to attain the level of practice required to achieve goals; however, adherence can be difficult to accomplish. In this paper, we describe the protocol for a randomised controlled trial to evaluate the effectiveness of delivering a home exercise programme to school-age children with disabilities using Physitrack, an online exercise prescription tool with a website or app interface. Methods and analysis Participants aged 6–17 years, with CP or other neurodevelopmental disabilities, receiving community physiotherapy services in Western Australia, will be recruited. Participants will be stratified by age and functional mobility and randomised to either the intervention group, who will complete an 8-week home exercise programme using Physitrack, or the control group, who will complete an 8-week exercise programme without Physitrack. Researcher blinding to group allocation, and participant blinding to outcome, will be maintained. The primary outcome measures are adherence to the home exercise programme with weekly collection of home exercise logs; achievement of individualised goals by phone interview before and after intervention; and correctness of exercise performance by collection and analysis of videos of participants performing home exercises. Secondary outcome measures include enjoyment of physical activity, confidence to complete exercise programme, preferred method of delivery of programme and usability of Physitrack. A sample size of 58 participants will be necessary to see an effect on home programme adherence. Data will be analysed using the intention-to-treat principle. Ethics and dissemination Ethical approval was obtained from Curtin University Human Research Ethics Committee in July 2016 (10391). Outcomes will be disseminated through publication in peer-reviewed journals and presentations at scientific conferences. Trial registration number ACTRN12616000743460; Pre-results. PMID:29362255

Effects of Exercise on Cognitive Function in Older People with Dementia: A Randomized Controlled Trial.

PubMed

Toots, Annika; Littbrand, Håkan; Boström, Gustaf; Hörnsten, Carl; Holmberg, Henrik; Lundin-Olsson, Lillemor; Lindelöf, Nina; Nordström, Peter; Gustafson, Yngve; Rosendahl, Erik

2017-01-01

Although physical exercise has been suggested to influence cognitive function, previous exercise studies show inconsistent results in people with dementia. To investigate effects of exercise on cognitive function in people with dementia. The Umeå Dementia and Exercise (UMDEX) study, a cluster-randomized controlled trial, was set in 16 nursing homes in Umeå, Sweden. One hundred-and-forty-one women and 45 men with dementia; mean age of 85 y and mean Mini-Mental State Examination (MMSE) score of 15, were randomized to a High-Intensity Functional Exercise program or a seated attention control activity. Blinded assessors measured global cognitive function using the MMSE and the Alzheimer's disease Assessment Scale - Cognitive subscale (ADAS-Cog), and executive function using Verbal fluency (VF) at baseline and 4 months (directly after intervention completion), and MMSE and VF at 7 months. Linear mixed models showed no between-group effects in mean difference from baseline (95% confidence intervals, CI) at 4 months in MMSE (-0.27; 95% CI -1.4 to 0.87, p = 0.644), ADAS-Cog (-1.04, 95% CI -4 to 1.92, p = 0.491), or VF (-0.53, 95% CI -1.42 to 0.35, p = 0.241) or at 7 months in MMSE (-1.15, 95% CI -2.32 to 0.03, p = 0.056) or VF (-0.18, 95% CI -1.09 to 0.74, p = 0.707). A 4-month, high-intensity functional exercise program had no superior effects on global cognition or executive function in people with dementia living in nursing homes when compared with an attention control activity.

Evaluation of pain and function after two home exercise programs in a clinical trial on women with chronic neck pain - with special emphasises on completers and responders

PubMed Central

2014-01-01

Background Different types of exercises can help manage chronic neck pain. Supervised exercise interventions are widely used, but these protocols require substantial resources. The aim of this trial, which focused on adherence, was to evaluate two home exercise interventions. Methods This parallel group randomized controlled trial included 57 women randomly allocated into two groups – a strength training group (STRENGTH, 34 subjects) and a stretching group (STRETCH, 23 subjects). The interventions focused on the neck and shoulder muscles and lasted for 12 months. The STRENGTH group performed weight training and ended each session with stretching exercises. These stretching exercises constituted the entirety of the STRETCH group’s training session. Both groups were instructed to exercise three times per week. All the participants kept an exercise diary. In addition, all participants were offered support via phone and e-mail. The primary outcomes were pain intensity and function. The trial included a four- to six-month and a twelve-month follow-up. A completer in this study exercised at least 1,5 times per week during eight unbroken weeks. A responder in this study reported clinically significant improvements on pain and function. The statistical analyses used the Mann Whitney U-test, Wilcoxon signed-rank test, and X 2 test. Results At four- to six-months, the numbers of completers were 19 in the STRENGTH group and 17 in the STRETCH group. At twelve months, the corresponding numbers were 11 (STRENGTH) and 10 (STRETCH). At four- to six-months, the proportions of subjects reporting clinically important changes (STRENGTH and STRETCH) were for neck pain: 47% and 41%, shoulder pain: 47% and 47%, function: 37% and 29%. At twelve months, the corresponding numbers were for neck pain: 45% and 40%, shoulder pain: 55% and 50%, function: 55% and 20%. Conclusions No differences in the two primary outcomes between the two interventions were found, a finding that may be due to the insufficient statistical power of the study. Both interventions based on home exercises improved the two primary outcomes, but the adherences were relatively low. Future studies should investigate ways to improve adherence to home exercise treatments. Trial registration ClinicalTrials.gov Id: NCT01876680 PMID:24400934

Effects of a Home-Based DVD-Delivered Physical Activity Program on Self-Esteem in Older Adults: Results from A Randomized Controlled Trial

PubMed Central

Awick, Elizabeth A; Ehlers, Diane; Fanning, Jason; Phillips, Siobhan M; Wójcicki, Thomas; Mackenzie, Michael J; Motl, Robert; McAuley, Edward

2016-01-01

Objective Although center-based supervised physical activity interventions have proven to be successful in attenuating health declines in older adults, such methods can be costly and have limited reach. In the present study, we examined the effects of a DVD-delivered exercise intervention on self-esteem and its subdomains and the extent to which these effects were maintained. In addition, we examined whether psychological, demographic, and biological factors acted as determinants of self-esteem. Methods Low active, older adults (N=307 ; Mean age =71.0 [SD=5.1] years) were randomly assigned to a six-month, home-based exercise program consisting of a DVD-delivered exercise intervention focused on increasing flexibility, toning, and balance (FlexToBa) or an attentional control DVD condition focused on healthy aging. Physical self-worth, three subdomains of self-esteem, global self-esteem, and self-efficacy were assessed at baseline, six months, and 12 months. Results There was a differential effect of time for the two groups for physical self-worth [F interaction (2, 530.10) = 4.17, p = 0.016] and perception of physical condition [F(2, 630.77) = 8.31, p = 0.004]. Self-efficacy, sex, body mass index (BMI), and age were significant predictors of changes in physical self-worth and perception of physical condition. Conclusion Our findings suggest a DVD-delivered exercise intervention is efficacious for improving and maintaining subdomain and domain levels of self-esteem in older adults. Additionally, self-efficacy was the strongest predictor of changes in physical self-worth and perceptions of physical condition. This innovative method of delivering an exercise training program via DVD is practical, effective, and has the potential for broad reach and dissemination. Trial Registration clinicaltrials.gov identifier NCT01030419 PMID:27359182

Ottawa Panel Evidence-Based Clinical Practice Guidelines for Structured Physical Activity in the Management of Juvenile Idiopathic Arthritis.

PubMed

Cavallo, Sabrina; Brosseau, Lucie; Toupin-April, Karine; Wells, George A; Smith, Christine A; Pugh, Arlanna G; Stinson, Jennifer; Thomas, Roanne; Ahmed, Sara; Duffy, Ciarán M; Rahman, Prinon; Àlvarez-Gallardo, Inmaculada C; Loew, Laurianne; De Angelis, Gino; Feldman, Debbie Ehrmann; Majnemer, Annette; Gagnon, Isabelle J; Maltais, Désirée; Mathieu, Marie-Ève; Kenny, Glen P; Tupper, Susan; Whitney-Mahoney, Kristi; Bigford, Sarah

2017-05-01

To create guidelines focused on the use of structured physical activity (PA) in the management of juvenile idiopathic arthritis (JIA). A systematic literature search was conducted using the electronic databases Cochrane Central Register of Controlled Trials, MEDLINE (Ovid), EMBASE (Ovid), and Physiotherapy Evidence Database for all studies related to PA programs for JIA from January 1966 until December 2014, and was updated in May 2015. Study selection was completed independently by 2 reviewers. Studies were included if they involved individuals aged ≤21 years diagnosed with JIA who were taking part in therapeutic exercise or other PA interventions for which effects of various disease-related outcomes were compared with a control group (eg, no PA program or activity of lower intensity). Two reviewers independently extracted information on interventions, comparators, outcomes, time period, and study design. The statistical analysis was reported using the Cochrane Collaboration methods. The quality of the included studies was assessed according to the Physiotherapy Evidence Database Scale. Five randomized controlled trials (RCTs) fit the selection criteria; of these, 4 were high-quality RCTs. The following recommendations were developed: (1) Pilates for improving quality of life, pain, functional ability, and range of motion (ROM) (grade A); (2) home exercise program for improving quality of life and functional ability (grade A); (3) aquatic aerobic fitness for decreasing the number of active joints (grade A); and (4) and cardio-karate aerobic exercise for improving ROM and number of active joints (grade C+). The Ottawa Panel recommends the following structured exercises and physical activities for the management of JIA: Pilates, cardio-karate, home and aquatic exercises. Pilates showed improvement in a higher number of outcomes. Copyright © 2017. Published by Elsevier Inc.

Effects of a Home-Based DVD-Delivered Physical Activity Program on Self-Esteem in Older Adults: Results From a Randomized Controlled Trial.

PubMed

Awick, Elizabeth Ann; Ehlers, Diane; Fanning, Jason; Phillips, Siobhan M; Wójcicki, Thomas; Mackenzie, Michael J; Motl, Robert; McAuley, Edward

2017-01-01

Although center-based supervised physical activity interventions have proved to be successful in attenuating health declines in older adults, such methods can be costly and have limited reach. In the present study, we examined the effects of a DVD-delivered exercise intervention on self-esteem and its subdomains and the extent to which these effects were maintained. In addition, we examined whether psychological, demographic, and biological factors acted as determinants of self-esteem. Low-active, older adults (n = 307; mean [standard deviation] age =71.0 [5.1] years) were randomly assigned to a 6-month, home-based exercise program consisting of a DVD-delivered exercise intervention focused on increasing flexibility, toning, and balance (FlexToBa) or an attentional control DVD condition focused on healthy aging. Physical self-worth and three subdomains of self-esteem, global self-esteem, and self-efficacy were assessed at baseline, 6 months, and 12 months. There was a differential effect of time for the two groups for physical self-worth (F interaction(2,530.10) = 4.17, p = .016) and perception of physical condition (F interaction(1,630.77) = 8.31, p = .004). Self-efficacy, sex, body mass index, and age were significant predictors of changes in physical self-worth and perception of physical condition. Our findings suggest that a DVD-delivered exercise intervention is efficacious for improving and maintaining subdomain and domain levels of self-esteem in older adults. In addition, self-efficacy was the strongest predictor of changes in physical self-worth and perceptions of physical condition. This innovative method of delivering an exercise training program via DVD is practical and effective and has the potential for broad reach and dissemination. Clinicaltrials.govidentifier:NCT01030419.

Beware of Illegally Marketed Diabetes Treatments

MedlinePlus

... exercise program,” Humbert said. Health care professionals and consumers should report any problems or reactions—often referred to as ... Continuing Education Inspections & Compliance Federal, State & Local Officials ... Content Home Latest Recalls Report an Adverse Event MedWatch Safety Alerts News Releases ...

Unrecognized heart failure and chronic obstructive pulmonary disease (COPD) in frail elderly detected through a near-home targeted screening strategy.

PubMed

van Mourik, Yvonne; Bertens, Loes C M; Cramer, Maarten J M; Lammers, Jan-Willem J; Reitsma, Johannes B; Moons, Karel G M; Hoes, Arno W; Rutten, Frans H

2014-01-01

Reduced exercise tolerance and dyspnea are common in older people, and heart failure (HF) and chronic obstructive pulmonary disease (COPD) are the main causes. We want to determine the prevalence of previously unrecognized HF, COPD, and other chronic diseases in frail older people using a near-home targeted screening strategy. Community-dwelling frail persons aged ≥65 years underwent a 2-step screening strategy. First, they received a questionnaire inquiring about dyspnea and exercise tolerance. Those with exercise intolerance and/or dyspnea were invited to visit their primary care physician's office for a screening program, including medical history taking, physical examination, blood tests, electrocardiography, spirometry, and echocardiography. The final diagnosis of every patient was determined by a panel consisting of 3 physicians. Of the 570 elderly who filled out the questionnaire, 395 (69%) had reduced exercise tolerance or dyspnea. Of these, 389 underwent the screening program: 127 (33.5%, 95% confidence interval, 28.9-38.4%) were newly diagnosed with HF (mainly HF with a preserved ejection fraction [23.5%]), and previously unrecognized COPD was detected in 16.8% (95% confidence interval, 13.4-20.9%). In total, 165 patients (43.9%) received a new diagnosis of either HF, COPD, or both. Other new diagnoses (in 32.7% of the screening program patients) included atrial fibrillation (1.8%), valvular disease (21.4%), (persisting) asthma (3.1%), anemia (12.7%), and thyroid disease (0.6%). No clear explanation for the complaints of 47 patients (12.2%) was found using our strategy. Unrecognized chronic diseases might be detected in community-dwelling frail elderly using a near-home screening strategy that is simple to implement. It remains to be proven, however, whether optimizing treatment of the newly detected diagnoses in this fragile population with multimorbidities and polypharmacy improves quality of life and reduces morbidity and mortality. © Copyright 2014 by the American Board of Family Medicine.

Physical activity and neuropsychiatric symptoms of Parkinson disease.

PubMed

Abrantes, Ana M; Friedman, Joseph H; Brown, Richard A; Strong, David R; Desaulniers, Julie; Ing, Eileen; Saritelli, Jennifer; Riebe, Deborah

2012-09-01

Neuropsychiatric symptoms of Parkinson disease (PD) such as fatigue, depression, and apathy are common and detract from quality of life. There is little published on the impact of physical activity on the neuropsychiatric symptoms of PD. A convenience sample of 45 patients with PD (mean age = 66.1 years; 33% female) completed questionnaires on physical activity, neuropsychiatric symptoms, and specific exercise preferences. Covarying for age and gender, higher levels of physical activity were associated with significantly less fatigue, as well as a trend for less apathy and depression and greater positive affect. Exercise preferences included moderate intensity (73%), at home (56%), in the morning (73%), scheduled (69%), options for varied activities (73%), and preference for both structured/supervised (50%), and unsupervised/self-paced (50%) programs. Preferred activities included the use of aerobic exercise equipment, resistance training, and yoga. Developing and tailoring exercise programs that incorporate specific preferences may result in more effective interventions for patients with PD.

Effects of a Clinician Referral and Exercise Program for Men Who Have Completed Active Treatment for Prostate Cancer: A Multicenter Cluster Randomized Controlled Trial (ENGAGE)

PubMed Central

Livingston, Patricia M; Craike, Melinda J; Salmon, Jo; Courneya, Kerry S; Gaskin, Cadeyrn J; Fraser, Steve F; Mohebbi, Mohammadreza; Broadbent, Suzanne; Botti, Mari; Kent, Bridie

2015-01-01

BACKGROUND The purpose of this study was to determine the efficacy of a clinician referral and exercise program in improving exercise levels and quality of life for men with prostate cancer. METHODS This was a multicenter cluster randomized controlled trial in Melbourne, Australia comprising 15 clinicians: 8 clinicians were randomized to refer eligible participants (n = 54) to a 12-week exercise program comprising 2 supervised gym sessions and 1 home-based session per week, and 7 clinicians were randomized to follow usual care (n = 93). The primary outcome was self-reported physical activity; the secondary outcomes were quality of life, anxiety, and symptoms of depression. RESULTS A significant intervention effect was observed for vigorous-intensity exercise (effect size: Cohen's d, 0.46; 95% confidence interval [CI], 0.09-0.82; P = .010) but not for combined moderate and vigorous exercise levels (effect size: d, 0.08; 95% CI, −0.28 to 0.45; P = .48). Significant intervention effects were also observed for meeting exercise guidelines (≥150 min/wk; odds ratio, 3.9; 95% CI, 1.9-7.8; P = .002); positive intervention effects were observed in the intervention group for cognitive functioning (effect size: d, 0.34; 95% CI, −0.02 to 0.70; P = .06) and depression symptoms (effect size: d, −0.35; 95% CI, −0.71 to 0.02; P = .06). Eighty percent of participants reported that the clinician's referral influenced their decision to participate in the exercise program. CONCLUSIONS The clinician referral and 12-week exercise program significantly improved vigorous exercise levels and had a positive impact on mental health outcomes for men living with prostate cancer. Further research is needed to determine the sustainability of the exercise program and its generalizability to other cancer populations. Cancer 2015;121:2646–2654. © 2015 American Cancer Society. PMID:25877784

Interactive Games for Home Delivery of Exercise and Rehabilitation Interventions for Older Adults: An Australian Perspective.

PubMed

Smith, Stuart Trevor; Bird, Marie-Louise

2016-01-01

Over the past few decades there has been a wealth of published scientific evidence for the physical, cognitive and social health-related benefits of increased physical activity, especially in older adults and people living with chronic disease. Despite the clear evidence base demonstrating the health-related benefits of physical activity, uptake and adherence is often disappointing. Therefore, methods for remote delivery of guided exercise programs are required, both to maximise the reach of physical activity promotion initiatives and programs across the older community and to minimise attrition once people begin to be physically active. One method by which we can increase understanding of the importance of, and compliance with, exercise programs involves the use of fun and engaging videogames. In the following we outline two ways in which we are using games technology in an Australian context.

Effects of topical essential oil on exercise volume after a 12-week exercise program for women with fibromyalgia: a pilot study.

PubMed

Rutledge, Dana N; Jones, C Jessie

2007-12-01

We determined--in women with fibromyalgia (FM)--effects of essential oils used with a 12-week exercise program on exercise volume, pain, physical performance, and physical function. This was a randomized clinical trial comparing 024 essential oil with sham oil combined with exercise. SETTINGS included community sites in southern California. The study included 20 women randomized to 024 oil, 23 to sham oil. Women were trained in oil application before exercise, at bedtime on exercise days; the 12-week program included weekly group sessions with trained leaders guided by a prerecorded regimen (allowing choice of program level) plus 2 days of home exercise with the recorded regimen. Primary: Exercise volume (number of days exercised multiplied by exercise level--intensity and duration). Secondary: Pain (Brief Pain Inventory), measures of physical performance (30-second chair stands, 6-minute walk, multidimensional balance), and self-reported physical function (Composite Physical Function scale). The average participant was 54 years old, had some college education, was married, Caucasian, and minimally/mildly depressed. There was no significant difference in exercise volume between women using 024 as compared with those using sham oil after 12 weeks (depression as covariate). There were no significant group nor pre- to postexercise changes in pain intensity or interference. There were greater positive changes in 30-second chair stands, 6-minute walk distance, and multidimensional balance scores in the 024 group than in the sham group, but these were not significant. The counterirritant 024 oil was not different from the sham oil in its effect on exercise volume (frequency, exercise level--intensity and duration) for women with FM. It is unknown whether 024 actually decreases local pain when used with exercise. Increases in physical function found, while not significant, may be attributable to the exercise regimen or to the interaction of the oils and exercise regimen.

The efficacy of early initiated, supervised, progressive resistance training compared to unsupervised, home-based exercise after unicompartmental knee arthroplasty: a single-blinded randomized controlled trial.

PubMed

Jørgensen, Peter B; Bogh, Søren B; Kierkegaard, Signe; Sørensen, Henrik; Odgaard, Anders; Søballe, Kjeld; Mechlenburg, Inger

2017-01-01

To examine if supervised progressive resistance training was superior to home-based exercise in rehabilitation after unicompartmental knee arthroplasty. Single blinded, randomized clinical trial. Surgery, progressive resistance training and testing was carried out at Aarhus University Hospital and home-based exercise was carried out in the home of the patient. Fifty five patients were randomized to either progressive resistance training or home-based exercise. Patients were randomized to either progressive resistance training (home based exercise five days/week and progressive resistance training two days/week) or control group (home based exercise seven days/week). Preoperative assessment, 10-week (primary endpoint) and one-year follow-up were performed for leg extension power, spatiotemporal gait parameters and knee injury and osteoarthritis outcome score (KOOS). Forty patients (73%) completed 1-year follow-up. Patients in the progressive resistance training group participated in average 11 of 16 training sessions. Leg extension power increased from baseline to 10-week follow-up in progressive resistance training group (progressive resistance training: 0.28 W/kg, P= 0.01, control group: 0.01 W/kg, P=0.93) with no between-group difference. Walking speed and KOOS scores increased from baseline to 10-week follow-up in both groups with no between-group difference (six minutes walk test P=0.63, KOOS P>0.29). Progressive resistance training two days/week combined with home based exercise five days/week was not superior to home based exercise seven days/week in improving leg extension power of the operated leg.

Effects of internet-based pain coping skills training prior to home exercise for individuals with hip osteoarthritis (HOPE trial): a randomised controlled trial.

PubMed

Bennell, Kim L; Nelligan, Rachel K; Rini, Christine; Keefe, Francis J; Kasza, Jessica; French, Simon; Forbes, Andrew; Dobson, Fiona; Abbott, J Haxby; Dalwood, Andrew; Harris, Anthony; Vicenzino, Bill; Hodges, Paul W; Hinman, Rana S

2018-05-22

This assessor-, therapist- and participant-blinded randomised controlled trial evaluated the effects of an automated internet-based pain coping skills training (PCST) program prior to home exercise for people with clinically-diagnosed hip osteoarthritis (OA). 144 people were randomised to either the PCST group or the comparator group. In the first 8 weeks, the PCST group received online education and PCST while the comparison group received online education only. From weeks 8-24, both groups visited a physiotherapist 5 times for home exercise prescription. Assessments were performed at baseline, 8, 24 and 52 weeks. Primary outcomes were hip pain on walking (11-point numerical rating scale) and physical function (Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)) at 24 weeks. Secondary outcomes were other measures of pain, quality-of-life, global change, self-efficacy, pain coping, pain catastrophizing, depression, anxiety, stress, physical activity and adverse events. Primary outcomes were completed by 137 (95%), 131 (91%) and 127 (88%) participants at 8, 24 and 52 weeks, respectively. There were no significant between-group differences in primary outcomes at week 24 (change in: walking pain (mean difference 0.5 units; 95%CI, -0.3 to 1.3) and function (-0.9 units; 95%CI, -4.8 to 2.9)), with both groups showing clinically-relevant improvements. At week 8, the PCST group had greater improvements in function, pain coping and global improvement than comparison. Greater pain coping improvements persisted at 24 and 52 weeks. In summary, online PCST immediately improved pain coping and function but did not confer additional benefits to a subsequent exercise program, despite sustained pain coping improvements.

Effect of an eccentrically biased hamstring strengthening home program on knee flexor strength and the length-tension relationship.

PubMed

Orishimo, Karl F; McHugh, Malachy P

2015-03-01

The purposes of this study were to document relative activation intensities of the hamstrings and gluteus maximus during 4 eccentric hamstring strengthening exercises and to assess the effects of a short-term strengthening program comprised of these exercises on knee flexor strength and the length-tension relationship. Twelve healthy subjects participated in this study. Electromyographic (EMG) activities from the biceps femoris, semitendinosus, and gluteus maximus were recorded as subjects performed (a) standing hip extension with elastic resistance, (b) trunk flexion in single limb stance (diver), (c) standing split (glider), and (d) supine sliding bridge (slider). Baseline isometric knee flexor strength was measured at 90, 70, 50, and 30° of flexion at the knee with the subject seated and the hip flexed to 50° from horizontal. After completing the 4-week training program, strength tests were repeated. Repeated-measures analysis of variance were used to compare EMG activity between muscles and to assess angle-specific strength improvements. Hamstring activity exceeded gluteus maximus activity for resisted hip extension, glider, and slider exercises (p < 0.001) but not for the diver (p = 0.087). Hamstring activation was greatest during the slider and resisted hip extension and lowest during the glider and the diver. Knee flexor strength improved by 9.0% (p = 0.005) but was not angle specific (training by angle p = 0.874). The short-term home training program effectively targeted the hamstrings and resulted in strength gains that were similar at short and long muscle lengths. These data demonstrate that hamstring strength can be improved using eccentrically biased unilateral exercises without the use of weights or other equipments.

Addition of Supervised Exercise Training to a Post-Hospital Disease Management Program for Patients Recently Hospitalized With Acute Heart Failure: The EJECTION-HF Randomized Phase 4 Trial.

PubMed

Mudge, Alison M; Denaro, Charles P; Scott, Adam C; Meyers, Deborah; Adsett, Julie A; Mullins, Robert W; Suna, Jessica M; Atherton, John J; Marwick, Thomas H; Scuffham, Paul; O'Rourke, Peter

2018-02-01

This study sought to measure the impact on all-cause death or readmission of adding center-based exercise training (ET) to disease management programs for patients with a recent acute heart failure (HF) hospitalization. ET is recommended for patients with HF, but evidence is based mainly on ET as a single intervention in stable outpatients. A randomized, controlled trial with blinded outcome assessor, enrolling adult participants with HF discharged from 5 hospitals in Queensland, Australia. All participants received HF-disease management program plus supported home exercise program; intervention participants were offered 24 weeks of supervised center-based ET. Primary outcome was all-cause 12-month death or readmission. Pre-planned subgroups included age (<70 years vs. older), sex, left ventricular ejection fraction (≤40% vs. >40%), and exercise adherence. Between May 2008 and July 2013, 278 participants (140 intervention, 138 control) were enrolled: 98 (35.3%) age ≥70 years, 71 (25.5%) females, and 62 (23.3%) with a left ventricular ejection fraction of >40%. There were no adverse events associated with ET. There was no difference in primary outcome between groups (84 of 140 [60.0%] intervention vs. 90 of 138 [65.2%] control; p = 0.37), but a trend toward greater benefit in participants age <70 years (OR: 0.56 [95% CI: 0.30 to 1.02] vs. OR: 1.56 [95% CI: 0.67 to 3.64]; p for interaction = 0.05). Participants who exercised to guidelines (72 of 101 control and 92 of 117 intervention at 3 months) had a significantly lower rate of death and readmission (91 of 164 [55.5%] vs. 41 of 54 [75.9%]; p = 0.008). Supervised center-based ET was a safe, feasible addition to disease management programs with supported home exercise in patients recently hospitalized with acute HF, but did not reduce combined end-point of death or readmission. (A supervised exercise programme following hospitalisation for heart failure: does it add to disease management?; ACTRN12608000263392). Copyright © 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Effectiveness of Home-Based Exercises Without Supervision by Physical Therapists for Patients With Early-Stage Amyotrophic Lateral Sclerosis: A Pilot Study.

PubMed

Kitano, Kosuke; Asakawa, Takashi; Kamide, Naoto; Yorimoto, Keisuke; Yoneda, Masaki; Kikuchi, Yutaka; Sawada, Makoto; Komori, Tetsuo

2018-03-31

To verify the effects of structured home-based exercises without supervision by a physical therapist in patients with early-stage amyotrophic lateral sclerosis (ALS). A historical controlled study that is part of a multicenter collaborative study. Rehabilitation departments at general hospitals and outpatient clinics with a neurology department. Patients (N=21) with ALS were enrolled and designated as the home-based exercise (Home-EX) group, and they performed unsupervised home-based exercises. As a control group, 84 patients with ALS who underwent supervised exercise with a physical therapist for 6 months were extracted from a database of patients with ALS and matched with the Home-EX group in terms of their basic attributes and clinical features. The Home-EX group was instructed to perform structured home-based exercises without supervision by a physical therapist that consisted of muscle stretching, muscle training, and functional training for 6 months. The primary outcome was the score on the ALS Functional Rating Scale-Revised (ALSFRS-R), which is composed of 3 domains: bulbar function, limb function, and respiratory function. The score ranges from 0 to 48 points, with a higher score indicating better function. In the Home-EX group, 15 patients completed the home-based exercises for 6 months, and 6 patients dropped out because of medical reasons or disease progression. No adverse events were reported. The Home-EX group was found to have a significantly higher respiratory function subscore and total score on the ALSFRS-R than the control group at follow-up (P<.001 and P<.05, respectively). Structured home-based exercises without supervision by a physical therapist could be used to alleviate functional deterioration in patients with early-stage ALS. Copyright © 2018 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Moms in motion: a group-mediated cognitive-behavioral physical activity intervention.

PubMed

Cramp, Anita G; Brawley, Lawrence R

2006-08-22

When examining the prevalence of physical inactivity by gender and age, women over the age of 25 are at an increased risk for sedentary behavior. Childbearing and motherhood have been explored as one possible explanation for this increased risk. Post natal exercise studies to date demonstrate promising physical and psychological outcomes, however few physical activity interventions have been theory-driven and tailored to post natal exercise initiates. The purpose of this study was to compare the effects of a group-mediated cognitive behavioral intervention based upon social-cognitive theory and group dynamics (GMCB) to a standard care postnatal exercise program (SE). A randomized, two-arm intervention design was used. Fifty-seven post natal women were randomized to one of two conditions: (1) a standard exercise treatment (SE) and (2) a standard exercise treatment plus group-mediated cognitive behavioral intervention (GMCB). Participants in both conditions participated in a four-week intensive phase where participants received standard exercise training. In addition, GMCB participants received self-regulatory behavioral skills training via six group-mediated counseling sessions. Following the intensive phase, participants engaged in a four-week home-based phase of self-structured exercise. Measures of physical activity, barrier efficacy, and proximal outcome expectations were administered and data were analyzed using ANCOVA procedures. ANCOVA of change scores for frequency, minutes, and volume of physical activity revealed significant treatment effects over the intensive and home-based phases (p's < 0.01). In addition, ANCOVA of change in mean barrier efficacy and proximal outcome expectations at the conclusion of the intensive phase demonstrated that GMCB participants increased their initial level of barrier efficacy and outcome expectations while SE participants decreased (p < 0.05). While both exercise programs resulted in improvements to exercise participation, the GMCB intervention produced greater improvement in overall physical activity, barrier efficacy and proximal outcome expectations.

Home-based hand rehabilitation with a robotic glove in hemiplegic patients after stroke: a pilot feasibility study.

PubMed

Bernocchi, Palmira; Mulè, Chiara; Vanoglio, Fabio; Taveggia, Giovanni; Luisa, Alberto; Scalvini, Simonetta

2018-03-01

To evaluate the feasibility and safety of home rehabilitation of the hand using a robotic glove, and, in addition, its effectiveness, in hemiplegic patients after stroke. In this non-randomized pilot study, 21 hemiplegic stroke patients (Ashworth spasticity index ≤ 3) were prescribed, after in-hospital rehabilitation, a 2-month home-program of intensive hand training using the Gloreha Lite glove that provides computer-controlled passive mobilization of the fingers. Feasibility was measured by: number of patients who completed the home-program, minutes of exercise and number of sessions/patient performed. Safety was assessed by: hand pain with a visual analog scale (VAS), Ashworth spasticity index for finger flexors, opponents of the thumb and wrist flexors, and hand edema (circumference of forearm, wrist and fingers), measured at start (T0) and end (T1) of rehabilitation. Hand motor function (Motricity Index, MI), fine manual dexterity (Nine Hole Peg Test, NHPT) and strength (Grip test) were also measured at T0 and T1. Patients performed, over a mean period 56 (49-63) days, a total of 1699 (1353-2045) min/patient of exercise with Gloreha Lite, 5.1 (4.3-5.8) days/week. Seventeen patients (81%) completed the full program. The mean VAS score of hand pain, Ashworth spasticity index and hand edema did not change significantly at T1 compared to T0. The MI, NHPT and Grip test improved significantly (p = 0.0020, 0.0156 and 0.0024, respectively) compared to baseline. Gloreha Lite is feasible and safe for use in home rehabilitation. The efficacy data show a therapeutic effect which need to be confirmed by a randomized controlled study.

Maximizing post-stroke upper limb rehabilitation using a novel telerehabilitation interactive virtual reality system in the patient's home: study protocol of a randomized clinical trial.

PubMed

Kairy, Dahlia; Veras, Mirella; Archambault, Philippe; Hernandez, Alejandro; Higgins, Johanne; Levin, Mindy F; Poissant, Lise; Raz, Amir; Kaizer, Franceen

2016-03-01

Telerehabilitation (TR), or the provision of rehabilitation services from a distance using telecommunication tools such as the Internet, can contribute to ensure that patients receive the best care at the right time. This study aims to assess the effect of an interactive virtual reality (VR) system that allows ongoing rehabilitation of the upper extremity (UE) following a stroke, while the person is in their own home, with offline monitoring and feedback from a therapist at a distance. A single-blind (evaluator is blind to group assignment) two-arm randomized controlled trial is proposed, with participants who have had a stroke and are no longer receiving rehabilitation services randomly allocated to: (1) 4-week written home exercise program, i.e. usual care discharge home program or (2) a 4-week home-based TR exercise program using VR in addition to usual care i.e. treatment group. Motor recovery of the UE will be assessed using the Fugl-Meyer Assessment-UE and the Box and Block tests. To determine the efficacy of the system in terms of functional recovery, the Motor Activity Log, a self-reported measure of UE use will be used. Impact on quality of life will be determined using the Stroke Impact Scale-16. Lastly, a preliminary cost-effectiveness analysis will be conducted using costs and outcomes for all groups. Findings will contribute to evidence regarding the use of TR and VR to provide stroke rehabilitation services from a distance. This approach can enhance continuity of care once patients are discharged from rehabilitation, in order to maximize their recovery beyond the current available services. Copyright © 2015 Elsevier Inc. All rights reserved.

A pilot study of an online cognitive rehabilitation program for executive function skills in children with cancer-related brain injury

PubMed Central

Kesler, Shelli R.; Lacayo, Norman J.; Jo, Booil

2011-01-01

Primary objectives Children with a history of cancer are at increased risk for cognitive impairments, particularly in executive and memory domains. Traditional, in-person cognitive rehabilitation strategies may be unavailable and/or impractical for many of these children given difficulties related to resources and health status. The feasibility and efficacy of implementing a computerized, home-based cognitive rehabilitation curriculum designed to improve executive function skills was examined in these children. Methods A one-arm open trial pilot study of an original executive function cognitive rehabilitation curriculum was conducted with 23 paediatric cancer survivors aged 7–19. Results Compliance with the cognitive rehabilitation program was 83%, similar to that of many traditional programs. Following the cognitive intervention, participants showed significantly increased processing speed, cognitive flexibility, verbal and visual declarative memory scores as well as significantly increased pre-frontal cortex activation compared to baseline. Conclusions These results suggest that a program of computerized cognitive exercises can be successfully implemented at home in young children with cancer. These exercises may be effective for improving executive and memory skills in this group, with concurrent changes in neurobiologic status. PMID:21142826

Promotion of Home-Based Exercise Training as Secondary Prevention of Coronary Heart Disease: A PILOT WEB-BASED INTERVENTION.

PubMed

Torri, Anna; Panzarino, Claudia; Scaglione, Anna; Modica, Maddalena; Bordoni, Bruno; Redaelli, Raffaella; De Maria, Renata; Ferratini, Maurizio

2018-07-01

Although cardiac rehabilitation (CR) is cost- effective in improving the health of patients with coronary heart disease (CHD), less than half of eligible CHD patients attend a CR program. Innovative web-based technologies might improve CR delivery and utilization. We assessed the feasibility and impact on functional capacity and secondary prevention targets of a long-term web-monitored exercise-based CR maintenance program. Low- to moderate-risk CHD patients were recruited at discharge from inpatient CR after a coronary event or revascularization. We developed an interactive web-based platform for secure home individual access control, monitoring, and validation of exercise training. Of 86 eligible patients, 26 consented to participate in the study intervention (IG). Using a quasi-experimental design, we recruited in parallel 27 eligible patients, unavailable for regular web monitoring, who consented to a follow-up visit as usual care (UC). Among IG, active daily data transmission was 100% during month 1, 88% at month 3, and 81% at 6 months, with sustained improvement in self-reported physical activity beginning with the first week after discharge from inpatient CR (2467 [1854-3554] MET-min/wk) to month 3 (3411 [1981-5347] MET-min/wk, P = .019). Both groups showed favorable changes over time in lipid profile, ventricular function, distance walked in 6 min, and quality of life. At 6 mo, IG achieved a significantly higher proportion of cardiovascular risk factor targets than UC (75 ± 20% vs 59 ± 30%, P = .029). Our web-based home CR maintenance program was feasible, well-accepted, and effective in improving physical activity during 6 mo and achieved higher overall adherence to cardiovascular risk targets than UC.

Exercise barriers and the relationship to self-efficacy for exercise over 12 months of a lifestyle-change program for people with heart disease and/or diabetes.

PubMed

Alharbi, Muaddi; Gallagher, Robyn; Neubeck, Lis; Bauman, Adrian; Prebill, Gabrielle; Kirkness, Ann; Randall, Sue

2017-04-01

Barriers to exercise are common in people with coronary heart disease (CHD) and/or diabetes mellitus (DM), and may influence self-efficacy for exercise. The purpose of this study was to describe the exercise barriers experienced by people who have CHD and/or DM participating in the Healthy Eating and Exercise Lifestyle Program and to determine whether these barriers influence self-efficacy. Participants ( n = 134) identified their barriers to exercise and completed the self-efficacy for exercise survey at baseline, at 4 months (following structured and supervised exercise) and at 12 months (following home-based exercise with three follow-up calls). The sample mean age was 63.6 years (SD 8.5) and 58% were male. Barriers to exercise were reported by 88% at baseline, 76% at 4 months, and 47% at 12 months. The most common barriers were lack of motivation (40.3%), lack of time overall (30.6%), and lack of time due to family commitments (17.2%). Only motivation changed significantly over time from baseline (40%) to 4 months (23%, p = 0.040). Lower self-efficacy for exercise was associated with lack of motivation at 12 months only, more depressive symptoms at baseline and 4 months, and a CHD diagnosis and higher body mass index at 12 months. In contrast, male gender and having higher self-efficacy at baseline were associated with higher self-efficacy for exercise at 4 and 12 months. Patients identified many exercise barriers despite participating in a lifestyle-change program. Lack of motivation negatively influenced self-efficacy for exercise at 12 months. Other factors needing attention include baseline self-efficacy, depressive symptoms, being female, being more overweight, and having CHD.

The Yale Fitness Intervention Trial in female cancer survivors: Cardiovascular and physiological outcomes.

PubMed

Knobf, M Tish; Jeon, Sangchoon; Smith, Barbara; Harris, Lyndsay; Thompson, Siobhan; Stacy, Mitchel R; Insogna, Karl; Sinusas, Albert J

Induced premature menopause and cardio-toxic therapy increase cardiovascular disease risk in female cancer survivors. To compare the effects of a 12 month aerobic-resistance fitness center intervention to home based physical activity on cardiovascular function and metabolic risk factors. Subjects (N = 154) who had completed primary and/or adjuvant chemotherapy (past 3 years) were randomized to a fitness center intervention or a home based group. The fitness center intervention was a structured thrice weekly aerobic (30 min brisk walking treadmill in target heart range) combined with resistance (30 min of lower body strength training) exercise program, supervised for the first 6 months. The home based group received national guidelines for 30 min moderate intensity exercise most days of the week. Fasting serum samples were collected at baseline, 6 and 12 months for insulin, glucose, lipids and hemoglobin A-1C. A graded exercise stress test was also performed at baseline and 6 months. The majority of subjects were white (85.7%), had breast cancer (83.1%) and the average age was 51.9 years. Subjects in the fitness center intervention had significantly improved time on treadmill (p = .039), improved heart rate recovery at 1 min (p = .028), greater MET minutes/week (p ≤ .0001), a trend for improved insulin resistance (p = .067) and stable insulin levels (p = .045) compared to the home based physical activity group. Exercise represents a potential cardiac risk reduction intervention for cancer survivors. CLINICAL TRIALS.GOV: NCT01102985. Copyright © 2017. Published by Elsevier Inc.

Effects of online group exercises for older adults on physical, psychological and social wellbeing: a randomized pilot trial.

PubMed

Baez, Marcos; Khaghani Far, Iman; Ibarra, Francisco; Ferron, Michela; Didino, Daniele; Casati, Fabio

2017-01-01

Intervention programs to promote physical activity in older adults, either in group or home settings, have shown equivalent health outcomes but different results when considering adherence. Group-based interventions seem to achieve higher participation in the long-term. However, there are many factors that can make of group exercises a challenging setting for older adults. A major one, due to the heterogeneity of this particular population, is the difference in the level of skills. In this paper we report on the physical, psychological and social wellbeing outcomes of a technology-based intervention that enable online group exercises in older adults with different levels of skills. A total of 37 older adults between 65 and 87 years old followed a personalized exercise program based on the OTAGO program for fall prevention, for a period of eight weeks. Participants could join online group exercises using a tablet-based application. Participants were assigned either to the Control group, representing the traditional individual home-based training program, or the Social group, representing the online group exercising. Pre- and post- measurements were taken to analyze the physical, psychological and social wellbeing outcomes. After the eight-weeks training program there were improvements in both the Social and Control groups in terms of physical outcomes, given the high level of adherence of both groups. Considering the baseline measures, however, the results suggest that while in the Control group fitter individuals tended to adhere more to the training, this was not the case for the Social group, where the initial level had no effect on adherence. For psychological outcomes there were improvements on both groups, regardless of the application used. There was no significant difference between groups in social wellbeing outcomes, both groups seeing a decrease in loneliness despite the presence of social features in the Social group. However, online social interactions have shown to be correlated to the decrease in loneliness in the Social group. The results indicate that technology-supported online group-exercising which conceals individual differences in physical skills is effective in motivating and enabling individuals who are less fit to train as much as fitter individuals. This not only indicates the feasibility of training together despite differences in physical skills but also suggests that online exercise might reduce the effect of skills on adherence in a social context. However, results from this pilot are limited to a small sample size and therefore are not conclusive. Longer term interventions with more participants are instead recommended to assess impacts on wellbeing and behavior change.

A New Measure of Home Exercise Benefits and Barriers

ERIC Educational Resources Information Center

Thind, Herpreet; Fava, Joseph; Traficante, Regina; Bock, Beth C.

2016-01-01

Background: To increase physical activity among college students, new approaches are needed including the exploration of home-based exercise. However, research related to potential facilitators and barriers to exercising at home is limited. Purpose: The goal of this study was to develop a reliable and valid measure that can assess predictors of…

A home-based program using patterned sensory enhancement improves resistance exercise effects for children with cerebral palsy: a randomized controlled trial.

PubMed

Wang, Tze-Hsuan; Peng, Yi-Chun; Chen, Yu-Ling; Lu, Tung-Wu; Liao, Hua-Fang; Tang, Pei-Fang; Shieh, Jeng-Yi

2013-10-01

Neurologic music therapy has demonstrated improved walking performance in persons with neurologic disease; however, little evidence supports the use of music with functional resistance exercise to improve motor capacity and daily functions for children with cerebral palsy. To investigate the effect of additional patterned sensory enhancement (PSE) music combined with exercise for children with spastic diplegia. An assessor-blind, randomized controlled trial with 6- and 12-week follow-ups was carried out. Thirty-six children with spastic diplegia, aged 5 to 13 years, were assigned to a PSE group (n = 18) or a no-music group (n = 18). Both groups received 6-week, home-based, loaded sit-to-stand exercise, but only the PSE group exercised with prerecorded PSE music. The primary outcome was Gross Motor Function Measure (GMFM). Secondary outcomes included Pediatric Evaluation of Disability Inventory (PEDI) mobility and self-care domains, 1-repetition maximum of sit-to-stand, and walking speeds. Three children did not complete the program. Intention-to-treat analysis showed both groups improved in GMFM D, E, and Goal dimensions; Functional Skills Scales of PEDI mobility domain; and 1-repetition maximum of sit-to-stand at posttest and follow-ups (P ≤ .005). The PSE group improved significantly greater than the no-music group in the GMFM D and Goal dimensions (P < .005) after training, and the improvement persisted for at least 6 or 12 weeks (P ≤ .013). No significant improvements in the rest PEDI scales and walking speeds were found. Adding neurologic music therapy to functional resistance exercise could induce greater improvements in gross motor capacity for children with cerebral palsy.

Cost analysis of an exercise program for older women with respect to social welfare and healthcare costs: a pilot study.

PubMed

Timonen, L; Rantanen, T; Mäkinen, E; Timonen, T E; Törmäkangas, T; Sulkava, R

2008-12-01

The aim of this study was to analyze social welfare and healthcare costs and fall-related healthcare costs after a group-based exercise program. The 10-week exercise program, which started after discharge from the hospital, was designed to improve physical fitness, mood, and functional abilities in frail elderly women. Sixty-eight acutely hospitalized and mobility-impaired women (mean age 83.0, SD 3.9 years) were randomized into either group-based (intervention) or home exercise (control) groups. Information on costs was collected during 1 year after hospital discharge. There were no differences between the intervention and control groups in the mean individual healthcare costs: 4381 euros (SD 3829 euros) vs 3539 euros (SD 3967 euros), P=0.477, in the social welfare costs: 3336 euros (SD 4418 euros) vs 4073 euros (SD 5973 euros), P=0.770, or in the fall-related healthcare costs: 996 euros (SD 2612 euros) vs 306 euros (SD 915), P=0.314, respectively. This exercise intervention, which has earlier proved to be effective in improving physical fitness and mood, did not result in any financial savings in municipal costs. These results serve as a pilot study and further studies are needed to establish the cost-effectiveness of this exercise intervention for elderly people.

Does a Nintendo Wii exercise program provide similar exercise demands as a traditional pulmonary rehabilitation program in adults with COPD?

PubMed

LeGear, Tyler; LeGear, Mark; Preradovic, Dejan; Wilson, Geoffrey; Kirkham, Ashley; Camp, Pat G

2016-05-01

The chronic obstructive pulmonary disease (COPD) population can experience lower activity and fitness levels than the non-COPD population. The Nintendo Wii may be an appropriate at-home training device for the COPD population, which could be used as a supplement for a pulmonary rehabilitation program. This study was a randomized, within-subject, cross-over study involving 10 adults with COPD previously enrolled in St Paul's Hospital's pulmonary rehabilitation program. This study attempted to determine if specific Wii activities resulted in similar energy expenditures to that of a more traditional pulmonary rehabilitation activity. Participants completed two 15-min exercise interventions in a single session, with a washout period of 30 min in-between. The interventions were an experimental Wii intervention and a traditional treadmill intervention. There was no significant difference in total energy expenditure between the two 15-min exercise interventions [mean difference 36.3 joules; 95% confidence interval (CI): 31.4, 104]. There was no significant difference in heart rate (mean difference -0.167 beats per minute; 95% CI: -4.83, 4.50), rating of perceived exertion (mean difference 0.100; 95% CI: -0.416, 0.616) and Borg dyspnea scale (mean difference 0.267; 95% CI: -0.004, 0.537) between the two 15-min exercise interventions. There was a significant difference in SpO2 between the two 15-min exercise interventions (Wii intervention mean difference 2.33% > treadmill intervention; 95% CI: 1.52, 3.15). Gaming technology can provide an exercise program that has similar cardiovascular demands to traditional pulmonary rehabilitation programs for patients with COPD. Further research is necessary to address feasibility and long-term adherence. © 2014 John Wiley & Sons Ltd.

Exercise Among Women With Ovarian Cancer: A Feasibility and Pre-/Post-Test Exploratory Pilot Study.

PubMed

Zhang, Xiaochen; McClean, Daniel; Ko, Emily; Morgan, Mark A; Schmitz, Kathryn

2017-05-01

To establish the feasibility and acceptability of completing a higher dose of the planned physical activity volume among women with ovarian cancer, including those undergoing active treatment. 
. A pre-/post-test exercise intervention. All participants were asked to complete 225 minutes per week of physical activity for 26 weeks. Multiple supports were provided, including exercise DVDs, self-reported logs, and an objective physical activity tracker (Fitbit®).
. Home-based exercise intervention with in-person training and telephone follow-ups.
. 10 women with ovarian cancer who were treated within Penn Medicine in Philadelphia, Pennsylvania.
. Home-based, in-person exercise counseling was provided by an exercise trainer weekly for the first six weeks and then monthly for a total of 26 weeks. Weekly follow-up telephone calls were used to assess exercise adherence and barriers to completing exercise, review symptom changes, and provide behavioral support. 
. Feasibility and acceptability.
. Eight participants completed the study and achieved at least 80% of the prescribed exercise dose. Five participants were undergoing chemotherapy simultaneously. Participants experienced no adverse events during the 26-week intervention. Compared to baseline, average steps increased by 1,593 per day and moderate-intensity physical activity increased by 15 minutes per day. 
. A 225-minutes-per-week exercise program is feasible and acceptable in a population of patients with ovarian cancer. Participants significantly improved their physical activity during the 26-week intervention.
. The findings suggest that nursing professionals could recommend that women with ovarian cancer exercise 225 minutes per week regardless of cancer and/or treatment trajectory. For those experiencing aches and pains, behavioral supports and suggestions of a lower exercise dose are needed to maintain physical activity.

TEAMS (Tele-Exercise and Multiple Sclerosis), a Tailored Telerehabilitation mHealth App: Participant-Centered Development and Usability Study

PubMed Central

Rimmer, James H; Johnson, George; Wilroy, Jereme; Young, Hui-Ju; Mehta, Tapan; Lai, Byron

2018-01-01

Background People with multiple sclerosis face varying levels of disability and symptoms, thus requiring highly trained therapists and/or exercise trainers to design personalized exercise programs. However, for people living in geographically isolated communities, access to such trained professionals can be challenging due to a number of barriers associated with cost, access to transportation, and travel distance. Generic mobile health exercise apps often fall short of what people with multiple sclerosis need to become physically active (ie, exercise content that has been adapted to accommodate a wide range of functional limitations). Objective This usability study describes the development process of the TEAMS (Tele-Exercise and Multiple Sclerosis) app, which is being used by people with multiple sclerosis in a large randomized controlled trial to engage in home-based telerehabilitation. Methods Twenty-one participants with disabilities (10 people with multiple sclerosis) were involved in the double iterative design, which included the simultaneous development of the app features and exercise content (exercise videos and articles). Framed within a user-centered design approach, the development process included 2 stages: ground-level creation (focus group followed by early stage evaluations and developments), and proof of concept through 2 usability tests. Usability (effectiveness, usefulness, and satisfaction) was evaluated using a mixed-methods approach. Results During testing of the app’s effectiveness, the second usability test resulted in an average of 1 problem per participant, a decrease of 53% compared to the initial usability test. Five themes were constructed from the qualitative data that related to app usefulness and satisfaction, namely: high perceived confidence for app usability, positive perceptions of exercise videos, viable exercise option at home, orientation and familiarity required for successful participation, and app issues. Participants acknowledged that the final app was ready to be delivered to the public after minor revisions. After including these revisions, the project team released the final app that is being used in the randomized controlled trial. Conclusions A multi-level user-centered development process resulted in the development of an inclusive exercise program for people with multiple sclerosis operated through an easy-to-use app. The promotion of exercise through self-regulated mHealth programs requires a stakeholder-driven approach to app development. This ensures that app and content match the preferences and functional abilities of the end user (ie, people with varying levels of multiple sclerosis). PMID:29798832

TEAMS (Tele-Exercise and Multiple Sclerosis), a Tailored Telerehabilitation mHealth App: Participant-Centered Development and Usability Study.

PubMed

Thirumalai, Mohanraj; Rimmer, James H; Johnson, George; Wilroy, Jereme; Young, Hui-Ju; Mehta, Tapan; Lai, Byron

2018-05-24

People with multiple sclerosis face varying levels of disability and symptoms, thus requiring highly trained therapists and/or exercise trainers to design personalized exercise programs. However, for people living in geographically isolated communities, access to such trained professionals can be challenging due to a number of barriers associated with cost, access to transportation, and travel distance. Generic mobile health exercise apps often fall short of what people with multiple sclerosis need to become physically active (ie, exercise content that has been adapted to accommodate a wide range of functional limitations). This usability study describes the development process of the TEAMS (Tele-Exercise and Multiple Sclerosis) app, which is being used by people with multiple sclerosis in a large randomized controlled trial to engage in home-based telerehabilitation. Twenty-one participants with disabilities (10 people with multiple sclerosis) were involved in the double iterative design, which included the simultaneous development of the app features and exercise content (exercise videos and articles). Framed within a user-centered design approach, the development process included 2 stages: ground-level creation (focus group followed by early stage evaluations and developments), and proof of concept through 2 usability tests. Usability (effectiveness, usefulness, and satisfaction) was evaluated using a mixed-methods approach. During testing of the app's effectiveness, the second usability test resulted in an average of 1 problem per participant, a decrease of 53% compared to the initial usability test. Five themes were constructed from the qualitative data that related to app usefulness and satisfaction, namely: high perceived confidence for app usability, positive perceptions of exercise videos, viable exercise option at home, orientation and familiarity required for successful participation, and app issues. Participants acknowledged that the final app was ready to be delivered to the public after minor revisions. After including these revisions, the project team released the final app that is being used in the randomized controlled trial. A multi-level user-centered development process resulted in the development of an inclusive exercise program for people with multiple sclerosis operated through an easy-to-use app. The promotion of exercise through self-regulated mHealth programs requires a stakeholder-driven approach to app development. This ensures that app and content match the preferences and functional abilities of the end user (ie, people with varying levels of multiple sclerosis). ©Mohanraj Thirumalai, James H Rimmer, George Johnson, Jereme Wilroy, Hui-Ju Young, Tapan Mehta, Byron Lai. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 24.05.2018.

Does a Wii-based exercise program enhance balance control of independently functioning older adults? A systematic review

PubMed Central

Laufer, Yocheved; Dar, Gali; Kodesh, Einat

2014-01-01

Background Exercise programs that challenge an individual’s balance have been shown to reduce the risk of falls among older adults. Virtual reality computer-based technology that provides the user with opportunities to interact with virtual objects is used extensively for entertainment. There is a growing interest in the potential of virtual reality-based interventions for balance training in older adults. This work comprises a systematic review of the literature to determine the effects of intervention programs utilizing the Nintendo Wii console on balance control and functional performance in independently functioning older adults. Methods Studies were obtained by searching the following databases: PubMed, CINAHL, PEDro, EMBASE, SPORTdiscus, and Google Scholar, followed by a hand search of bibliographic references of the included studies. Included were randomized controlled trials written in English in which Nintendo Wii Fit was used to enhance standing balance performance in older adults and compared with an alternative exercise treatment, placebo, or no treatment. Results Seven relevant studies were retrieved. The four studies examining the effect of Wii-based exercise compared with no exercise reported positive effects on at least one outcome measure related to balance performance in older adults. Studies comparing Wii-based training with alternative exercise programs generally indicated that the balance improvements achieved by Wii-based training are comparable with those achieved by other exercise programs. Conclusion The review indicates that Wii-based exercise programs may serve as an alternative to more conventional forms of exercise aimed at improving balance control. However, due to the great variability between studies in terms of the intervention protocols and outcome measures, as well as methodological limitations, definitive recommendations as to optimal treatment protocols and the potential of such an intervention as a safe and effective home-based treatment cannot be made at this point. PMID:25364238

A mobile phone-based care model for outpatient cardiac rehabilitation: the care assessment platform (CAP).

PubMed

Walters, Darren L; Sarela, Antti; Fairfull, Anita; Neighbour, Kylie; Cowen, Cherie; Stephens, Belinda; Sellwood, Tom; Sellwood, Bernadette; Steer, Marie; Aust, Michelle; Francis, Rebecca; Lee, Chi-Keung; Hoffman, Sheridan; Brealey, Gavin; Karunanithi, Mohan

2010-01-28

Cardiac rehabilitation programs offer effective means to prevent recurrence of a cardiac event, but poor uptake of current programs have been reported globally. Home based models are considered as a feasible alternative to avoid various barriers related to care centre based programs. This paper sets out the study design for a clinical trial seeking to test the hypothesis that these programs can be better and more efficiently supported with novel Information and Communication Technologies (ICT). We have integrated mobile phones and web services into a comprehensive home- based care model for outpatient cardiac rehabilitation. Mobile phones with a built-in accelerometer sensor are used to measure physical exercise and WellnessDiary software is used to collect information on patients' physiological risk factors and other health information. Video and teleconferencing are used for mentoring sessions aiming at behavioural modifications through goal setting. The mentors use web-portal to facilitate personal goal setting and to assess the progress of each patient in the program. Educational multimedia content are stored or transferred via messaging systems to the patients phone to be viewed on demand. We have designed a randomised controlled trial to compare the health outcomes and cost efficiency of the proposed model with a traditional community based rehabilitation program. The main outcome measure is adherence to physical exercise guidelines. The study will provide evidence on using mobile phones and web services for mentoring and self management in a home-based care model targeting sustainable behavioural modifications in cardiac rehabilitation patients. The trial has been registered in the Australian New Zealand Clinical Trials Registry (ANZCTR) with number ACTRN12609000251224.

A mobile phone-based care model for outpatient cardiac rehabilitation: the care assessment platform (CAP)

PubMed Central

2010-01-01

Background Cardiac rehabilitation programs offer effective means to prevent recurrence of a cardiac event, but poor uptake of current programs have been reported globally. Home based models are considered as a feasible alternative to avoid various barriers related to care centre based programs. This paper sets out the study design for a clinical trial seeking to test the hypothesis that these programs can be better and more efficiently supported with novel Information and Communication Technologies (ICT). Methods/Design We have integrated mobile phones and web services into a comprehensive home- based care model for outpatient cardiac rehabilitation. Mobile phones with a built-in accelerometer sensor are used to measure physical exercise and WellnessDiary software is used to collect information on patients' physiological risk factors and other health information. Video and teleconferencing are used for mentoring sessions aiming at behavioural modifications through goal setting. The mentors use web-portal to facilitate personal goal setting and to assess the progress of each patient in the program. Educational multimedia content are stored or transferred via messaging systems to the patients phone to be viewed on demand. We have designed a randomised controlled trial to compare the health outcomes and cost efficiency of the proposed model with a traditional community based rehabilitation program. The main outcome measure is adherence to physical exercise guidelines. Discussion The study will provide evidence on using mobile phones and web services for mentoring and self management in a home-based care model targeting sustainable behavioural modifications in cardiac rehabilitation patients. Trial registration The trial has been registered in the Australian New Zealand Clinical Trials Registry (ANZCTR) with number ACTRN12609000251224. PMID:20109196

Older Adults' Perspectives on Home Exercise after Falls Rehabilitation: Understanding the Importance of Promoting Healthy, Active Ageing

ERIC Educational Resources Information Center

Hawley, Helen

2009-01-01

Objective To explore what might encourage older people to exercise at home after falls rehabilitation. Design: Qualitative research methods were used based on a grounded theory approach, to provide insights into older adults' experiences following a fall, of both rehabilitation and home exercise. Setting: Community dwellings. Method: Nine…

Physical therapists' perceptions about patients with incomplete post-traumatic paraplegia adherence to recommended home exercises: a qualitative study.

PubMed

Serpanou, Ismini; Sakellari, Evanthia; Psychogiou, Maria; Zyga, Sofia; Sapountzi-Krepia, Despina

2018-06-08

The overall purpose of physical therapy for patients with spinal cord injury is to improve health-related quality of life. However, poor adherence is a problem in physical therapy and may have negative impact on outcomes. To explore the physical therapists' perspectives about patients with incomplete post-traumatic paraplegia adherence to recommended home exercises. A qualitative content analysis was conducted. Data were collected in a convenience sample using semi-structured interviews. Thirteen registered physical therapists in Athens area participated in the study. Five categories emerged from the data: (1) reasons to recommend home exercise by the physical therapist; (2) obstacles to recommend home exercise by the physical therapist; (3) methods addressing these obstacles; (4) the family's role in the adherence to recommended home exercise; and (5) the impact of financial crisis in adherence to recommended home exercise. All participants found the recommended home exercises essential to rehabilitation and health maintenance, and they value their benefits. They also expressed the obstacles that need to be faced during rehabilitation process in order to promote adherence. Physical therapists should take into account the different obstacles that may prevent patients with incomplete post-traumatic paraplegia adherence to recommended home exercises. These involve the patients and their families, while, financial crisis has also an impact in adherence. In order to overcome these obstacles and increase adherence, communication with patient and family while taking into account the individual's needs, capacities, and resources are essential. Copyright © 2018 Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia. Publicado por Elsevier Editora Ltda. All rights reserved.

Randomized Face-to-Face vs. Home Exercise Interventions in Pregnant Women with Gestational Diabetes

PubMed Central

DOWNS, Danielle Symons; DINALLO, Jennifer M.; BIRCH, Leann L.; PAUL, Ian M.; ULBRECHT, Jan S.

2017-01-01

Objectives Evaluate effects of a theoretically-based, semi-intensive (Face-to-Face; F2F) exercise intervention and minimum-contact (Home) exercise intervention to the standard care (Control) on exercise, its motivational determinants, blood glucose levels, and insulin use of pregnant women with gestational diabetes mellitus (GDM). Design Randomized control trial with two intervention arms and control (standard care). Method Participants (N=65) were randomized to a Control (standard prenatal care/GDM dietary counseling), Home (standard care + phone education/support + home exercise), or F2F (standard care + on-site education/support + guided exercise with instructor on 2 days/week) group from ~20 weeks gestation to delivery. Assessments of exercise and motivational determinants were obtained at baseline (20-weeks gestation) and follow-up (32-weeks gestation). Blood glucose levels (fasting/postprandial mg/dL) and insulin use were extrapolated from medical records. Results At the 32-week follow-up, the F2F group had significantly higher exercise min, pedometer steps/day, and motivational determinants (attitude, subjective norm, perceived control, intention) than controls (p’s < .05) and significantly higher exercise min and subjective norm than the Home group (p’s < .05); these effect sizes were medium-large (η2 = .11–.23). There was a medium effect (η2 = .13) on postprandial blood glucose at 36-weeks gestation with the F2F group having lower values than controls. Although not significant, the F2F group started insulin later (33 weeks gestation) than the Home (27 weeks) and Control (31 weeks) groups. Conclusion A theoretically-based, F2F exercise intervention has multiple health benefits and may be the necessary approach for promoting exercise motivation and behavior among GDM women. PMID:28428728

Randomized Face-to-Face vs. Home Exercise Interventions in Pregnant Women with Gestational Diabetes.

PubMed

Downs, Danielle Symons; Dinallo, Jennifer M; Birch, Leann L; Paul, Ian M; Ulbrecht, Jan S

2017-05-01

Evaluate effects of a theoretically-based, semi-intensive (Face-to-Face; F2F) exercise intervention and minimum-contact (Home) exercise intervention to the standard care (Control) on exercise, its motivational determinants, blood glucose levels, and insulin use of pregnant women with gestational diabetes mellitus (GDM). Randomized control trial with two intervention arms and control (standard care). Participants ( N =65) were randomized to a Control (standard prenatal care/GDM dietary counseling), Home (standard care + phone education/support + home exercise), or F2F (standard care + on-site education/support + guided exercise with instructor on 2 days/week) group from ~20 weeks gestation to delivery. Assessments of exercise and motivational determinants were obtained at baseline (20-weeks gestation) and follow-up (32-weeks gestation). Blood glucose levels (fasting/postprandial mg/dL) and insulin use were extrapolated from medical records. At the 32-week follow-up, the F2F group had significantly higher exercise min, pedometer steps/day, and motivational determinants (attitude, subjective norm, perceived control, intention) than controls ( p 's < .05) and significantly higher exercise min and subjective norm than the Home group ( p 's < .05); these effect sizes were medium-large (η 2 = .11-.23). There was a medium effect (η 2 = .13) on postprandial blood glucose at 36-weeks gestation with the F2F group having lower values than controls. Although not significant, the F2F group started insulin later (33 weeks gestation) than the Home (27 weeks) and Control (31 weeks) groups. A theoretically-based, F2F exercise intervention has multiple health benefits and may be the necessary approach for promoting exercise motivation and behavior among GDM women.

EFFECTS OF DIFFERENT DURATION EXERCISE PROGRAMS IN CHILDREN WITH SEVERE BURNS

PubMed Central

Clayton, Robert P.; Wurzer, Paul; Andersen, Clark R.; Mlcak, Ronald P.; Herndon, David N.; Suman, Oscar E.

2016-01-01

Introduction Burns lead to persistent and detrimental muscle breakdown and weakness. Standard treatment at our institution includes a voluntary 12-week rehabilitative exercise program to limit and reverse the effects of increased muscle catabolism. In the present work, we investigated if different durations of exercise, 6 or 12 weeks, produce comparable improvements in muscle strength, body composition, and cardiopulmonary fitness. Methods We prospectively enrolled and randomized patients with ≥30% total body surface area (TBSA) burned to receive 6- or 12-weeks of exercise rehabilitation. Patients were evaluated for muscle strength, oxygen consumption capacity, and lean body mass at discharge (n = 42) and post exercise. After 6 weeks (n = 18) or 12 weeks (n = 24) of exercise training, leg muscle strength was assessed as peak torque per body weight using a Biodex Isokinetic Dynamometer. Oxygen consumption capacity, measured as peak VO2, was studied using a standard treadmill-based test, and lean body mass was determined using dual-energy X-ray absorptiometry. Results Significant improvements in muscle strength, peak VO2, and lean body mass were seen after 6 weeks of exercise training (p<0.001), with only significant improvements in peak VO2 being seen after 6 weeks more of training. Conclusion These data suggest that a 6-week rehabilitative exercise program is sufficient for improving muscle strength, body composition, and cardiopulmonary fitness in pediatric burn patients. However, continuation of at- or near-home cardiopulmonary training following the 6 weeks of at-hospital rehabilitation may be useful. PMID:27908464

The effects of a nurse-supervised home exercise programme on improving patients' perceptions of the benefits and barriers to exercise: A randomised controlled trial.

PubMed

Tao, Xingjuan; Chow, Susan Ka Yee; Wong, Frances Ky

2017-09-01

To explore the effects of a home exercise programme on patients' perceptions of the barriers and benefits to exercise and adherence to the programme. Great efforts have been made to encourage dialysis patients to participate in rehabilitation regimens. The promotion of exercise in this population is still limited. This was a post hoc analysis of a randomised, two-group parallel study. A total of 113 adult patients recruited from the haemodialysis units were randomised into two groups on a 1:1 ratio. Both groups received in-centre group exercise training weekly for 6 weeks. The intervention group patients were provided with an additional individualised nurse-led home exercise prescription and behavioural support for 12 weeks. The patients' perceptions of the barriers and benefits to exercise, adherence to the home exercise prescription and their exercise level at weeks 6 and 12 were evaluated. There was a significant between-group difference in the score on patient perceptions of the barriers and benefits to exercise, with the intervention group reporting a greater reduction in perceived barriers to exercise. Significant group differences were noted in exercise level upon the completion of the programme, with the intervention group reporting higher such levels. The average adherence rate to the negotiated exercise plans was 78.9%. The intervention group of patients did better at meeting or exceeding the minimum exercise goal than did the control group. Home exercise prescriptions and behavioural support provided by trained nurses are effective at helping patients to remove barriers to engaging in exercise training. Physical exercise in a clinical arena should not be considered the exclusive domain of physical therapists; the team could collaborate with nurses to play a core role in making physical exercise for patients an essential practice of care in a multidisciplinary team. © 2017 John Wiley & Sons Ltd.

The effect of dance on depressive symptoms in nursing home residents.

PubMed

Vankova, Hana; Holmerova, Iva; Machacova, Katerina; Volicer, Ladislav; Veleta, Petr; Celko, Alexander Martin

2014-08-01

To evaluate the effect of a dance-based therapy on depressive symptoms among institutionalized older adults. Randomized controlled trial. Nursing homes. Older adults (60 years or older) permanently living in a nursing home. Exercise Dance for Seniors (EXDASE) Program designed for the use in long-term care settings performed once a week for 60 minutes for 3 months. Baseline measures included sociodemographic characteristics, ability to perform basic as well as instrumental activities of daily living, basic mobility, self-rated health, and cognitive status. Outcome measures were collected before and after the intervention and included assessment of depressive symptoms using the geriatric depression scale (GDS). Comparison of participants with MMSE of 15 or higher showed that GDS scores in the intervention group significantly improved (P = .005), whereas the control group had a trend of further worsening of depressive symptoms (P = .081). GLM analysis documented highly statistically significant effect of dance therapy (P = .001) that was not influenced by controlling for intake of antidepressants and nursing home location. Dance therapy may have decreased depressive symptoms even in participants with MMSE lower than 15 and resulted in more discontinuations and fewer prescriptions of antidepressants in the intervention group than in the control group. This study provides evidence that dance-based exercise can reduce the amount of depressive symptoms in nursing home residents. In general, this form of exercise seems to be very suitable and beneficial for this population. Copyright © 2014 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

Comparison of the Effectiveness of Transcutaneous Electrical Nerve Stimulation and Interferential Therapy on the Upper Trapezius in Myofascial Pain Syndrome: A Randomized Controlled Study.

PubMed

Dissanayaka, Thusharika Dilrukshi; Pallegama, Ranjith Wasantha; Suraweera, Hilari Justus; Johnson, Mark I; Kariyawasam, Anula Padma

2016-09-01

The aim of this study was to compare the effectiveness of transcutaneous electrical nerve stimulation and interferential therapy (IFT) both in combination with hot pack, myofascial release, active range of motion exercise, and a home exercise program on myofascial pain syndrome patients with upper trapezius myofascial trigger point. A total of 105 patients with an upper trapezius myofascial trigger point were recruited to this single-blind randomized controlled trial. Following random allocation of patients to three groups, three therapeutic regimens-control-standard care (hot pack, active range of motion exercises, myofascial release, and a home exercise program with postural advice), transcutaneous electrical nerve stimulation-standard care and IFT-standard care-were administered eight times during 4 wks at regular intervals. Pain intensity and cervical range of motions (cervical extension, lateral flexion to the contralateral side, and rotation to the ipsilateral side) were measured at baseline, immediately after the first treatment, before the eighth treatment, and 1 wk after the eighth treatment. Immediate and short-term improvements were marked in the transcutaneous electrical nerve stimulation group (n = 35) compared with the IFT group (n = 35) and the control group (n = 35) with respect to pain intensity and cervical range of motions (P < 0.05). The IFT group showed significant improvement on these outcome measurements than the control group did (P < 0.05). Transcutaneous electrical nerve stimulation with standard care facilitates recovery better than IFT does in the same combination.

Effectiveness of aquatic therapy in the treatment of fibromyalgia syndrome: a randomized controlled open study.

PubMed

Evcik, Deniz; Yigit, Ilknur; Pusak, Hasan; Kavuncu, Vural

2008-07-01

The aim of this study was to investigate the efficacy of aquatic exercises in fibromyalgia syndrome (FMS). A total of 63 patients were included and allocated to two groups. Group I (n = 33) received an aquatic exercise program and Group II (n = 30) received a home-based exercise program for 60 min, 3x a week, over 5 weeks. Patients were evaluated for pain (visual analogue scale, VAS), number of tender points (NTP), Beck depression inventory (BDI), and functional capacity (fibromyalgia impact questionnaire, FIQ). All assessment parameters were measured at baseline, and at weeks 4, 12, and 24. There were statistically significant differences in FIQ and NTP in both groups at the end and during follow-up (P < 0.05). Group I showed a statistically significant decrease in BDI scores after 4 and 12 weeks (P < 0.05) that remained after 24 weeks (P < 0.001). In Group II, a significant decrease in BDI scores was observed at the end and during follow-up (P < 0.001). Also, a significant improvement was found in VAS at weeks 4 and 12 in both groups (P < 0.001). The average of reduction in pain scores was 40% in Group1 and 21% in Group II. However, this was still significant at week 24 only in the aquatic therapy group. A comparison of the two groups showed no statistically significant difference for FIQ, NTP, and BDI scores except VAS (P < 0.001) Our results showed that both aquatic therapy and home-based exercise programs have beneficial effects on FIQ, BDI, and NTP. In pain management, only aquatic therapy seems to have long-term effects.

Virtual reality rehabilitation as a treatment approach for older women with mixed urinary incontinence: a feasibility study.

PubMed

Elliott, Valérie; de Bruin, Eling D; Dumoulin, Chantale

2015-03-01

Motivated patients are more likely to adhere to treatment resulting in better outcomes. Virtual reality rehabilitation (VRR) is a treatment approach that includes video gaming to enhance motivation and functional training. The study objectives were (1) to evaluate the feasibility of using a combination of pelvic floor muscles (PFM) exercises and VRR (PFM/VRR) to treat mixed urinary incontinence (MUI) in older women, (2) to evaluate the effectiveness of the PFM/VRR program on MUI symptoms, quality of life (QoL), and (3) gather quantitative information regarding patient satisfaction with this new combined training program. Women 65 years and older with at least 2 weekly episodes of MUI were recruited. Participants were evaluated two times before and one time after a 12-week PFM/VRR training program. Feasibility was defined as the participants' rate of participation in and completion of both the PFM/VRR training program and the home exercise. Effectiveness was evaluated through a bladder diary, pad test, symptom and QoL questionnaire, and participant's satisfaction through a questionnaire. Twenty-four women (70.5 ± 3.6 years) participated. The participants complied with the study demands in terms of attendance at the weekly treatment sessions (91%), adherence to home exercise (92%) and completion of the three evaluations (96%). Post-intervention, the frequency and quantity of urine leakage decreased and patient-reported symptoms and QoL improved significantly. Most participants were very satisfied with treatment (91%). A combined PFM/VRR program is an acceptable, efficient, and satisfying functional treatment for older women with MUI and should be explore through further RCTs. © 2014 Wiley Periodicals, Inc.

Integrated low-intensity biofeedback therapy in fecal incontinence: evidence that "good" in-home anal sphincter exercise practice makes perfect.

PubMed

Vasant, D H; Solanki, K; Balakrishnan, S; Radhakrishnan, N V

2017-01-01

Biofeedback therapy (BFT) is an established treatment for fecal incontinence (FI), with access often being restricted to tertiary centers due to resources and the perceived requirement for high-intensity regimes. However, the optimal regime remains unknown. We evaluated outcomes from our low-intensity integrated BFT program in a secondary care center. Outcomes of our BFT service for FI were evaluated retrospectively. Response was defined by ≥50% improvement in FI frequency from baseline or complete continence. Responders were compared to non-responders for factors including symptoms, manometry data, sphincter exercise technique and duration of practice, and the number and frequency of sessions. Where patients dropped out, outcomes and the reason for dropout were obtained retrospectively. Fecal incontinence patients (n=205, median 62 years, 72% female) attended a median (IQR) 3 (2) BFT sessions with 55 (36) days between visits. Overall, 146/205 (71%) responded with 97/205 (47%) achieving continence. Fecal incontinence frequency improved dramatically in completed cases (P=0.000). While non-response was associated with males (P=0.03) and dropout (P=0.000), "good" anal sphincter exercise technique (P=0.008) and longer in-home practice (P=0.007) and more sessions (P=0.04) were associated with response. Dropout rate was 80/205 (39%), with the reason for dropout being obtained in 80%. Despite low-intensity BFT, comparable outcomes to data from tertiary centers were achieved. Our data emphasize the importance of technique and in-home practice of anal sphincter exercises. Customizing BFT intensity based on predictive factors and encouraging in-home practice may optimize outcomes, reduce dropout rates, and rationalize resources. © 2016 John Wiley & Sons Ltd.

In-Home Pulmonary Telerehabilitation for Patients with Chronic Obstructive Pulmonary Disease: A Pre-experimental Study on Effectiveness, Satisfaction, and Adherence.

PubMed

Marquis, Nicole; Larivée, Pierre; Saey, Didier; Dubois, Marie-France; Tousignant, Michel

2015-11-01

Pulmonary rehabilitation (PR) has proven effective in improving exercise tolerance and quality of life in patients with chronic obstructive pulmonary disease (COPD). In Canada, however, there are insufficient rehabilitation services. New strategies such as telerehabilitation must be deployed to increase accessibility. This study aims to investigate the effect of telerehabilitation on exercise tolerance and quality of life and to document patient satisfaction and adherence. Twenty-six patients with moderate to very severe COPD participated in this pre-/postintervention study. They received 15 in-home teletreatment sessions over 8 weeks via videoconference from a service center to their home. Education was provided via self-learning health capsules. Assessments were carried out twice before (T0 and T1; 8 weeks apart) and immediately after the intervention (T2). Primary outcome measures were changes in exercise tolerance (6-min walk test [6MWT] and cycle endurance test [CET]) and quality of life (Chronic Respiratory Questionnaire [CRQ]). There were significant improvements between pre- and postintervention (T2-T1) on the 6MWT (32 m; p<0.001), CET (41 s; p=0.005), and three of four CRQ domains (dyspnea [p<0.001], fatigue [p=0.002], and emotion [p=0.002]). Improvements in the CET and fatigue during the 8-week intervention period were greater than changes over 8 weeks of maturation (T1-T0) (p=0.004 and 0.02, respectively). Participants' satisfaction and adherence rate with telerehabilitation were very high. Using telehealth technology to deliver in-home PR is a feasible and practical solution for patients with moderate to very severe COPD. The telerehabilitation program was associated with beneficial effects on exercise tolerance and quality of life and was well received by users.

Balance improvement after physical therapy training using specially developed serious games for cerebral palsy children: preliminary results.

PubMed

Bonnechère, Bruno; Omelina, Lubos; Jansen, Bart; Van Sint Jan, Serge

2017-02-01

Cerebral palsy (CP) leads to various clinical signs mainly induced by muscle spasticity and muscle weakness. Among these ones impaired balance and posture are very common. Traditional physical therapy exercise programs are focusing on this aspect, but it is difficult to motivate patients to regularly perform these exercises, especially at home without therapist supervision. Specially developed serious games (SG) could therefore be an interesting option to motivate children to perform specific exercise for balance improvement. Ten CP children participated in this study. Patients received four sessions of SG included into conventional therapy (1 session of 30 min a week during 4 weeks). Trunk control and balance were assessed using Trunk Control Motor Scale (TCMS) before and after interventions. Children presented a significant improvement in TCMS global score after interventions [37.6 (8.7) and 39.6 (9.5) before and after interventions, respectively, p = 0.04]. SG could therefore be an interesting option to integrate in the conventional treatment of CP children. Implication for Rehabilitation Cerebral palsy (CP) leads to balance issues. Rehabilitation exercises are not performed (enough) at home. Serious games (SG) could increase patients' motivation. SG increase balance control of CP children.

The majority are not performing home-exercises correctly two weeks after their initial instruction-an assessor-blinded study.

PubMed

Faber, Mathilde; Andersen, Malene H; Sevel, Claus; Thorborg, Kristian; Bandholm, Thomas; Rathleff, Michael

2015-01-01

Introduction. Time-under-tension (TUT) reflects time under load during strength training and is a proxy of the total exercise dose during strength training. The purpose of this study was to investigate if young participants are able to reproduce TUT and exercise form after two weeks of unsupervised exercises. Material and Methods. The study was an assessor-blinded intervention study with 29 participants. After an initial instruction, all participants were instructed to perform two weeks of home-based unsupervised shoulder abduction exercises three times per week with an elastic exercise band. The participants were instructed in performing an exercise with a predefined TUT (3 s concentric; 2 s isometric; 3 s eccentric; 2 s break) corresponding to a total of 240 s of TUT during three sets of 10 repetitions. After completing two weeks of unsupervised home exercises, they returned for a follow-up assessment of TUT and exercise form while performing the shoulder abduction exercise. A stretch sensor attached to the elastic band was used to measure TUT at baseline and follow-up. A physiotherapist used a pre-defined clinical observation protocol to determine if participants used the correct exercise form. Results. Fourteen of the 29 participants trained with the instructed TUT at follow-up (predefined target: 240 s ±8%). Thirteen of the 29 participants performed the shoulder abduction exercise with a correct exercise form. Seven of the 29 participants trained with the instructed TUT and exercise form at follow-up. Conclusion. The majority of participants did not use the instructed TUT and exercise form at follow-up after two weeks of unsupervised exercises. These findings emphasize the importance of clear and specific home exercise instructions if participants are to follow the given exercise prescription regarding TUT and exercise form as too many or too few exercise stimuli in relation to the initially prescribed amount of exercise most likely will provide a misinterpretation of the actual effect of any given specific home exercise intervention.

Effects of the Pulmonary Hypertension Manual (PulHMan) on Awareness of Exercise in Patients with Pulmonary Hypertension.

PubMed

Babu, Abraham Samuel; Ramachandran, Padmakumar; Maiya, Arun G

2016-01-01

Patient education is an important part of holistic care for patients with chronic diseases. With the success of the Heart Manual, it was felt there is a strong need to develop such a manual for those with pulmonary hypertension (PH) - the Pulmonary Hypertension Manual (PulHMan). This was developed through a qualitative methodology in order to ensure the needs of the patients were being met. The impact of the PulHMan on awareness about exercise-related benefits and PH are not known. Therefore the aim of this study was to assess the effects of the PulHMan on improving awareness among individuals with PH. A repeat cross sectional study was carried out on 30 patients with PH to assess the effects of using the PulHMan on awareness of exercise-related benefits in PH. Awareness was assessed from a self-developed and validated questionnaire that included components of PH and exercise related components. Thirty patients with PH (mean right ventricular systolic pressure and six minute walk distance of 89.2±4.1mm Hg and 322.8±102m respectively) were included in the study. At baseline, it was seen that there was a low awareness regarding the benefits of exercise for PH. However, they were aware of the general health benefits of walking. After three months, it was seen that the PulHMan improved awareness on the benefits of exercising. Despite a low number willing to exercise (2/30) and participate in a home-based program (2/30), after using the PulHMan for three months, there was an improvement in those willing to exercise and participate in a home-based program (22/30 and 25/30 respectively). The PulHMan was seen to improve awareness regarding the exercise-related benefits among patients with PH. More studies are needed to determine if this change in awareness translates into a behavioural change for those with PH. Copyright © 2015 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

Is exercise effective for the management of neck pain and associated disorders or whiplash-associated disorders? A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration.

PubMed

Southerst, Danielle; Nordin, Margareta C; Côté, Pierre; Shearer, Heather M; Varatharajan, Sharanya; Yu, Hainan; Wong, Jessica J; Sutton, Deborah A; Randhawa, Kristi A; van der Velde, Gabrielle M; Mior, Silvano A; Carroll, Linda J; Jacobs, Craig L; Taylor-Vaisey, Anne L

2016-12-01

In 2008, the Neck Pain Task Force (NPTF) recommended exercise for the management of neck pain and whiplash-associated disorders (WAD). However, no evidence was available on the effectiveness of exercise for Grade III neck pain or WAD. Moreover, limited evidence was available to contrast the effectiveness of various types of exercises. To update the findings of the NPTF on the effectiveness of exercise for the management of neck pain and WAD grades I to III. Systematic review and best evidence synthesis. Studies comparing the effectiveness of exercise to other conservative interventions or no intervention. Outcomes of interest included self-rated recovery, functional recovery, pain intensity, health-related quality of life, psychological outcomes, and/or adverse events. We searched eight electronic databases from 2000 to 2013. Eligible studies were critically appraised using the Scottish Intercollegiate Guidelines Network criteria. The results of scientifically admissible studies were synthesized following best-evidence synthesis principles. We retrieved 4,761 articles, and 21 randomized controlled trials (RCTs) were critically appraised. Ten RCTs were scientifically admissible: nine investigated neck pain and one addressed WAD. For the management of recent neck pain Grade I/II, unsupervised range-of-motion exercises, nonsteroidal anti-inflammatory drugs and acetaminophen, or manual therapy lead to similar outcomes. For recent neck pain Grade III, supervised graded strengthening is more effective than advice but leads to similar short-term outcomes as a cervical collar. For persistent neck pain and WAD Grade I/II, supervised qigong and combined strengthening, range-of-motion, and flexibility exercises are more effective than wait list. Additionally, supervised Iyengar yoga is more effective than home exercise. Finally, supervised high-dose strengthening is not superior to home exercises or advice. We found evidence that supervised qigong, Iyengar yoga, and combined programs including strengthening, range of motion, and flexibility are effective for the management of persistent neck pain. We did not find evidence that one supervised exercise program is superior to another. Overall, most studies reported small effect sizes suggesting that a small clinical effect can be expected with the use of exercise alone. Copyright © 2014 Elsevier Inc. All rights reserved.

Predictors of parents' adherence to home exercise programs for children with developmental disabilities, regarding both exercise frequency and duration: a survey design.

PubMed

Medina-Mirapeix, Francesc; Lillo-Navarro, Carmen; Montilla-Herrador, Joaquina; Gacto-Sánchez, Mariano; Franco-Sierra, María Á; Escolar-Reina, Pilar

2017-08-01

Many families have problems adhering to home exercise programs (HEP) for children with developmental disabilities. However, parental participation in HEP is known to have a positive effect on child-related outcome variables, as well as on parental functioning. This study examined whether the different behaviours of health professionals, and the behaviour and social characteristics of parents determine rates of parental adherence to both the frequency per week, and duration per session, of HEP for children with developmental disabilities attending paediatric services in early intervention centres. In this study, developmental disabilities include those caused by developmental delay or specific health conditions such as cerebral palsy, congenital illness, or others. Survey. Eighteen early intervention centers. Parents of children with developmental disabilities receiving HEP. A self-reported questionnaire was used to examine: whether frequency and duration of weekly exercise sessions was prescribed by physiotherapists; whether the child had received the HEP according to what was prescribed; and items related to the individual, social support, illnesses and the involvement of the health professional. Multiple logistic regression analyses examined their relative relevance. In this study 219 parents participated. The rate of adherence to the prescribed frequency and duration of the HEP was similar (61.4-57.2%). The probability of adherence to both components increased for parents who had a low perception of the existence of barriers for integrating the exercises into their daily routine (OR=2.62 and 4.83). Furthermore, other cognitive factors of parents had a variable influence. The involvement of the professional had a significant impact regarding the frequency of the HEP. Professional involvement increased the probability of exercises being followed accurately by adopting strategies such as: providing information about the progress and evolution of the exercises (OR=3.75); justifying their usefulness (OR=2.17); giving advice on how to include them into the daily routine (OR=2.54); checking skills during follow-up (OR=2.21) and asking about home adherence (OR=2.20). Providing information during clinical encounters, advising how to include exercises into the daily routine, and checking skills and adherence during follow-up represent practical targets for clinicians aiming to improve the frequency of HEP for children with developmental disabilities. This study contributes to the knowledge of physicians and therapists regarding how their interventions (in particular, information, instructions for HEP and follow-up) influence parents regarding their adherence to HEP.

Virtual reality exercise on a home-based phase III cardiac rehabilitation program, effect on executive function, quality of life and depression, anxiety and stress: a randomized controlled trial.

PubMed

Vieira, Ágata; Melo, Cristina; Machado, Jorge; Gabriel, Joaquim

2018-02-01

To analyse the effect of a six-month home-based phase III cardiac rehabilitation (CR) specific exercise program, performed in a virtual reality (Kinect) or conventional (booklet) environment, on executive function, quality of life and depression, anxiety and stress of subjects with coronary artery disease. A randomized controlled trial was conducted with subjects, who had completed phase II, randomly assigned to intervention group 1 (IG1), whose program encompassed the use of Kinect (n = 11); or intervention group 2 (IG2), a paper booklet (n = 11); or a control group (CG), only subjected to the usual care (n = 11). The three groups received education on cardiovascular risk factors. The assessed parameters, at baseline (M0), 3 (M1) and 6 months (M2), were executive function, control and integration in the implementation of an adequate behaviour in relation to a certain objective, specifically the ability to switch information (Trail Making Test), working memory (Verbal Digit Span test), and selective attention and conflict resolution ability (Stroop test), quality of life (MacNew questionnaire) and depression, anxiety and stress (Depression, Anxiety and Stress Scale 21). Descriptive and inferential statistical measures were used, significance level was set at .05. The IG1 revealed significant improvements, in the selective attention and conflict resolution ability, in comparison with the CG in the variable difference M0 - M2 (p = .021) and in comparison with the IG2 in the variable difference M1 - M2 and M0 - M2 (p = .001 and p = .002, respectively). No significant differences were found in the quality of life, and depression, anxiety and stress. The virtual reality format had improved selective attention and conflict resolution ability, revealing the potential of CR, specifically with virtual reality exercise, on executive function. Implications for Rehabilitation In cardiac rehabilitation, especially in phase III, it is important to develop and to present alternative strategies, as virtual reality using the Kinect in a home context. Taking into account the relationship between the improvement of the executive function with physical exercise, it is relevant to access the impact of a cardiac rehabilitation program on the executive function. Enhancing the value of the phase III of cardiac rehabilitation.

Manual physical therapy and exercise versus supervised home exercise in the management of patients with inversion ankle sprain: a multicenter randomized clinical trial.

PubMed

Cleland, Joshua A; Mintken, Paul E; McDevitt, Amy; Bieniek, Melanie L; Carpenter, Kristin J; Kulp, Katherine; Whitman, Julie M

2013-01-01

Randomized clinical trial. To compare the effectiveness of manual therapy and exercise (MTEX) to a home exercise program (HEP) in the management of individuals with an inversion ankle sprain. An in-clinic exercise program has been found to yield similar outcomes as an HEP for individuals with an inversion ankle sprain. However, no studies have compared an MTEX approach to an HEP. Patients with an inversion ankle sprain completed the Foot and Ankle Ability Measure (FAAM) activities of daily living subscale, the FAAM sports subscale, the Lower Extremity Functional Scale, and the numeric pain rating scale. Patients were randomly assigned to either an MTEX or an HEP treatment group. Outcomes were collected at baseline, 4 weeks, and 6 months. The primary aim (effects of treatment on pain and disability) was examined with a mixed-model analysis of variance. The hypothesis of interest was the 2-way interaction (group by time). Seventy-four patients (mean ± SD age, 35.1 ± 11.0 years; 48.6% female) were randomized into the MTEX group (n = 37) or the HEP group (n = 37). The overall group-by-time interaction for the mixed-model analysis of variance was statistically significant for the FAAM activities of daily living subscale (P<.001), FAAM sports subscale (P<.001), Lower Extremity Functional Scale (P<.001), and pain (P ≤.001). Improvements in all functional outcome measures and pain were significantly greater at both the 4-week and 6-month follow-up periods in favor of the MTEX group. The results suggest that an MTEX approach is superior to an HEP in the treatment of inversion ankle sprains. Registered at clinicaltrials.gov (NCT00797368). Therapy, level 1b-.

Functional measures show improvements after a home exercise program following supervised balance training in older adults with elevated fall risk.

PubMed

Tisher, Kristen; Mann, Kimberly; VanDyke, Sarah; Johansson, Charity; Vallabhajosula, Srikant

2018-03-05

Supervised balance training shows immediate benefit for older adults at fall risk. The long-term effectiveness of such training can be enhanced by implementing a safe and simple home exercise program (HEP). We investigated the effects of a12-week unsupervised HEP following supervised clinic-based balance training on functional mobility, balance, fall risk, and gait. Six older adults with an elevated fall risk obtained an HEP and comprised the HEP group (HEPG) and five older adults who were not given an HEP comprised the no HEP group (NoHEPG). The HEP consisted of three static balance exercises: feet-together, single-leg stance, and tandem. Each exercise was to be performed twice for 30-60 s, once per day, 3 days per week for 12 weeks. Participants were educated on proper form, safety, and progression of exercises. Pre- and post-HEP testing included Berg Balance Scale (BBS), Timed Up and Go, Short Physical Performance Battery (SPPB) assessments, Activities-Balance Confidence, Late-Life Functional Disability Instrument and instrumented assessments of balance and gait (Limits of Stability, modified Clinical Test of Sensory Interaction on Balance, Gait). A healthy control group (HCG; n = 11) was also tested. For most of the measures, the HEPG improved to the level of HCG. Though task-specific improvements like BBS and SPPB components were seen, the results did not carry over to more dynamic assessments. Results provide proof of concept that a simple HEP can be independently implemented and effective for sustaining and/or improving balance in older adults at elevated fall-risk after they have undergone a clinic-based balance intervention.

The effects of a family fitness program on the physical activity and nutrition behaviors of third-grade children.

PubMed

Hopper, Chris A; Munoz, Kathy D; Gruber, Mary B; Nguyen, Kim P

2005-06-01

This study examined the efficacy of a school-based exercise and nutrition program with a parent component. Third-grade children (N = 238) from six elementary schools participated in the study, with three schools randomly assigned to a program group and the other three schools to a control group. The program group received a health-related fitness school-based program and a home program that required parents and children to complete activities and earn points for nutrition and exercise activities. The control group received their traditional physical education and nutrition education program. Univariate analysis of variance on pre- and posttest scores were completed on the following variables: height, weight, body mass index, skinfold, blood cholesterol, mile run, exercise and nutrition knowledge, calories, protein, carbohydrates, total fat, saturated fat, dietary cholesterol, fiber, sodium, percentage of calories from carbohydrates, and percentage of calories from fat. At pretest, the treatment and control groups did not significantly differ on the measures using schools as the unit of analysis. Girls scored significantly higher than boys on skinfold and pretest knowledge. At posttest, the treatment group scored significantly higher than the control group on exercise and nutrition knowledge and significantly lower than the control group on total fat intake, using schools as the unit of analysis. There was no improvement in physiological measures, including blood cholesterol. The study demonstrated that schools can adjust curriculum to meet some health needs of students and achieve modest changes in exercise and nutrition knowledge and diet. The family component of the program provided a practical approach to improving physical activity and nutrition behaviors for elementary school teachers who teach many participants in a crowded curriculum.

Effects of online group exercises for older adults on physical, psychological and social wellbeing: a randomized pilot trial

PubMed Central

Khaghani Far, Iman; Ibarra, Francisco; Ferron, Michela; Didino, Daniele; Casati, Fabio

2017-01-01

Background Intervention programs to promote physical activity in older adults, either in group or home settings, have shown equivalent health outcomes but different results when considering adherence. Group-based interventions seem to achieve higher participation in the long-term. However, there are many factors that can make of group exercises a challenging setting for older adults. A major one, due to the heterogeneity of this particular population, is the difference in the level of skills. In this paper we report on the physical, psychological and social wellbeing outcomes of a technology-based intervention that enable online group exercises in older adults with different levels of skills. Methods A total of 37 older adults between 65 and 87 years old followed a personalized exercise program based on the OTAGO program for fall prevention, for a period of eight weeks. Participants could join online group exercises using a tablet-based application. Participants were assigned either to the Control group, representing the traditional individual home-based training program, or the Social group, representing the online group exercising. Pre- and post- measurements were taken to analyze the physical, psychological and social wellbeing outcomes. Results After the eight-weeks training program there were improvements in both the Social and Control groups in terms of physical outcomes, given the high level of adherence of both groups. Considering the baseline measures, however, the results suggest that while in the Control group fitter individuals tended to adhere more to the training, this was not the case for the Social group, where the initial level had no effect on adherence. For psychological outcomes there were improvements on both groups, regardless of the application used. There was no significant difference between groups in social wellbeing outcomes, both groups seeing a decrease in loneliness despite the presence of social features in the Social group. However, online social interactions have shown to be correlated to the decrease in loneliness in the Social group. Conclusion The results indicate that technology-supported online group-exercising which conceals individual differences in physical skills is effective in motivating and enabling individuals who are less fit to train as much as fitter individuals. This not only indicates the feasibility of training together despite differences in physical skills but also suggests that online exercise might reduce the effect of skills on adherence in a social context. However, results from this pilot are limited to a small sample size and therefore are not conclusive. Longer term interventions with more participants are instead recommended to assess impacts on wellbeing and behavior change. PMID:28392983

Effectiveness of ultrasound-guided injections combined with shoulder exercises in the treatment of subacromial adhesive bursitis.

PubMed

Gasparre, Giuseppe; Fusaro, Isabella; Galletti, Stefano; Volini, Silvia; Benedetti, Maria Grazia

2012-05-01

The aim of this study was to evaluate whether the association of exercises for the shoulder with ultrasound-guided injection into the bursa significantly improves the treatment outcome in adhesive bursitis. Two groups of 35 patients, one treated with ultrasound-guided injection (UGI) and the other one with ultrasound-guided injection and home exercise program (UGI-exercise) for 1 month, were assessed for pain and shoulder function before treatment, 1 and 3 months post-treatment. Fourteen patients in UGI group and 23 patients in the UGI-exercises group were completely free of pain after 1 month (p = 0.031). At 3 months' follow-up, patients in the UGI-exercise group showed a significant improvement with respect to the other group (p = 0.005). No differences were found in function assessment. The UGI combined with shoulder exercises in the treatment of subacromial adhesive bursitis is effective to ensure a more frequent complete pain relief in the medium term.

Factors affecting pain relief in response to physical exercise interventions among healthcare workers.

PubMed

Jakobsen, M D; Sundstrup, E; Brandt, M; Andersen, L L

2017-12-01

The aim of this study is to identify factors associated with musculo-skeletal pain reduction during workplace-based or home-based physical exercise interventions among healthcare workers. Two hundred female healthcare workers (age: 42.0, BMI: 24.1, average pain intensity: 3.1 on a scale of 0-10) from three hospitals participated. Participants were randomly allocated at the cluster level (18 departments) to 10 weeks of (i) workplace physical exercise (WORK) performed in groups during working hours for 5 × 10 minutes per week and up to five group-based coaching sessions on motivation for regular physical exercise, or (ii) home-based physical exercise (HOME) performed alone during leisure-time for 5 × 10 minutes per week. Linear mixed models accounting for cluster identified factors affecting pain reduction. On average 2.2 (SD: 1.1) and 1.0 (SD: 1.2) training sessions were performed per week in WORK and HOME, respectively. The multi-adjusted analysis showed a significant effect on pain reduction of both training adherence (P=.04) and intervention group (P=.04) with participants in WORK experiencing greater reductions compared with HOME. Obesity at baseline was associated with better outcome. Leisure-time exercise, daily patient transfer, age, and chronic pain did not affect the changes in pain. In conclusion, even when adjusted for training adherence, performing physical exercise at the workplace is more effective than home-based exercise in reducing musculo-skeletal pain in healthcare workers. Noteworthy, obese individuals may especially benefit from physical exercise interventions targeting musculo-skeletal pain. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Effectiveness of a 6-month home-based training program in Prader-Willi patients.

PubMed

Vismara, Luca; Cimolin, Veronica; Grugni, Graziano; Galli, Manuela; Parisio, Cinzia; Sibilia, Olivia; Capodaglio, Paolo

2010-01-01

In addition to hypotonia and relative sarcopenia, patients with Prader-Willi syndrome (PWS) show reduced spontaneous physical activity and gait disorders. Scant evidence exists that daily muscle training increases their lean mass and physical activity levels. Whether adequate long-term physical training is feasible and effective in improving muscle function and gait in PWS is still unknown. Eleven adult PWS patients (mean age: 33.8±4.3 years; mean BMI: 43.3±5.9 kg/m(2)) admitted to our hospital were enrolled in this study. During their hospital stay they attended a 2-week rehabilitation program which included supervised exercise sessions. At discharge, Group 1 (6 patients) continued the same exercises at home for 6 months, while Group 2 (5 patients) did not continue home-based training. They were assessed at admission (PRE), at 2 weeks (POST1) and at 6 months (POST2). The assessment consisted of a clinical examination, 3D gait analysis and muscle strength measurement with an isokinetic dynamometer. After 2 weeks of supervised training (POST1), no significant changes in spatial-temporal gait parameters were observed, although significant improvements in ankle dorsal flexion during stance and swing and knee flexor strength were evidenced by 3D gait analysis and dynamometry in all patients. Following 6 months of home training (POST2), Group 1 had showed significant improvements in cadence and reduced knee hyperextension in mid-stance. Ankle plantar and dorsal flexors isokinetic strength had improved significantly at 120° s(-1), whereas Group 2 showed no changes in their spatial-temporal and kinematic parameters. The present study reinforces the idea that even in participants with PWS who present with a distinctive psychological profile, long-term group interventions are feasible and effective in improving their overall physical functioning. Providing an effective and simple home-based training program represents a continuum of the rehabilitation process outside the hospital, which is a crucial issue in chronic conditions. Copyright © 2010 Elsevier Ltd. All rights reserved.

Effects of different duration exercise programs in children with severe burns.

PubMed

Clayton, Robert P; Wurzer, Paul; Andersen, Clark R; Mlcak, Ronald P; Herndon, David N; Suman, Oscar E

2017-06-01

Burns lead to persistent and detrimental muscle breakdown and weakness. Standard treatment at our institution includes a voluntary 12-week rehabilitative exercise program to limit and reverse the effects of increased muscle catabolism. In the present work, we investigated if different durations of exercise, 6 or 12 weeks, produce comparable improvements in muscle strength, body composition, and cardiopulmonary fitness. We prospectively enrolled and randomized patients with ≥30% total body surface area (TBSA) burned to receive 6 or 12 weeks of exercise rehabilitation. Patients were evaluated for muscle strength, oxygen consumption capacity, and lean body mass at discharge (n=42) and after exercise. After 6 weeks (n=18) or 12 weeks (n=24) of exercise training, leg muscle strength was assessed as peak torque per body weight using a Biodex isokinetic dynamometer. Oxygen consumption capacity, measured as peak VO 2 , was studied using a standard treadmill-based test, and lean body mass was determined using dual-energy X-ray absorptiometry. Significant improvements in muscle strength, peak VO 2 , and lean body mass were seen after 6 weeks of exercise training (p<0.001), with only significant improvements in peak VO 2 being seen after 6 weeks more of training. These data suggest that a 6-week rehabilitative exercise program is sufficient for improving muscle strength, body composition, and cardiopulmonary fitness in pediatric burn patients. However, continuation of at- or near-home cardiopulmonary training following the 6 weeks of at-hospital rehabilitation may be useful. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

Dual-energy x-ray absorptiometry to measure the effects of a thirteen-week moderate to vigorous aquatic exercise and nutritional education intervention on percent body fat in adults with intellectual disabilities from group home settings.

PubMed

Casey, Amanda; Boyd, Colin; Mackenzie, Sasho; Rasmussen, Roy

2012-05-01

People with intellectual disability are more likely to be obese and extremely obese than people without intellectual disability with rates remaining elevated among adults, women and individuals living in community settings. Dual-energy X-ray absorptiometry measured the effects of a 13-week aquatic exercise and nutrition intervention on percent body fat in eight adults with intellectual disabilities (aged 41.0 ± 13.7 yrs) of varying fat levels (15%-39%) from two group homes. A moderate to vigorous aquatic exercise program lasted for the duration of 13 weeks with three, one-hour sessions held at a 25m pool each week. Nutritional assistants educated participants as to the importance of food choice and portion size. A two-tailed Wilcoxon matched-pairs signed-ranks test determined the impact of the combined intervention on body fat percentage and BMI at pre and post test. Median body fat percentage (0.8 %) and BMI (0.3 kg/m(2)) decreased following the exercise intervention, but neither were statistically significant, p = .11 and p = .55, respectively. The combined intervention was ineffective at reducing percent body fat in adults with intellectual disability according to dual-energy X-ray absorptiometry. These results are in agreement with findings from exercise alone interventions and suggest that more stringent nutritional guidelines are needed for this population and especially for individuals living in group home settings. The study did show that adults with intellectual disability may participate in moderate to vigorous physical activity when given the opportunity.

Comparison of the effects of virtual reality-based balance exercises and conventional exercises on balance and fall risk in older adults living in nursing homes in Turkey.

PubMed

Yeşilyaprak, Sevgi Sevi; Yıldırım, Meriç Şenduran; Tomruk, Murat; Ertekin, Özge; Algun, Z Candan

2016-01-01

There is limited information on effective balance training techniques including virtual reality (VR)-based balance exercises in residential settings and no studies have been designed to compare the effects of VR-based balance exercises with conventional balance exercises in older adults living in nursing homes in Turkey. The objective of our study was to investigate the effects of VR-based balance exercises on balance and fall risk in comparison to conventional balance exercises in older adults living in nursing homes. A total sample of 18 subjects (65-82 years of age) with fall history who were randomly assigned to either the VR group (Group 1, n = 7) or the conventional exercise group (Group 2, n = 11) completed the exercise training. In both groups, Berg balance score (BBS), timed up & go duration, and left leg stance and tandem stance duration with eyes closed significantly improved with time (p < 0.05), but changes were similar in both groups (p > 0.05) after training, indicating that neither the exercise method was superior. Similar improvements were found in balance and fall risk with VR-based balance training and conventional balance training in older adults living in the nursing home. Both exercise trainings can be preferable by health care professionals considering fall prevention. Appropriate patient selection is essential.

Assessment of virtual reality robotic simulation performance by urology resident trainees.

PubMed

Ruparel, Raaj K; Taylor, Abby S; Patel, Janil; Patel, Vipul R; Heckman, Michael G; Rawal, Bhupendra; Leveillee, Raymond J; Thiel, David D

2014-01-01

To examine resident performance on the Mimic dV-Trainer (MdVT; Mimic Technologies, Inc., Seattle, WA) for correlation with resident trainee level (postgraduate year [PGY]), console experience (CE), and simulator exposure in their training program to assess for internal bias with the simulator. Residents from programs of the Southeastern Section of the American Urologic Association participated. Each resident was scored on 4 simulator tasks (peg board, camera targeting, energy dissection [ED], and needle targeting) with 3 different outcomes (final score, economy of motion score, and time to complete exercise) measured for each task. These scores were evaluated for association with PGY, CE, and simulator exposure. Robotic skills training laboratory. A total of 27 residents from 14 programs of the Southeastern Section of the American Urologic Association participated. Time to complete the ED exercise was significantly shorter for residents who had logged live robotic console compared with those who had not (p = 0.003). There were no other associations with live robotic console time that approached significance (all p ≥ 0.21). The only measure that was significantly associated with PGY was time to complete ED exercise (p = 0.009). No associations with previous utilization of a robotic simulator in the resident's home training program were statistically significant. The ED exercise on the MdVT is most associated with CE and PGY compared with other exercises. Exposure of trainees to the MdVT in training programs does not appear to alter performance scores compared with trainees who do not have the simulator. © 2013 Published by Association of Program Directors in Surgery on behalf of Association of Program Directors in Surgery.

Fall Preventive Exercise With or Without Behavior Change Support for Community-Dwelling Older Adults: A Randomized Controlled Trial With Short-Term Follow-up.

PubMed

Arkkukangas, Marina; Söderlund, Anne; Eriksson, Staffan; Johansson, Ann-Christin

2017-02-27

In Western countries, falls and fall-related injuries are a well-known threat to health in the aging population. Studies indicate that regular exercise improves strength and balance and can therefore decrease the incidence of falls and fall-related injuries. The challenge, however, is to provide exercise programs that are safe, effective, and attractive to the older population. The aim of this study was to investigate the short-term effect of a home-based exercise program with or without motivational interviewing (MI) compared with standard care on physical performance, fall self-efficacy, balance, activity level, handgrip strength, adherence to the exercise, and fall frequency. A total of 175 older adults participated in this randomized controlled study. They were randomly allocated for the Otago Exercise Program (OEP) (n = 61), OEP combined with MI (n = 58), or a control group (n = 56). The participants' mean age was 83 years. The recruitment period was from October 2012 to May 2015. Measurements of physical performance, fall self-efficacy, balance, activity level, handgrip strength, adherence to the exercise, and fall frequency were done before and 12 weeks after randomization. A total of 161 participants were followed up, and there were no significant differences between groups after a period of 12 weeks of regular exercise. Within the OEP + MI group, physical performance, fall self-efficacy, physical activity level, and handgrip strength improved significantly; likewise, improved physical performance and fall self-efficacy were found in the control group. A corresponding difference did not occur in the OEP group. Adherence to the exercise was generally high in both exercise groups. In the short-term perspective, there were no benefits of an exercise program with or without MI regarding physical performance, fall self-efficacy, activity level, handgrip strength, adherence to the exercise, and fall frequency in comparison to a control group. However, some small effects occurred within the OEP + MI group, indicating that there may be some possible value in behavioral change support combined with exercise in older adults that requires further evaluation in both short- and long-term studies.

Does self-efficacy mediate functional change in older adults participating in an exercise program after hip fracture? A randomized control trial

PubMed Central

Latham, Nancy K.; Ni, Pengsheng; Jette, Alan M.

2015-01-01

Objectives This study examined whether self-efficacy mediated the effect of the HIP Rehab exercise program on activity limitations in older adults after hip fracture, and whether the mediation effect was different between different gender and age groups. Design Randomized controlled trial (RCT) Setting Community Participants Two hundred and thirty two participants aged 79±9.4 years with hip fracture were randomly assigned to intervention (n=120) or attention control (n=112) groups. Interventions The 6-month intervention, the HIP Rehab, is a functionally-oriented, home-based exercise program. Data was collected at baseline, post-intervention (6 months), and follow-up (9 months). Main outcome measure Activity Measure for Post-Acute Care (AM-PAC) Results The mediation effect of the HIP Rehab exercise program on Basic Mobility function through self-efficacy for exercise was significant at 9 months (βindirect=0.21). Similarly, the mediation effect of the intervention on Daily Activity function through self-efficacy for exercise was significant at 9 months (βindirect=0.49). In subgroup analyses, the mediation effect was significant at 9 months in the younger group (≤79 years old) in comparison to the older group, and was significant in females in comparison to males. Conclusion Self-efficacy may play a partial mediating role for the effect on some longer-term functional outcomes in the HIP Rehab intervention. The results suggest that program components that target self-efficacy should be incorporated in the future hip fracture rehabilitation interventions. Age and gender of the targeted participants may also need to be considered when developing interventions. PMID:25701101

Home-based telerehabilitation is not inferior to a centre-based program in patients with chronic heart failure: a randomised trial.

PubMed

Hwang, Rita; Bruning, Jared; Morris, Norman R; Mandrusiak, Allison; Russell, Trevor

2017-04-01

Is a 12-week, home-based telerehabilitation program conducted in small groups non-inferior to a traditional centre-based program in terms of the change in 6-minute walk distance? Is the telerehabilitation program also non-inferior to a centre-based program in terms of functional capacity, muscle strength, quality of life, urinary incontinence, patient satisfaction, attendance rates, and adverse events? Randomised, parallel, non-inferiority trial with concealed allocation, intention-to-treat analysis and assessor blinding. Patients with stable chronic heart failure (including heart failure with reduced or preserved ejection fraction) were recruited from two tertiary hospitals in Brisbane, Australia. The experimental group received a 12-week, real-time exercise and education intervention delivered into the participant's home twice weekly, using online videoconferencing software. The control group received a traditional hospital outpatient-based program of the same duration and frequency. Both groups received similar exercise prescription. Participants were assessed by independent assessors at baseline (Week 0), at the end of the intervention (Week 12) and at follow-up (Week 24). The primary outcome was a between-group comparison of the change in 6-minute walk distance, with a non-inferiority margin of 28m. Secondary outcomes included other functional measures, quality of life, patient satisfaction, program attendance rates and adverse events. In 53 participants (mean age 67 years, 75% males), there were no significant between-group differences on 6-minute walk distance gains, with a mean difference of 15m (95% CI -28 to 59) at Week 12. The confidence intervals were within the predetermined non-inferiority range. The secondary outcomes indicated that the experimental intervention was at least as effective as traditional rehabilitation. Significantly higher attendance rates were observed in the telerehabilitation group. Telerehabilitation was not inferior to a hospital outpatient-based rehabilitation program in patients with chronic heart failure. Telerehabilitation appears to be an appropriate alternative because it promotes greater attendance at the rehabilitation sessions. ACTRN12613000390785. [Hwang R, Bruning J, Morris NR, Mandrusiak A, Russell T (2017) Home-based telerehabilitation is not inferior to a centre-based program in patients with chronic heart failure: a randomised trial. Journal of Physiotherapy 63: 101-107]. Crown Copyright © 2017. Published by Elsevier B.V. All rights reserved.

Use of a Telehealth System to Enhance a Home Exercise Program for a Person With Parkinson Disease: A Case Report.

PubMed

Chatto, Charlotte A; York, Paul T; Slade, Catherine P; Hasson, Scott M

2018-01-01

This case addresses feasibility of a home-based telehealth system to enhance home exercise program (HEP) adherence for a patient with Parkinson disease (PD). We describe START-System for Technology-Augmented Rehabilitation and Training-and discuss outcomes after integrating START into the HEP component of an established therapy protocol, Lee Silverman Voice Technique BIG (LSVT BIG). The participant was a 67-year-old woman with PD at Hoehn and Yahr Stage II. During the first 4 weeks of a 4-month intervention, a physical therapist guided the participant through the LSVT BIG protocol. START was introduced at week 3; the participant was encouraged to complement her daily HEP through the end of the fourth month with START. Improvements in gait, endurance, balance confidence, and quality of life were observed from the start of the assessment to the end of month 1. By month 4, the participant maintained or improved with respect to these outcomes. Monitored by START, the rate of adherence to her twice-daily HEP prescription was 24%, but her daily participation rate was 78%. The participant's satisfaction with the START system was high, although autonomous feedback provided by START was a limiting concern. There were no technical issues or adverse events reported. This case supports START as a feasible HEP telehealth solution for physical therapy, given that increased long-term exercise adherence may improve health outcomes for people with PD. The outcomes of this case study support further investigation into the use of START for people with PD.Video Abstract available for more insights from the authors (see Video; Supplemental Digital Content 1, http://links.lww.com/JNPT/A192).

Effects of task-specific and impairment-based training compared with usual care on functional walking ability after inpatient stroke rehabilitation: LEAPS Trial.

PubMed

Nadeau, Stephen E; Wu, Samuel S; Dobkin, Bruce H; Azen, Stanley P; Rose, Dorian K; Tilson, Julie K; Cen, Steven Y; Duncan, Pamela W

2013-05-01

After inpatient stroke rehabilitation, many people still cannot participate in community activities because of limited walking ability. To compare the effectiveness of 2 conceptually different, early physical therapy (PT) interventions to usual care (UC) in improving walking 6 months after stroke. The locomotor experience applied post-stroke (LEAPS) study was a single-blind, randomized controlled trial conducted in 408 adults with disabling hemiparetic stroke. Participants were stratified at baseline (2 months) by impairment in walking speed: severe (<0.4 m/s) or moderate (0.4 to <0.8 m/s). Between 2 and 6 months, they received either only UC (n = 143) or UC plus 36 therapist-provided sessions of either (1) walking training on a treadmill using body-weight support and practice overground at clinics (locomotor training program [LTP], n = 139) or (2) impairment-based strength and balance exercise at home (home exercise program [HEP], n = 126). LTP participants were 18% more likely to transition to a higher functional walking level: severe to >0.4 m/s and moderate to >0.8 m/s than UC participants (95% confidence interval [CI] = 7%-29%), and HEP participants were 17% more likely to transition (95% CI = 5%-29%). Mean gain in walking speed in LTP participants was 0.13 m/s greater (95% CI = 0.09-0.18) and in HEP participants, 0.10 m/s greater (95% CI = 0.05-0.14) than in UC participants. Progressive PT, using either walking training on a treadmill and overground, conducted in a clinic, or strength and balance exercises conducted at home, was superior to UC in improving walking, regardless of severity of initial impairment.

Effects of Exercise on Cognition: The Finnish Alzheimer Disease Exercise Trial: A Randomized, Controlled Trial.

PubMed

Öhman, Hannareeta; Savikko, Niina; Strandberg, Timo E; Kautiainen, Hannu; Raivio, Minna M; Laakkonen, Marja-Liisa; Tilvis, Reijo; Pitkälä, Kaisu H

2016-04-01

To examine whether a regular, long-term exercise program performed by individuals with Alzheimer's disease (AD) at home or as group-based exercise at an adult daycare center has beneficial effects on cognition; to examine secondary outcomes of a trial that has been published earlier. Randomized, controlled trial. Community. Community-dwelling dyads (N = 210) of individuals with AD and their spousal caregivers randomized into three groups. Two types of intervention comprising customized home-based exercise (HE) and group-based exercise (GE), each twice a week for 1 year, were compared with a control group (CG) receiving usual community care. Cognitive function was measured using the Clock Drawing Test (CDT), Verbal Fluency (VF), Clinical Dementia Rating (CDR), and Mini-Mental State Examination (MMSE) at baseline and 3, 6, and 12 months of follow-up. Executive function, measured using CDT, improved in the HE group, and changes in the score were significantly better than those of the CG at 12 months (adjusted for age, sex, and CDR, P = .03). All groups deteriorated in VF and MMSE score during the intervention, and no significant differences between the groups were detected at 12-month follow-up when analyses were adjusted for age, sex, and CDR. Regular, long-term, customized HE improved the executive function of community-dwelling older people with memory disorders, but the effects were mild and were not observed in other domains of cognition. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

Effects of a DVD-delivered exercise program on patterns of sedentary behavior in older adults: a randomized controlled trial.

PubMed

Fanning, J; Porter, G; Awick, E A; Wójcicki, T R; Gothe, N P; Roberts, S A; Ehlers, D K; Motl, R W; McAuley, E

2016-06-01

In the present study, we examined the influence of a home-based, DVD-delivered exercise intervention on daily sedentary time and breaks in sedentary time in older adults. Between 2010 and 2012, older adults (i.e., aged 65 or older) residing in Illinois (N = 307) were randomized into a 6-month home-based, DVD-delivered exercise program (i.e., FlexToBa; FTB) or a waitlist control. Participants completed measurements prior to the first week (baseline), following the intervention period (month 6), and after a 6 month no-contact follow-up (month 12). Sedentary behavior was measured objectively using accelerometers for 7 consecutive days at each time point. Differences in daily sedentary time and breaks between groups and across the three time points were examined using mixed-factor analysis of variance (mixed ANOVA) and analysis of covariance (ANCOVA). Mixed ANOVA models revealed that daily minutes of sedentary time did not differ by group or time. The FTB condition, however, demonstrated a greater number of daily breaks in sedentary time relative to the control condition (p = .02). ANCOVA models revealed a non-significant effect favoring FTB at month 6, and a significant difference between groups at month 12 (p = .02). While overall sedentary time did not differ between groups, the DVD-delivered exercise intervention was effective for maintaining a greater number of breaks when compared with the control condition. Given the accumulating evidence emphasizing the importance of breaking up sedentary time, these findings have important implications for the design of future health behavior interventions.

Rationale and methods for a randomized controlled trial of a movement-to-music video program for decreasing sedentary time among mother-child pairs.

PubMed

Tuominen, Pipsa P A; Husu, Pauliina; Raitanen, Jani; Luoto, Riitta M

2015-10-05

Measured objectively, under a quarter of adults and fewer than half of preschool children meet the criteria set in the aerobic physical activity recommendations of the Centers for Disease Control and Prevention. Moreover, adults reportedly are sedentary (seated or lying down) for most of their waking hours. Importantly, greater amounts of sedentary time on parents' part are associated with an increased risk of more sedentary time among their children. A randomized controlled trial targeting mother-child pairs has been designed, to examine whether a movement-to-music video program may be effective in reducing sedentary time and increasing physical activity in the home environment. Mother-child pairs (child age of 4-7 years) will be recruited from among NELLI lifestyle-modification study five-year follow-up cohort participants, encompassing 14 municipalities in Pirkanmaa region, Finland. Accelerometer and exercise diary data are to be collected for intervention and control groups at the first, second and eighth week after the baseline measurements. Background factors, physical activity, screen time, motivation to exercise, and self-reported height and weight, along with quality of life, will be assessed via questionnaires. After the baseline and first week measurements, the participants of the intervention group will receive a movement-to-music video program designed to reduce sedentary time and increase physical activity. Intervention group mother-child pairs will be instructed to exercise every other day while watching the video program over the next seven weeks. Information on experiences of the use of the movement-to-music video program will be collected 8 weeks after baseline. Effects of the intervention will be analyzed in line with the intention-to-treat principle through comparison of the changes in the main outcomes between intervention and control group participants. The study has received ethics approval from the Pirkanmaa Ethics Committee in Human Sciences. The study will yield information on the effectiveness of movement-to-music video exercise in reducing sedentary behavior. Intervention-based methods have proven effective in increasing physical activity in home environments. Music may improve exercise adherence, which creates a possibility of achieving long-term health benefits. The study is registered at ClinicalTrials.gov, as NCT02270138. It was registered on October 2, 2014.

Individual preferences for physical exercise as secondary prevention for non-specific low back pain: A discrete choice experiment

PubMed Central

Hagberg, Jan; Axén, Iben; Kwak, Lydia; Lohela-Karlsson, Malin; Skillgate, Eva; Dahlgren, Gunilla; Jensen, Irene

2017-01-01

Background Exercise is effective in improving non-specific low back pain (LBP). Certain components of physical exercise, such as the type, intensity and frequency of exercise, are likely to influence participation among working adults with non-specific LBP, but the value and relative importance of these components remain unknown. The study’s aim was to examine such specific components and their influence on individual preferences for exercise for secondary prevention of non-specific LBP among working adults. Methods In a discrete choice experiment, working individuals with non-specific LBP answered a web-based questionnaire. Each respondent was given ten pairs of hypothetical exercise programs and asked to choose one option from each pair. The choices comprised six attributes of exercise (i.e., type of training, design, intensity, frequency, proximity and incentives), each with either three or four levels. A conditional logit regression that reflected the random utility model was used to analyze the responses. Results The final study population consisted of 112 participants. The participants’ preferred exercise option was aerobic (i.e., cardiovascular) rather than strength training, group exercise with trainer supervision, rather than individual or unsupervised exercise. They also preferred high intensity exercise performed at least once or twice per week. The most popular types of incentive were exercise during working hours and a wellness allowance rather than coupons for sports goods. The results show that the relative value of some attribute levels differed between young adults (age ≤ 44 years) and older adults (age ≥ 45 years) in terms of the level of trainer supervision required, exercise intensity, travel time to exercise location and financial incentives. For active study participants, exercise frequency (i.e., twice per week, 1.15; CI: 0.25; 2.06) influenced choice of exercise. For individuals with more than one child, travel time (i.e., 20 minutes, -0.55; CI: 0.65; 3.26) was also an influential attribute for choice of exercise, showing that people with children at home preferred to exercise close to home. Conclusions This study adds to our knowledge about what types of exercise working adults with back pain are most likely to participate in. The exercise should be a cardiovascular type of training carried out in a group with trainer supervision. It should also be of high intensity and preferably performed twice per week during working hours. Coupons for sports goods do not appear to motivate physical activity among workers with LBP. The findings of the study could have a substantial impact on the planning and development of exercise provision and promotion strategies to improve non-specific LBP. Providers and employers may be able to improve participation in exercise programs for adults with non-specific LBP by focusing on the exercise components which are the most attractive. This in turn would improve satisfaction and adherence to exercise interventions aimed at preventing recurrent non-specific LBP. PMID:29244841

Individual preferences for physical exercise as secondary prevention for non-specific low back pain: A discrete choice experiment.

PubMed

Aboagye, Emmanuel; Hagberg, Jan; Axén, Iben; Kwak, Lydia; Lohela-Karlsson, Malin; Skillgate, Eva; Dahlgren, Gunilla; Jensen, Irene

2017-01-01

Exercise is effective in improving non-specific low back pain (LBP). Certain components of physical exercise, such as the type, intensity and frequency of exercise, are likely to influence participation among working adults with non-specific LBP, but the value and relative importance of these components remain unknown. The study's aim was to examine such specific components and their influence on individual preferences for exercise for secondary prevention of non-specific LBP among working adults. In a discrete choice experiment, working individuals with non-specific LBP answered a web-based questionnaire. Each respondent was given ten pairs of hypothetical exercise programs and asked to choose one option from each pair. The choices comprised six attributes of exercise (i.e., type of training, design, intensity, frequency, proximity and incentives), each with either three or four levels. A conditional logit regression that reflected the random utility model was used to analyze the responses. The final study population consisted of 112 participants. The participants' preferred exercise option was aerobic (i.e., cardiovascular) rather than strength training, group exercise with trainer supervision, rather than individual or unsupervised exercise. They also preferred high intensity exercise performed at least once or twice per week. The most popular types of incentive were exercise during working hours and a wellness allowance rather than coupons for sports goods. The results show that the relative value of some attribute levels differed between young adults (age ≤ 44 years) and older adults (age ≥ 45 years) in terms of the level of trainer supervision required, exercise intensity, travel time to exercise location and financial incentives. For active study participants, exercise frequency (i.e., twice per week, 1.15; CI: 0.25; 2.06) influenced choice of exercise. For individuals with more than one child, travel time (i.e., 20 minutes, -0.55; CI: 0.65; 3.26) was also an influential attribute for choice of exercise, showing that people with children at home preferred to exercise close to home. This study adds to our knowledge about what types of exercise working adults with back pain are most likely to participate in. The exercise should be a cardiovascular type of training carried out in a group with trainer supervision. It should also be of high intensity and preferably performed twice per week during working hours. Coupons for sports goods do not appear to motivate physical activity among workers with LBP. The findings of the study could have a substantial impact on the planning and development of exercise provision and promotion strategies to improve non-specific LBP. Providers and employers may be able to improve participation in exercise programs for adults with non-specific LBP by focusing on the exercise components which are the most attractive. This in turn would improve satisfaction and adherence to exercise interventions aimed at preventing recurrent non-specific LBP.

Exercise rehabilitation on home-dwelling patients with Alzheimer's disease--a randomized, controlled trial. Study protocol.

PubMed

Pitkala, Kaisu H; Raivio, Minna M; Laakkonen, Marja-Liisa; Tilvis, Reijo S; Kautiainen, Hannu; Strandberg, Timo E

2010-10-06

Besides cognitive decline, Alzheimer's disease (AD) leads to physical disability, need for help and permanent institutional care. The trials investigating effects of exercise rehabilitation on physical functioning of home-dwelling older dementia patients are still scarce. The aim of this study is to investigate the effectiveness of intensive exercise rehabilitation lasting for one year on mobility and physical functioning of home-dwelling patients with AD. During years 2008-2010, patients with AD (n = 210) living with their spousal caregiver in community are recruited using central AD registers in Finland, and they are offered exercise rehabilitation lasting for one year. The patients are randomized into three arms: 1) tailored home-based exercise twice weekly 2) group-based exercise twice weekly in rehabilitation center 3) control group with usual care and information of exercise and nutrition. Main outcome measures will be Guralnik's mobility and balance tests and FIM-test to assess physical functioning. Secondary measures will be cognition, neuropsychiatric symptoms according to the Neuropsychiatric Inventory, caregivers' burden, depression and health-related quality of life (RAND-36). Data concerning admissions to institutional care and the use and costs of health and social services will be collected during a two year follow-up. To our knowledge this is the first large scale trial exploring whether home-dwelling patients with AD will benefit from intense and long-lasting exercise rehabilitation in respect to their mobility and physical functioning. It will also provide data on cost-effectiveness of the intervention. ACTRN12608000037303.

Community walking programs for treatment of peripheral artery disease

PubMed Central

Mays, Ryan J.; Rogers, R. Kevin; Hiatt, William R.; Regensteiner, Judith G.

2013-01-01

Background Supervised walking programs offered at medical facilities for patients with peripheral artery disease (PAD) and intermittent claudication (IC), while effective, are often not utilized due to barriers including lack of reimbursement and the need to travel to specialized locations for the training intervention. Walking programs for PAD patients that occur in community settings, such as those outside of supervised settings, may be a viable treatment option, as they are convenient and potentially bypass the need for supervised walking. This review evaluated the various methodologies and outcomes of community walking programs for PAD. Methods A literature review using appropriate search terms was conducted within PubMed/Medline and the Cochrane databases to identify studies in the English language employing community walking programs to treat PAD patients with IC. Search results were reviewed, and relevant articles were identified that form the basis of this review. The primary outcome was peak walking performance on the treadmill. Results Randomized controlled trials (n=10) examining peak walking outcomes in 558 PAD patients demonstrated that supervised exercise programs were more effective than community walking studies that consisted of general recommendations for patients with IC to walk at home. Recent community trials that incorporated more advice and feedback for PAD patients in general resulted in similar outcomes with no differences in peak walking time compared to supervised walking exercise groups. Conclusions Unstructured recommendations for patients with symptomatic PAD to exercise in the community are not efficacious. Community walking programs with more feedback and monitoring offer improvements in walking performance for patients with claudication and may bypass some obstacles associated with facility-based exercise programs. PMID:24103409

Core stability exercise is as effective as task-oriented motor training in improving motor proficiency in children with developmental coordination disorder: a randomized controlled pilot study.

PubMed

Au, Mei K; Chan, Wai M; Lee, Lin; Chen, Tracy Mk; Chau, Rosanna Mw; Pang, Marco Yc

2014-10-01

To compare the effectiveness of a core stability program with a task-oriented motor training program in improving motor proficiency in children with developmental coordination disorder (DCD). Randomized controlled pilot trial. Outpatient unit in a hospital. Twenty-two children diagnosed with DCD aged 6-9 years were randomly allocated to the core stability program or the task-oriented motor program. Both groups underwent their respective face-to-face training session once per week for eight consecutive weeks. They were also instructed to carry out home exercises on a daily basis during the intervention period. Short Form of the Bruininks-Oseretsky Test of Motor Proficiency (Second Edition) and Sensory Organization Test at pre- and post-intervention. Intention-to-treat analysis revealed no significant between-group difference in the change of motor proficiency standard score (P=0.717), and composite equilibrium score derived from the Sensory Organization Test (P=0.100). Further analysis showed significant improvement in motor proficiency in both the core stability (mean change (SD)=6.3(5.4); p=0.008) and task-oriented training groups (mean change(SD)=5.1(4.0); P=0.007). The composite equilibrium score was significantly increased in the task-oriented training group (mean change (SD)=6.0(5.5); P=0.009), but not in the core stability group (mean change(SD) =0.0(9.6); P=0.812). In the task-oriented training group, compliance with the home program was positively correlated with change in motor proficiency (ρ=0.680, P=0.030) and composite equilibrium score (ρ=0.638, P=0.047). The core stability exercise program is as effective as task-oriented training in improving motor proficiency among children with DCD. © The Author(s) 2014.

A Calendar of Activities for Parents of Handicapped Students, 1983-1984. Developmentally Young.

ERIC Educational Resources Information Center

District of Columbia Public Schools, Washington, DC. Div. of Special Education and Pupil Personnel Services.

These activities for handicapped preschool children in the Washington, D.C. school district can be used by all parents interested in developing a structured home development program for their children. A calendar format offers daily activities ranging from brief discussions and exercises to day-long family excursions. Each month's activities cover…

Long-Term Impact of Fit and Strong! On Older Adults with Osteoarthritis

ERIC Educational Resources Information Center

Hughes, Susan L.; Seymour, Rachel B.; Campbell, Richard T.; Huber, Gail; Pollak, Naomi; Sharma, Leena; Desai, Pankaja

2006-01-01

Purpose: We present final outcomes from the multiple-component Fit and Strong! intervention for older adults with lower extremity osteoarthritis. Design and Methods: A randomized controlled trial compared the effects of this exercise and behavior-change program followed by home-based reinforcement (n = 115) with a wait list control (n = 100) at 2,…

Walking Aids Moderate Exercise Effects on Gait Speed in People With Dementia: A Randomized Controlled Trial.

PubMed

Toots, Annika; Littbrand, Håkan; Holmberg, Henrik; Nordström, Peter; Lundin-Olsson, Lillemor; Gustafson, Yngve; Rosendahl, Erik

2017-03-01

To investigate the effects of exercise on gait speed, when tested using walking aids and without, and whether effects differed according to amount of support in the test. A cluster-randomized controlled trial. The Umeå Dementia and Exercise (UMDEX) study was set in 16 nursing homes in Umeå, Sweden. One hundred forty-one women and 45 men (mean age 85 years) with dementia, of whom 145 (78%) habitually used walking aids. Participants were randomized to the high-intensity functional exercise program or a seated attention control activity. Blinded assessors measured 4-m usual gait speed with walking aids if any gait speed (GS), and without walking aids and with minimum amount of support, at baseline, 4 months (on intervention completion), and 7 months. Linear mixed models showed no between-group effect in either gait speed test at 4 or 7 months. In interaction analyses exercise effects differed significantly between participants who walked unsupported compared with when walking aids or minimum support was used. Positive between-group exercise effects on gait speed (m/s) were found in subgroups that walked unsupported at 4 and 7 months (GS: 0.07, P = .009 and 0.13, P < .001; and GS test without walking aids: 0.05, P = .011 and 0.07, P = .029, respectively). In people with dementia living in nursing homes exercise had positive effects on gait when tested unsupported compared with when walking aids or minimum support was used. The study suggests that the use of walking aids in gait speed tests may conceal exercise effects. Copyright © 2016 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

Telerehabilitation booster sessions and remote patient monitoring in the management of chronic low back pain: A case series.

PubMed

Peterson, Seth

2018-05-01

Improvements in chronic low back pain (CLBP) seen in physical therapy do not appear to be retained over the long term. Booster sessions have been proposed, but barriers exist to their implementation. Telerehabilitation (TR) and remote patient monitoring (RPM) may be ways to circumvent these barriers. The purpose of this case series was to describe the implementation of TR booster sessions and RPM in three patients with CLBP. Three females with CLBP tracked their daily pain level and home exercise program adherence using a mobile phone application for 12 months following discharge from traditional face-to-face physical therapy. Synchronous audio and video TR booster sessions were conducted at months 1, 3, 6, and 12. All patients met their individual goals. They demonstrated excellent home exercise program adherence and self-efficacy. A temporary increase in pain was seen in all patients, but they managed solely with the TR booster sessions and without other healthcare resources. Satisfaction with the program was very high. This case series describes the use of TR booster sessions and RPM in three patients with CLBP. The positive results suggest this approach may be helpful in improving long-term management of patients with CLBP but demand further investigation.

Comparison of Veteran experiences of low-cost, home-based diet and exercise interventions.

PubMed

Holtz, Bree; Krein, Sarah L; Bentley, Douglas R; Hughes, Maria E; Giardino, Nicholas D; Richardson, Caroline R

2014-01-01

Obesity is a significant health problem among Veterans who receive care from the Department of Veterans Affairs, as it is for so many other Americans. Veterans from Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) experience a myriad of chronic conditions, which can make it difficult to maintain a physically active lifestyle. This pilot study tested the feasibility and user satisfaction with three low-cost, home-based diet and exercise programs, as well as point-of-decision prompts among these Veterans. The three programs target mechanisms that have been shown to improve healthy behavior change, including (1) online mediated social support, (2) objective monitoring of physical activity, and (3) structured high-intensity workouts. This was a randomized crossover trial; each participant used two of the three programs, and all used the point-of-decision prompts. Our qualitative results identified five overall themes related to social support, objective monitoring, structured activity, awareness and understanding, and the point-of-decision prompts. In general, participants were satisfied with and lost weight with each of the interventions. This study demonstrated that these low-cost interventions could be successful with the OIF/OEF Veteran population. A larger and longer study is planned to further investigate the effectiveness of these interventions.

Family-Mediated Exercises (FAME): an exploration of participant's involvement in a novel form of exercise delivery after stroke.

PubMed

Galvin, Rose; Stokes, Emma; Cusack, Tara

2014-01-01

Family members and caregivers play a significant supporting role in the rehabilitation process after stroke, a role that may increase with the growing trend of providing stroke rehabilitation in the individual's own home after discharge from the hospital. To explore the impact of family involvement in exercise delivery after stroke from the perspective of the individual with stroke and his or her family member. A qualitative research design was used in which in-depth semi-structured interviews were carried out with participants who had taken part in an 8-week family-mediated exercise program (FAME). A phenomenological theoretical framework and a grounded theory methodology were used to inform the data analysis. Fifteen individuals with acute stroke and 15 designated "family" members participated in the study after completion of an 8-week, individually tailored, family-mediated exercise intervention. An overarching concept of patient-centeredness emerged after data analysis, which detailed the extent to which individuals with stroke and their families felt that their rehabilitation was enhanced by the active role of their families. Four key themes that expanded the concept of patient-centeredness were identified: personalized nature of the reported benefits, therapeutic value of the program, family involvement, and caregiver commitment to program. This research serves to increase our understanding of the role of family members in the rehabilitation process after stroke, particularly in relation to exercise delivery, from the perspective of the individuals with stroke and their family members.

Preventing Loss of Independence through Exercise (PLIÉ): qualitative analysis of a clinical trial in older adults with dementia.

PubMed

Wu, Eveline; Barnes, Deborah E; Ackerman, Sara L; Lee, Jennifer; Chesney, Margaret; Mehling, Wolf E

2015-01-01

Preventing Loss of Independence through Exercise (PLIÉ) is a novel, integrative exercise program for individuals with dementia that combines elements of different conventional and complementary exercise modalities (e.g. tai-chi, yoga, Feldenkrais, and dance movement therapy) and focuses on training procedural memory for basic functional movements (e.g., sit-to-stand) while increasing mindful body awareness and facilitating social connection. This study presents analyses of qualitative data collected during a 36-week cross-over pilot clinical trial in 11 individuals. Qualitative data included exercise instructors' written notes, which were prepared after each class and also following biweekly telephone calls with caregivers and monthly home visits; three video-recorded classes; and written summaries prepared by research assistants following pre- and post-intervention quantitative assessments. Data were extracted for each study participant and placed onto a timeline for month of observation. Data were coded and analyzed to identify themes that were confirmed and refined through an iterative, collaborative process by the entire team including a qualitative researcher (SA) and the exercise instructors. Three overarching themes emerged: (1) Functional changes included increasing body awareness, movement memory and functional skill. (2) Emotional changes included greater acceptance of resting, sharing of personal stories and feelings, and positive attitude toward exercise. (3) Social changes included more coherent social interactions and making friends. These qualitative results suggest that the PLIÉ program may be associated with beneficial functional, emotional, and social changes for individuals with mild to moderate dementia. Further study of the PLIÉ program in individuals with dementia is warranted.

Tai Chi and health-related quality of life in nursing home residents.

PubMed

Lee, Linda Y K; Lee, Diana T F; Woo, Jean

2009-03-01

Health-related quality of life (HRQOL) that is good is regarded as the goal of elderly residential care. However, limited evidence exists indicating a promising intervention that can achieve this goal. The aim of this study is to examine the effect of Tai Chi on HRQOL in nursing home residents. A nonequivalent pretest-posttest control-group design. A convenience sample of 139 residents from six nursing homes in Hong Kong was used. The experimental group (n=66) joined a 26-week Tai Chi program, while the control group (n=73) continued with usual daily activities. The physical and mental components of HRQOL were designated as the dependent variables. Resident satisfaction was considered as a covariate. Doubly multivariate repeated measures analysis of covariance was done to examine the intervention effect. After adjusting for the confounding effect of resident satisfaction, a statistically significant difference (p<0.05) in the physical and mental components of HRQOL between the experimental and control groups was found. Findings showed significant improvement in HRQOL after residents practiced Tai Chi. These investigators contribute additional knowledge about the health benefits of Tai Chi among nursing home residents and indicates support for its use in this population to improve HRQOL. Tai Chi has unique characteristics as a health exercise that is particularly suitable for nursing home residents. The inclusion of Tai Chi exercise in elderly residential care practice is recommended.

The effectiveness of Cognitive Behavioral Therapy (CBT) with general exercises versus general exercises alone in the management of chronic low back pain.

PubMed

Khan, Muhammad; Akhter, Saeed; Soomro, Rabail Rani; Ali, Syed Shahzad

2014-07-01

To evaluate the effectiveness of Cognitive Behavioural Therapy (CBT) along with General exercises and General exercises alone in chronic low back pain. Total 54 patients with chronic low back pain who fulfilled inclusion criteria were recruited from Physiotherapy, Department of Alain Poly Clinic Karachi and Institute of Physical Medicine & Rehabilitation Dow University of Health Sciences Karachi. Selected patients were equally divided and randomly assigned into two groups with simple randomisation method. The Cognitive Behavioural Therapy (CBT) and General exercises group received Operant model of CBT and General Exercises whereas General exercises group received General exercises only. Both groups received a home exercise program as well. Patients in both groups received 3 treatment sessions per week for 12 consecutive weeks. Clinical assessment was performed using Visual Analogue Scale (VAS) and Ronald Morris Disability Questionnaire at baseline and after 12 weeks. Both study groups showed statistically significant improvements in both outcomes measures p=0.000. However, mean improvements in post intervention VAS score and Ronald Morris score was better in CBT and exercises group as compared to General exercise group. In conclusion, both interventions are effective in treating chronic low back pain however; CBT & General exercises are clinically more effective than General exercises alone.

Effects of weight-bearing exercise on a mini-trampoline on foot mobility, plantar pressure and sensation of diabetic neuropathic feet; a preliminary study

PubMed Central

Kanchanasamut, Wararom; Pensri, Praneet

2017-01-01

ABSTRACT Objective: Foot and ankle exercise has been advocated as a preventative approach in reducing the risk of foot ulceration. However, knowledge about the appropriate types and intensity of exercise program for diabetic foot ulcer prevention is still limited. The current study aimed to examine the effects of an eight-week mini-trampoline exercise on improving foot mobility, plantar pressure and sensation of diabetic neuropathic feet. Methods: Twenty-one people with diabetic peripheral neuropathy who had impaired sensation perception were divided into two groups. The exercise group received a foot-care education program plus an eight-week home exercise program using the mini-trampoline (n = 11); whereas a control group received a foot-care education only (n = 10). Measurements were undertaken at the beginning, at the completion of the eight-week program and at a 20-week follow-up. Results: Both groups were similar prior to the study. Subjects in the exercise group significantly increased the range of the first metatarsophalangeal joint in flexion (left: p = 0.040, right: p = 0.012) and extension (left: p = 0.013) of both feet more than controlled subjects. There was a trend for peak plantar pressure at the medial forefoot to decrease in the exercise group (p = 0.016), but not in the control group. At week 20, the number of subjects in the exercise group who improved their vibration perception in their feet notably increased when compared to the control group (left: p = 0.043; right: p = 0.004). Conclusions: This is a preliminary study to document the improvements in foot mobility, plantar pressure and sensation following weight-bearing exercise on a flexible surface in people with diabetic neuropathic feet. Mini-trampoline exercise may be used as an adjunct to other interventions to reduce risk of foot ulceration. A larger sample size is needed to verify these findings. This trial is registered with COA No. 097.2/55. PMID:28326159

Effects of weight-bearing exercise on a mini-trampoline on foot mobility, plantar pressure and sensation of diabetic neuropathic feet; a preliminary study.

PubMed

Kanchanasamut, Wararom; Pensri, Praneet

2017-01-01

Objective : Foot and ankle exercise has been advocated as a preventative approach in reducing the risk of foot ulceration. However, knowledge about the appropriate types and intensity of exercise program for diabetic foot ulcer prevention is still limited. The current study aimed to examine the effects of an eight-week mini-trampoline exercise on improving foot mobility, plantar pressure and sensation of diabetic neuropathic feet. Methods : Twenty-one people with diabetic peripheral neuropathy who had impaired sensation perception were divided into two groups. The exercise group received a foot-care education program plus an eight-week home exercise program using the mini-trampoline ( n  = 11); whereas a control group received a foot-care education only ( n  = 10). Measurements were undertaken at the beginning, at the completion of the eight-week program and at a 20-week follow-up. Results : Both groups were similar prior to the study. Subjects in the exercise group significantly increased the range of the first metatarsophalangeal joint in flexion (left: p  = 0.040, right: p  = 0.012) and extension (left: p  = 0.013) of both feet more than controlled subjects. There was a trend for peak plantar pressure at the medial forefoot to decrease in the exercise group ( p  = 0.016), but not in the control group. At week 20, the number of subjects in the exercise group who improved their vibration perception in their feet notably increased when compared to the control group (left: p  = 0.043; right: p  = 0.004). Conclusions : This is a preliminary study to document the improvements in foot mobility, plantar pressure and sensation following weight-bearing exercise on a flexible surface in people with diabetic neuropathic feet. Mini-trampoline exercise may be used as an adjunct to other interventions to reduce risk of foot ulceration. A larger sample size is needed to verify these findings. This trial is registered with COA No. 097.2/55.

The efficacy of unsupervised home-based exercise regimens in comparison to supervised laboratory-based exercise training upon cardio-respiratory health facets.

PubMed

Blackwell, James; Atherton, Philip J; Smith, Kenneth; Doleman, Brett; Williams, John P; Lund, Jonathan N; Phillips, Bethan E

2017-09-01

Supervised high-intensity interval training (HIIT) can rapidly improve cardiorespiratory fitness (CRF). However, the effectiveness of time-efficient unsupervised home-based interventions is unknown. Eighteen volunteers completed either: laboratory-HIIT (L-HIIT); home-HIIT (H-HIIT) or home-isometric hand-grip training (H-IHGT). CRF improved significantly in L-HIIT and H-HIIT groups, with blood pressure improvements in the H-IHGT group only. H-HIIT offers a practical, time-efficient exercise mode to improve CRF, away from the laboratory environment. H-IHGT potentially provides a viable alternative to modify blood pressure in those unable to participate in whole-body exercise. © 2017 The Authors. Physiological Reports published by Wiley Periodicals, Inc. on behalf of The Physiological Society and the American Physiological Society.

Exercise-Induced Bronchoconstriction Quiz

MedlinePlus

... navigation Home ▸ Conditions & Treatments ▸ Asthma ▸ EIB Quiz Share | Exercise-Induced Bronchoconstriction or Exercise-Induced Asthma Quiz Exercise-Induced Bronchoconstriction (also called ...

Effectiveness of balance exercises in the acute post-operative phase following total hip and knee arthroplasty: A randomized clinical trial

PubMed Central

Overend, Tom J; Spaulding, Sandi J; Zecevic, Aleksandra; Kramer, John F

2015-01-01

Objectives: To determine the effectiveness of balance exercises in the acute post-operative phase following total hip arthroplasty or total knee arthroplasty. Methods: Patients who had total hip arthroplasty (n = 30) or total knee arthroplasty (n = 33) were seen in their residence 1–2 times per week for 5 weeks. At the first post-operative home visit, patients were randomly assigned to either typical (TE, n = 33) or typical plus balance (TE + B, n = 30) exercise groups. The TE group completed seven typical surgery-specific joint range-of-motion and muscle strengthening exercises, while the TE + B group completed the typical exercises plus three balance exercises. Patients were assessed before and 5 weeks after administering the rehabilitation program using four outcome measures: (1) the Berg Balance Scale, (2) the Timed Up and Go test, (3) the Western Ontario McMaster Universities Osteoarthritis Index, and (4) the Activities-specific Balance Confidence Scale. Results: Post-intervention scores for all four outcome measures were significantly improved (p < 0.01) over baseline scores. Patients who participated in the TE + B group demonstrated significantly greater improvement on the Berg Balance Scale and the Timed Up and Go tests (p < 0.01). Conclusion: Balance exercises added to a typical rehabilitation program resulted in significantly greater improvements in balance and functional mobility compared to typical exercises alone. PMID:26770765

A model to increase rehabilitation adherence to home exercise programmes in patients with varying levels of self-efficacy.

PubMed

Picha, Kelsey J; Howell, Dana M

2018-03-01

Patient adherence to rehabilitation programmes is frequently low - particularly adherence to home exercise programmes. Home exercise programmes have been identified as complementary to clinic-based physical therapy in an orthopaedic setting. Barriers to patient adherence have previously been identified within the literature. Low self-efficacy is a barrier to adherence that clinicians have the ability to have an impact on and improve. The theory of self-efficacy is defined as a person's confidence in their ability to perform a task. This theory examines the ability of a person to change through exerting control over inner processes of goal setting, self-monitoring, feedback, problem solving and self-evaluation. If clinicians are able to identify patients with low self-efficacy prior to the prescription of a home exercise programme, adjustments to individualized care can be implemented. Individualized care based on improving self-efficacy for home exercise programmes may improve patient adherence to these programmes. The purpose of this article was to use the theory of self-efficacy to direct clinicians in providing individualized programmes to patients with varying levels of self-efficacy. Copyright © 2017 John Wiley & Sons, Ltd.

Feasibility of Interactive Resistance Chair in Older Adults with Diabetes.

PubMed

Finkelstein, Joseph; Cisse, Pape; Jeong, In Cheol

2015-01-01

An interactive resistance chair (RC) exercise system has been designed to support patients at home in following their individualized strengthening exercise plan. The aim of this study was (1) to introduce a computer-assisted home-based resistance exercise for older adults and (2) to demonstrate feasibility of the proposed system in older adults with diabetes. The RC exercise system was well accepted by older adults with diabetes regardless of education level, race or gender. The post-task questionnaires demonstrated ease of system use and satisfaction with the system. The attitudinal survey results showed positive seniors' attitudes towards the RC exercise system. The system usability (SUS) scale score was 94.0±5.76 demonstrating high acceptance of the RC exercise system. From the qualitative interviews, individualized feedback yielded important system upgrade solutions that can be useful in tailoring patient needs, values and preferences specific for seniors with diabetes. Further research is warranted to assess impact of RC exercise system in home setting with a larger sample size in a randomized trial.

Metabolic and Psychological Impact of a Pragmatic Exercise Intervention Program in Adolescent and Young Adult Survivors of Pediatric Cancer-Related Cerebral Insult.

PubMed

Rath, Shoshana R; Long, Treya M; Bear, Natasha L; Miles, Gordon C P; Bullock, Andrew M; Gottardo, Nicholas G; Cole, Catherine H; Naylor, Louise H; Choong, Catherine S Y

2018-06-01

To assess metabolic function among adolescent and young adult (AYA) survivors of childhood cancer-related brain surgery or cranial irradiation (CRT) and to determine feasibility, safety, and metabolic as well as psychological impact of a 6-month exercise program in this cohort. Twenty AYAs aged 15-23 years were recruited. All had completed cancer treatment by age 15.5 and were more than 1 year after end of treatment. Metabolic function was assessed at baseline (T1), after a 6-month non-intervention period (T2), and after the 6-month intervention (T3). Psychological assessments were performed at T1 and T3. Eight to 12 months after the program (T4), its lasting impact was assessed by questionnaire. The 6-month intervention consisted of small group-based, tailored, supervised exercise sessions combining resistance and aerobic exercise. Sessions were offered up to thrice per week and adherence defined as participation in ≥24 sessions. Flexibility was built into the design with an alternative home-based program offered to those who could not attend the gymnasium. Thirteen of the 20 recruited participants were adherent to the program. There was one fall during exercise, but no injury was sustained. Higher rates of metabolic impairment than would be expected in a healthy cohort were found at baseline both among brain tumor survivors and survivors of total body irradiation. Central adiposity reduced post-intervention (p = 0.014) and improvements in adaptive function were seen. Participants enjoyed the program, but work and study commitments limited attendance. AYA survivors of childhood brain tumors and CRT should be screened for metabolic and psychological well-being. Small group-based exercise is safe, feasible, and enjoyable for this cohort and may benefit them both metabolically and psychologically. ACTRN12614000796684. Retrospectively registered July 28, 2014.

A preliminary study to evaluate postural improvement in subjects with scoliosis: active therapeutic movement version 2 device and home exercises using the Mulligan's mobilization-with-movement concept.

PubMed

Lewis, Clare; Diaz, Rafael; Lopez, Geoff; Marki, Nicholas; Olivio, Ben

2014-09-01

The purpose of this preliminary study was to determine if the use of Active Therapeutic Movement Version 2 (ATM2) device and home exercises using the Mulligan's mobilization-with-movement concept by subjects with scoliosis would result in postural improvement and to document any changes in trunk range of motion and quality of life. Forty-three subjects between the ages of 12 to 75 years were recruited for the study. Each subject underwent a low back evaluation along with specific measurements for their scoliosis. Subjects participated in a 4-week intervention, 2 times a week consisting of treatment utilizing the ATM2 and were also given a home exercise program to mimic the specific movement(s) they performed on the ATM2. Photographic assessment of posture was taken before and after the intervention. Subjects were surveyed during the initial assessment and again at the final intervention using the following outcome measures: Fear Avoidance Belief Questionnaire, Short-Form Health Survey-36, Oswestry Disability Index, and a Numeric Pain Rating Scale. Results were significant for most of the variables measured. Subjects gained improvement in spinal ranges of motion for all directions except for flexion and extension (most subjects had reference range of flexion and extension at the beginning of the study). Most subjects had improved pelvic alignment after the intervention. Before and after photographs demonstrated improved posture. Subjective measurements of pain, disability, and quality of life improved. Results of this preliminary study showed improvement for selected variables. The use of ATM2 and home exercises using the Mulligan's mobilization-with-movement concept by subjects with scoliosis appears to be a potentially viable conservative treatment alternative to address various findings associated with scoliosis, including posture improvement. Copyright © 2014 National University of Health Sciences. Published by Elsevier Inc. All rights reserved.

Developing Home-Based Virtual Reality Therapy Interventions.

PubMed

Lin, Janice; Kelleher, Caitlin L; Engsberg, Jack R

2013-02-01

Stroke is one of the leading causes of serious long-term disability. However, home exercise programs given at rehabilitation often lack in motivational aspects. The purposes of this pilot study were (1) create individualized virtual reality (VR) games and (2) determine the effectiveness of VR games for improving movement in upper extremities in a 6-week home therapy intervention for persons with stroke. Participants were two individuals with upper extremity hemiparesis following a stroke. VR games were created using the Looking Glass programming language and modified based on personal interests, goals, and abilities. Participants were asked to play 1 hour each day for 6 weeks. Assessments measured upper extremity movement (range of motion and Action Research Arm Test [ARAT]) and performance in functional skills (Canadian Occupational Performance Measure [COPM] and Motor Activity Log [MAL]). Three VR games were created by a supervised occupational therapist student. The participants played approximately four to six times a week and performed over 100 repetitions of movements each day. Participants showed improvement in upper extremity movement and participation in functional tasks based on results from the COPM, ARAT, and MAL. Further development in the programming environment is needed to be plausible in a rehabilitation setting. Suggestions include graded-level support and continuation of creating a natural programming language, which will increase the ability to use the program in a rehabilitation setting. However, the VR games were shown to be effective as a home therapy intervention for persons with stroke. VR has the potential to advance therapy services by creating a more motivating home-based therapy service.

Effects of a Home-Based Upper Limb Training Program in Patients With Multiple Sclerosis: A Randomized Controlled Trial.

PubMed

Ortiz-Rubio, Araceli; Cabrera-Martos, Irene; Rodríguez-Torres, Janet; Fajardo-Contreras, Waldo; Díaz-Pelegrina, Ana; Valenza, Marie Carmen

2016-12-01

To evaluate the effects of a home-based upper limb training program on arm function in patients with multiple sclerosis (MS). Additionally, the effects of this program on manual dexterity, handgrip strength, and finger prehension force were analyzed. Randomized, single-blind controlled trial. Home based. Patients with a clinical diagnosis of MS acknowledging impaired manual ability (N=37) were randomized into 2 groups. Patients in the experimental group were included in a supervised home-based upper limb training program for 8 weeks twice a week. Patients in the control group received information in the form of a leaflet with a schedule of upper limb exercise training. The primary outcome measure was arm function (motor functioning assessed using the finger tapping test and a functional measure, the Action Research Arm Test). The secondary outcome measures were manual dexterity assessed with the Purdue Pegboard Test and handgrip strength and finger prehension force evaluated with a handgrip and a pinch dynamometer, respectively. After 8 weeks, a significant between-group improvement (P<.05) was found on the Action Research Arm Test bilaterally and the finger tapping test in the most affected upper limb. The secondary outcomes also improved in the most affected limb in the experimental group. An 8-week home-based intervention program focused on upper limbs twice a week improved arm function and physiologic variables with a primary focus on the more affected extremity in patients with MS compared with the control group. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Feasibility of a multidimensional home-based exercise programme for the elderly with structured support given by the general practitioner's surgery: Study protocol of a single arm trial preparing an RCT [ISRCTN58562962

PubMed Central

2009-01-01

Background Physical activity programmes can help to prevent functional decline in the elderly. Until now, such programmes use to target either on healthy community-dwelling seniors or on elderly living in special residences or care institutions. Sedentary or frail people, however, are difficult to reach when they live in their own homes. The general practitioner's (GP) practice offers a unique opportunity to acquire these people for participation in activity programmes. We conceptualised a multidimensional home-based exercise programme that shall be delivered to the target group through cooperation between GPs and exercise therapists. In order to prepare a randomised controlled trial (RCT), a feasibility study is being conducted. Methods The study is designed as a single arm interventional trial. We plan to recruit 90 patients aged 70 years and above through their GPs. The intervention lasts 12 weeks and consists of physical activity counselling, a home-exercise programme, and exercise consultations provided by an exercise therapist in the GP's practice and via telephone. The exercise programme consists of two main components: 1. a combination of home-exercises to improve strength, flexibility and balance, 2. walking for exercise to improve aerobic capacity. Primary outcome measures are: appraisal by GP, undesirable events, drop-outs, adherence. Secondary outcome measures are: effects (a. motor tests: timed-up-and-go, chair rising, grip strength, tandem stand, tandem walk, sit-and-reach; b. telephone interview: PRISCUS-Physical Activity Questionnaire, Short Form-8 Health Survey, three month recall of frequency of falls, Falls Efficacy Scale), appraisal by participant, exercise performance, focus group discussion. Data analyses will focus on: 1. decision-making concerning the conduction of a RCT, 2. estimation of the effects of the programme, detection of shortcomings and identification of subgroups with contrary results, 3. feedback to participants and to GPs. Conclusion A new cooperation between GPs and exercise therapists to approach community-dwelling seniors and to deliver a home-exercise programme is object of research with regard to feasibility and acceptance. In case of success, an RCT should examine the effects of the programme. A future implementation within primary medical care may take advantage from the flexibility of the programme. Trial registration Current Controlled Trials ISRCTN58562962. PMID:19686587

Effect of workplace- versus home-based physical exercise on pain in healthcare workers: study protocol for a single blinded cluster randomized controlled trial

PubMed Central

2014-01-01

Background The prevalence and consequences of musculoskeletal pain is considerable among healthcare workers, allegedly due to high physical work demands of healthcare work. Previous investigations have shown promising results of physical exercise for relieving pain among different occupational groups, but the question remains whether such physical exercise should be performed at the workplace or conducted as home-based exercise. Performing physical exercise at the workplace together with colleagues may be more motivating for some employees and thus increase adherence. On the other hand, physical exercise performed during working hours at the workplace may be costly for the employers in terms of time spend. Thus, it seems relevant to compare the efficacy of workplace- versus home-based training on musculoskeletal pain. This study is intended to investigate the effect of workplace-based versus home-based physical exercise on musculoskeletal pain among healthcare workers. Methods/Design This study was designed as a cluster randomized controlled trial performed at 3 hospitals in Copenhagen, Denmark. Clusters are hospital departments and hospital units. Cluster randomization was chosen to increase adherence and avoid contamination between interventions. Two hundred healthcare workers from 18 departments located at three different hospitals is allocated to 10 weeks of 1) workplace based physical exercise performed during working hours (using kettlebells, elastic bands and exercise balls) for 5 × 10 minutes per week and up to 5 group-based coaching sessions, or 2) home based physical exercise performed during leisure time (using elastic bands and body weight exercises) for 5 × 10 minutes per week. Both intervention groups will also receive ergonomic instructions on patient handling and use of lifting aides etc. Inclusion criteria are female healthcare workers working at a hospital. Average pain intensity (VAS scale 0-10) of the back, neck and shoulder (primary outcome) and physical exertion during work, social capital and work ability (secondary outcomes) is assessed at baseline and 10-week follow-up. Further, postural balance and mechanical muscle function is assessed during clinical examination at baseline and follow-up. Discussion This cluster randomized trial will investigate the change in self-rated average pain intensity in the back, neck and shoulder after either 10 weeks of physical exercise at the workplace or at home. Trial registration ClinicalTrials.gov (NCT01921764). PMID:24708570

Effect of workplace- versus home-based physical exercise on pain in healthcare workers: study protocol for a single blinded cluster randomized controlled trial.

PubMed

Jakobsen, Markus D; Sundstrup, Emil; Brandt, Mikkel; Kristensen, Anne Zoëga; Jay, Kenneth; Stelter, Reinhard; Lavendt, Ebbe; Aagaard, Per; Andersen, Lars L

2014-04-07

The prevalence and consequences of musculoskeletal pain is considerable among healthcare workers, allegedly due to high physical work demands of healthcare work. Previous investigations have shown promising results of physical exercise for relieving pain among different occupational groups, but the question remains whether such physical exercise should be performed at the workplace or conducted as home-based exercise. Performing physical exercise at the workplace together with colleagues may be more motivating for some employees and thus increase adherence. On the other hand, physical exercise performed during working hours at the workplace may be costly for the employers in terms of time spend. Thus, it seems relevant to compare the efficacy of workplace- versus home-based training on musculoskeletal pain. This study is intended to investigate the effect of workplace-based versus home-based physical exercise on musculoskeletal pain among healthcare workers. This study was designed as a cluster randomized controlled trial performed at 3 hospitals in Copenhagen, Denmark. Clusters are hospital departments and hospital units. Cluster randomization was chosen to increase adherence and avoid contamination between interventions. Two hundred healthcare workers from 18 departments located at three different hospitals is allocated to 10 weeks of 1) workplace based physical exercise performed during working hours (using kettlebells, elastic bands and exercise balls) for 5 × 10 minutes per week and up to 5 group-based coaching sessions, or 2) home based physical exercise performed during leisure time (using elastic bands and body weight exercises) for 5 × 10 minutes per week. Both intervention groups will also receive ergonomic instructions on patient handling and use of lifting aides etc. Inclusion criteria are female healthcare workers working at a hospital. Average pain intensity (VAS scale 0-10) of the back, neck and shoulder (primary outcome) and physical exertion during work, social capital and work ability (secondary outcomes) is assessed at baseline and 10-week follow-up. Further, postural balance and mechanical muscle function is assessed during clinical examination at baseline and follow-up. This cluster randomized trial will investigate the change in self-rated average pain intensity in the back, neck and shoulder after either 10 weeks of physical exercise at the workplace or at home. ClinicalTrials.gov (NCT01921764).

Feasibility, Safety, and Preliminary Effectiveness of a Home-Based Self-Managed High-Intensity Interval Training Program Offered to Long-Term Manual Wheelchair Users.

PubMed

Gauthier, Cindy; Brosseau, Rachel; Hicks, Audrey L; Gagnon, Dany H

2018-01-01

To investigate and compare the feasibility, safety, and preliminary effectiveness of home-based self-managed manual wheelchair high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT) programs. Eleven manual wheelchair users were randomly assigned to the HIIT ( n = 6) or the MICT group ( n = 5). Both six-week programs consisted of three 40-minute propulsion training sessions per week. The HIIT group alternated between 30 s high-intensity intervals and 60 s low-intensity intervals, whereas the MICT group maintained a constant moderate intensity. Cardiorespiratory fitness, upper limb strength, and shoulder pain were measured before and after the programs. Participants completed a questionnaire on the programs that explored general areas of feasibility. The answers to the questionnaire demonstrated that both training programs were feasible in the community. No severe adverse events occurred, although some participants experienced increased shoulder pain during HIIT. Neither program yielded a significant change in cardiorespiratory fitness or upper limb strength. However, both groups reported moderate to significant subjective improvement. Home-based wheelchair HIIT appears feasible and safe although potential development of shoulder pain remains a concern and should be addressed with a future preventive shoulder exercise program. Some recommendations have been proposed for a larger study aiming to strengthen evidence regarding the feasibility, safety, and effectiveness of HIIT.

Movement-Based Interaction Applied to Physical Rehabilitation Therapies

PubMed Central

Ruiz Penichet, Victor Manuel; Lozano Pérez, María Dolores

2014-01-01

Background Health care environments are continuously improving conditions, especially regarding the use of current technology. In the field of rehabilitation, the use of video games and related technology has helped to develop new rehabilitation procedures. Patients are able to work on their disabilities through new processes that are more motivating and entertaining. However, these patients are required to leave their home environment to complete their rehabilitation programs. Objective The focus of our research interests is on finding a solution to eliminate the need for patients to interrupt their daily routines to attend rehabilitation therapy. We have developed an innovative system that allows patients with a balance disorder to perform a specific rehabilitation exercise at home. Additionally, the system features an assistive tool to complement the work of physiotherapists. Medical staff are thus provided with a system that avoids the need for them to be present during the exercise in specific cases in which patients are under suitable supervision. Methods A movement-based interaction device was used to achieve a reliable system for monitoring rehabilitation exercises performed at home. The system accurately utilizes parameters previously defined by the specialist for correct performance of the exercise. Accordingly, the system gives instructions and corrects the patient’s actions. The data generated during the session are collected for assessment by the specialist to adapt the difficulty of the exercise to the patient’s progress. Results The evaluation of the system was conducted by two experts in balance disorder rehabilitation. They were required to verify the effectiveness of the system, and they also facilitated the simulation of real patient behavior. They used the system freely for a period of time and provided interesting and optimistic feedback. First, they evaluated the system as a tool for real-life rehabilitation therapy. Second, their interaction with the system allowed us to obtain important feedback needed to improve the system. Conclusions The system improves the rehabilitation conditions of people with balance disorder. The main contribution comes from the fact that it allows patients to carry out the rehabilitation process at home under the supervision of physiotherapists. As a result, patients avoid having to attend medical centers. Additionally, medical staff have access to an assistant, which means their presence is not required in many exercises that involve constant repetition. PMID:25491148

Movement-based interaction applied to physical rehabilitation therapies.

PubMed

Garrido Navarro, Juan Enrique; Ruiz Penichet, Victor Manuel; Lozano Pérez, María Dolores

2014-12-09

Health care environments are continuously improving conditions, especially regarding the use of current technology. In the field of rehabilitation, the use of video games and related technology has helped to develop new rehabilitation procedures. Patients are able to work on their disabilities through new processes that are more motivating and entertaining. However, these patients are required to leave their home environment to complete their rehabilitation programs. The focus of our research interests is on finding a solution to eliminate the need for patients to interrupt their daily routines to attend rehabilitation therapy. We have developed an innovative system that allows patients with a balance disorder to perform a specific rehabilitation exercise at home. Additionally, the system features an assistive tool to complement the work of physiotherapists. Medical staff are thus provided with a system that avoids the need for them to be present during the exercise in specific cases in which patients are under suitable supervision. A movement-based interaction device was used to achieve a reliable system for monitoring rehabilitation exercises performed at home. The system accurately utilizes parameters previously defined by the specialist for correct performance of the exercise. Accordingly, the system gives instructions and corrects the patient's actions. The data generated during the session are collected for assessment by the specialist to adapt the difficulty of the exercise to the patient's progress. The evaluation of the system was conducted by two experts in balance disorder rehabilitation. They were required to verify the effectiveness of the system, and they also facilitated the simulation of real patient behavior. They used the system freely for a period of time and provided interesting and optimistic feedback. First, they evaluated the system as a tool for real-life rehabilitation therapy. Second, their interaction with the system allowed us to obtain important feedback needed to improve the system. The system improves the rehabilitation conditions of people with balance disorder. The main contribution comes from the fact that it allows patients to carry out the rehabilitation process at home under the supervision of physiotherapists. As a result, patients avoid having to attend medical centers. Additionally, medical staff have access to an assistant, which means their presence is not required in many exercises that involve constant repetition.

Preparing for the unexpected: violence in the home care environment, one agency's story.

PubMed

Browning, Sarah Via; Clark, Rebecca Culver; Glick, Roger E

2013-06-01

Home care and hospice agencies, bound by regulations, prepare for emergencies and disasters by creating policies and protocols for management of emergency situations, perhaps conducting table top or other types of drills, and discussing hazards likely to impact home care. Is this preparation merely an exercise to meet a requirement, or is it life-saving preparation? For one home care agency, the emergency exercise saved the day as the scenario enacted in the drill was actually lived out a few weeks after the exercise-a scenario the agency leaders hoped they would never face. This account explores how the agency prepared to meet the emergent situation and details lessons learned in the aftermath.

Impact of a Home-Based Physical and Nutritional Intervention Program Conducted by Lay-Volunteers on Handgrip Strength in Prefrail and Frail Older Adults: A Randomized Control Trial.

PubMed

Haider, Sandra; Dorner, Thomas E; Luger, Eva; Kapan, Ali; Titze, Sylvia; Lackinger, Christian; Schindler, Karin E

2017-01-01

A randomized controlled trial was performed to compare the effects of a home-based physical and nutritional intervention program carried out by lay-volunteers to home visits with social support alone. Buddies visited 80 prefrail or frail older persons at home twice a week for 12 weeks. The physical training and nutrition group (PTN, n = 39) performed two sets of six strength exercises, discussed nutritional topics and received social support. The social support group (SoSu, n = 41) received home visits with social support only. In the PTN group, handgrip strength increased significantly by 2.4 kg (95% CI: 1.0-3.8). In the SoSu group we did not see a significant improvement. However, no significant between-group difference was found. Physical performance increased in both groups, although with a higher increase of 1.0 point (95% CI: 0.1-2.0) in the PTN group. In none of the groups muscle mass changed. Further results showed that frail individuals benefit more from the intervention than prefrail individuals (OR: 2.78; 95% CI: 1.01-7.66). Handgrip strength in the intervention group increased by a clinically relevant value and this effect is comparable to that obtained by health-care professionals. Therefore, home visits with a physical training and nutritional program could offer a new perspective in the care of community-dwelling prefrail and frail older persons.

Effects on motor development of kicking and stepping exercise in preterm infants with periventricular brain injury: a pilot study.

PubMed

Campbell, Suzann K; Gaebler-Spira, Deborah; Zawacki, Laura; Clark, April; Boynewicz, Kara; deRegnier, Raye-Ann; Kuroda, Maxine M; Bhat, Rama; Yu, Jinsheng; Campise-Luther, Rose; Kale, Dipti; Bulanda, Michelle; Zhou, Xiaohong Joe

2012-01-01

Preterm infants with periventricular brain injury (PBI) have a high incidence of atypical development and leg movements. Determine whether kicking and treadmill stepping intervention beginning at 2 months corrected age (CA) in children with PBI improves motor function at 12 months CA when compared with control subjects. In a multi-center pilot study for a controlled clinical trial, sixteen infants with PBI were randomly assigned to home exercise consisting of kicking and treadmill stepping or a no-training control condition. Development was assessed at 2, 4, 6, 10, and 12 months CA with the Alberta Infant Motor Scale (AIMS). At 12 months children were classified as normal, delayed, or with cerebral palsy (CP). At 12 months CA 3 of 7 (43%) of the exercise group children walked alone or with one hand held versus 1 of 9 (11%) in the control group (p=0.262), but no significant differences in AIMS scores were found at any age. Half of the subjects had CP or delay; the outcomes of these infants were not improved by exercise. Compliance with the home program was lower than requested and may have affected results. Although not statistically significant with a small sample size, self-produced kicking and treadmill exercise may lower age at walking in infants with normal development following PBI, but improvements of the protocol to increase and document compliance are needed before a larger study is implemented.

Effects on Motor Development of Kicking and Stepping Exercise in Preterm Infants with Periventricular Brain Injury: A Pilot Study

PubMed Central

Campbell, Suzann K.; Gaebler-Spira, Deborah; Zawacki, Laura; Clark, April; Boynewicz, Kara; deRegnier, Raye-Ann; Kuroda, Maxine M.; Bhat, Rama; Yu, Jinsheng; Campise-Luther, Rose; Kale, Dipti; Bulanda, Michelle; Zhou, Xiaohong Joe

2013-01-01

Background Preterm infants with periventricular brain injury (PBI) have a high incidence of atypical development and leg movements. Objective Determine whether kicking and treadmill stepping intervention beginning at 2 months corrected age (CA) in children with PBI improves motor function at 12 months CA when compared with control subjects. Method In a multi-center pilot study for a controlled clinical trial, sixteen infants with PBI were randomly assigned to home exercise consisting of kicking and treadmill stepping or a no-training control condition. Development was assessed at 2, 4, 6, 10, and 12 months CA with the Alberta Infant Motor Scale (AIMS). At 12 months children were classified as normal, delayed, or with cerebral palsy (CP). Results At 12 months CA 3 of 7 (43%) of the exercise group children walked alone or with one hand held versus 1 of 9 (11%) in the control group (p=.262), but no significant differences in AIMS scores were found at any age. Half of the subjects had CP or delay; the outcomes of these infants were not improved by exercise. Compliance with the home program was lower than requested and may have affected results. Conclusion Although not statistically significant with a small sample size, self-produced kicking and treadmill exercise may lower age at walking in infants with normal development following PBI, but improvements of the protocol to increase and document compliance are needed before a larger study is implemented. PMID:22543889

Exercise training for depressed older adults with Alzheimer's disease.

PubMed

Williams, C L; Tappen, R M

2008-01-01

The purpose of this study was to compare the effects of 16 weeks of a comprehensive exercise routine to supervised walking and social conversation on depression in nursing home residents with Alzheimer's disease (AD). This study was a three-group, repeated-measures design with random assignment to treatment group. Forty-five nursing home residents with moderate to severe AD were randomly assigned to a 16-week programme of comprehensive exercise, supervised walking or social conversation. Raters were blinded to treatment group assignment. Major outcome variables were depression measured by the Cornell Scale for Depression in Dementia, mood measured by the Dementia Mood Assessment Scale and the Alzheimer's Mood Scale, and affect measured by the Observed Affect Scale. Depression was reduced in all three groups with some evidence of superior benefit from exercise. Depression is a common problem with serious and costly consequences for nursing home residents with AD. Exercise as a behavioural approach to treatment of depression in nursing home residents with severe AD evidenced a clear benefit to participants in this study. More research is needed to clarify the relative benefits of different types of exercise in conjunction with or without pharmacological intervention.

Effectiveness of an interactive telerehabilitation system with home-based exercise training in patients after total hip or knee replacement: study protocol for a multicenter, superiority, no-blinded randomized controlled trial.

PubMed

Eichler, Sarah; Rabe, Sophie; Salzwedel, Annett; Müller, Steffen; Stoll, Josefine; Tilgner, Nina; John, Michael; Wegscheider, Karl; Mayer, Frank; Völler, Heinz

2017-09-21

Total hip or knee replacement is one of the most frequently performed surgical procedures. Physical rehabilitation following total hip or knee replacement is an essential part of the therapy to improve functional outcomes and quality of life. After discharge from inpatient rehabilitation, a subsequent postoperative exercise therapy is needed to maintain functional mobility. Telerehabilitation may be a potential innovative treatment approach. We aim to investigate the superiority of an interactive telerehabilitation intervention for patients after total hip or knee replacement, in comparison to usual care, regarding physical performance, functional mobility, quality of life and pain. This is an open, randomized controlled, multicenter superiority study with two prospective arms. One hundred and ten eligible and consenting participants with total knee or hip replacement will be recruited at admission to subsequent inpatient rehabilitation. After comprehensive, 3-week, inpatient rehabilitation, the intervention group performs a 3-month, interactive, home-based exercise training with a telerehabilitation system. For this purpose, the physiotherapist creates an individual training plan out of 38 different strength and balance exercises which were implemented in the system. Data about the quality and frequency of training are transmitted to the physiotherapist for further adjustment. Communication between patient and physiotherapist is possible with the system. The control group receives voluntary, usual aftercare programs. Baseline assessments are investigated after discharge from rehabilitation; final assessments 3 months later. The primary outcome is the difference in improvement between intervention and control group in 6-minute walk distance after 3 months. Secondary outcomes include differences in the Timed Up and Go Test, the Five-Times-Sit-to-Stand Test, the Stair Ascend Test, the Short-Form 36, the Western Ontario and McMaster Universities Osteoarthritis Index, the International Physical Activity Questionnaire, and postural control as well as gait and kinematic parameters of the lower limbs. Baseline-adjusted analysis of covariance models will be used to test for group differences in the primary and secondary endpoints. We expect the intervention group to benefit from the interactive, home-based exercise training in many respects represented by the study endpoints. If successful, this approach could be used to enhance the access to aftercare programs, especially in structurally weak areas. German Clinical Trials Register (DRKS), ID: DRKS00010009 . Registered on 11 May 2016.

Psychosocial benefits of workplace physical exercise: cluster randomized controlled trial.

PubMed

Jakobsen, Markus D; Sundstrup, Emil; Brandt, Mikkel; Andersen, Lars L

2017-10-10

While benefits of workplace physical exercise on physical health is well known, little is known about the psychosocial effects of such initiatives. This study evaluates the effect of workplace versus home-based physical exercise on psychosocial factors among healthcare workers. A total of 200 female healthcare workers (Age: 42.0, BMI: 24.1) from 18 departments at three hospitals were cluster-randomized to 10 weeks of: 1) home-based physical exercise (HOME) performed alone during leisure time for 10 min 5 days per week or 2) workplace physical exercise (WORK) performed in groups during working hours for 10 min 5 days per week and up to 5 group-based coaching sessions on motivation for regular physical exercise. Vitality and mental health (SF-36, scale 0-100), psychosocial work environment (COPSOQ, scale 0-100), work- and leisure disability (DASH, 0-100), control- (Bournemouth, scale 0-10) and concern about pain (Pain Catastrophizing Scale, scale 0-10) were assessed at baseline and at 10-week follow-up. Vitality as well as control and concern about pain improved more following WORK than HOME (all p < 0.05) in spite of increased work pace (p < 0.05). Work- and leisure disability, emotional demands, influence at work, sense of community, social support and mental health remained unchanged. Between-group differences at follow-up (WORK vs. HOME) were 7 [95% confidence interval (95% CI) 3 to 10] for vitality, -0.8 [95% CI -1.3 to -0.3] for control of pain and -0.9 [95% CI -1.4 to -0.5] for concern about pain, respectively. Performing physical exercise together with colleagues during working hours was more effective than home-based exercise in improving vitality and concern and control of pain among healthcare workers. These benefits occurred in spite of increased work pace. NCT01921764 at ClinicalTrials.gov . Registered 10 August 2013.

A multimodal physical therapy approach utilizing the Maitland concept in the management of a patient with cervical and lumbar radiculitis and Ehlers-Danlos syndrome-hypermobility type: A case report.

PubMed

Pennetti, Adelina

2018-07-01

The purpose of this case report is to present a multimodal approach for patient management using the Maitland concept framework for cervical and lumbar radiculitis with an underlying diagnosis of Ehlers-Danlos Syndrome-Hypermobility Type (EDS-HT). This case presents care guided by evidence, patient values, and rationale for the selected course of physical therapy treatment provided by therapist experience. A 35-year-old female with a 2-year history of worsening lumbar and cervical pain was referred to physical therapy to address these musculoskeletal issues concurrent with diagnostic testing for EDS. A multimodal approach including manual therapy, therapeutic exercise, postural and body mechanics education, and a home exercise program was used. The patient specific functional scale (PSFS) was used to gauge patient's perceived improvements which were demonstrated by increased scores at reevaluation and at discharge. Following the Maitland concept framework, the physical therapist was able to make sound clinical decisions by tracking the logical flow of constant patient assessment. A 10-month course of treatment designed to maximize recovery of function was successful with a chronic history of pain and the EDS-HT diagnosis. The role of education and empowering the patient is shown to be of utmost importance. Optimizing therapeutic outcomes long-term for this patient population requires maintaining a home exercise program, adaptation and modifications of work and lifestyle activities.

Pelvic Floor Muscle Exercise for Paediatric Functional Constipation.

PubMed

Farahmand, Fatemeh; Abedi, Aidin; Esmaeili-Dooki, Mohammad Reza; Jalilian, Rozita; Tabari, Sanaz Mehrabani

2015-06-01

Functional constipation (FC) is one of the most common gastrointestinal problems among children. This study was designed to investigate the effectiveness of pelvic floor muscle exercise on treatment of FC. In this study which was conducted in Children's Medical Center, children with a diagnosis of FC (aged 4-18 y) who did not respond to medical treatment, performed sessions of pelvic floor muscle exercise at home twice a day for 8 wk. Frequency of defecation, overall improvement of constipation, stool withholding, painful defecation and stool consistency were measured at the final week of the intervention compared to baseline. Forty children (16 males, 24 females mean age 5.6±1.03 y) completed the 8-wk exercise program. Subjective overall improvement of the symptoms was present in 36 patients (90%). The changes in stool frequency, stool diameter and consistency were statistically significant. However, there were no statistically significant differences in the stool withholding, fecal impaction, fecal incontinence and painful defecation. Pelvic floor muscle exercise is an effective non-pharmacologic treatment for Paediatric FC.

Yoga's effect on falls in rural, older adults.

PubMed

Hamrick, Irene; Mross, Paul; Christopher, Nate; Smith, Paul D

2017-12-01

Unintentional falls affect 30% of people over age 65 years. Yoga has been shown to improve balance. We designed this study to examine if yoga reduces falls. We conducted 16 sessions of Hatha yoga over 8 weeks. Participants were randomly assigned to practice 10min of yoga daily at home in addition to 5-min relaxation exercises or relaxation exercises only (control group). Of the 38 participants completing the intervention, 15 participants reported a total of 27 falls in the 6-months before the study, compared to 13 participants sustaining 14 falls in the 6 months from the start of the study (p<0.047), without difference between yoga home-exercise and home relaxation-only groups. Compared to baseline scores, all participants improved on the Berg Balance Scale (53-54 out of 56, p=0.002), the Functional Gait Assessment (22.9-25.8 out of 30 points, p<0.001), and the Dynamic Gait Index (20.6-22.4 out of 24 points, p<0.001). Right leg stand time improved from a mean of 13.3s to 17.1s (p=0.020) and standing forward reach distance from 26.0cm to 29.6cm (p<0.001). Without difference between groups. Confidence, with the Activities-specific Balance Confidence Scale, increased in the yoga home-exercise group (88%-93%, p=0.037) compared to 90% unchanged from pre-intervention in the home relaxation-only group. Yoga classes reduce self-reported falls and improve balance measures. The addition of home yoga exercises did not enhance benefit over relaxation exercise only. Copyright © 2017 Elsevier Ltd. All rights reserved.

[Factors regarding awareness of preventive care exercises: Distance to exercise facilities and their social networks].

PubMed

Soma, Yuki; Tsunoda, Kenji; Kitano, Naruki; Jindo, Takashi; Okura, Tomohiro

2015-01-01

The present study examines factors affecting individuals' awareness of certain types of preventive care exercises, particularly the distance from their home to an exercise facility and their social networks. Participants were 3206 men (age, 73.0±6.2 years) and 3395 women (age, 73.2±6.4 years) aged ≥65 years who had not been certified as persons with care needs and who had responded to an inventory survey conducted in Kasama City, Japan, in 2013. We performed multiple logistic regression analysis to assess the characteristics associated with participants' awareness of two types of exercises for preventive care: "silver rehabili taisou" (SRT) and "square-stepping exercise" (SSE). Independent variables were distance from home to the exercise facility, social networks, transportation availability, physical function, cognitive function, and neighborhood population density. Older adults who were aware of the exercises lived significantly closer to an exercise facility (SRT, aware: 1,148.5±961.3 m vs. unaware: 1,284.2±1,027.4 m; SSE, aware: 1,415.9±1104.1 m vs. unaware: 1,615.7±1,172.2 m). Multiple logistic regression analysis showed that participation in community activities (men, SRT-odds ratio [OR]=2.54 and SSE-OR=2.19; women, SRT-OR=4.14 and SSE-OR=3.34] and visiting friends (men, SRT-OR=1.45 and SSE-OR=1.49; women SRT-OR=1.44 and SSE-OR=1.73) were promoting factors for awareness of both types of exercises. In men and women, low physical function (SRT-OR=0.73 and SSE-OR=0.56) and dependence on another person to drive them to the destination (SRT-OR=0.79 and SSE-OR=0.78) were inhibiting factors, respectively. A distance of >500 m between their home and the facility tended to be an inhibiting factor. A shorter distance from home to an exercise facility and better social networks increased awareness of preventive care exercises in both sexes and for both types of exercise. Establishing exercise centers and devising effective methods of imparting information to individuals (e.g., via community magazines and home visits) may promote participation in preventive care exercises.

Experimental protocol of a randomized controlled clinical trial investigating exercise, subclinical atherosclerosis, and walking mobility in persons with multiple sclerosis.

PubMed

Griffith, Garett; Klaren, Rachel E; Motl, Robert W; Baynard, Tracy; Fernhall, Bo

2015-03-01

This randomized controlled trial (RCT) will investigate the effects of a home-based aerobic exercise training regimen (i.e., cycle ergometry) on subclinical atherosclerosis and walking mobility in persons with multiple sclerosis (MS) and minimal disability. This RCT will recruit 54 men and women who have an Expanded Disability Status Scale characteristic of the 1st stage of MS (i.e., 0-4.0) to participate in a 3 month exercise or stretching intervention, with assessments of subclinical atherosclerosis and walking mobility conducted at baseline, week 6 (midpoint), and week 12 (conclusion) of the program. The exercise intervention will consist of 3 days/week of cycling, with a gradual increase of duration followed by an increase in intensity across the 3 month period. The attention-control condition will incorporate stretching activities and will require the same contact time commitment as the exercise condition. Both study groups will participate in weekly video chat sessions with study personnel in order to monitor and track program adherence. Primary outcomes will consist of assessments of vascular structure and function, as well as several walking tasks. Additional outcomes will include questionnaires, cardiorespiratory fitness assessment, and a 1-week free-living physical activity assessment. This investigation will increase understanding of the role of aerobic exercise as part of a treatment plan for managing subclinical atherosclerosis and improving walking mobility persons in the 1st stage of MS. Overall, this study design has the potential to lead to effective aerobic exercise intervention strategies for this population and improve program adherence. Copyright © 2015 Elsevier Inc. All rights reserved.

Managing mobility outcomes in vulnerable seniors ( MMOVeS): a randomized controlled pilot study.

PubMed

Figueiredo, Sabrina; Morais, Jose A; Mayo, Nancy

2017-12-01

To estimate feasibility and potential for efficacy of an individualized, exercise-focused, self-management program (i.e. Managing Mobility Outcomes In Vulnerable Seniors ( MMOVeS)), in comparison to exercise information in improving mobility after six months among seniors recently discharged from hospital. Randomized pilot study. Two McGill University-teaching hospitals. Community dwelling seniors, aged 70 years and older, recently discharged from either participating hospitals. The physiotherapy-facilitated intervention consisted of (1) evaluation of mobility capacity, (2) setting short- and long-term goals, (3) delineation of an exercise treatment plan, (4) an educational booklet to enhance mobility self-management skills, and (5) six monthly telephone calls. Control group received a booklet with information on exercises targeting mobility limitations in seniors. Mobility, pain, and health status were assessed at baseline and at six months using multiple indicators drawn from Disabilities of the Arm, Shoulder, and Hand (DASH) Score, Lower Extremity Functional Scale (LEFS) and Short-Form (SF)-36. In all, 26 people were randomized to the intervention (mean age: 81 ± 8; 39% women), and 23 were randomized to the control (mean age: 79 ± 7; 33% women). The odds ratio for the mobility outcomes combined was 3.08 and the 95% confidence interval excluded 1 (1.65-5.77). The odds ratio for pain and health perception favored the MMOVeS group, but the 95% confidence interval included the null value. This feasibility study highlights the potential for efficacy of an individualized, exercise-focused, self-management program in comparison to exercise information in improving mobility outcome for seniors. Furthermore, a home-program combining self-management skills and exercise taught with minimal supervision prove to be feasible. Finally, data from this study can be used to estimate sample size for a confirmatory trial.

An Exercise Intervention During Chemotherapy for Women With Recurrent Ovarian Cancer: A Feasibility Study.

PubMed

Mizrahi, David; Broderick, Carolyn; Friedlander, Michael; Ryan, Mary; Harrison, Michelle; Pumpa, Kate; Naumann, Fiona

2015-07-01

The aim of this study was to determine the feasibility of a combined supervised and home-based exercise intervention during chemotherapy for women with recurrent ovarian cancer. Secondary aims were to determine the impact of physical activity on physical and psychological outcomes and on chemotherapy completion rates. Women with recurrent ovarian cancer were recruited from 3 oncology outpatient clinics in Sydney and Canberra, Australia. All participants received an individualized exercise program that consisted of 90 minutes or more of low to moderate aerobic, resistance, core stability, and balance exercise per week, for 12 weeks. Feasibility was determined by recruitment rate, retention rate, intervention adherence, and adverse events. Aerobic capacity, muscular strength, fatigue, sleep quality, quality of life, depression, and chemotherapy completion rates were assessed at weeks 0, 12, and 24. Thirty participants were recruited (recruitment rate, 63%), with a retention rate of 70%. Participants averaged 196 ± 138 min · wk of low to moderate physical activity throughout the intervention, with adherence to the program at 81%. There were no adverse events resulting from the exercise intervention. Participants who completed the study displayed significant improvements in quality of life (P = 0.017), fatigue (P = 0.004), mental health (P = 0.007), muscular strength (P = 0.001), and balance (P = 0.003) after the intervention. Participants completing the intervention had a higher relative dose intensity than noncompleters (P = 0.03). A program consisting of low to moderate exercise of 90 min · wk was achieved by two-thirds of women with recurrent ovarian cancer in this study, with no adverse events reported. Randomized control studies are required to confirm the benefits of exercise reported in this study.

Use of Low Level of Continuous Heat as an Adjunct to Physical Therapy Improves Knee Pain Recovery and the Compliance for Home Exercise in Patients With Chronic Knee Pain: A Randomized Controlled Trial.

PubMed

Petrofsky, Jerrold S; Laymon, Michael S; Alshammari, Faris S; Lee, Haneul

2016-11-01

Petrofsky, JS, Laymon, MS, Alshammari, FS, and Lee, H. Use of low level of continuous heat as an adjunct to physical therapy improves knee pain recovery and the compliance for home exercise in patients with chronic knee pain: a randomized controlled trial. J Strength Cond Res 30(11): 3107-3115, 2016-This study examined if the use of low level continuous heat (LLCH) wraps at home between physical therapy sessions at a clinic resulted in better therapy outcomes in patients with chronic knee pain. Fifty individuals with chronic nonspecific knee pain was randomly allocated to 2 groups: the LLCH group and the placebo group. All subjects underwent 1 hour of conventional physical therapy twice per week for 2 weeks at the outpatient clinic and they were asked to accomplish 1 hour of therapeutic exercise at home each day between sessions. The LLCH group applied LLCH knee wraps for 6 hours at home before home exercise while placebo group took a placebo ibuprofen. (This was done since placebo heat is impossible to use since subjects would notice that the wraps were cold) Before, during, and after intervention, pain intensity, active range of motion of the knee (AROM), knee strength, and home exercise compliance were measured. The LLCH group showed pain attenuation after 2 weeks of therapy sessions (p ≤ 0.05). AROM and strength of the knee significantly improved over time compared to the placebo group. Home exercise compliance was significantly higher in the LLCH group than placebo group (p ≤ 0.05). These results indicated that the use of LLCH as an adjunct to conventional physical therapy for chronic knee pain significantly improved pain attenuation and recovery of strength and movement in patients with chronic knee pain.

Role of nonoperative treatment in managing degenerative tears of the medial meniscus posterior root.

PubMed

Neogi, Devdatta Suhas; Kumar, Ashok; Rijal, Laxman; Yadav, Chandra Shekhar; Jaiman, Ashish; Nag, Hira Lal

2013-09-01

Tears of the medial meniscus posterior root can lead to progressive arthritis, and its management has no consensus. The aim of our study was to evaluate the effect of supervised exercise therapy on patients with medial meniscus posterior root tears. Between January 2005 and May 2007, 37 patients with this tear verified by magnetic resonance imaging (MRI) and osteoarthritis grade 1-2 by radiographic examination were treated by a short course of analgesics daily for up to 6 weeks and then as required during follow-up, as well as a 12-week supervised exercise program followed by a home exercise program. Final analysis was performed for 33 patients, average age 55.8 (range 50-62) years and average follow-up of 35 (range 26-49) months. Patients were followed up at 3, 6, and 12 months and yearly thereafter using the Lysholm Knee Scoring Scale, Tegner Activity Scale (TAS), and visual analog scale (VAS). The analysis was performed using one-way analysis of variance (ANOVA) and Pearson's correlation coefficient to determine the relationship between Lysholm score and body mass index (BMI). Patients showed an improvement in Lysholm score, TAS, and VAS, which reached maximum in 6 months and later was accompanied by a decline. However, scores at the final follow-up were significantly better than the pretherapy scores. There was also a progression in arthritis as per Kellgren and Lawrence radiographic classification from median 1 preintervention to median 2 at the final follow-up. A correlation between BMI and Lysholm scores was seen (r = 0.47). Supervised physical therapy with a short course of analgesics followed by a home-based program results in symptomatic and functional improvement over a short-term follow-up; however, osteoarthritis progression continues and is related to BMI.

Home-based pulmonary rehabilitation improves clinical features and systemic inflammation in chronic obstructive pulmonary disease patients.

PubMed

do Nascimento, Eloisa Sanches Pereira; Sampaio, Luciana Maria Malosá; Peixoto-Souza, Fabiana Sobral; Dias, Fernanda Dultra; Gomes, Evelim Leal Freitas Dantas; Greiffo, Flavia Regina; Ligeiro de Oliveira, Ana Paula; Stirbulov, Roberto; Vieira, Rodolfo Paula; Costa, Dirceu

2015-01-01

Chronic obstructive pulmonary disease (COPD) is a respiratory disease characterized by chronic airflow limitation that leads beyond the pulmonary changes to important systemic effects. COPD is characterized by pulmonary and systemic inflammation. However, increases in the levels of inflammatory cytokines in plasma are found even when the disease is stable. Pulmonary rehabilitation improves physical exercise capacity and quality of life and decreases dyspnea. The aim of this study was to evaluate whether a home-based pulmonary rehabilitation (HBPR) program improves exercise tolerance in COPD patients, as well as health-related quality of life and systemic inflammation. This prospective study was conducted at the Laboratory of Functional Respiratory Evaluation, Nove de Julho University, São Paulo, Brazil. After anamnesis, patients were subjected to evaluations of health-related quality of life and dyspnea, spirometry, respiratory muscle strength, upper limbs incremental test, incremental shuttle walk test, and blood test for quantification of systemic inflammatory markers (interleukin [IL]-6 and IL-8). At the end of the evaluations, patients received a booklet containing the physical exercises to be performed at home, three times per week for 8 consecutive weeks. Around 25 patients were enrolled, and 14 completed the pre- and post-HBPR ratings. There was a significant increase in the walked distance and the maximal inspiratory pressure, improvements on two components from the health-related quality-of-life questionnaire, and a decrease in plasma IL-8 levels after the intervention. The HBPR is an important and viable alternative to pulmonary rehabilitation for the treatment of patients with COPD; it improves exercise tolerance, inspiratory muscle strength, quality of life, and systemic inflammation in COPD patients.

Sustaining self-regulatory efficacy and psychological outcome expectations for postnatal exercise: effects of a group-mediated cognitive behavioural intervention.

PubMed

Cramp, A G; Brawley, L R

2009-09-01

The objective of the current investigation was to examine if the effects of a group-mediated cognitive behavioural counselling plus exercise intervention were superior to the effects of a standard exercise care condition on postnatal mothers' self-regulatory efficacy (SRE), outcome expectations (OEs) and self-directed physical activity (PA). The design of the study consisted of two intervention conditions; group-mediated cognitive behavioural counselling plus exercise (GMCB) and standard exercise (SE). Each condition consisted of two phases; a 4-week supervised, centre-based intensive exercise training phase followed by a 4-week home-based phase. Participants were 57 postnatal women randomly assigned to conditions (SE: N=31; GMCB: N=26). Measures of SRE and OEs were assessed prior to and following the centre-based aspect of the intervention. Physical activity was measured following the intensive exercise training phase as well as the home-based phase. GMCB participants' SRE and OEs were sustained during the intervention whereas those of SE participants declined. GMCB participants also reported significantly greater time spent engaging in self-directed PA at the conclusion of the intensive and home-based phases. Mediation analysis revealed that SRE partially mediated the relationship between intervention condition and post home-based PA as confirmed by a significant sobel test. These findings suggest that a theory-based GMCB counselling plus exercise intervention is superior to the SE condition in sustaining SRE and OEs, and in promoting greater self-directed PA. SRE partially mediated the relationship between intervention condition and post home-based PA supporting the targeting of that variable for change as part of the intervention.

Understanding the Experiences of Rural Community-Dwelling Older Adults in Using a New DVD-Delivered Otago Exercise Program: A Qualitative Study.

PubMed

Agha, Arun; Liu-Ambrose, Teresa Y L; Backman, Catherine L; Leese, Jennifer; Li, Linda C

2015-08-13

The home-based Otago Exercise Program (OEP) has been shown to reduce the occurrence of falls in community-dwelling seniors. A new OEP DVD was recently developed for people living in rural communities to be used with minimal coaching by a physical therapist. This study aimed to understand older adults' experiences using the DVD-delivered OEP and explore barriers and facilitators to implementing the DVD-delivered OEP from the participants' perspectives. Rural community-dwelling older adults (75 years and older) who participated in a six-month DVD-delivered OEP study were invited to participate in this qualitative study. Two small group interviews were initially conducted to explore the breadth of participants' experiences with the program. These were followed by semi-structured individual interviews to gain an in-depth understanding of these experiences. An inductive constant comparison analysis of the transcripts was performed. To ensure methodological rigor, field notes, journaling, and an audit trail were maintained, supplemented by peer-review. Of 32 eligible participants, five participated in group interviews and 16 in individual interviews. Three themes emerged. Theme 1, The OEP DVD-useful training tool but in need of more pep, represented participants' experiences that the DVD provided important guidance at program onset, but was too slow and low-energy for longer-term use. Theme 2, Gaining control over one's exercise regimen, but sometimes life gets in the way of staying active, described participants' appreciation of the program's flexibility, but personal health concerns and everyday lives posed challenges to adhering to the program. Theme 3, Social creatures-wanting greater human connection during exercise, described how some participants desired further social interactions for enhancing motivation and receiving guidance. Individuals should be encouraged to refer to the OEP user manual or DVD as needed and engage friends and family in exercises. The importance of exercise even when living with health problems should be raised at program onset, and participants should be supported in working through challenging issues. Health professionals should work with individuals to integrate the program with their everyday activities.

Translating exercise interventions to an in-home setting for seniors: preliminary impact on physical activity and function.

PubMed

Dondzila, Christopher J; Swartz, Ann M; Keenan, Kevin G; Harley, Amy E; Azen, Razia; Strath, Scott J

2016-12-01

The purpose of this study is to investigate whether an in-home, individually tailored intervention is efficacious in promoting increases in physical activity (PA) and improvements in physical functioning (PF) in low-active older adults. Participants were randomized to two groups for the 8-week intervention. The enhanced physical activity (EPA) group received individualized exercise programming, including personalized step goals and a resistance band training program, and the standard of care (SoC) group received a general activity goal. Pre- and post-intervention PF measures included choice step reaction time, knee extension/flexion strength, hand grip strength, and 8 ft up and go test completion time. Thirty-nine subjects completed this study (74.6 ± 6.4 years). Significant increases in steps/day were observed for both the EPA and SoC groups, although the improvements in the EPA group were significantly higher when including only those who adhered to weekly step goals. Both groups experienced significant PF improvements, albeit greater in the EPA group for the 8 ft up and go test and knee extension strength. A low cost, in-home intervention elicited improvements in both PA and PF. Future research is warranted to expand upon the size and scope of this study, exploring dose thresholds (and time frames) for PA to improve PF and strategies to further bolster adherence rates to maximize intervention benefits.

Effects of a home-exercise therapy programme on cervical and lumbar range of motion among nurses with neck and lower back pain: a quasi-experimental study.

PubMed

Freimann, Tiina; Merisalu, Eda; Pääsuke, Mati

2015-01-01

Cervical and lumbar range of motion limitations are usually associated with musculoskeletal pain in the neck and lower back, and are a major health problem among nurses. Physical exercise has been evaluated as an effective intervention method for improving cervical and lumbar range of motion, and for preventing and reducing musculoskeletal pain. The purpose of this study was to investigate the effects of a home-exercise therapy programme on cervical and lumbar range of motion among intensive care unit nurses who had experienced mild to moderate musculoskeletal pain in the neck and or lower back during the previous six months. A quasi-experimental study was conducted among intensive care unit nurses at Tartu University Hospital (Estonia) between May and July 2011. Thirteen nurses who had suffered musculoskeletal pain episodes in the neck and or lower back during the previous six months underwent an 8-week home-exercise therapy programme. Eleven nurses without musculoskeletal pain formed a control group. Questions from the Nordic Musculoskeletal Questionnaire and the 11-point Visual Analogue Scale were used to select potential participants for the experimental group via an assessment of the prevalence and intensity of musculoskeletal pain. Cervical range of motion and lumbar range of motion in flexion, extension, lateral flexion and (cervical range of motion only) rotation were measured with a digital goniometer. A paired t-test was used to compare the measured parameters before and after the home-exercise therapy programme. A Student's t-test was used to analyse any differences between the experimental and control groups. After the home-exercise therapy, there was a significant increase (p < 0.05) in cervical range of motion in flexion, extension, lateral flexion and rotation, and in lumbar range of motion in lateral flexion. Cervical range of motion in flexion was significantly higher (p < 0.01) in the experimental group compared to the control group after therapy. Our results suggest an 8-week intensive home-exercise therapy programme may improve cervical and lumbar range of motion among intensive care nurses. Further studies are needed to develop this simple but effective home-exercise therapy programme to help motivate nurses to perform such exercises regularly. Current Controlled Trials ISRCTN19278735. Registered 27 November 2015.

Effects of a three-month therapeutic exercise programme on flexibility in subjects with low back pain.

PubMed

Kuukkanen, T; Mälkiä, E

2000-01-01

Spinal and muscle flexibility have been studied intensively and used clinically as outcome measurements in the rehabilitation of subjects with low back pain. The results of previous studies are contradictory and there is a lack of longitudinal data on the effects of long term therapeutic exercise on flexibility. A controlled experimental study was conducted to determine the effects of progressive therapeutic exercise on spinal and muscle flexibility. Eighty-six chronic low back pain subjects fulfilled the inclusion criteria and were divided into three study groups: (1) intensive training group, (2) home exercise group and (3) control group. The intervention period lasted three months and measurements were performed at both the beginning of the study and immediately after intervention. Follow-up measurements were carried out six and 12 months after baseline. Spinal flexibility was measured with lumbar flexion, extension, spinal lateral flexion and rotation, and muscle flexibility was measured with measurements of erector spinae, hamstring and iliopsoas muscles. Also self-reported outcomes of the Oswestry Index and Borg Scale--Back Pain Intensity were used. Associations between change (pre- to post-treatment) were determined for the dependent variables. The results showed no correlation between flexibility, the Oswestry Index or back pain intensity. After the first three-month period lumbar flexion, extension and spinal rotation decreased among all subjects. Spinal rotation and erector spinae muscle flexibility improved significantly with intensive training. At the nine-month follow-up, erector spine flexibility was still greater than at baseline. Hamstring flexibility increased among the intensive training and home exercise groups from pre- to post-intervention. However, the degree of hamstring flexibility gained during training was subsequently lost following the period without programmed exercise in both training groups. Self-reported outcome variables showed positive changes among the three study groups after the completion of intervention period, but these changes were only able to be maintained during subsequent follow-ups for the intensive training and home exercise groups. The findings suggest that flexibility does not play an important role in coping with chronic low back pain for subjects whose functional limitations are not severe. Also, it appears that the achieved gains in spinal and muscle flexibility may not be able to be maintained without continued exercise.

Effects of physical exercise interventions in frail older adults: a systematic review of randomized controlled trials.

PubMed

de Labra, Carmen; Guimaraes-Pinheiro, Christyanne; Maseda, Ana; Lorenzo, Trinidad; Millán-Calenti, José C

2015-12-02

Low physical activity has been shown to be one of the most common components of frailty, and interventions have been considered to prevent or reverse this syndrome. The purpose of this systematic review of randomized, controlled trials is to examine the exercise interventions to manage frailty in older people. The PubMed, Web of Science, and Cochrane Central Register of Controlled Trials databases were searched using specific keywords and Medical Subject Headings for randomized, controlled trials published during the period of 2003-2015, which enrolled frail older adults in an exercise intervention program. Studies where frailty had been defined were included in the review. A narrative synthesis approach was performed to examine the results. The Physiotherapy Evidence Database (PEDro scale) was used to assess the methodological quality of the selected studies. Of 507 articles, nine papers met the inclusion criteria. Of these, six included multi-component exercise interventions (aerobic and resistance training not coexisting in the intervention), one included physical comprehensive training, and two included exercises based on strength training. All nine of these trials included a control group receiving no treatment, maintaining their habitual lifestyle or using a home-based low level exercise program. Five investigated the effects of exercise on falls, and among them, three found a positive impact of exercise interventions on this parameter. Six trials reported the effects of exercise training on several aspects of mobility, and among them, four showed enhancements in several measurements of this outcome. Three trials focused on the effects of exercise intervention on balance performance, and one demonstrated enhanced balance. Four trials investigated functional ability, and two showed positive results after the intervention. Seven trials investigated the effects of exercise intervention on muscle strength, and five of them reported increases; three trials investigated the effects of exercise training on body composition, finding improvements in this parameter in two of them; finally, one trial investigated the effects of exercise on frailty using Fried's criteria and found an improvement in this measurement. Exercise interventions have demonstrated improvement in different outcome measurements in frail older adults, however, there were large differences between studies with regard to effect sizes. This systematic review suggested that frail older adults seemed to benefit from exercise interventions, although the optimal program remains unclear. More studies of this topic and with frail populations are needed to select the most favorable exercise program.

Cognitive remediation training improves performance in patients with chronic fatigue syndrome.

PubMed

McBride, Richard L; Horsfield, Sarah; Sandler, Carolina X; Cassar, Joanne; Casson, Sally; Cvejic, Erin; Vollmer-Conna, Uté; Lloyd, Andrew R

2017-11-01

Neurocognitive disturbance with subjectively-impaired concentration and memory is a common, disabling symptom reported by patients with chronic fatigue syndrome (CFS). We recently reported preliminary evidence for benefits of cognitive remediation as part of an integrated cognitive-behavioral therapy (CBT)/ graded exercise therapy (GET) program. Here, we describe a contemporaneous, case-control trial evaluating the effectiveness of an online cognitive remediation training program (cognitive exercise therapy; CET) in addition to CBT/GET (n=36), compared to CBT/GET alone (n=36). The study was conducted in an academic, tertiary referral outpatient setting over 12 weeks (11 visits) with structured, home-based activities between visits. Participants self-reported standardized measures of symptom severity and functional status before and after the intervention. Those in the CET arm also completed standardized neurocognitive assessment before, and following, treatment. The addition of formal CET led to significantly greater improvements in self-reported neurocognitive symptoms compared to CBT/GET alone. Subjective improvement was predicted by CET group and lower baseline mood disturbance. In the CET group, significant improvements in objectively-measured executive function, processing speed, and working memory were observed. These subjective and objective performance improvements suggest that a computerized, home-based cognitive training program may be an effective intervention for patients with CFS, warranting randomized controlled trials. Copyright © 2017 Elsevier B.V. All rights reserved.

Core strength training using a combination of home exercises and a dynamic sling system for the management of low back pain in pre-professional ballet dancers: a case series.

PubMed

Kline, Jessica Beckmann; Krauss, John R; Maher, Sara F; Qu, Xianggui

2013-01-01

Estimates of low back pain prevalence in USA ballet dancers range from 8% to 23%. Lumbar stabilization and extensor muscle training has been shown to act as a hypoalgesic for low back pain. Timing and coordination of multifidi and transverse abdominis muscles are recognized as important factors for spinal stabilization. The purpose of this study was to explore the effects of training methods using home exercises and a dynamic sling system on core strength, disability, and low back pain in pre-professional ballet dancers. Five participants were randomly assigned to start a traditional unsupervised lumbar stabilization home exercise program (HEP) or supervised dynamic sling training to strengthen the core and lower extremities. Measurements were taken at baseline and at weeks 3 and 6 for disability using the patient specific functional scale (PSFS), pain using the Numerical Pain Rating System (NPRS), core strength and endurance using timed plank, side-plank, and bridge positions, and sciatic nerve irritability using the straight leg raise (SLR). Data were analyzed using descriptive statistics. From initial to final measurements, all participants demonstrated an improvement in strength and SLR range, and those with initial pain and disability reported relief of symptoms. These results suggest that dynamic sling training and a HEP may help to increase strength, decrease pain, and improve function in dancers without aggravating sciatic nerve irritation.

Effects of a low-resistance, interval bicycling intervention in Parkinson's Disease.

PubMed

Uygur, Mehmet; Bellumori, Maria; Knight, Christopher A

2017-12-01

Previous studies have shown that people with Parkinson's disease (PD) benefit from a variety of exercise modalities with respect to symptom management and function. Among the possible exercise modalities, speedwork has been identified as a promising strategy, with direct implications for the rate and amplitude of nervous system involvement. Considering that previous speed-based exercise for PD has often been equipment, personnel and/or facility dependent, and often time intensive, our purpose was to develop a population-specific exercise program that could be self-administered with equipment that is readily found in fitness centers or perhaps the home. Fourteen individuals with PD (Hoehn-Yahr (H-Y) stage of 3.0 or less) participated in twelve 30-min sessions of low-resistance interval training on a stationary recumbent bicycle. Motor examination section of the Unified Parkinson's Disease Rating Scale (UPDRS), 10-meter walk (10mW), timed-up-and-go (TUG), functional reach, four-square step test (4SST), nine-hole peg test (9HPT) and simple reaction time scores all exhibited significant improvements (p < 0.05). These results add further support to the practice of speedwork for people with PD and outline a population-amenable program with high feasibility.

Emergency department-reported injuries associated with mechanical home exercise equipment in the USA

PubMed Central

Graves, Janessa M; Iyer, Krithika R; Willis, Margaret M; Ebel, Beth E; Rivara, Frederick P; Vavilala, Monica S

2015-01-01

The goal of this study was to generate national estimates of injuries associated with mechanical home exercise equipment, and to describe these injuries across all ages. Emergency department (ED)-treated injuries associated with mechanical home exercise equipment were identified from 2007 to 2011 from the National Electronic Injury Surveillance System. Text narratives provided exercise equipment type (treadmill, elliptical, stationary bicycle, unspecified/other exercise machine). Approximately 70 302 (95% CI 59 086 to 81 519) mechanical exercise equipment-related injuries presented to US EDs nationally during 2007–2011, of which 66% were attributed to treadmills. Most injuries among children (≤4 years) were lacerations (34%) or soft tissue injuries (48%); among adults (≥25 years) injuries were often sprains/strains (30%). Injured older adults (≥65 years) had greater odds of being admitted, held for observation, or transferred to another hospital, compared with younger ages (OR: 2.58; 95% CI 1.45 to 4.60). Mechanical exercise equipment is a common cause of injury across ages. Injury awareness and prevention are important complements to active lifestyles. PMID:24061163

Yoga and exercise for symptoms of depression and anxiety in people with poststroke disability: a randomized, controlled pilot trial.

PubMed

Chan, Weili; Immink, Maarten A; Hillier, Susan

2012-01-01

Mood disorders are prevalent in people after stroke, and a disorder's onset can exacerbate stroke-related disabilities. While evidence supports the mental-health benefits of participation in exercise and yoga, it is unknown whether such benefits extend to a population with poststroke hemiparesis. The study investigated whether supplementing exercise with participation in a yoga program would provide further improvements in self-reported symptoms of depression and anxiety in a chronic poststroke population, and it also assessed trial feasibility for future studies. The research team designed a randomized, controlled pilot trial that included an exercise-only group (EX, control) and a yoga-and-exercise group (YEX, intervention). The study took place at the Centre for Physical Activity in Ageing an exercise rehabilitation and activity center at the Royal Adelaide Hospital in South Australia. The participants included 14 individuals with chronic poststroke hemiparesis: eight in the intervention group and six in the control group. The YEX group participated in a 6-week standardized program that included yoga in weekly group sessions and home practice in addition to exercise in a weekly group class. The EX group participated only in the group exercise class weekly for 6 weeks. The research team assessed self-reported symptoms of depression using the Geriatric Depression Scale (GDS15) and symptoms of anxiety and negative affect using the State Trait Anxiety Inventory (STAI). The team based the feasibility evaluation on recruitment outcomes, retention of participants, participants' compliance with the intervention program, and the safety of the intervention. Changes in depression and state and trait anxiety did not significantly differ between intervention groups (GDS15 P=.749, STAI-Y1, P=.595, STAI-Y2, P=.407). Comparison of individuals' case results indicated clinically relevant improvements in both groups, although members of the intervention group had greater improvements. Participants reported no adverse events, and the study experienced high retention of participants and high compliance in the yoga program. This pilot study provides preliminary data on the effects of yoga combined with exercise to influence mood poststroke. It is a feasible, safe, and acceptable intervention, and the field requires additional investigations with a larger sample size.

Comparison of neuromuscular and quadriceps strengthening exercise in the treatment of varus malaligned knees with medial knee osteoarthritis: a randomised controlled trial protocol.

PubMed

Bennell, Kim L; Egerton, Thorlene; Wrigley, Tim V; Hodges, Paul W; Hunt, Michael; Roos, Ewa M; Kyriakides, Mary; Metcalf, Ben; Forbes, Andrew; Ageberg, Eva; Hinman, Rana S

2011-12-05

Osteoarthritis of the knee involving predominantly the medial tibiofemoral compartment is common in older people, giving rise to pain and loss of function. Many people experience progressive worsening of the disease over time, particularly those with varus malalignment and increased medial knee joint load. Therefore, interventions that can reduce excessive medial knee loading may be beneficial in reducing the risk of structural progression. Traditional quadriceps strengthening can improve pain and function in people with knee osteoarthritis but does not appear to reduce medial knee load. A neuromuscular exercise program, emphasising optimal alignment of the trunk and lower limb joints relative to one another, as well as quality of movement performance, while dynamically and functionally strengthening the lower limb muscles, may be able to reduce medial knee load. Such a program may also be superior to traditional quadriceps strengthening with respect to improved pain and physical function because of the functional and dynamic nature. This randomised controlled trial will investigate the effect of a neuromuscular exercise program on medial knee joint loading, pain and function in individuals with medial knee joint osteoarthritis. We hypothesise that the neuromuscular program will reduce medial knee load as well as pain and functional limitations to a greater extent than a traditional quadriceps strengthening program. 100 people with medial knee pain, radiographic medial compartment osteoarthritis and varus malalignment will be recruited and randomly allocated to one of two 12-week exercise programs: quadriceps strengthening or neuromuscular exercise. Each program will involve 14 supervised exercise sessions with a physiotherapist plus four unsupervised sessions per week at home. The primary outcomes are medial knee load during walking (the peak external knee adduction moment from 3D gait analysis), pain, and self-reported physical function measured at baseline and immediately following the program. Secondary outcomes include the external knee adduction moment angular impulse, electromyographic muscle activation patterns, knee and hip muscle strength, balance, functional ability, and quality-of-life. The findings will help determine whether neuromuscular exercise is superior to traditional quadriceps strengthening regarding effects on knee load, pain and physical function in people with medial knee osteoarthritis and varus malalignment. Australian New Zealand Clinical Trials Registry reference: ACTRN12610000660088.

Comparison of neuromuscular and quadriceps strengthening exercise in the treatment of varus malaligned knees with medial knee osteoarthritis: a randomised controlled trial protocol

PubMed Central

2011-01-01

Background Osteoarthritis of the knee involving predominantly the medial tibiofemoral compartment is common in older people, giving rise to pain and loss of function. Many people experience progressive worsening of the disease over time, particularly those with varus malalignment and increased medial knee joint load. Therefore, interventions that can reduce excessive medial knee loading may be beneficial in reducing the risk of structural progression. Traditional quadriceps strengthening can improve pain and function in people with knee osteoarthritis but does not appear to reduce medial knee load. A neuromuscular exercise program, emphasising optimal alignment of the trunk and lower limb joints relative to one another, as well as quality of movement performance, while dynamically and functionally strengthening the lower limb muscles, may be able to reduce medial knee load. Such a program may also be superior to traditional quadriceps strengthening with respect to improved pain and physical function because of the functional and dynamic nature. This randomised controlled trial will investigate the effect of a neuromuscular exercise program on medial knee joint loading, pain and function in individuals with medial knee joint osteoarthritis. We hypothesise that the neuromuscular program will reduce medial knee load as well as pain and functional limitations to a greater extent than a traditional quadriceps strengthening program. Methods/Design 100 people with medial knee pain, radiographic medial compartment osteoarthritis and varus malalignment will be recruited and randomly allocated to one of two 12-week exercise programs: quadriceps strengthening or neuromuscular exercise. Each program will involve 14 supervised exercise sessions with a physiotherapist plus four unsupervised sessions per week at home. The primary outcomes are medial knee load during walking (the peak external knee adduction moment from 3D gait analysis), pain, and self-reported physical function measured at baseline and immediately following the program. Secondary outcomes include the external knee adduction moment angular impulse, electromyographic muscle activation patterns, knee and hip muscle strength, balance, functional ability, and quality-of-life. Discussion The findings will help determine whether neuromuscular exercise is superior to traditional quadriceps strengthening regarding effects on knee load, pain and physical function in people with medial knee osteoarthritis and varus malalignment. Trial Registration Australian New Zealand Clinical Trials Registry reference: ACTRN12610000660088 PMID:22141334

Physical activity levels of older adults receiving a home care service.

PubMed

Burton, Elissa; Lewin, Gill; Boldy, Duncan

2013-04-01

The 3 study objectives were to compare the activity levels of older people who had received a restorative home care service with those of people who had received "usual" home care, explore the predictors of physical activity in these 2 groups, and determine whether either group met the minimum recommended activity levels for their age group. A questionnaire was posted to 1,490 clients who had been referred for a home care service between 2006 and 2009. Older people who had received a restorative care service were more active than those who had received usual care (p = .049), but service group did not predict activity levels when other variables were adjusted for in a multiple regression. Younger individuals who were in better physical condition, with good mobility and no diagnosis of depression, were more likely to be active. Investigation of alternatives to the current exercise component of the restorative program is needed.

[Review of the approach to exercise behavior modification from the viewpoint of preventive medicine].

PubMed

Nomura, Takuo; Kouta, Munetsugu; Shigemori, Kenta; Yoshimoto, Yoshinobu; Sato, Atsushi

2008-05-01

The purpose of this study was to summarize the approaches to behavior modification for exercise from the viewpoint of preventive medicine. Articles were searched according to the particular field of preventive medicine, i.e., primary prevention, secondary prevention, tertiary prevention, and other fields of prevention. In the field of primary prevention for elderly people living at home, many fall prevention programs were found to have been carried out. In these studies, various programs were found to be effective if the exercise proved to be sufficient. Although some approaches were observed to be based on the productive aging theory and social capital, the number of such studies was small. In the field of secondary prevention, illness and functional disorders are prevented from becoming worse. It is therefore important for each individual to exercise by himself/herself and also acquire sufficient self-monitoring skills. Social capital is useful for learning good exercise habits. In the field of tertiary prevention, although exercise therapy is effective for improving physical functions and preventing disease recurrence in patients with chronic disease, some patients nevertheless find it difficult to continue such an exercise therapy. The approaches to behavior modification were extremely effective for patients with chronic disease. In other fields of preventive medicine, daily exercises such stair climbing are effective methods for reducing the risk of chronic disease and such a behavior modification may lead to a considerable public health gain. In the future, further studies with a many lines of evidence should be performed, and approaches based on behavioral science should be established.

The effects of a home-based arm ergometry exercise programme on physical fitness, fatigue and activity in Polio survivors: a randomised controlled trial.

PubMed

Murray, D; Hardiman, O; Campion, A; Vance, R; Horgan, F; Meldrum, D

2017-07-01

To investigate the effect of an eight-week home-based arm ergometry aerobic exercise programme on physical fitness, fatigue, activity and quality of life in Polio Survivors. An assessor blinded randomised controlled trial. Home-based exercise. Fifty-five Polio survivors randomised to exercise or control groups. Home-based arm ergometry at an intensity of 50%-70% maximum heart rate, compared with usual physiotherapy care. The Six-minute Arm Test, Fatigue Severity Scale, Physical Activity Scale for Individuals with Physical Disabilities and SF-36. Assessments were completed at baseline and at eight weeks. There was no significant difference in the primary outcome, exercising heart rate during the Six-minute Arm Test, between the groups at follow-up [97.6 (SD10.1) compared to 102.4 (SD13.7) beats per minute ( P=0.20)]. Blood pressure was significantly lower in the intervention group at follow-up [systolic blood pressure 132(18.6)mmHg compared to 144.1(14.6)mmHg ( P=0.002)]. There were no between group differences in the Fatigue Severity Scale ( P=0.25) or Physical Activity Scale for Individuals with Physical Disabilities ( P=0.49), with a small difference in SF-36 physical component score ( P=0.04). This home-based arm ergometry programme successfully facilitated aerobic exercise in Polio Survivors, but did not result in a significant change in physical fitness, measured by the Six-minute Arm Test.

Effect of Exercise on Serum Sex Hormones in Men: A 12-Month Randomized Clinical Trial

PubMed Central

HAWKINS, VIVIAN N.; FOSTER-SCHUBERT, KAREN; CHUBAK, JESSICA; SORENSEN, BESS; ULRICH, CORNELIA M.; STANCYZK, FRANK Z.; PLYMATE, STEPHEN; STANFORD, JANET; WHITE, EMILY; POTTER, JOHN D.; MCTIERNAN, ANNE

2011-01-01

Purpose The effect of exercise on androgens in middle-aged to older men is poorly understood, and it could have implications for several aspects of health. This analysis was conducted to examine the effects of long-term aerobic exercise on serum sex hormones in middle-aged to older men. Methods One hundred two sedentary men, ages 40–75 yr, were randomly assigned to a 12-month exercise intervention or a control group (no change in activity). The combined facility- and home-based exercise program consisted of moderate/vigorous-intensity aerobic activity for 60 min·d−1, 6 d·wk−1. Serum concentrations of testosterone, free testosterone, dihydrotestosterone (DHT), 3α-androstanediol glucuronide (3α-Diol-G), estradiol, free estradiol, and sex hormone–binding globulin (SHBG) were measured at baseline, 3, and 12 months. Results Exercisers trained a mean of 370 min·wk−1 (102% of goal), with only two dropouts. Cardiopulmonary fitness (V̇O2max) increased 10.8% in exercisers and decreased by 1.8% in controls (P < 0.001). DHT increased 14.5% in exercisers versus 1.7% in controls at 3 months (P = 0.04); at 12 months, it remained 8.6% above baseline in exercisers versus a 3.1% decrease in controls (P = 0.03). SHBG increased 14.3% in exercisers versus 5.7% in controls at 3 months (P = 0.04); at 12 months, it remained 8.9% above baseline in exercisers versus 4.0% in controls (P = 0.13). There were significant trends toward increasing DHT and SHBG, with greater increases in V̇O2max at 3 and 12 months in exercisers. No statistically significant differences were observed for testosterone, free testosterone, 3α-Diol-G, estradiol, or free estradiol in exercisers versus controls. Conclusions A yearlong, moderate-intensity aerobic exercise program increased DHT and SHBG, but it had no effect on other androgens in middle-aged to older men. PMID:18202581

Task-Oriented Training with Computer Games for People with Rheumatoid Arthritis or Hand Osteoarthritis: A Feasibility Randomized Controlled Trial.

PubMed

Srikesavan, Cynthia Swarnalatha; Shay, Barbara; Szturm, Tony

2016-09-13

To examine the feasibility of a clinical trial on a novel, home-based task-oriented training with conventional hand exercises in people with rheumatoid arthritis or hand osteoarthritis. To explore the experiences of participants who completed their respective home exercise programmes. Thirty volunteer participants aged between 30 and 60 years and diagnosed with rheumatoid arthritis or hand osteoarthritis were proposed for a single-center, assessor-blinded, randomized controlled trial ( ClinicalTrials.gov : NCT01635582). Participants received task-oriented training with interactive computer games and objects of daily life or finger mobility and strengthening exercises. Both programmes were home based and were done four sessions per week with 20 minutes each session for 6 weeks. Major feasibility outcomes were number of volunteers screened, randomized, and retained; completion of blinded assessments, exercise training, and home exercise sessions; equipment and data management; and clinical outcomes of hand function. Reaching the recruitment target in 18 months and achieving exercise compliance >80% were set as success criteria. Concurrent with the trial, focus group interviews explored experiences of those participants who completed their respective programmes. After trial initiation, revisions in inclusion criteria were required to promote recruitment. A total of 17 participants were randomized and 15 were retained. Completion of assessments, exercise training, and home exercise sessions; equipment and data collection and management demonstrated excellent feasibility. Both groups improved in hand function outcomes and exercise compliance was above 85%. Participants perceived both programmes as appropriate and acceptable. Participants who completed task-oriented training also agreed that playing different computer games was enjoyable, engaging, and motivating. Findings demonstrate initial evidence on recruitment, feasibility of trial procedures, and acceptability of task-oriented training in people with rheumatoid arthritis or hand osteoarthritis. Since the pilot trial was unsuccessful in participant recruitment, a large trial will not follow.

Effects of two physiotherapy booster sessions on outcomes with home exercise in people with knee osteoarthritis: a randomized controlled trial.

PubMed

Bennell, Kim L; Kyriakides, Mary; Hodges, Paul W; Hinman, Rana S

2014-11-01

Enhancing exercise adherence over the longer term is an important goal in self-management of knee osteoarthritis (OA). Following an initial period of more intensive exercise supervision, this study investigated whether 2 additional physiotherapy visits improved outcomes with continued home exercise over a subsequent 24-week period. A total of 78 people with medial knee OA (mean ± SD age 62.1 ± 6.9 years, mean ± SD body mass index 29.4 ± 4.0 kg/m(2) , and radiographic disease severity 19% mild, 49% moderate, and 32% severe) who completed a 12-week physiotherapist-supervised exercise trial were randomly allocated to 2 30-minute physiotherapy booster sessions (delivered by 8 physiotherapists in private clinics) or no booster sessions for the subsequent 24 weeks. All participants were asked to continue home exercises 4 times weekly. Primary outcomes were change in pain, using a 100-mm visual analog scale, and self-reported physical function, measured using the Western Ontario McMaster Universities Osteoarthritis Index. Participants and physiotherapists were unblinded to group allocation, although participants were blinded to the study hypothesis. A total of 74 participants (95%) completed the trial. There was no significant difference between groups for change in pain (mean difference [95% confidence interval (95% CI)] 0.7 mm [-9.4, 8.0]; P = 0.88) or physical function (-0.3 units [95% CI -4.0, 3.5]; P = 0.88). The mean ± SD percentage of home exercise sessions completed was 56% ± 34% in the booster group and 51% ± 37% in the control group (P > 0.05). Two booster sessions with a physiotherapist did not influence pain or physical function outcomes, or measures of home exercise adherence. These findings suggest other more effective strategies are needed to maximize longer-term adherence with the aim to achieve greater improvements in clinical outcomes from exercise in this patient population. Copyright © 2014 by the American College of Rheumatology.

Patients' preference for exercise setting and its influence on the health benefits gained from exercise-based cardiac rehabilitation.

PubMed

Tang, Lars H; Kikkenborg Berg, Selina; Christensen, Jan; Lawaetz, Jannik; Doherty, Patrick; Taylor, Rod S; Langberg, Henning; Zwisler, Ann-Dorthe

2017-04-01

To assess patient preference for exercise setting and examine if choice of setting influences the long-term health benefit of exercise-based cardiac rehabilitation. Patients participating in a randomised controlled trial following either heart valve surgery, or radiofrequency ablation for atrial fibrillation were given the choice to perform a 12-week exercise programme in either a supervised centre-based, or a self-management home-based setting. Exercise capacity and physical and mental health outcomes were assessed for up to 24months after hospital discharge. Outcomes between settings were compared using a time×setting interaction using a mixed effects regression model. Across the 158 included patients, an equivalent proportion preferred to undertake exercise rehabilitation in a centre-based setting (55%, 95% CI: 45% to 63%) compared to a home-based setting (45%, 95% CI: 37% to 53%, p=0.233). At baseline, those who preferred a home-based setting reported better physical health (mean difference in physical component score: 5.0, 95% CI 2.3 to 7.4; p=0.001) and higher exercise capacity (mean between group difference 15.9watts, 95% CI 3.7 to 28.1; p=0.011). With the exception of the depression score in the Hospital Anxiety and Depression Score (F(3.65), p=0.004), there was no evidence of a significant difference in outcomes between settings. The preference of patients to participate in home-based and centre-based exercise programmes appears to be equivalent and provides similar health benefits. Whilst these findings support that patients should be given the choice between exercise-settings when initiating cardiac rehabilitation, further confirmatory evidence is needed. Copyright © 2017. Published by Elsevier B.V.

Home based computer-assisted upper limb exercise for young children with cerebral palsy: a feasibility study investigating impact on motor control and functional outcome.

PubMed

Weightman, Andrew; Preston, Nick; Levesley, Martin; Holt, Raymond; Mon-Williams, Mark; Clarke, Mike; Cozens, Alastair J; Bhakta, Bipin

2011-03-01

We developed a home-based rehabilitation exercise system incorporating a powered joystick linked to a computer game, to enable children with arm paresis to participate in independent home exercise. We investigated the feasibility and impact of using the system in the home setting. Eighteen children with cerebral palsy (median age 7.5 years, age range 5-16 years) were recruited from local National Health Service and the exercise system was installed in their home for approximately 4 weeks. Baseline and post-intervention assessments were taken: Canadian Occupational Performance Measure (COPM); kinematic measurement of movement quality (indexed by duration and smoothness) measured using a motion tracking system when performing a standardized computer task. The system was used for a median time of 75 min (interquartile range (IQR) 17-271), equating to 606 outward and 734 inward movements. Pre-COPM, (median 4.2); post-COPM (median 6.0); obs=34; z=3.62, p<0.01). Kinematic analysis of pre- and post-intervention movements on the standardized task showed decreased duration and increased smoothness. Some improvements in self-reported function and quality of movement are observed. This pilot study suggests that the system could be used to augment home-based arm exercise in an engaging way for children with cerebral palsy, although a controlled clinical trial is required to establish clinical efficacy. The feasibility of this technology has been demonstrated.

Physical exercise at the workplace prevents deterioration of work ability among healthcare workers: cluster randomized controlled trial.

PubMed

Jakobsen, Markus D; Sundstrup, Emil; Brandt, Mikkel; Jay, Kenneth; Aagaard, Per; Andersen, Lars L

2015-11-25

Imbalance between individual resources and work demands can lead to musculoskeletal disorders and reduced work ability. The purpose of this study was to investigate the effect of workplace- versus home-based physical exercise on work ability among healthcare workers. Two hundred female healthcare workers (Age: 42.0, BMI: 24.1, work ability index [WAI]: 43.1) from 18 departments at three Danish hospitals participated (Copenhagen, Denmark, Aug 2013-Jan 2014). Participants were randomly allocated at the cluster level to 10 weeks of: 1) workplace physical exercise (WORK) performed during working hours for 5x10 min per week and up to 5 group-based coaching sessions on motivation for regular physical exercise, or 2) home-based physical exercise (HOME) performed during leisure time for 5x10 min per week. Both groups received ergonomic counseling on patient handling and use of lifting aides. The main outcome measure was the change from baseline to 10-week follow-up in WAI. Significant group by time interaction was observed for WAI (p < 0.05). WAI at follow-up was 1.1 (0.3 to 1.8) higher in WORK compared with HOME corresponding to a small effect size (Cohens'd = 0.24). Within-group changes indicated that between-group differences were mainly caused by a reduction in WAI in HOME. Of the seven items of WAI, item 2 (work ability in relation to the demands of the job) and item 5 (sickness absence during the past year) were improved in WORK compared with HOME (P < 0.05). Performing physical exercise together with colleagues at the workplace prevents deterioration of work ability among female healthcare workers. ClinicalTrials.gov NCT01921764 . Registered 10 August 2013.

A prospective randomized controlled trial comparing occupational therapy with home-based exercises in conservative treatment of rotator cuff tears.

PubMed

Krischak, Gert; Gebhard, Florian; Reichel, Heiko; Friemert, Benedikt; Schneider, Florian; Fisser, Christoph; Kaluscha, Rainer; Kraus, Michael

2013-09-01

This pilot study evaluates the outcome after occupational therapy, compared to home-based exercises in the conservative treatment of patients with full thickness rotator cuff tears. Forty-three adult subjects (range, 18-75 years), who had a full thickness rupture of the rotator cuff which was verified by magnetic imaging tomography, with clinical signs of a chronic rotator cuff impingement, and who were available for follow-up, were randomized to occupational therapy or to independent home-based exercises using a booklet. After drop-out, 38 patients were available for full examination at follow-up. Before therapy and after 2 months of conservative treatment, pain intensity, the Constant-Murley score, isokinetic strength testing in abduction and external rotation, functional limitation, clinical shoulder tests and health-related quality of life (EQ-5D) were evaluated. Two-thirds of the patients improved in clinical shoulder tests, regardless of the therapy group. There were no significant differences between the groups with reference to pain, range of motion, maximum peak force (abduction, external rotation), the Constant-Murley score, and the EQ-5D index. The only significant difference observed was the improvement in the self-assessed health- related quality of life (EQ-5D VAS) favoring home-based exercises. Home-based exercise, on the basis of an illustrated booklet with exercises twice a day, supplies comparable results to formal occupational therapy in the conservative treatment of rotator cuff tears. The results of this pilot study suggest some potential advantages related to psychological benefits using home-based treatment. Copyright © 2013 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

Effects of Adding an Internet-Based Pain Coping Skills Training Protocol to a Standardized Education and Exercise Program for People With Persistent Hip Pain (HOPE Trial): Randomized Controlled Trial Protocol

PubMed Central

Rini, Christine; Keefe, Francis; French, Simon; Nelligan, Rachel; Kasza, Jessica; Forbes, Andrew; Dobson, Fiona; Haxby Abbott, J.; Dalwood, Andrew; Vicenzino, Bill; Harris, Anthony; Hinman, Rana S.

2015-01-01

Background Persistent hip pain in older people is usually due to hip osteoarthritis (OA), a major cause of pain, disability, and psychological dysfunction. Objective The purpose of this study is to evaluate whether adding an Internet-based pain coping skills training (PCST) protocol to a standardized intervention of education followed by physical therapist–instructed home exercise leads to greater reductions in pain and improvements in function. Design An assessor-, therapist-, and participant-blinded randomized controlled trial will be conducted. Setting The study will be conducted in a community setting. Participants The participants will be 142 people over 50 years of age with self-reported hip pain consistent with hip OA. Intervention Participants will be randomly allocated to: (1) a control group receiving a 24-week standardized intervention comprising an 8-week Internet-based education package followed by 5 individual physical therapy exercise sessions plus home exercises (3 times weekly) or (2) a PCST group receiving an 8-week Internet-based PCST protocol in addition to the control intervention. Measurements Outcomes will be measured at baseline and 8, 24, and 52 weeks, with the primary time point at 24 weeks. Primary outcomes are hip pain on walking and self-reported physical function. Secondary outcomes include health-related quality-of-life, participant-perceived treatment response, self-efficacy for pain management and function, pain coping attempts, pain catastrophizing, and physical activity. Measurements of adherence, adverse events, use of health services, and process measures will be collected at 24 and 52 weeks. Cost-effectiveness will be assessed at 52 weeks. Limitations A self-reported diagnosis of persistent hip pain will be used. Conclusions The findings will help determine whether adding an Internet-based PCST protocol to standardized education and physical therapist–instructed home exercise is more effective than education and exercise alone for persistent hip pain. This study has the potential to guide clinical practice toward innovative modes of psychosocial health care provision. PMID:26023213

Effects of the Finnish Alzheimer disease exercise trial (FINALEX): a randomized controlled trial.

PubMed

Pitkälä, Kaisu H; Pöysti, Minna M; Laakkonen, Marja-Liisa; Tilvis, Reijo S; Savikko, Niina; Kautiainen, Hannu; Strandberg, Timo E

2013-05-27

Few rigorous clinical trials have investigated the effectiveness of exercise on the physical functioning of patients with Alzheimer disease (AD). To investigate the effects of intense and long-term exercise on the physical functioning and mobility of home-dwelling patients with AD and to explore its effects on the use and costs of health and social services. A randomized controlled trial. A total of 210 home-dwelling patients with AD living with their spousal caregiver. The 3 trial arms included (1) group-based exercise (GE; 4-hour sessions with approximately 1-hour training) and (2) tailored home-based exercise (HE; 1-hour training), both twice a week for 1 year, and (3) a control group (CG) receiving the usual community care. The Functional Independence Measure (FIM), the Short Physical Performance Battery, and information on the use and costs of social and health care services. All groups deteriorated in functioning during the year after randomization, but deterioration was significantly faster in the CG than in the HE or GE group at 6 (P = .003) and 12 (P = .015) months. The FIM changes at 12 months were -7.1 (95% CI, -3.7 to -10.5), -10.3 (95% CI, -6.7 to -13.9), and -14.4 (95% CI, -10.9 to -18.0) in the HE group, GE group, and CG, respectively. The HE and GE groups had significantly fewer falls than the CG during the follow-up year. The total costs of health and social services for the HE patient-caregiver dyads (in US dollars per dyad per year) were $25,112 (95% CI, $17,642 to $32,581) (P = .13 for comparison with the CG), $22,066 in the GE group ($15,931 to $28,199; P = .03 vs CG), and $34,121 ($24,559 to $43,681) in the CG. An intensive and long-term exercise program had beneficial effects on the physical functioning of patients with AD without increasing the total costs of health and social services or causing any significant adverse effects. anzctr.org.au Identifier: ACTRN12608000037303.

Effects of Adding an Internet-Based Pain Coping Skills Training Protocol to a Standardized Education and Exercise Program for People With Persistent Hip Pain (HOPE Trial): Randomized Controlled Trial Protocol.

PubMed

Bennell, Kim L; Rini, Christine; Keefe, Francis; French, Simon; Nelligan, Rachel; Kasza, Jessica; Forbes, Andrew; Dobson, Fiona; Abbott, J Haxby; Dalwood, Andrew; Vicenzino, Bill; Harris, Anthony; Hinman, Rana S

2015-10-01

Persistent hip pain in older people is usually due to hip osteoarthritis (OA), a major cause of pain, disability, and psychological dysfunction. The purpose of this study is to evaluate whether adding an Internet-based pain coping skills training (PCST) protocol to a standardized intervention of education followed by physical therapist-instructed home exercise leads to greater reductions in pain and improvements in function. An assessor-, therapist-, and participant-blinded randomized controlled trial will be conducted. The study will be conducted in a community setting. The participants will be 142 people over 50 years of age with self-reported hip pain consistent with hip OA. Participants will be randomly allocated to: (1) a control group receiving a 24-week standardized intervention comprising an 8-week Internet-based education package followed by 5 individual physical therapy exercise sessions plus home exercises (3 times weekly) or (2) a PCST group receiving an 8-week Internet-based PCST protocol in addition to the control intervention. Outcomes will be measured at baseline and 8, 24, and 52 weeks, with the primary time point at 24 weeks. Primary outcomes are hip pain on walking and self-reported physical function. Secondary outcomes include health-related quality-of-life, participant-perceived treatment response, self-efficacy for pain management and function, pain coping attempts, pain catastrophizing, and physical activity. Measurements of adherence, adverse events, use of health services, and process measures will be collected at 24 and 52 weeks. Cost-effectiveness will be assessed at 52 weeks. A self-reported diagnosis of persistent hip pain will be used. The findings will help determine whether adding an Internet-based PCST protocol to standardized education and physical therapist-instructed home exercise is more effective than education and exercise alone for persistent hip pain. This study has the potential to guide clinical practice toward innovative modes of psychosocial health care provision. © 2015 American Physical Therapy Association.

Effect of home exercise of quadriceps on knee osteoarthritis compared with nonsteroidal antiinflammatory drugs: a randomized controlled trial.

PubMed

Doi, Tokuhide; Akai, Masami; Fujino, Keiji; Iwaya, Tsutomu; Kurosawa, Hisashi; Hayashi, Kunihiko; Marui, Eiji

2008-04-01

To examine the effect of home-based exercise on knee osteoarthritis among Japanese in comparison with that of nonsteroidal antiinflammatory drugs (NSAIDs). An open-labeled, randomized, controlled, multiclinic trial compared home-based quadriceps exercise with NSAIDs. Treatments were basically evaluated after 8 wks and compared with the baseline scores. Outcomes were evaluated with a set of psychometric measurements including the Western Ontario and McMaster Universities Arthritis Index (WOMAC), 36-Item Short-Form Health Survey (SF-36), Japanese Knee Osteoarthritis Measure (JKOM), and pain with the visual analog scale. A total of 142 patients entered this trial to provide the baseline data. After 21 cases withdrew, the final number analyzed was 121 cases: 63 for the exercise group and 58 for the NSAIDs group. Between these two groups, there was no significant difference in gender, age, body height and weight, body mass index, or each score at baseline. The subjects in both groups showed improvements in all scores at the end of intervention. The difference in improvement rate of each score between the two groups was not statistically significant, though the mean rank score measured with JKOM in the exercise was slightly better than that of the NSAIDs. Home-based exercise using quadriceps strengthening improves knee osteoarthritis no less than NSAIDs.

Team-level flexibility, work–home spillover, and health behavior

PubMed Central

Moen, Phyllis; Fan, Wen; Kelly, Erin L.

2013-01-01

Drawing on two waves of survey data conducted six months apart in 2006, this study examined the impacts of a team-level flexibility initiative (ROWE – Results Only Work Environment) on changes in the work-home spillover and health behavior of employees at the Midwest headquarters of a large US corporation. Using cluster analysis, we identified three distinct baseline spillover constellations: employees with high negative spillover, high positive spillover, and low overall spillover. Within-team spillover measures were highly intercorrelated, suggesting that work teams as well as individuals have identifiable patterns of spillover. Multilevel analyses showed ROWE reduced individual- and team-level negative work-home spillover but not positive work-home spillover or spillover from home-to-work. ROWE also promoted employees’ health behaviors: increasing the odds of quitting smoking, decreasing smoking frequency, and promoting perceptions of adequate time for healthy meals. Trends suggest that ROWE also decreased the odds of excessive drinking and improved sleep adequacy and exercise frequency. Some health behavior effects were mediated via reduced individual-level negative work-home spillover (exercise frequency, adequate time for sleep) and reduced team-level negative work-home spillover (smoking frequency, exercise frequency, and adequate time for sleep). While we found no moderating effects of gender, ROWE especially improved the exercise frequency of singles and reduced the smoking frequency of employees with low overall spillover at baseline. PMID:23517706

Team-level flexibility, work-home spillover, and health behavior.

PubMed

Moen, Phyllis; Fan, Wen; Kelly, Erin L

2013-05-01

Drawing on two waves of survey data conducted six months apart in 2006, this study examined the impacts of a team-level flexibility initiative (ROWE--results only work environment) on changes in the work-home spillover and health behavior of employees at the Midwest headquarters of a large U.S. corporation. Using cluster analysis, we identified three distinct baseline spillover constellations: employees with high negative spillover, high positive spillover, and low overall spillover. Within-team spillover measures were highly intercorrelated, suggesting that work teams as well as individuals have identifiable patterns of spillover. Multilevel analyses showed ROWE reduced individual- and team-level negative work-home spillover but not positive work-home spillover or spillover from home-to-work. ROWE also promoted employees' health behaviors: increasing the odds of quitting smoking, decreasing smoking frequency, and promoting perceptions of adequate time for healthy meals. Trends suggest that ROWE also decreased the odds of excessive drinking and improved sleep adequacy and exercise frequency. Some health behavior effects were mediated via reduced individual-level negative work-home spillover (exercise frequency, adequate time for sleep) and reduced team-level negative work-home spillover (smoking frequency, exercise frequency, and adequate time for sleep). While we found no moderating effects of gender, ROWE especially improved the exercise frequency of singles and reduced the smoking frequency of employees with low overall spillover at baseline. Copyright © 2013. Published by Elsevier Ltd.

A computerized recognition system for the home-based physiotherapy exercises using an RGBD camera.

PubMed

Ar, Ilktan; Akgul, Yusuf Sinan

2014-11-01

Computerized recognition of the home based physiotherapy exercises has many benefits and it has attracted considerable interest among the computer vision community. However, most methods in the literature view this task as a special case of motion recognition. In contrast, we propose to employ the three main components of a physiotherapy exercise (the motion patterns, the stance knowledge, and the exercise object) as different recognition tasks and embed them separately into the recognition system. The low level information about each component is gathered using machine learning methods. Then, we use a generative Bayesian network to recognize the exercise types by combining the information from these sources at an abstract level, which takes the advantage of domain knowledge for a more robust system. Finally, a novel postprocessing step is employed to estimate the exercise repetitions counts. The performance evaluation of the system is conducted with a new dataset which contains RGB (red, green, and blue) and depth videos of home-based exercise sessions for commonly applied shoulder and knee exercises. The proposed system works without any body-part segmentation, bodypart tracking, joint detection, and temporal segmentation methods. In the end, favorable exercise recognition rates and encouraging results on the estimation of repetition counts are obtained.

Preventing Burns in Your Home

MedlinePlus

... Plans Nutrients and Nutritional Info Sugar and Sugar Substitutes Exercise and Fitness Exercise Basics Sports Safety Injury ... Plans Nutrients and Nutritional Info Sugar and Sugar Substitutes Exercise and Fitness Exercise Basics Sports Safety Injury ...

A comparison between stabilization exercises and pelvic floor muscle training in women with pelvic organ prolapse.

PubMed

Özengin, Nuriye; Ün Yıldırım, Necmiye; Duran, Bülent

2015-03-01

This study aimed to compare the effectiveness of stabilization exercises and pelvic floor muscle training in women with stage 1 and 2 pelvic organ prolapse. In a total 38 women with pelvic organ prolapse whose average age was 45.60 years, pelvic floor muscles were evaluated with electromyography, and prolapse with pelvic organ prolapse quantification system, and the quality of life with prolapse quality of life questionnaire. Afterwards, the subjects were divided into two groups; stabilization exercise group (n=19) and pelvic floor muscle training group (n=19). Stabilization exercise group were given training for 8 weeks, 3 times a week. Pelvic floor muscle training group were given eight-week home exercises. Each group was assessed before training and after eight weeks. An increase was found in the pelvic muscle activation response in the 2 groups (p≤0.05). There was no difference in EMG activity values between the groups (p>0.05). A difference was found in the values Aa, Ba and C in subjects of each group (p≤0.05), and the TVL, Ap, Bp and D values of subjects in pelvic floor muscle training group (p≤0.05) in the before and after pelvic organ prolapse quantification system assessment, however, no difference was found between the groups (p≤0.05). A positive difference was found in the effect of prolapse sub parameter in each of the two groups, and in general health perception sub parameter in subjects of stabilization exercise group (p<0.05) in the prolapse quality of life questionnaire. It was concluded that both training programs increased the pelvic floor muscle strength, provided a decline in prolapse stages. Stabilization exercise has increased general health perception unlike home training, thus, these exercises can be added to the treatment of women with prolapse.

A comparison between stabilization exercises and pelvic floor muscle training in women with pelvic organ prolapse

PubMed Central

Özengin, Nuriye; Ün Yıldırım, Necmiye; Duran, Bülent

2015-01-01

Objective: This study aimed to compare the effectiveness of stabilization exercises and pelvic floor muscle training in women with stage 1 and 2 pelvic organ prolapse. Materials and Methods: In a total 38 women with pelvic organ prolapse whose average age was 45.60 years, pelvic floor muscles were evaluated with electromyography, and prolapse with pelvic organ prolapse quantification system, and the quality of life with prolapse quality of life questionnaire. Afterwards, the subjects were divided into two groups; stabilization exercise group (n=19) and pelvic floor muscle training group (n=19). Stabilization exercise group were given training for 8 weeks, 3 times a week. Pelvic floor muscle training group were given eight-week home exercises. Each group was assessed before training and after eight weeks. Results: An increase was found in the pelvic muscle activation response in the 2 groups (p≤0.05). There was no difference in EMG activity values between the groups (p>0.05). A difference was found in the values Aa, Ba and C in subjects of each group (p≤0.05), and the TVL, Ap, Bp and D values of subjects in pelvic floor muscle training group (p≤0.05) in the before and after pelvic organ prolapse quantification system assessment, however, no difference was found between the groups (p≤0.05). A positive difference was found in the effect of prolapse sub parameter in each of the two groups, and in general health perception sub parameter in subjects of stabilization exercise group (p<0.05) in the prolapse quality of life questionnaire. Conclusions: It was concluded that both training programs increased the pelvic floor muscle strength, provided a decline in prolapse stages. Stabilization exercise has increased general health perception unlike home training, thus, these exercises can be added to the treatment of women with prolapse. PMID:28913034

Computer-assisted upper extremity training using interactive biking exercise (iBikE) platform.

PubMed

Jeong, In Cheol; Finkelstein, Joseph

2012-01-01

Upper extremity exercise training has been shown to improve clinical outcomes in different chronic health conditions. Arm-operated bicycles are frequently used to facilitate upper extremity training however effective use of these devices at patient homes is hampered by lack of remote connectivity with clinical rehabilitation team, inability to monitor exercise progress in real time using simple graphical representation, and absence of an alert system which would prevent exertion levels exceeding those approved by the clinical rehabilitation team. We developed an interactive biking exercise (iBikE) platform aimed at addressing these limitations. The platform uses a miniature wireless 3-axis accelerometer mounted on a patient wrist that transmits the cycling acceleration data to a laptop. The laptop screen presents an exercise dashboard to the patient in real time allowing easy graphical visualization of exercise progress and presentation of exercise parameters in relation to prescribed targets. The iBikE platform is programmed to alert the patient when exercise intensity exceeds the levels recommended by the patient care provider. The iBikE platform has been tested in 7 healthy volunteers (age range: 26-50 years) and shown to reliably reflect exercise progress and to generate alerts at pre-setup levels. Implementation of remote connectivity with patient rehabilitation team is warranted for future extension and evaluation efforts.

[Exercise contacts in the treatment of substance dependence and mental disorders].

PubMed

Skrede, Atle; Munkvold, Harald; Watne, Øyvind; Martinsen, Egil W

2006-08-10

Physical exercise is useful for individuals with mental disorders with additional substance dependency or abuse. Many exercise actively while in institution, but a major challenge is to continue after discharge. Many patients are isolated and lonely and find it hard to motivate themselves to exercise on their own. In Sogn og Fjordane county, Norway, the problem was dealt with through a training program of exercise contacts. These are social support persons who were thus assigned a new function. By way of a 40-hour course that covered physical activity, psychological problems, and substance abuse and dependency, lay people were trained to help people in their home environment. By the end of 2005, almost 300 exercise contacts, living in 25 of the 26 municipalities in the county, had passed the course exam. Their expertise is highly demanded and more courses have been requested. The course evaluations have been quite positive. In particular, the practical instructions about how to exercise, in combination with updated theory on substance abuse/dependence and mental disorders, were highly appreciated. Clients were helped to continue with regular physical activity and they have appreciated the improved physical and mental health that was associated with regular exercise. Moreover, the exercise contacts help clients break social isolation and have given them access to the common social arenas.

Testing the effectiveness of a self-efficacy based exercise intervention for adults with venous leg ulcers: protocol of a randomised controlled trial

PubMed Central

2014-01-01

Background Exercise and adequate self-management capacity may be important strategies in the management of venous leg ulcers. However, it remains unclear if exercise improves the healing rates of venous leg ulcers and if a self-management exercise program based on self-efficacy theory is well adhered to. Method/design This is a randomised controlled in adults with venous leg ulcers to determine the effectiveness of a self-efficacy based exercise intervention. Participants with venous leg ulcers are recruited from 3 clinical sites in Australia. After collection of baseline data, participants are randomised to either an intervention group or control group. The control group receive usual care, as recommended by evidence based guidelines. The intervention group receive an individualised program of calf muscle exercises and walking. The twelve week exercise program integrates multiple elements, including up to six telephone delivered behavioural coaching and goal setting sessions, supported by written materials, a pedometer and two follow-up booster calls if required. Participants are encouraged to seek social support among their friends, self-monitor their weekly steps and lower limb exercises. The control group are supported by a generic information sheet that the intervention group also receive encouraging lower limb exercises, a pedometer for self-management and phone calls at the same time points as the intervention group. The primary outcome is the healing rates of venous leg ulcers which are assessed at fortnightly clinic appointments. Secondary outcomes, assessed at baseline and 12 weeks: functional ability (range of ankle motion and Tinetti gait and balance score), quality of life and self-management scores. Discussion This study seeks to address a significant gap in current wound management practice by providing evidence for the effectiveness of a home-based exercise program for adults with venous leg ulcers. Theory-driven, evidence-based strategies that can improve an individual’s exercise self-efficacy and self-management capacity could have a significant impact in improving the management of people with venous leg ulcers. Information gained from this study will provide much needed information on management of this chronic disease to promote health and independence in this population. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12612000475842. PMID:25277416

Increased independence and decreased vertigo after vestibular rehabilitation.

PubMed

Cohen, Helen S; Kimball, Kay T

2003-01-01

We sought to determine the effectiveness in decreasing some symptoms, such as vertigo, and increasing performance of daily life skills after vestibular rehabilitation. Patients who had chronic vertigo due to peripheral vestibular impairments were seen at a tertiary care center. They were referred for vestibular rehabilitation and were assessed on vertigo intensity and frequency with the use of the Vertigo Symptom Scale, the Vertigo Handicap Questionnaire, the Vestibular Disorders Activities of Daily Living Scale, and the Dizziness Handicap Inventory. They were then randomly assigned to 1 of 3 home program treatment groups. Vertigo decreased and independence in activities of daily living improved significantly. Improvement was not affected by age, gender, or history of vertigo. For many patients a simple home program of vestibular habituation head movement exercises is related to reduction in symptoms and increasing independence in activities of daily living.

A New App for At-Home Cognitive Training: Description and Pilot Testing on Patients with Multiple Sclerosis.

PubMed

Tacchino, Andrea; Pedullà, Ludovico; Bonzano, Laura; Vassallo, Claudio; Battaglia, Mario Alberto; Mancardi, Gianluigi; Bove, Marco; Brichetto, Giampaolo

2015-08-31

Cognitive impairment is common in people with neurological diseases and severely affects their social and professional life. It has been shown that intensive and personalized cognitive rehabilitation (CR), based on working memory exercises, leads to improved cognitive status of healthy and cognitive-impaired subjects. New technologies would help to promote accessible, at-home, and self-managed CR interventions. The aim of this paper is to describe the design of Cognitive Training Kit (COGNI-TRAcK), an app for mobile devices, to self-administer an at-home, intensive, and personalized CR intervention based on working memory exercises, and test its disposability-to-use (usability, motivation to use, compliance to treatment) on cognitive-impaired patients with multiple sclerosis (MS). COGNI-TRAcK includes user-friendly interfaces for personal data input and management and for CR intervention configurations. Inner routines automatically implement adaptive working load algorithms and allow data processing and analysis. A dedicated team developed COGNI-TRAcK with C# programming language, by using the platform Xamarin Studio 4.0.10 for Android (API level 15 and following). Three exercises based on working memory are now available. To assess the disposability-to-use of the system, patients with MS were selected as likely users due to the young age of disease onset. Cognitive-impaired patients with MS (N=16) with a mean age of 49.06 years (SD 9.10) and a mean score of 3.75 (SD 1.92) on the Expanded Disability Status Scale (EDSS) were submitted to an 8-week at-home intervention administered by the app. The intervention consisted of 5 daily scheduled 30-minute sessions per week. Disposability-to-use of COGNI-TRAcK was investigated by means of a questionnaire administered to patients at the end of the training. The adherence to the treatment was 84% (33.4/40). Of the patients with MS, 94% (15/16) understood the instructions given, 100% (16/16) felt independent to use COGNI-TRAcK at home, 75% (12/16) found the exercises interesting, and 81% (13/16) found the exercises useful and were motivated to use the app again. Moreover, during the exercises, patients with MS were highly motivated to perform well (mean score 3.19/4, SE 0.16), experienced rather low levels of stress (mean score 2.19/4, SE 0.26), were not bored (mean score 1.81/4, SE 0.30), and felt amusement (mean score 2.25/4, SE 0.23). As COGNI-TRAcK is highly usable, motivating, and well-accepted by patients with MS, its effectiveness can now be investigated. To improve COGNI-TRAcK, new releases should contain more working memory exercises, have enhanced perceived amusement, and promote Internet communication procedures for data transfer and fostering remote control of the intervention.

A New App for At-Home Cognitive Training: Description and Pilot Testing on Patients with Multiple Sclerosis

PubMed Central

Bonzano, Laura; Vassallo, Claudio; Battaglia, Mario Alberto; Mancardi, Gianluigi; Bove, Marco

2015-01-01

Background Cognitive impairment is common in people with neurological diseases and severely affects their social and professional life. It has been shown that intensive and personalized cognitive rehabilitation (CR), based on working memory exercises, leads to improved cognitive status of healthy and cognitive-impaired subjects. New technologies would help to promote accessible, at-home, and self-managed CR interventions. Objective The aim of this paper is to describe the design of Cognitive Training Kit (COGNI-TRAcK), an app for mobile devices, to self-administer an at-home, intensive, and personalized CR intervention based on working memory exercises, and test its disposability-to-use (usability, motivation to use, compliance to treatment) on cognitive-impaired patients with multiple sclerosis (MS). Methods COGNI-TRAcK includes user-friendly interfaces for personal data input and management and for CR intervention configurations. Inner routines automatically implement adaptive working load algorithms and allow data processing and analysis. A dedicated team developed COGNI-TRAcK with C# programming language, by using the platform Xamarin Studio 4.0.10 for Android (API level 15 and following). Three exercises based on working memory are now available. To assess the disposability-to-use of the system, patients with MS were selected as likely users due to the young age of disease onset. Cognitive-impaired patients with MS (N=16) with a mean age of 49.06 years (SD 9.10) and a mean score of 3.75 (SD 1.92) on the Expanded Disability Status Scale (EDSS) were submitted to an 8-week at-home intervention administered by the app. The intervention consisted of 5 daily scheduled 30-minute sessions per week. Disposability-to-use of COGNI-TRAcK was investigated by means of a questionnaire administered to patients at the end of the training. Results The adherence to the treatment was 84% (33.4/40). Of the patients with MS, 94% (15/16) understood the instructions given, 100% (16/16) felt independent to use COGNI-TRAcK at home, 75% (12/16) found the exercises interesting, and 81% (13/16) found the exercises useful and were motivated to use the app again. Moreover, during the exercises, patients with MS were highly motivated to perform well (mean score 3.19/4, SE 0.16), experienced rather low levels of stress (mean score 2.19/4, SE 0.26), were not bored (mean score 1.81/4, SE 0.30), and felt amusement (mean score 2.25/4, SE 0.23). Conclusions As COGNI-TRAcK is highly usable, motivating, and well-accepted by patients with MS, its effectiveness can now be investigated. To improve COGNI-TRAcK, new releases should contain more working memory exercises, have enhanced perceived amusement, and promote Internet communication procedures for data transfer and fostering remote control of the intervention. PMID:26323749

Exercise for everyone: a randomized controlled trial of project workout on wheels in promoting exercise among wheelchair users.

PubMed

Froehlich-Grobe, Katherine; Lee, Jaehoon; Aaronson, Lauren; Nary, Dorothy E; Washburn, Richard A; Little, Todd D

2014-01-01

To compare the effectiveness of 2 home-based behavioral interventions for wheelchair users to promote exercise adoption and maintenance over 12 months. Randomized controlled trial, with participants stratified into groups based on disability type (stable, episodic, progressive) and support partner availability. Exercise occurred in participant-preferred locations (eg, home, recreation center), with physiological data collected at a university-based exercise laboratory. Inactive wheelchair users (N=128; 64 women) with sufficient upper arm mobility for arm-based exercise were enrolled. Participants on average were 45 years of age and lived with their impairment for 22 years, with spinal cord injury (46.1%) most commonly reported as causing mobility impairment. Both groups received home-based exercise interventions. The staff-supported group (n=69) received intensive exercise support, while the self-guided group (n=59) received minimal support. Both received exercise information, resistance bands, instructions to self-monitor exercise, regularly scheduled phone calls, and handwritten cards. The primary outcome derived from weekly self-reported exercise. Secondary outcomes included physical fitness (aerobic/muscular) and predictors of exercise participation. The staff-supported group reported significantly greater exercise (∼17min/wk) than the self-guided group over the year (t=10.6, P=.00), with no significant between-group difference in aerobic capacity (t=.76, P=.45) and strength (t=1.5, P=.14). Although the staff-supported group reported only moderately more exercise, the difference is potentially clinically significant because they also exercised more frequently. The staff-supported approach holds promise for encouraging exercise among wheelchair users, yet additional support may be necessary to achieve more exercise to meet national recommendations. Copyright © 2014 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Exercise for Everyone: A randomized controlled trial of Project Workout On Wheels in promoting exercise among wheelchair users

PubMed Central

Froehlich-Grobe, Katherine; Lee, Jaehoon; Aaronson, Lauren; Nary, Dorothy E.; Washburn, Richard A; Little, Todd D

2015-01-01

Objective To compare the effectiveness of two home-based behavioral interventions to promote wheelchair users exercise adoption and maintenance over 12 months. Design Randomized controlled trial, with participants stratified into groups based on disability type (stable, episodic, progressive) and support partner availability. Setting Exercise occurred in participant preferred locations (e.g., home, recreation center), with physiological data collected at the university-based exercise lab. Participants One hundred twenty-eight inactive wheelchair users (64 women) with sufficient upper arm mobility for arm-based exercise enrolled. Participants on average were 45 years old, lived with their impairment for 22 years, with spinal cord injury (46.1%) most commonly reported as causing mobility impairment. Interventions Both groups received home-based exercise interventions. The staff-supported group (n= 69) received intensive exercise support, while the self-guided group (n= 59) received minimal support. Both received exercise information, resistance bands, instructions to self-monitor exercise, regularly-scheduled phone calls, and handwritten cards. Main Outcome Measures The primary outcome derived from weekly self-reported exercise. Secondary outcomes included physical fitness (aerobic/muscular) and predictors of exercise participation. Results The staff-supported group reported significantly greater exercise (~ 16 minutes/week) than the self-guided group over the year (t=10.6, p=0.00), with no significant between group difference in aerobic capacity (t=0.76, p=0.45) and strength (t=1.5, p=0.14). Conclusions Although the staff-supported group reported only moderately more exercise, the difference is potentially clinically significant as they also exercised more frequently. The staff-supported approach holds promise for encouraging exercise among wheelchair users, yet additional support may be necessary to achieve more exercise to meet national recommendations. PMID:23872080

Feasibility, safety and preliminary evidence of the effectiveness of a home-based exercise programme for older people with Alzheimer's disease: a pilot randomized controlled trial.

PubMed

Suttanon, Plaiwan; Hill, Keith D; Said, Catherine M; Williams, Susan B; Byrne, Karin N; LoGiudice, Dina; Lautenschlager, Nicola T; Dodd, Karen J

2013-05-01

To evaluate the feasibility and safety of a home-based exercise programme for people with Alzheimer's disease, and to provide preliminary evidence of programme effectiveness in improving balance and mobility and reducing falls risk. A randomized controlled trial. Community. Forty people with mild to moderate Alzheimer's disease (mean age 81.9, SD 5.72; 62.5% female). Participants were randomized to a six-month home-based individually tailored balance, strengthening and walking exercise programme (physiotherapist) or a six-month home-based education programme (control) (occupational therapist). Both programmes provided six home-visits and five follow-up phone calls. Balance, mobility, falls and falls risk were measured at baseline and programme completion. Intention-to-treat analysis using a generalized linear model with group allocation as a predictor variable was performed to evaluate programme effectiveness. Feasibility and adverse events were systematically recorded at each contact. Fifty-eight per cent of the exercise group finished the programme, completing an average of 83% of prescribed sessions, with no adverse events reported. Functional Reach improved significantly (P = 0.002) in the exercise group (mean (SD), 2.28 (4.36)) compared to the control group (-2.99 (4.87)). Significant improvement was also observed for the Falls Risk for Older People - Community score (P = 0.008) and trends for improvement on several other balance, mobility, falls and falls risk measures for the exercise group compared to the control group. The exercise programme was feasible and safe and may help improve balance and mobility performance and reduce falls risk in people with Alzheimer's disease.

Ecologically optimizing exercise maintenance in men and women post-cardiac rehabilitation: Protocol for a randomized controlled trial of efficacy with economics (ECO-PCR).

PubMed

Reid, Robert; Blanchard, Chris M; Wooding, Evyanne; Harris, Jennifer; Krahn, Murray; Pipe, Andrew; Chessex, Caroline; Grace, Sherry L

2016-09-01

Exercise-based cardiac rehabilitation (CR) participation results in increased cardio-metabolic fitness, which is associated with reduced mortality. However, many graduates fail to maintain exercise post-program. ECO-PCR investigates the efficacy and cost-effectiveness of a social ecologically-based intervention to increase long-term exercise maintenance following the completion of CR. A three-site, 2-group, parallel randomized controlled trial is underway. 412 male and 192 female (N=604) supervised CR participants are being recruited just before CR graduation. Participants are randomized (1:1 concealed allocation) to intervention or usual care. A 50-week exercise facilitator intervention has been designed to assist CR graduates in the transition from structured, supervised exercise to self-managed home- or community-based (e.g., Heart Wise Exercise programs) exercise. The intervention consists of 8 telephone contacts over the 50week period: 3 individual and 5 group. Assessments occur at CR graduation, and 26, 52 and 78weeks post-randomization. The primary outcome is change in minutes of accelerometer-measured moderate to vigorous-intensity physical activity (MVPA) from CR graduation to 52weeks post-randomization. Secondary measures include exercise capacity, quality of life, and cardiovascular risk factors. Analyses will be undertaken based on intention-to-treat. For the primary outcome, an analysis of variance will be computed to test the change in minutes of MVPA in each group between CR graduation and 52week follow-up (2 [arm]×2 [time]). Secondary objectives will be assessed using mixed-model repeated measures analyses to compare differences between groups over time. Mean costs and quality-adjusted life years for each arm will be estimated. Copyright © 2016 Elsevier Inc. All rights reserved.

An Evaluation of FrancoForme: A CASE-MANAGED HOME-BASED PRIMARY AND SECONDARY CARDIOVASCULAR DISEASE PREVENTION PROGRAM FOR FRENCH-SPEAKING CANADIANS.

PubMed

Prince, Stephanie A; Laflamme, Marc; Harris, Jennifer; Tulloch, Heather E; de Margerie, Michele

2017-11-01

Cardiovascular disease (CVD) is the leading cause of mortality globally. Telephone-delivered interventions targeting cardiovascular risk factors are gaining popularity. This study is an evaluation of FrancoForme, a cardiovascular risk factor reduction program for the primary and secondary prevention of CVD among French-speaking patients of Eastern Ontario. This study reports on changes in cardiovascular risk factors, weekly exercise levels, and psychosocial characteristics including anxiety, depression, and quality of life upon program completion (3 months) and at 1 year after the start of the program. Repeated-measures analysis of variance was used to compare changes in outcomes between primary prevention risk groups (low, moderate, and high risk for CVD) and the secondary prevention group (ie, cardiac rehabilitation) at baseline, 3 months and 12 months. A total of 762 patients enrolled in FrancoForme between 2008 and 2015. At 3 months, all program completers (n = 507) experienced significant reductions for all cardiovascular risk factors except diastolic blood pressure. Minutes of self-reported exercise increased significantly by an average 90 minutes per week and all psychosocial variables improved. Significant group effects were observed across several risk factors. Among 12-month responders (n = 240), exercise, high-density lipoproteins, triglycerides, cholesterol, and all psychosocial variables were improved over baseline results. FrancoForme is unique in targeting both the primary and secondary prevention of CVD and removes several of the barriers to participating in a conventional CVD prevention program for French-speaking patients. FrancoForme is successful, receiving high satisfaction rates and resulting in significant improvements in cardiovascular risk factors, exercise, anxiety, and depression, as well as quality of life.

Effectiveness of focused meditation for patients with chronic low back pain-A randomized controlled clinical trial.

PubMed

Michalsen, Andreas; Kunz, Natalie; Jeitler, Michael; Brunnhuber, Stefan; Meier, Larissa; Lüdtke, Rainer; Büssing, Arndt; Kessler, Christian

2016-06-01

We aimed to evaluate the effectiveness of an 8-week meditation program (focused meditation) in patients with chronic low-back pain. A randomized clinical trial was conducted on 68 patients (55 years;75% female) with chronic low-back pain who scored >40mm on a 100mm Visual-Analogue-Scale. Subjects were allocated to an 8-week meditation program (focused meditation) with weekly 75min classes or to a self-care exercise program with a wait-list offer for meditation. Both groups were instructed to practice at home. Outcomes were assessed baseline and after 4 and 8 weeks. The primary outcome measure was the change in mean back pain at rest after 8 weeks. Secondary outcomes included function, pain-related bothersomeness, perceived stress, quality-of-life (QOL), and psychological outcomes. Twelve (meditation) and 4 (exercise) patients were lost to follow-up. The primary outcome, pain at rest after 8 weeks, was reduced from 59.3±13.9mm to 40.8±21.8mm with meditation vs. 52.9±11.8mm to 37.3±18.2mm with exercise (adjusted group difference: -1.4 (95%CI:11.6;8.8;p=n.s.) Perceived stress was significantly more reduced with meditation (p=0.011). No significant treatment effects were found for other secondary outcomes as pain-related bothersomeness, function, quality-of-life and psychological scores, although the meditation group consistently showed non-significant better improvements compared to the exercise group. Focused meditation and self-care exercise lead to comparable, symptomatic improvements in patients with chronic low back pain. Future studies should include longer-term follow-ups and develop guided meditation programs to support compliance. Copyright © 2016 Elsevier Ltd. All rights reserved.

Home-exercise Childhood Obesity Intervention: A Randomized Clinical Trial Comparing Print Versus Web-based (Move It) Platforms.

PubMed

Bruñó, Alejandro; Escobar, Patricia; Cebolla, Ausias; Álvarez-Pitti, Julio; Guixeres, Jaime; Lurbe, Empar; Baños, Rosa; Lisón, Juan F

2018-05-07

To compare the impact of adhering to a Mediterranean diet plus mixed physical exercise program (Move-It) implemented by means of printed instructions or via a web-platform (with or without e-mail support) on body composition, physical fitness, and blood pressure. Randomized clinical trial. Fifty-two overweight or obese Spanish children and adolescents were randomly assigned to the print-based (n = 18), Move-It (n = 18), or Move-It plus support (n = 16) intervention groups. Two-way mixed ANOVA tests were used to compare any changes between the groups in terms of percentage body fat, physical fitness (VO 2 peak), handgrip strength, and systolic and diastolic blood pressure. The measurements were taken before and after a three-month mixed-exercise (aerobic and resistance) and Mediterranean-diet program which was either implemented by means of printed instructions or via a web-platform (with or without e-mail support). No statistical differences were found between groups. However, the results highlighted significant improvements in body fat percentage metrics over time for all three groups (print-based: -1.8%, 95%CI -3.3% to -0.3%; Move-It: -1.8%, 95%CI -3.3% to -0.3%; Move-It plus support: -2.0%, 95%CI -3.7% to -0.4%, P < 0.05). We also observed a tendency towards improvement in the VO 2 peak, handgrip strength, and blood pressure variable values 10 min after the exercise-stress test in these three groups. The program improved the body composition, regardless of the way it is implemented. A mixed physical exercise program lasting for three months, combined with a Mediterranean diet, improves the body composition of children and adolescents with overweight/obesity. Copyright © 2018 Elsevier Inc. All rights reserved.

Exercise and fractures in postmenopausal women. Final results of the controlled Erlangen Fitness and Osteoporosis Prevention Study (EFOPS).

PubMed

Kemmler, W; Bebenek, M; Kohl, M; von Stengel, S

2015-10-01

The EFOPS trial clearly established the positive effect of long-term exercise on clinical low-trauma fractures in postmenopausal women at risk. Bearing in mind that the complex anti-fracture exercise protocols also affect a large variety of diseases of increased age, we strongly encourage older adults to perform multipurpose exercise programs. Physical exercise may be an efficient option for autonomous fracture prevention during increasing age. The aim of the study was to evaluate the effect of exercise on clinical overall fracture incidence and bone mineral density (BMD) in elderly subjects at risk. In 1998 initially, 137 early-postmenopausal, osteopenic women living in Erlangen-Nuremberg, Germany, were included in the EFOPS trial. Subjects of the exercise group (EG; n = 86) conducted two supervised group and two home exercise sessions/week while the control group (CG; n = 51) was requested to maintain their physical activity. Primary study endpoints were clinical overall low-trauma fractures determined by questionnaires, structured interviews, and BMD at the lumbar spine and femoral neck assessed by dual-energy X-ray absorptiometry. In 2014, 105 subjects (EG: n = 59 vs. CG: n = 46) representing 1680 participant-years were included in the 16-year follow-up analysis. Risk ratio in the EG for overall low-trauma fractures was 0.51 (95% confidence interval (95% CI) 0.23 to 0.97, p = .046), rate ratio was 0.42 (95% CI 0.20 to 0.86, p = .018). Based on comparable baseline values, lumbar spine (MV -1.5%, 95% CI -0.1 to -2.8 vs. -5.8%, -3.3 to -7.2%) and femoral neck (-6.5%, -5.2 to -7.7 vs. -9.6%, -8.2 to 11.1%) BMD decreased in both groups; however, the reduction was more pronounced in the CG (p ≤ .001). This study clearly evidenced the high anti-fracture efficiency of multipurpose exercise programs. Considering furthermore the favorable effect of exercise on most other risk factors of increasing age, we strongly encourage older adults to perform multipurpose exercise programs.

Exercise for depression in care home residents: a randomised controlled trial with cost-effectiveness analysis (OPERA).

PubMed

Underwood, M; Lamb, S E; Eldridge, S; Sheehan, B; Slowther, A; Spencer, A; Thorogood, M; Atherton, N; Bremner, S A; Devine, A; Diaz-Ordaz, K; Ellard, D R; Potter, R; Spanjers, K; Taylor, S J C

2013-05-01

Many older people living in care homes (long term residential care or nursing homes) are depressed. Exercise is a promising non-drug intervention for preventing and treating depression in this population. To evaluate the impact of a 'whole-home' intervention, consisting of training for residential and nursing home staff backed up with a twice-weekly, physiotherapist-led exercise class on depressive symptoms in care home residents. A cluster randomised controlled trial with a cost-effectiveness analysis to compare (1) the prevalence of depression in intervention homes with that in control homes in all residents contributing data 12 months after homes were randomised (cross-sectional analysis); (2) the number of depressive symptoms at 6 months between intervention and control homes in residents who were depressed at pre-randomisation baseline assessment (depressed cohort comparison); and (3) the number of depressive symptoms at 12 months between intervention and control homes in all residents who were present at pre-randomisation baseline assessment (cohort comparison). Seventy-eight care homes in Coventry and Warwickshire and north-east London. Care home residents aged ≥ 65 years. Control intervention: Depression awareness training programme for care home staff. Active intervention: A 'whole-home' exercise intervention, consisting of training for care home staff backed up with a twice-weekly, physiotherapist-led exercise group. Geriatric Depression Scale-15, proxy European Quality of Life-5 Dimensions (EQ-5D), cost-effectiveness from an National Health Service perspective, peripheral fractures and death. We recruited a total of 1054 participants. Cross-sectional analysis: We obtained 595 Geriatric Depression Scale-15 scores and 724 proxy EQ-5D scores. For the cohort analyses we obtained 765 baseline Geriatric Depression Scale-15 scores and 776 proxy EQ-5D scores. Of the 781 who we assessed prior to randomisation, 765 provided a Geriatric Depression Scale-15 score. Of these 374 (49%) were depressed and constitute our depressed cohort. Resource-use and quality-adjusted life-year data, based on proxy EQ-5D, were available for 798 residents recruited prior to randomisation. We delivered 3191 group exercise sessions with 31,705 person attendances and an average group size of 10 (5.3 study participants and 4.6 non-study participants). On average, our participants attended around half of the possible sessions. No serious adverse events occurred during the group exercise sessions. In the cross-sectional analysis the odds for being depressed were 0.76 [95% confidence interval (CI) 0.53 to 1.09] lower in the intervention group at 12 months. The point estimates for benefit for both the cohort analysis (0.13, 95% CI -0.33 to 0.60) and depressed cohort (0.22, 95% CI -0.52 to 0.95) favoured the control intervention. There was no evidence of differences in fracture rates or mortality (odds ratio 1.07, 95% CI 0.79 to 1.48) between the two groups. There was no evidence of differences in the other outcomes between the two groups. Economic analysis: The additional National Health Service cost of the OPERA intervention was £374 per participant (95% CI -£655 to £1404); the mean difference in quality-adjusted life-year was -0.0014 (95% CI -0.0728 to 0.0699). The active intervention was thus dominated by the control intervention, which was more effective and less costly. The results do not support the use of a whole-home physical activity and moderate-intensity exercise programme to reduce depression in care home residents. Current Controlled Trials ISRCTN43769277. This project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 17, No. 18. See the Health Technology Assessment programme website for further project information.

Efficacy of a randomized trial examining commercial weight loss programs and exercise on metabolic syndrome in overweight and obese women.

PubMed

Baetge, Claire; Earnest, Conrad P; Lockard, Brittanie; Coletta, Adriana M; Galvan, Elfego; Rasmussen, Christopher; Levers, Kyle; Simbo, Sunday Y; Jung, Y Peter; Koozehchian, Majid; Oliver, Jonathan; Dalton, Ryan; Sanchez, Brittany; Byrd, Michael J; Khanna, Deepesh; Jagim, Andrew; Kresta, Julie; Greenwood, Mike; Kreider, Richard B

2017-02-01

While commercial dietary weight-loss programs typically advise exercise, few provide actual programing. The goal of this study was to compare the Curves Complete 90-day Challenge (CC, n = 29), which incorporates exercising and diet, to programs advocating exercise (Weight Watchers Points Plus (WW, n = 29), Jenny Craig At Home (JC, n = 27), and Nutrisystem Advance Select (NS, n = 28)) or control (n = 20) on metabolic syndrome (MetS) and weight loss. We randomized 133 sedentary, overweight women (age, 47 ± 11 years; body mass, 86 ± 14 kg; body mass index, 35 ± 6 kg/m 2 ) into respective treatment groups for 12 weeks. Data were analyzed using chi square and general linear models adjusted for age and respective baseline measures. Data are means ± SD or mean change ± 95% confidence intervals (CIs). We observed a significant trend for a reduction in energy intake for all treatment groups and significant weight loss for all groups except control: CC (-4.32 kg; 95% CI, -5.75, -2.88), WW (-4.31 kg; 95% CI, -5.82, -2.96), JC (-5.34 kg; 95% CI, -6.86, -3.90), NS (-5.03 kg; 95% CI, -6.49, -3.56), and control (0.16 kg, 95% CI, -1.56, 1.89). Reduced MetS prevalence was observed at follow-up for CC (35% vs. 14%, adjusted standardized residuals (adjres.) = 3.1), but not WW (31% vs. 28% adjres. = 0.5), JC (37% vs. 42%, adjres. = -0.7), NS (39% vs. 50% adjres. = -1.5), or control (45% vs. 55% adjres. = -1.7). While all groups improved relative fitness (mL·kg -1 ·min -1 ) because of weight loss, only the CC group improved absolute fitness (L/min). In conclusion, commercial programs offering concurrent diet and exercise programming appear to offer greater improvements in MetS prevalence and cardiovascular function after 12 weeks of intervention.

Rationale and design of the tele-exercise and multiple sclerosis (TEAMS) study: A comparative effectiveness trial between a clinic- and home-based telerehabilitation intervention for adults with multiple sclerosis (MS) living in the deep south.

PubMed

Rimmer, James H; Thirumalai, Mohanraj; Young, Hui-Ju; Pekmezi, Dori; Tracy, Tracy; Riser, Emily; Mehta, Tapan

2018-05-30

Long-term exercise/rehabilitation is an integral component of the continual care for people with multiple sclerosis (MS). However, access to this care, which includes comprehensive exercise/rehabilitation services to people with MS, remains a significant challenge, especially in rural, low-income areas. Telerehabilitation, or what we refer to as teleexercise, can help fill service gaps for underserved MS populations in this region. This pragmatic, cluster randomized controlled effectiveness trial will compare a 12-week, 20 session complementary and alternative medicine (CAM) intervention composed of neurorehabilitative (functional) exercise, yoga and Pilates delivered at home, using pre-loaded tablets and Interactive Voice Response (IVR) system technology (TeleCAM), to the same intervention delivered in clinic by a therapist (DirectCAM). Eight hundred and twenty people with MS are being recruited across Alabama, Mississippi and Tennessee. Primary self-reported patient-centered health outcomes are: pain, fatigue, quality of life and physical activity. Secondary outcomes include four physical functioning measures: balance, endurance, gait, and strength. Each of these outcomes will be examined by age, race, sex, severity of MS and other demographics to determine if outcomes are beneficial across all groups (i.e., heterogeneity of treatment effect). The project is important to people with MS and/or caregivers because it aims to reduce their barriers to receiving exercise treatment and increases the convenience and appeal of such programs through technology. Clinical Trials.gov Identifier: NCT03117881. Copyright © 2017. Published by Elsevier Inc.

Multimodal impairment-based physical therapy for the treatment of patients with post-concussion syndrome: A retrospective analysis on safety and feasibility.

PubMed

Grabowski, Patrick; Wilson, John; Walker, Alyssa; Enz, Dan; Wang, Sijian

2017-01-01

Demonstrate implementation, safety and feasibility of multimodal, impairment-based physical therapy (PT) combining vestibular/oculomotor and cervical rehabilitation with sub-symptom threshold exercise for the treatment of patients with post-concussion syndrome (PCS). University hospital outpatient sports medicine facility. Twenty-five patients (12-20 years old) meeting World Health Organization criteria for PCS following sport-related concussion referred for supervised PT consisting of sub-symptom cardiovascular exercise, vestibular/oculomotor and cervical spine rehabilitation. Retrospective cohort. Post-Concussion Symptom Scale (PCSS) total score, maximum symptom-free heart rate (SFHR) during graded exercise testing (GXT), GXT duration, balance error scoring system (BESS) score, and number of adverse events. Patients demonstrated a statistically significant decreasing trend (p < 0.01) for total PCSS scores (pre-PT M = 18.2 (SD = 14.2), post-PT M = 9.1 (SD = 10.8), n = 25). Maximum SFHR achieved on GXT increased 23% (p < 0.01, n = 14), and BESS errors decreased 52% (p < 0.01, n = 13). Two patients reported mild symptom exacerbation with aerobic exercise at home, attenuated by adjustment of the home exercise program. Multimodal, impairment-based PT is safe and associated with diminishing PCS symptoms. This establishes feasibility for future clinical trials to determine viable treatment approaches to reduce symptoms and improve function while avoiding negative repercussions of physical inactivity and premature return to full activity. Copyright © 2016 Elsevier Ltd. All rights reserved.

Home exercises for pelvic floor in continent women one year after physical therapy treatment for urinary incontinence: an observational study.

PubMed

Krüger, Ana P; Luz, Soraia C T; Virtuoso, Janeisa F

2011-01-01

To describe the results of home exercise targeting the pelvic floor in continent women one year after the end of a physical therapy treatment for the following outcomes: functional assessment of the pelvic floor and urinary incontinence. This is an observational study that evaluated fifteen women one year after physical therapy treatment for Stress Urinary Incontinence (SUI). The outcomes for this study were: situations of urinary loss, use of daily protection, practice of home exercises for the pelvic floor, functional assessment of the pelvic floor (FAPF) and patient satisfaction. We also investigated some confounding variables such as hormonal status, number of vaginal deliveries and previous history of episiotomy. One year after completion of physical therapy treatment, we observed that the FAPF median remained stable over time (Median=5, p=0.08). The presence of urinary incontinence was reported by 40% of women in the sample, however, was characterized as mild (i.e. not requiring the use of daily protection). There was also a significant association (p=0.001) between the completion of home exercises (twice or more per week) and the normal clinical status. Confounding variables, which could compromise the clinical status, showed no significant association with the outcomes (p≥0.05). Home exercises contributed to the maintenance of continence following a physical therapy treatment.

Cyber Fundamental Exercises

DTIC Science & Technology

2013-03-01

the /bin, /sbin, /etc, /var/log, /home, /proc, /root, /dev, /tmp, and /lib directories • Describe the purpose of the /etc/shadow and /etc/ passwd ...UNLIMITED 19 2.6.2 /etc/ passwd and /etc/shadow The /etc/shadow file didn’t exist on early Linux distributions. Originally only root could access the...etc/ passwd file, which stored user names, user configuration information, and passwords. However, when common programs such as ls running under

Daughters and mothers exercising together: effects of home- and community-based programs.

PubMed

Ransdell, Lynda B; Taylor, Alison; Oakland, Darcie; Schmidt, Jenny; Moyer-Mileur, Laurie; Shultz, Barry

2003-02-01

This pilot study compares the effectiveness of home- and community-based physical activity interventions that target mothers and daughters to increase physical activity and improve health-related fitness. Mothers (45.18 +/- 7.49 yr) and daughters (15.41 +/- 1.33 yr) were randomly assigned to a community-based (CB) (N = 20 participants) or home-based (HB) (N = 14 participants) program. CB participants attended three instructor-led sessions per week for 12 wk. HB participants were asked to participate in 3 sessions per week for 12 wk in a program similar to the CB program. The main difference between the programs was that CB activities were completed at a fitness facility within a university and HB activities were completed in or near the home. Before and after the intervention, changes in health-related fitness and physical activity were assessed. A series of 2 (group assignment) x 2 (time) ANOVAs were conducted to assess changes separately for mothers and daughters. CB participants attended 77% of the sessions, and none of the pairs dropped out. HB participants completed 70% of the recommended sessions, and three pairs dropped out. Mothers and daughters in both groups significantly increased their participation in aerobic, muscular strength, and flexibility activities (P = 0.02 to 0.000). Daughters in both groups significantly improved their muscular endurance (sit-ups,P = 0.000). Mothers in both groups improved their muscular strength (push-ups, P = 0.003), muscular endurance (sit-ups, P = 0.000), flexibility (sit-and-reach, P = 0.008), and aerobic capacity (1-mile walk, P = 0.002). Positive changes in diastolic blood pressure also occurred (P = 0.008). Mothers and daughters responded positively to CB and HB physical activity programs. Home-based physical activity programming is a cost-effective means to increase physical activity and improve health-related fitness in these groups.

The benefits and tolerance of exercise in myasthenia gravis (MGEX): study protocol for a randomised controlled trial.

PubMed

Birnbaum, Simone; Hogrel, Jean-Yves; Porcher, Raphael; Portero, Pierre; Clair, Bernard; Eymard, Bruno; Demeret, Sophie; Bassez, Guillaume; Gargiulo, Marcela; Louët, Estelle; Berrih-Aknin, Sonia; Jobic, Asmaa; Aegerter, Philippe; Thoumie, Philippe; Sharshar, Tarek

2018-01-18

Research exploring the effects of physical exercise in auto-immune myasthenia gravis (MG) is scarce. The few existing studies present methodological shortcomings limiting the conclusions and generalisability of results. It is hypothesised that exercise could have positive physical, psychological as well as immunomodulatory effects and may be a beneficial addition to current pharmacological management of this chronic disease. The aim of this study is to evaluate the benefits on perceived quality of life (QOL) and physical fitness of a home-based physical exercise program compared to usual care, for patients with stabilised, generalised auto-immune MG. MGEX is a multi-centre, interventional, randomised, single-blind, two-arm parallel group, controlled trial. Forty-two patients will be recruited, aged 18-70 years. Following a three-month observation period, patients will be randomised into a control or experimental group. The experimental group will undertake a 40-min home-based physical exercise program using a rowing machine, three times a week for three months, as an add-on to usual care. The control group will receive usual care with no additional treatment. All patients will be followed up for a further three months. The primary outcome is the mean change in MGQOL-15-F score between three and six months (i.e. pre-intervention and immediately post-intervention periods). The MGQOL-15-F is an MG-specific patient-reported QOL questionnaire. Secondary outcomes include the evaluation of deficits and functional limitations via MG-specific clinical scores (Myasthenia Muscle Score and MG-Activities of Daily Living scale), muscle force and fatigue, respiratory function, free-living physical activity as well as evaluations of anxiety, depression, self-esteem and overall QOL with the WHO-QOL BREF questionnaire. Exercise workload will be assessed as well as multiple safety measures (ECG, biological markers, medication type and dosage and any disease exacerbation or crisis). This is the largest randomised controlled trial to date evaluating the benefits and tolerance of physical exercise in this patient population. The comprehensive evaluations using standardised outcome measures should provide much awaited information for both patients and the scientific community. This study is ongoing. ClinicalTrials.gov, NCT02066519 . Registered on 13 January 2014.

Effectiveness of conventional versus virtual reality-based balance exercises in vestibular rehabilitation for unilateral peripheral vestibular loss: results of a randomized controlled trial.

PubMed

Meldrum, Dara; Herdman, Susan; Vance, Roisin; Murray, Deirdre; Malone, Kareena; Duffy, Douglas; Glennon, Aine; McConn-Walsh, Rory

2015-07-01

To compare the effectiveness of virtual reality-based balance exercises to conventional balance exercises during vestibular rehabilitation in patients with unilateral peripheral vestibular loss (UVL). Assessor-blind, randomized controlled trial. Two acute care university teaching hospitals. Patients with UVL (N=71) who had dizziness/vertigo, and gait and balance impairment. Patients with UVL were randomly assigned to receive 6 weeks of either conventional (n=36) or virtual reality-based (n=35) balance exercises during vestibular rehabilitation. The virtual reality-based group received an off-the-shelf virtual reality gaming system for home exercise, and the conventional group received a foam balance mat. Treatment comprised weekly visits to a physiotherapist and a daily home exercise program. The primary outcome was self-preferred gait speed. Secondary outcomes included other gait parameters and tasks, Sensory Organization Test (SOT), dynamic visual acuity, Hospital Anxiety and Depression Scale, Vestibular Rehabilitation Benefits Questionnaire, and Activities Balance Confidence Questionnaire. The subjective experience of vestibular rehabilitation was measured with a questionnaire. Both groups improved, but there were no significant differences in gait speed between the groups postintervention (mean difference, -.03m/s; 95% confidence interval [CI], -.09 to .02m/s). There were also no significant differences between the groups in SOT scores (mean difference, .82%; 95% CI, -5.00% to 6.63%) or on any of the other secondary outcomes (P>.05). In both groups, adherence to exercise was high (∼77%), but the virtual reality-based group reported significantly more enjoyment (P=.001), less difficulty with (P=.009) and less tiredness after (P=.03) balance exercises. At 6 months, there were no significant between-group differences in physical outcomes. Virtual reality-based balance exercises performed during vestibular rehabilitation were not superior to conventional balance exercises during vestibular rehabilitation but may provide a more enjoyable method of retraining balance after unilateral peripheral vestibular loss. Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Effects of home-based tele-exercise on sarcopenia among community-dwelling elderly adults: Body composition and functional fitness.

PubMed

Hong, Jeeyoung; Kim, Jeongeun; Kim, Suk Wha; Kong, Hyoun-Joong

2017-01-01

This study aims to develop a form of tele-exercise that would enable real-time interactions between exercise instructors and community-dwelling elderly people and to investigate its effects on improvement of sarcopenia-related factors of body composition and functional fitness among the elderly. Randomized, controlled trial, with a 12-week intervention period. Community-dwelling senior citizens in Gangseo-gu, Seoul, South Korea. The participants were 23 elderly individuals (tele-exercise group: 11, control group: 12), aged 69 to 93years. The tele-exercise program was developed utilizing a 15-in. all-in-one PC and video conferencing software (Skype™), with broadband Internet connectivity. The tele-exercise group performed supervised resistance exercise at home for 20-40min a day three times per week for 12weeks. The remote instructor provided one-on-one instruction to each participant during the intervention. The control group maintained their lifestyles without any special intervention. The sarcopenia-related factors of body composition and functional fitness were examined prior to, as well as following, a 12-week intervention period. The data were analyzed with a two-way repeated measures ANOVA. There were significant improvements in lower limb muscle mass (p=0.017), appendicular lean soft tissue (p=0.032), total muscle mass (p=0.033), and chair sit-and-reach length (p=0.019) for the tele-exercise group compared to the control group. No group×time interaction effects were detected for the 2-min step, chair stand, and time effects (p<0.05). Video conferencing-based supervised resistance exercise had positive effects on sarcopenia-related factors such as total-body skeletal muscle mass, appendicular lean soft tissue, lower limb muscle mass, and the chair sit-and-reach scores among community-dwelling elderly adults. These results imply that tele-exercise can be a new and effective intervention method for increasing skeletal muscle mass and the physical functioning of the lower limbs from the perspective of sarcopenia improvement among the elderly. Copyright © 2016 Elsevier Inc. All rights reserved.

Effectiveness of a balance training home exercise programme for adults with haemophilia: a pilot study.

PubMed

Hill, K; Fearn, M; Williams, S; Mudge, L; Walsh, C; McCarthy, P; Walsh, M; Street, A

2010-01-01

Adults with haemophilia and other bleeding disorders often develop lower limb musculoskeletal problems associated with bleeds into joints and muscles, which may affect balance performance and increase likelihood of falling. The aim of this study was to evaluate the effectiveness of an individualized balance and strength home exercise programme on improving balance and related outcomes for adults with haemophilia and other bleeding disorders. Twenty male adults with haemophilia and other bleeding disorders (mean age 39.4 years, 95% CI = 33.7-45.1) were recruited to participate. They underwent a comprehensive clinical and force platform assessment of balance and related measures. Based on assessment findings, the assessing physiotherapist provided an individualized home exercise programme of balance, strengthening and walking exercises. Re-assessment occurred after the 4-month exercise programme. Twelve participants (60%) completed the programme and were re-assessed. There were no safety problems or dropouts associated with the exercise programme aggravating joint status. Although there were no statistically significant changes in any of the measures (adjusted for multiple comparisons), there were improvements of between 5% and 22% on 10 of the 16 measures, with the Neurocom modified Clinical Test of Sensory Interaction on Balance (P = 0.036) and Timed Sit to Stand (P = 0.064) approaching significance. A tailored home exercise programme targeting balance, strengthening and walking is feasible for adults with haemophilia and other bleeding disorders. These results suggest that positive physical outcomes including improved balance and mobility may be achieved with this type of programme.

Aerobic Exercise Training in Very Severe Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis.

PubMed

Paneroni, Mara; Simonelli, Carla; Vitacca, Michele; Ambrosino, Nicolino

2017-08-01

To evaluate the effectiveness of exercise training in patients with very severe chronic obstructive pulmonary disease (COPD). We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Cumulative Index to Nursing and Allied Health Literature databases using the following as search terms: COPD, Chronic Obstructive Pulmonary Disease, Exercise, and Pulmonary Rehabilitation. We included randomized controlled trials (RCTs) of subjects with forced expiratory volume in the first second of less than 35% of the predicted normal value enrolled in in-patient, outpatient, or home- or community-based training programs lasting at least 4 weeks with respect to usual care. We included RCTs with outcome measures including the 6-minute walking test and/or health-related quality of life assessed by the St. George's Respiratory Questionnaire (SGRQ). Of 580 articles screened, 10 were included. The programs' duration ranged from 4 to 52 weeks with 1 to 5 sessions per week lasting 15 to 40 minutes each. The intervention group improved in 6-minute walking test [weighted mean difference, 67.1 (95% confidence interval [CI], 37.897-98.927); standardized mean difference, 3.86 (95% CI, 2.04-5.67)], and St. George's Respiratory Questionnaire [weighted mean difference, -8.041 (95% CI, -15.273 to -0.809); standardized mean difference, -1.23 (95% CI, -2.14 to -0.31)]. Exercise training improves exercise tolerance and health-related quality of life in patients with very severe COPD. However, because few studies on severely affected patients are available and the training programs are Highly heterogeneous, larger RCTs are needed.

Enhancing Cognitive Training Through Aerobic Exercise After a First Schizophrenia Episode: Theoretical Conception and Pilot Study

PubMed Central

Nuechterlein, Keith H.; Ventura, Joseph; McEwen, Sarah C.; Gretchen-Doorly, Denise; Vinogradov, Sophia; Subotnik, Kenneth L.

2016-01-01

Cognitive training (CT) and aerobic exercise have separately shown promise for improving cognitive deficits in schizophrenia. Aerobic exercise releases brain-derived neurotrophic factor, which promotes synaptic plasticity and neurogenesis. Thus, aerobic exercise provides a neurotrophic platform for neuroplasticity-based CT. The combination of aerobic exercise and CT may yield more robust effects than CT alone, particularly in the initial course of schizophrenia. In a pilot study, 7 patients with a recent onset of schizophrenia were assigned to Cognitive Training & Exercise (CT&E) and 9 to CT alone for a 10-week period. Posit Science programs were used for CT. Neurocognitive training focused on tuning neural circuits related to perceptual processing and verbal learning and memory. Social cognitive training used the same learning principles with social and affective stimuli. Both groups participated in these training sessions 2d/wk, 2h/d. The CT&E group also participated in an aerobic conditioning program for 30 minutes at our clinic 2d/wk and at home 2d/wk. The effect size for improvement in the MATRICS Consensus Cognitive Battery Overall Composite score for CT&E patients relative to CT patients was large. Functional outcome, particularly independent living skills, also tended to improve more in the CT&E than in the CT group. Muscular endurance, cardiovascular fitness, and diastolic blood pressure also showed relative improvement in the CT&E compared to the CT group. These encouraging pilot study findings support the promise of combining CT and aerobic exercise to improve the early course of schizophrenia. PMID:27460618

An in-depth, longitudinal examination of the daily physical activity of a patient with heart failure using a Nintendo Wii at home: a case report.

PubMed

Klompstra, Leonie Verheijden; Jaarsma, Tiny; Strömberg, Anna

2013-06-01

To explore the influence of the Nintendo Wii on the daily physical activity of a patient with chronic heart failure at home. A 74-year-old Swedish patient with heart failure had access to a Nintendo Wii at home for 12 weeks. Exercise motivation, exercise self-efficacy and exercise capacity were assessed before and after the intervention. Data on perceived physical effort, global well-being and expended energy were collected every day during the intervention. During the 12 weeks of access to the Nintendo Wii, daily physical activity increased by 200% on weekdays and 57% on weekends, compared with baseline. The patient's exercise motivation and exercise self-efficacy increased during the study, whereas perceived physical effort and global well-being did not change. The patient had no difficulties in using the system and did not suffer any major harm. The results of this case study suggest that providing patients with heart failure access to a Nintendo Wii is a promising and safe intervention. The energy expended by the patient per day increased, as did exercise capacity. Playing the Nintendo Wii did not increase the perceived physical effort, but increased motivation to exercise and decreased barriers to exercising.

Feasibility of Computer-Based Videogame Therapy for Children with Cerebral Palsy

PubMed Central

Radtka, Sandra; Hone, Robert; Brown, Charles; Mastick, Judy; Melnick, Marsha E.

2013-01-01

Abstract Objectives Standing and gait balance problems are common in children with cerebral palsy (CP), resulting in falls and injuries. Task-oriented exercises to strengthen and stretch muscles that shift the center of mass and change the base of support are effective in improving balance. Gaming environments can be challenging and fun, encouraging children to engage in exercises at home. The aims of this project were to demonstrate the technical feasibility, ease of use, appeal, and safety of a computer-based videogame program designed to improve balance in children with CP. Materials and Methods This study represents a close collaboration between computer design and clinical team members. The first two phases were performed in the laboratory, and the final phase was done in subjects' homes. The prototype balance game was developed using computer-based real-time three-dimensional programming that enabled the team to capture engineering data necessary to tune the system. Videogame modifications, including identifying compensatory movements, were made in an iterative fashion based on feedback from subjects and observations of clinical and software team members. Results Subjects (n=14) scored the game 21.5 out of 30 for ease of use and appeal, 4.0 out of 5 for enjoyment, and 3.5 on comprehension. There were no safety issues, and the games performed without technical flaws in final testing. Conclusions A computer-based videogame incorporating therapeutic movements to improve gait and balance in children with CP was appealing and feasible for home use. A follow-up study examining its effectiveness in improving balance in children with CP is recommended. PMID:24761324

Working memory training in survivors of pediatric cancer: a randomized pilot study.

PubMed

Hardy, Kristina K; Willard, Victoria W; Allen, Taryn M; Bonner, Melanie J

2013-08-01

Survivors of pediatric brain tumors and acute lymphoblastic leukemia (ALL) are at increased risk for neurocognitive deficits, but few empirically supported treatment options exist. We examined the feasibility and preliminary efficacy of a home-based, computerized working memory training program, CogmedRM, with survivors of childhood cancer. Survivors of brain tumors or ALL (n = 20) with identified deficits in attention and/or working memory were randomized to either the success-adapted computer intervention or a non-adaptive, active control condition. Specifically, children in the adaptive condition completed exercises that became more challenging with each correct trial, whereas those in the non-adaptive version trained with exercises that never increased in difficulty. All participants were asked to complete 25 training sessions at home, with weekly, phone-based coaching support. Brief assessments were completed pre-intervention and post-intervention; outcome measures included both performance-based and parent-report measures of working memory and attention. Eighty-five percent of survivors were compliant with the intervention, with no adverse events reported. After controlling for baseline intellectual functioning, survivors who completed the intervention program evidenced significant post-training improvements in their visual working memory and in parent-rated learning problems compared with those in the active control group. No differences in verbal working memory functioning were evident between groups, however. Home-based, computerized cognitive training demonstrates good feasibility and acceptability in our sample. Children with higher intellectual functioning at baseline appeared to benefit more from the training, although further study is needed to clarify the strength, scope, and particularly the generalizability of potential treatment effects. Copyright © 2012 John Wiley & Sons, Ltd.

Feasibility of Computer-Based Videogame Therapy for Children with Cerebral Palsy.

PubMed

Radtka, Sandra; Hone, Robert; Brown, Charles; Mastick, Judy; Melnick, Marsha E; Dowling, Glenna A

2013-08-01

Standing and gait balance problems are common in children with cerebral palsy (CP), resulting in falls and injuries. Task-oriented exercises to strengthen and stretch muscles that shift the center of mass and change the base of support are effective in improving balance. Gaming environments can be challenging and fun, encouraging children to engage in exercises at home. The aims of this project were to demonstrate the technical feasibility, ease of use, appeal, and safety of a computer-based videogame program designed to improve balance in children with CP. This study represents a close collaboration between computer design and clinical team members. The first two phases were performed in the laboratory, and the final phase was done in subjects' homes. The prototype balance game was developed using computer-based real-time three-dimensional programming that enabled the team to capture engineering data necessary to tune the system. Videogame modifications, including identifying compensatory movements, were made in an iterative fashion based on feedback from subjects and observations of clinical and software team members. Subjects ( n =14) scored the game 21.5 out of 30 for ease of use and appeal, 4.0 out of 5 for enjoyment, and 3.5 on comprehension. There were no safety issues, and the games performed without technical flaws in final testing. A computer-based videogame incorporating therapeutic movements to improve gait and balance in children with CP was appealing and feasible for home use. A follow-up study examining its effectiveness in improving balance in children with CP is recommended.

A Rehabilitation-Internet-of-Things in the Home to Augment Motor Skills and Exercise Training.

PubMed

Dobkin, Bruce H

2017-03-01

Although motor learning theory has led to evidence-based practices, few trials have revealed the superiority of one theory-based therapy over another after stroke. Nor have improvements in skills been as clinically robust as one might hope. We review some possible explanations, then potential technology-enabled solutions. Over the Internet, the type, quantity, and quality of practice and exercise in the home and community can be monitored remotely and feedback provided to optimize training frequency, intensity, and progression at home. A theory-driven foundation of synergistic interventions for walking, reaching and grasping, strengthening, and fitness could be provided by a bundle of home-based Rehabilitation Internet-of-Things (RIoT) devices. A RIoT might include wearable, activity-recognition sensors and instrumented rehabilitation devices with radio transmission to a smartphone or tablet to continuously measure repetitions, speed, accuracy, forces, and temporal spatial features of movement. Using telerehabilitation resources, a therapist would interpret the data and provide behavioral training for self-management via goal setting and instruction to increase compliance and long-term carryover. On top of this user-friendly, safe, and conceptually sound foundation to support more opportunity for practice, experimental interventions could be tested or additions and replacements made, perhaps drawing from virtual reality and gaming programs or robots. RIoT devices continuously measure the actual amount of quality practice; improvements and plateaus over time in strength, fitness, and skills; and activity and participation in home and community settings. Investigators may gain more control over some of the confounders of their trials and patients will have access to inexpensive therapies.

Comparison of three different approaches in the treatment of chronic low back pain.

PubMed

Koldaş Doğan, Sebnem; Sonel Tur, Birkan; Kurtaiş, Yeşim; Atay, Mesut Birol

2008-07-01

Our aim is to investigate the effects of three therapeutic approaches in the chronic low back pain on pain, spinal mobility, disability, psychological state, and aerobic capacity. Sixty patients with chronic low back pain were randomized to three groups: group 1, aerobic exercise + home exercise; group 2, physical therapy (hot pack, ultrasound, TENS) + home exercise; group 3, home exercise only. Spinal mobility, pain severity, disability, and psychological disturbance of the patients were assessed before and after the treatment and at 1-month follow-up. Aerobic capacities of the patients were measured before and after treatment. All of the groups showed similar decrease in pain after the treatment and at 1-month follow-up, and there was no significant difference between the groups. In group 2, a significant decrease in Beck Depression Inventory scores was observed with treatment. At 1-month follow-up, group 1 and 2 showed significant decreases in General Health Assessment Questionnaire scores. In group 2, there was also a significant improvement in Roland Morris Disability scores. There were similar improvements in exercise test duration and the MET levels in all the three groups. All of the three therapeutic approaches were found to be effective in diminishing pain and thus increasing aerobic capacity in patients with chronic low back pain. On the other hand, physical therapy + home exercise was found to be more effective regarding disability and psychological disturbance.

Randomised controlled trial on the effectiveness of home-based walking exercise on anxiety, depression and cancer-related symptoms in patients with lung cancer

PubMed Central

Chen, H-M; Tsai, C-M; Wu, Y-C; Lin, K-C; Lin, C-C

2015-01-01

Background: Although exercise has been addressed as an adjuvant treatment for anxiety, depression and cancer-related symptoms, limited studies have evaluated the effectiveness of exercise in patients with lung cancer. Methods: We recruited 116 patients from a medical centre in northern Taiwan, and randomly assigned them to either a walking-exercise group (n=58) or a usual-care group (n=58). We conducted a 12-week exercise programme that comprised home-based, moderate-intensity walking for 40 min per day, 3 days per week, and weekly exercise counselling. The outcome measures included the Hospital Anxiety and Depression Scale and the Taiwanese version of the MD Anderson Symptom Inventory. Results: We analysed the effects of the exercise programme on anxiety, depression and cancer-related symptoms by using a generalised estimating equation method. The exercise group patients exhibited significant improvements in their anxiety levels over time (P=0.009 and 0.006 in the third and sixth months, respectively) and depression (P=0.00006 and 0.004 in the third and sixth months, respectively) than did the usual-care group patients. Conclusions: The home-based walking exercise programme is a feasible and effective intervention method for managing anxiety and depression in lung cancer survivors and can be considered as an essential component of lung cancer rehabilitation. PMID:25490525

Effectiveness of jyoti meditation for patients with chronic neck pain and psychological distress--a randomized controlled clinical trial.

PubMed

Jeitler, Michael; Brunnhuber, Stefan; Meier, Larissa; Lüdtke, Rainer; Büssing, Arndt; Kessler, Christian; Michalsen, Andreas

2015-01-01

Chronic neck pain is a common medical complaint partly mediated by psychosocial distress and having a high socioeconomic impact. There is preliminary evidence that stress reduction by meditation might be beneficial in chronic pain syndromes. We aimed to evaluate the effectiveness of an 8-week meditation program (jyoti meditation) in patients with chronic neck pain by means of a randomized clinical trial. Eighty-nine patients (aged 49.7 ± 10.5 years, 73 female) with chronic neck pain who scored >40 mm on a 100-mm visual analog scale and had concomitant increased perceived stress were randomized to an 8-week meditation program (jyoti meditation) with weekly 90-minute classes (n = 45) or to a home-based exercise program (n = 44) with a wait list offer for meditation. Both groups were instructed to practice at home. Outcomes were assessed at baseline and after 8 weeks. Primary outcome measure was change of mean pain at rest (visual analog scale score) from baseline to week 8. Secondary outcomes included pain at motion, functional disability, pain-related bothersomeness, perceived stress, quality of life, and psychological outcomes. Patients had neck pain for a mean of 11 years. Eighteen patients in the meditation group and 16 patients in the exercise group were lost to follow-up. Meditation training significantly reduced pain when compared to the exercise group after 8 weeks (reduction of 45.5 ± 23.3 mm to 21.6 ± 17.2 mm in the meditation group, and 43.8 ± 22.0 mm to 37.7 ± 21.5 mm in the exercise group; mean difference: 13.2 mm [95% confidence interval: 2.1, 24.4; P = .02]). Pain-related bothersomeness decreased more in the meditation group (group difference 11.0 mm [95% confidence interval: 1.0, 21.0; P = .03]). No significant treatment effects were found for pain at motion, psychological scores, and quality of life, although the meditation group showed nonsignificant greater improvements compared to the exercise group. In conclusion, meditation may support chronic pain patients in pain reduction and pain coping. Further well-designed studies including more active control comparisons and longer-term follow-up are warranted. This article presents the results of a randomized controlled trial on the clinical effects of an 8-week meditation program or self-care exercise in patients with chronic neck pain. Meditation reduced pain at rest but not disability and might be a useful treatment option for pain management of chronic neck pain. Copyright © 2015 American Pain Society. Published by Elsevier Inc. All rights reserved.

Neuromuscular versus quadriceps strengthening exercise in patients with medial knee osteoarthritis and varus malalignment: a randomized controlled trial.

PubMed

Bennell, Kim L; Kyriakides, Mary; Metcalf, Ben; Egerton, Thorlene; Wrigley, Tim V; Hodges, Paul W; Hunt, Michael A; Roos, Ewa M; Forbes, Andrew; Ageberg, Eva; Hinman, Rana S

2014-04-01

To compare the effects of neuromuscular exercise (NEXA) and quadriceps strengthening (QS) on the knee adduction moment (an indicator of mediolateral distribution of knee load), pain, and physical function in patients with medial knee joint osteoarthritis (OA) and varus malalignment. One hundred patients with medial knee pain, mostly moderate-to-severe radiographic medial knee OA, and varus malalignment were randomly allocated to one of two 12-week exercise programs. Each program involved 14 individually supervised exercise sessions with a physiotherapist plus a home exercise component. Primary outcomes were peak external knee adduction moment (3-dimensional gait analysis), pain (visual analog scale), and self-reported physical function (Western Ontario and McMaster Universities Osteoarthritis Index). Eighty-two patients (38 [76%] of 50 in the NEXA group and 44 [88%] of 50 in the QS group) completed the trial. There was no significant between-group difference in the change in the peak knee adduction moment (mean difference 0.13 Nm/[body weight × height]% [95% confidence interval (95% CI) -0.08, 0.33]), pain (mean difference 2.4 mm [95% CI -6.0, 10.8]), or physical function (mean difference -0.8 units [95% CI -4.0, 2.4]). Neither group showed a change in knee moments following exercise, whereas both groups showed similar significant reductions in pain and improvement in physical function. Although comparable improvements in clinical outcomes were observed with both neuromuscular and quadriceps strengthening exercise in patients with moderate varus malalignment and mostly moderate-to-severe medial knee OA, these forms of exercise did not affect the knee adduction moment, a key predictor of structural disease progression. Copyright © 2014 by the American College of Rheumatology.

Perceived correlates of domain-specific physical activity in rural adults in the Midwest.

PubMed

Chrisman, Matthew; Nothwehr, Faryle; Yang, Jingzen; Oleson, Jacob

2014-01-01

In response to calls for more specificity when measuring physical activity, this study examined perceived correlates of this behavior in rural adults separately by the domain in which this behavior occurs (ie, home care, work, active living, and sport). A cross-sectional survey was completed by 407 adults from 2 rural towns in the Midwest. The questionnaire assessed the perceived social and physical environment, including neighborhood characteristics, as well as barriers to being active. The Kaiser Physical Activity Survey captured domain-specific activity levels. The response rate was 25%. Multiple regression analyses were conducted to examine the associations between social and physical environment factors and domain-specific physical activity. Having a favorable attitude toward using government funds for exercise and activity-friendly neighborhood characteristic were positively associated with active living. Friends encouraging exercise was positively associated with participation in sport. Barriers were inversely associated with active living and sport. Total physical activity was positively associated with workplace incentives for exercise, favorable policy attitudes toward supporting physical education in schools and supporting the use of government funds for biking trails, and it was inversely associated with barriers. There were no factors associated with physical activity in the domains of work or home care. Correlates of physical activity are unique to the domain in which this behavior occurs. Programs to increase physical activity in rural adults should target policy attitudes, neighborhood characteristics, and social support from friends while also working to decrease personal barriers to exercise. © 2014 National Rural Health Association.

Perceived Correlates of Domain-Specific Physical Activity in Rural Adults in the Midwest

PubMed Central

Chrisman, Matthew; Nothwehr, Faryle; Yang, Jingzen; Oleson, Jacob

2014-01-01

Purpose In response to calls for more specificity when measuring physical activity, this study examined perceived correlates of this behavior in rural adults separately by the domain in which this behavior occurs (ie, home care, work, active living, and sport). Methods A cross-sectional survey was completed by 407 adults from 2 rural towns in the Midwest. The questionnaire assessed the perceived social and physical environment, including neighborhood characteristics, as well as barriers to being active. The Kaiser Physical Activity Survey captured domainspecific activity levels. The response rate was 25%. Multiple regression analyses were conducted to examine the associations between social and physical environment factors and domain-specific physical activity. Findings Having a favorable attitude toward using government funds for exercise and activity-friendly neighborhood characteristic were positively associated with active living. Friends encouraging exercise was positively associated with participation in sport. Barriers were inversely associated with active living and sport. Total physical activity was positively associated with workplace incentives for exercise, favorable policy attitudes toward supporting physical education in schools and supporting the use of government funds for biking trails, and it was inversely associated with barriers. There were no factors associated with physical activity in the domains of work or home care. Conclusions Correlates of physical activity are unique to the domain in which this behavior occurs. Programs to increase physical activity in rural adults should target policy attitudes, neighborhood characteristics, and social support from friends while also working to decrease personal barriers to exercise. PMID:24576053

Effects of a whole body vibration (WBV) exercise intervention for institutionalized older people: a randomized, multicentre, parallel, clinical trial.

PubMed

Sitjà-Rabert, Mercè; Martínez-Zapata, Ma José; Fort Vanmeerhaeghe, Azahara; Rey Abella, Ferran; Romero-Rodríguez, Daniel; Bonfill, Xavier

2015-02-01

To assess the efficacy of an exercise program on a whole-body vibration platform (WBV) in improving body balance and muscle performance and preventing falls in institutionalized elderly people. A multicentre randomized parallel assessor-blinded clinical trial was conducted in elderly persons living in nursing homes. Participants were randomized to an exercise program performed either on a whole body vibratory platform (WBV plus exercise group) or on a stationary surface (exercise group). The exercise program for both groups consisted of static and dynamic exercises (balance and strength training over a 6-week training period of 3 sessions per week). The frequency applied on the vibratory platform was 30 to 35 Hz and amplitude was 2 to 4 mm. The primary outcome measurement was static/dynamic body balance. Secondary outcomes were muscle strength and number of falls. Efficacy was analyzed on an intention-to-treat basis and per protocol. The effects of the intervention were evaluated using the t test, Mann-Whitney test, or chi-square test, depending on the type of outcome. Follow-up measurements were collected 6 weeks and 6 months after randomization. A total of 159 participants from 10 centers were included: 81 in the WBV plus exercise group and 78 in the control group. Mean age was 82 years, and 67.29% were women. The Tinetti test score showed a significant overall improvement in both groups (P < .001). No significant differences were found between groups at week 6 (P = .890) or month 6 (P = .718). The Timed Up and Go test did not improve (P = .599) in either group over time, and no significant differences were found between groups at week 6 (P = .757) or month 6 (P = .959). Muscle performance results from the 5 Sit-To-Stand tests improved significantly across time (P = .001), but no statistically significant differences were found between groups at week 6 (P = .709) or month 6 (P = .841). A total of 57 falls (35.8%) were recorded during the follow-up period, with no differences between groups (P = .406). Exercise program on a vibratory platform provides benefits similar to those with exercise program on a stationary surface in relation to body balance, gait, functional mobility, and muscle strength in institutionalized elderly people. Longer studies in larger samples are needed to assess falls. Copyright © 2015 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

Increases in muscle strength and balance using a resistance training program administered via a telecommunications system in older adults.

PubMed

Sparrow, David; Gottlieb, Daniel J; Demolles, Deborah; Fielding, Roger A

2011-11-01

Resistance training programs have been found to improve muscle strength, physical function, and depressive symptoms in middle-aged and older adults. These programs have typically been provided in clinical facilities, health clubs, and senior centers, which may be inconvenient and/or cost prohibitive for some older adults. The purpose of this study was to investigate the effectiveness of an automated telemedicine intervention that provides real-time guidance and monitoring of resistance training in the home. A randomized clinical trial in 103 middle-aged or older participants. Participants were assigned to use of a theory-driven interactive voice response system designed to promote resistance training (Telephone-Linked Computer-based Long-term Interactive Fitness Trainer; n = 52) or to an attention control (n = 51) for a period of 12 months. Measurements of muscle strength, balance, walk distance, and mood were obtained at baseline, 3, 6, and 12 months. We observed increased strength, improved balance, and fewer depressive symptoms in the intervention group than in the control group. Using generalized estimating equations modeling, group differences were statistically significant for knee flexion strength (p = .035), single-leg stance time (p = .029), and Beck Depression Inventory (p = .030). This computer-based telecommunications exercise intervention led to improvements in participants' strength, balance, and depressive symptoms. Because of their low cost and easy accessibility, computer-based interventions may be a cost-effective way of promoting exercise in the home.

Vestibular Rehabilitation for Peripheral Vestibular Hypofunction: An Evidence-Based Clinical Practice Guideline

PubMed Central

Herdman, Susan J.; Whitney, Susan L.; Cass, Stephen P.; Clendaniel, Richard A.; Fife, Terry D.; Furman, Joseph M.; Getchius, Thomas S. D.; Goebel, Joel A.; Shepard, Neil T.; Woodhouse, Sheelah N.

2016-01-01

Background: Uncompensated vestibular hypofunction results in postural instability, visual blurring with head movement, and subjective complaints of dizziness and/or imbalance. We sought to answer the question, “Is vestibular exercise effective at enhancing recovery of function in people with peripheral (unilateral or bilateral) vestibular hypofunction?” Methods: A systematic review of the literature was performed in 5 databases published after 1985 and 5 additional sources for relevant publications were searched. Article types included meta-analyses, systematic reviews, randomized controlled trials, cohort studies, case control series, and case series for human subjects, published in English. One hundred thirty-five articles were identified as relevant to this clinical practice guideline. Results/Discussion: Based on strong evidence and a preponderance of benefit over harm, clinicians should offer vestibular rehabilitation to persons with unilateral and bilateral vestibular hypofunction with impairments and functional limitations related to the vestibular deficit. Based on strong evidence and a preponderance of harm over benefit, clinicians should not include voluntary saccadic or smooth-pursuit eye movements in isolation (ie, without head movement) as specific exercises for gaze stability. Based on moderate evidence, clinicians may offer specific exercise techniques to target identified impairments or functional limitations. Based on moderate evidence and in consideration of patient preference, clinicians may provide supervised vestibular rehabilitation. Based on expert opinion extrapolated from the evidence, clinicians may prescribe a minimum of 3 times per day for the performance of gaze stability exercises as 1 component of a home exercise program. Based on expert opinion extrapolated from the evidence (range of supervised visits: 2-38 weeks, mean = 10 weeks), clinicians may consider providing adequate supervised vestibular rehabilitation sessions for the patient to understand the goals of the program and how to manage and progress themselves independently. As a general guide, persons without significant comorbidities that affect mobility and with acute or subacute unilateral vestibular hypofunction may need once a week supervised sessions for 2 to 3 weeks; persons with chronic unilateral vestibular hypofunction may need once a week sessions for 4 to 6 weeks; and persons with bilateral vestibular hypofunction may need once a week sessions for 8 to 12 weeks. In addition to supervised sessions, patients are provided a daily home exercise program. Disclaimer: These recommendations are intended as a guide for physical therapists and clinicians to optimize rehabilitation outcomes for persons with peripheral vestibular hypofunction undergoing vestibular rehabilitation. Video Abstract available for more insights from the author (see Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A124). PMID:26913496

Exercise plus behavioral management in patients with Alzheimer disease: a randomized controlled trial.

PubMed

Teri, Linda; Gibbons, Laura E; McCurry, Susan M; Logsdon, Rebecca G; Buchner, David M; Barlow, William E; Kukull, Walter A; LaCroix, Andrea Z; McCormick, Wayne; Larson, Eric B

2003-10-15

Exercise training for patients with Alzheimer disease combined with teaching caregivers how to manage behavioral problems may help decrease the frailty and behavioral impairment that are often prevalent in patients with Alzheimer disease. To determine whether a home-based exercise program combined with caregiver training in behavioral management techniques would reduce functional dependence and delay institutionalization among patients with Alzheimer disease. Randomized controlled trial of 153 community-dwelling patients meeting National Institute of Neurological and Communicative Diseases and Stroke/Alzheimer Disease and Related Disorders Association criteria for Alzheimer disease, conducted between June 1994 and April 1999. Patient-caregiver dyads were randomly assigned to the combined exercise and caregiver training program, Reducing Disability in Alzheimer Disease (RDAD), or to routine medical care (RMC). The RDAD program was conducted in the patients' home over 3 months. Physical health and function (36-item Short-Form Health Survey's [SF-36] physical functioning and physical role functioning subscales and Sickness Impact Profile's Mobility subscale), and affective status (Hamilton Depression Rating Scale and Cornell Depression Scale for Depression in Dementia). At 3 months, in comparison with the routine care patients, more patients in the RDAD group exercised at least 60 min/wk (odds ratio [OR], 2.82; 95% confidence interval [CI], 1.25-6.39; P =.01) and had fewer days of restricted activity (OR, 3.10; 95% CI, 1.08-8.95; P<.001). Patients in the RDAD group also had improved scores for physical role functioning compared with worse scores for patients in the RMC group (mean difference, 19.29; 95% CI, 8.75-29.83; P<.001). Patients in the RDAD group had improved Cornell Depression Scale for Depression in Dementia scores while the patients in the RMC group had worse scores (mean difference, -1.03; 95% CI, -0.17 to -1.91; P =.02). At 2 years, the RDAD patients continued to have better physical role functioning scores than the RMC patients (mean difference, 10.89; 95% CI, 3.62-18.16; P =.003) and showed a trend (19% vs 50%) for less institutionalization due to behavioral disturbance. For patients with higher depression scores at baseline, those in the RDAD group improved significantly more at 3 months on the Hamilton Depression Rating Scale (mean difference, 2.21; 95% CI, 0.22-4.20; P =.04) and maintained that improvement at 24 months (mean difference, 2.14; 95% CI, 0.14-4.17; P =.04). Exercise training combined with teaching caregivers behavioral management techniques improved physical health and depression in patients with Alzheimer disease.

Added-purpose versus rote exercise in female nursing home residents.

PubMed

Yoder, R M; Nelson, D L; Smith, D A

1989-09-01

Seven recent experimental and quasi-experimental studies have compared the exercise of subjects instructed to pursue some added goal (often termed purposeful activity) with the exercise of subjects instructed to exercise without the suggestion of an added goal (often termed nonpurposeful activity). This article suggests a new terminology for this type of independent variable and describes an experiment within this developing tradition. An occupational form designed, through materials and instructions, to elicit a rotary arm exercise with the added purpose of stirring cookie dough was compared with an occupational form designed to elicit the rotary arm exercise with no added purpose. The subjects were 30 elderly female nursing home residents randomly assigned to the occupational forms. Results indicated that the added-purpose, occupationally embedded exercise condition elicited significantly more exercise repetitions than did the rote exercise condition (one-tailed p = .012). Exercise duration and exercise stoppages were also recorded. This study provides additional support for the traditional occupational therapy idea of embedding exercise within occupation. Suggestions are made for future research involving the experimental analysis of therapeutic occupation.

EXERCISE in pediatric autologous stem cell transplant patients: a randomized controlled trial protocol

PubMed Central

2012-01-01

Background Hematopoietic stem cell transplantation is an intensive therapy used to improve survivorship and cure various oncologic diseases. However, this therapy is associated with high mortality rates and numerous negative side-effects. The recovery of the immune system is a special concern and plays a key role in the success of this treatment. In healthy populations it is known that exercise plays an important role in immune system regulation, but little is known about the role of exercise in the hematological and immunological recovery of children undergoing hematopoietic stem cell transplant. The primary objective of this randomized-controlled trial (RCT) is to study the effect of an exercise program (in- and outpatient) on immune cell recovery in patients undergoing an autologous stem cell transplantation. The secondary objective is to determine if an exercise intervention diminishes the usual deterioration in quality of life, physical fitness, and the acquisition of a sedentary lifestyle. Methods This RCT has received approval from The Conjoint Health Research Ethics Board (CHREB) of the University of Calgary (Ethics ID # E-24476). Twenty-four participants treated for a malignancy with autologous stem cell transplant (5 to 18 years) in the Alberta Children’s Hospital will be randomly assigned to an exercise or control group. The exercise group will participate in a two-phase exercise intervention (in- and outpatient) from hospitalization until 10 weeks after discharge. The exercise program includes strength, flexibility and aerobic exercise. During the inpatient phase this program will be performed 5 times/week and will be supervised. The outpatient phase will combine a supervised session with two home-based exercise sessions with the use of the Wii device. The control group will follow the standard protocol without any specific exercise program. A range of outcomes, including quantitative and functional recovery of immune system, cytokine levels in serum, natural killer (NK) cells and their subset recovery and function, and gene expression of activating and inhibitory NK cell receptors, body composition, nutrition, quality of life, fatigue, health-related fitness assessment and physical activity levels will be examined, providing the most comprehensive assessment to date. Discussion We expect to find improvements in immunological recovery and quality of life, and decreased acquisition of sedentary behavior and fitness deconditioning. The comprehensive outcomes generated in this RCT will provide preliminary data to conduct a multisite study that will generate stronger outcomes. Trial registration Gov identification # NCT01666015 PMID:22963378

Effects of prehabilitation and rehabilitation including a home-based component on physical fitness, adherence, treatment tolerance, and recovery in patients with non-small cell lung cancer: A systematic review.

PubMed

Driessen, Elisabeth J; Peeters, Marieke E; Bongers, Bart C; Maas, Huub A; Bootsma, Gerbern P; van Meeteren, Nico L; Janssen-Heijnen, Maryska L

2017-06-01

This systematic review aimed to examine physical fitness, adherence, treatment tolerance, and recovery for (p)rehabilitation including a home-based component for patients with non-small cell lung cancer (NSCLC). PRISMA and Cochrane guidelines were followed. Studies describing (home-based) prehabilitation or rehabilitation in patients with NSCLC were included from four databases (January 2000-April 2016, N=11). Nine of ten rehabilitation studies and one prehabilitation study (437 NSCLC patients, mean age 59-72 years) showed significantly or clinically relevant improved physical fitness. Three (27%) assessed home-based training and eight (73%) combined training at home, inhospital (intramural) and/or at the physiotherapy practice/department (extramural). Six (55%) applied supervision of home-based components, and four (36%) a personalized training program. Adherence varied strongly (9-125% for exercises, 50-100% for patients). Treatment tolerance and recovery were heterogeneously reported. Although promising results of (p)rehabilitation for improving physical fitness were found (especially in case of supervision and personalization), adequately powered studies for home-based (p)rehabilitation are needed. Copyright © 2017 Elsevier B.V. All rights reserved.

The effectiveness of home hand exercise programmes in rheumatoid arthritis: a systematic review.

PubMed

Hammond, Alison; Prior, Yeliz

2016-09-01

Rheumatoid arthritis (RA) commonly reduces hand function. We systematically reviewed trials to investigate effects of home hand exercise programmes on hand symptoms and function in RA. We searched: Medline (1946-), AMED, CINAHL, Physiotherapy Evidence Database, OT Seeker, the Cochrane Library, ISI Web of Science from inception to January 2016. Nineteen trials were evaluated. Only three were randomized controlled trials with a low risk of bias (n = 665). Significant short-term improvements occurred in hand function, pain and grip strength, with long-term improvements in hand and upper limb function and pinch strength. Heterogeneity of outcome measures meant meta-analysis was not possible. Evaluation of low and moderate risk of bias trials indicated high-intensity home hand exercise programmes led to better short-term outcomes than low-intensity programmes. Such programmes are cost-effective. Further research is required to evaluate methods of helping people with RA maintain long-term home hand exercise. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Facilitating Self-Transcendence: An Intervention to Enhance Well-Being in Late Life.

PubMed

McCarthy, Valerie Lander; Hall, Lynne A; Crawford, Timothy N; Connelly, Jennifer

2018-06-01

This randomized controlled pilot study evaluated the effects of the Psychoeducational Approach to Transcendence and Health (PATH) Program, an 8-week intervention hypothesized to increase self-transcendence and improve well-being in community-dwelling women aged 60 years and older ( N = 20). The PATH combined mindfulness exercises, group processes, creative activities, and at-home practice using community engaged research methods. Findings provided some support for the effectiveness of PATH. Although there was no significant Group × Time interaction, self-transcendence, psychological well-being, and life satisfaction differed significantly pre- and postintervention in the wait-listed control group, which received a revised version of the program. Further study is needed with a larger sample to determine the effectiveness of PATH. Potentially, PATH may be a convenient and affordable activity to support personal development and improve well-being among older adults at senior centers, retirement communities, nursing homes, church groups, and other places where older adults gather.

Nordic Walking for the Management of People With Parkinson Disease: A Systematic Review.

PubMed

Cugusi, Lucia; Manca, Andrea; Dragone, Daniele; Deriu, Franca; Solla, Paolo; Secci, Claudio; Monticone, Marco; Mercuro, Giuseppe

2017-11-01

It is well known that physical exercise is the main therapeutic element of rehabilitation programs for people with Parkinson disease (PD). As traditional forms of exercise can guarantee significant health benefits, the emergence of nonconventional physical activities, such as Nordic walking (NW), may add positive effects. To appraise the available evidence on the main effects of NW in the rehabilitation programs for people with PD and to propose a design for upcoming research that might improve the uniformity of future trials. Systematic review. A literature search of 5 established databases (PubMed, MEDLINE, Scopus, Web of Science, and Cochrane) was conducted. Any relevant randomized controlled trials pertinent to NW in PD published in English from inception to February 2017 were included. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed, and the methodologic quality of each study was assessed by the Physiotherapy Evidence Database scale. Sixty-six studies were retrieved, and 6 randomized controlled trials (221 subjects) were entered into the qualitative synthesis. Overall, these studies portrayed NW as feasible and likely to be effective in improving the functional and clinical outcomes of people with PD. When we compared NW with other exercise-based interventions, such as treadmill training, free walking, a program of standardized whole-body movements with maximal amplitude (Lee Silverman Voice Treatment BIG training), or a home-based exercise program, the findings proved controversial. High heterogeneity and methodologic discrepancies among the studies prevent us from drawing firm conclusions on the effectiveness of NW in comparison with other exercise-based interventions currently used by people with PD. Further investigations with a common design are necessary to verify whether NW may be included within conventional rehabilitation programs commonly recommended to people with PD. II. Copyright © 2017 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

Associations between psychological factors and the effect of home-based physical exercise in women with chronic neck and shoulder pain

PubMed Central

Karlsson, Linn; Gerdle, Björn; Takala, Esa-Pekka; Andersson, Gerhard; Larsson, Britt

2016-01-01

Background: Exercise is often used in the treatment of chronic neck and shoulder muscle pain. It is likely that psychological aspects have an impact on the results of exercise-based treatments. Objectives: (1) To examine the associations between psychological factors and the effect of a home-based physical exercise intervention. (2) To examine differences in psychological factors at baseline between (a) subjects who continued in the trial and those who did not and (b) subjects who completed the intervention and those who did not. Method: A total of 57 women with chronic neck and shoulder pain were included in a home-based exercise intervention trial. Pain intensity, disability, and psychological factors (anxiety and depression symptoms, catastrophizing, fear-avoidance beliefs, self-efficacy, and pain acceptance) were measured at baseline, after 4–6 months, and after 1 year of exercise. Associations between the psychological factors and changes in pain intensity and disability were analysed, as well as differences in psychological factors at baseline between subjects who continued in and completed the intervention, and those who did not. Results: Associations between positive changes in pain intensity and disability were found for low fear-avoidance beliefs and low-pain self-efficacy at baseline. In addition, fear-avoidance beliefs at baseline were higher in the subjects who dropped out of the intervention than in those who continued. Pain acceptance at baseline was higher in the subjects who completed the intervention at the end of the trial. Conclusion: Particularly, fear-avoidance beliefs and pain self-efficacy should be taken into consideration when implementing home-based physical exercise as treatment for chronic neck pain. In addition, high pain acceptance might improve the adherence to prescribed exercise. PMID:27688880

Effects of training with a passive hand orthosis and games at home in chronic stroke: a pilot randomised controlled trial.

PubMed

Nijenhuis, Sharon M; Prange-Lasonder, Gerdienke B; Stienen, Arno Ha; Rietman, Johan S; Buurke, Jaap H

2017-02-01

To compare user acceptance and arm and hand function changes after technology-supported training at home with conventional exercises in chronic stroke. Secondly, to investigate the relation between training duration and clinical changes. A randomised controlled trial. Training at home, evaluation at research institute. Twenty chronic stroke patients with severely to mildly impaired arm and hand function. Participants were randomly assigned to six weeks (30 minutes per day, six days a week) of self-administered home-based arm and hand training using either a passive dynamic wrist and hand orthosis combined with computerised gaming exercises (experimental group) or prescribed conventional exercises from an exercise book (control group). Main outcome measures are the training duration for user acceptance and the Action Research Arm Test for arm and hand function. Secondary outcomes are the Intrinsic Motivation Inventory, Fugl-Meyer assessment, Motor Activity Log, Stroke Impact Scale and grip strength. The control group reported a higher training duration (189 versus 118 minutes per week, P = 0.025). Perceived motivation was positive and equal between groups ( P = 0.935). No differences in clinical outcomes over training between groups were found (P ⩾ 0.165). Changes in Box and Block Test correlated positively with training duration ( P = 0.001). Both interventions were accepted. An additional benefit of technology-supported arm and hand training over conventional arm and hand exercises at home was not demonstrated. Training duration in itself is a major contributor to arm and hand function improvements.

Patients' Perspectives on and Experiences of Home Exercise Programmes Delivered with a Mobile Application.

PubMed

Abramsky, Hillary; Kaur, Puneet; Robitaille, Mikale; Taggio, Leanna; Kosemetzky, Paul K; Foster, Hillary; Gibson Bmr Pt MSc PhD, Barbara E; Bergeron, Maggie; Jachyra, Patrick

2018-01-01

Purpose: We explored patients' perspectives on home exercise programmes (HEPs) and their experiences using a mobile application designed to facilitate home exercise. Method: Data were generated using qualitative, semi-structured, face-to-face interviews with 10 participants who were receiving outpatient physiotherapy. Results: Establishing a therapeutic partnership between physiotherapists and patients enabled therapists to customize the HEPs to the patients' lifestyles and preferences. Analysis suggests that using the mobile application improved participants' ability to integrate the HEP into their daily life and was overwhelmingly preferred to traditional paper handouts. Conclusions: The results suggest that efforts to engage patients in HEPs need to take their daily lives into account. To move in this direction, sample exercise prescription questions are offered. Mobile applications do not replace the clinical encounter, but they can be an effective tool and an extension of delivering personalized HEPs in an existing therapeutic partnership.

Application of a Web-Enabled Leg Training System for the Objective Monitoring and Quantitative Analysis of Exercise-Induced Fatigue

PubMed Central

Dedova, Irina V

2016-01-01

Background Sustained cardiac rehabilitation is the key intervention in the prevention and treatment of many human diseases. However, implementation of exercise programs can be challenging because of early fatigability in patients with chronic diseases, overweight individuals, and aged people. Current methods of fatigability assessment are based on subjective self-reporting such as rating of perceived exertion or require specialized laboratory conditions and sophisticated equipment. A practical approach allowing objective measurement of exercise-induced fatigue would be useful for the optimization of sustained delivery of cardiac rehabilitation to improve patient outcomes. Objectives The objective of this study is to develop and validate an innovative approach, allowing for the objective assessment of exercise-induced fatigue using the Web-enabled leg rehabilitation system. Methods MedExercise training devices were equipped with wireless temperature sensors in order to monitor their usage by temperature rise in the resistance unit (Δt°). Since Δt° correlated with the intensity and duration of exercise, this parameter was used to characterize participants’ leg work output (LWO). Personal smart devices such as laptop computers with wireless gateways and relevant software were used for monitoring of self-control training. Connection of smart devices to the Internet and cloud-based software allowed remote monitoring of LWO in participants training at home. Heart rates (HRs) were measured by fingertip pulse oximeters simultaneously with Δt° in 7 healthy volunteers. Results Exercise-induced fatigue manifested as the decline of LWO and/or rising HR, which could be observed in real-time. Conversely, training at the steady-state LWO and HR for the entire duration of exercise bout was considered as fatigue-free. The amounts of recommended daily physical activity were expressed as the individual Δt° values reached during 30-minute fatigue-free exercise of moderate intensity resulting in a mean of 8.1°C (SD 1.5°C, N=7). These Δt° values were applied as the thresholds for sending automatic notifications upon taking the personalized LWO doses by self-control training at home. While the mean time of taking LWO doses was 30.3 (SD 4.1) minutes (n=25), analysis of times required to reach the same Δt° by the same participant revealed that longer durations were due to fatigability, manifesting as reduced LWO at the later stages of training bouts. Typically, exercising in the afternoons associated with no fatigue, although longer durations of evening sessions suggested a diurnal fatigability pattern. Conclusions This pilot study demonstrated the feasibility of objective monitoring of fatigue development in real-time and online as well as retrospective fatigability quantification by the duration of training bouts to reach the same exercise dose. This simple method of leg training at home accompanied by routine fatigue monitoring might be useful for the optimization of exercise interventions in primary care and special populations. PMID:27549345

The limb movement analysis of rehabilitation exercises using wearable inertial sensors.

PubMed

Bingquan Huang; Giggins, Oonagh; Kechadi, Tahar; Caulfield, Brian

2016-08-01

Due to no supervision of a therapist in home based exercise programs, inertial sensor based feedback systems which can accurately assess movement repetitions are urgently required. The synchronicity and the degrees of freedom both show that one movement might resemble another movement signal which is mixed in with another not precisely defined movement. Therefore, the data and feature selections are important for movement analysis. This paper explores the data and feature selection for the limb movement analysis of rehabilitation exercises. The results highlight that the classification accuracy is very sensitive to the mount location of the sensors. The results show that the use of 2 or 3 sensor units, the combination of acceleration and gyroscope data, and the feature sets combined by the statistical feature set with another type of feature, can significantly improve the classification accuracy rates. The results illustrate that acceleration data is more effective than gyroscope data for most of the movement analysis.

Physical ExeRcise Following Esophageal Cancer Treatment (PERFECT) study: design of a randomized controlled trial.

PubMed

van Vulpen, Jonna K; Siersema, Peter D; van Hillegersberg, Richard; Nieuwenhuijzen, Grard A P; Kouwenhoven, Ewout A; Groenendijk, Richard P R; van der Peet, Donald L; Hazebroek, Eric J; Rosman, Camiel; Schippers, Carlo C G; Steenhagen, Elles; Peeters, Petra H M; May, Anne M

2017-08-18

Following esophagectomy, esophageal cancer patients experience a clinically relevant deterioration of health-related quality of life, both on the short- and long-term. With the currently growing number of esophageal cancer survivors, the burden of disease- and treatment-related complaints and symptoms becomes more relevant. This emphasizes the need for interventions aimed at improving quality of life. Beneficial effects of post-operative physical exercise have been reported in several cancer types, but so far comparable evidence in esophageal cancer patients is lacking. The aim of this study is to investigate effects of physical exercise on health-related quality of life in esophageal cancer patients following surgery. The Physical ExeRcise Following Esophageal Cancer Treatment (PERFECT) study is a multicenter randomized controlled trial including 150 esophageal cancer patients after surgery with curative intent. Patients are randomly allocated to an exercise group or usual care group. The exercise group participates in a 12-week combined aerobic and resistance exercise program, supervised by a physiotherapist near the patient's home-address. In addition, participants in the exercise group are requested to be physically active for at least 30 min per day, every day of the week. Participants allocated to the usual care group are asked to maintain their habitual physical activity pattern. The primary outcome is health-related quality of life (EORTC-QLQ-C30). Secondary outcomes include esophageal cancer specific quality of life, fatigue, anxiety and depression, sleep quality, work-related factors, cardiorespiratory fitness (VO 2peak ), muscle strength, physical activity, malnutrition risk, anthropometry, blood markers, recurrence of disease and survival. All questionnaire outcomes, diaries and accelerometers are assessed at baseline, post-intervention (12 weeks post-baseline) and 24 weeks post-baseline. Physical fitness, anthropometry and blood markers are assessed at baseline and post-intervention. In addition, adherence and safety are monitored throughout the exercise program. This randomized controlled trial investigates effects of physical exercise versus usual care in esophageal cancer patients after surgery. As the design of the exercise program closely resembles daily practice, this study can contribute both to evidence on effects of exercise in esophageal cancer patients, and to potential implementation strategies. Trial registration:Netherlands Trial Registry NTR5045 Date of trial registration: January 19th, 2015 Date and version study protocol: February 2017, version 1.

Audit of healthy lifestyle behaviors among patients with diabetes and hypertension attending ambulatory health care services in the United Arab Emirates.

PubMed

Baynouna, Latifa Mohammed; Neglekerke, Nico J D; Ali, Habiba E; ZeinAlDeen, Sana M; Al Ameri, Thuraya A

2014-12-01

Knowledge is limited on healthy lifestyle behaviors and their associations with glycemic and blood pressure control among patients with diabetes and hypertension in the United Arab Emirates (UAE). To examine healthy lifestyle behaviors and their associations with glycemic and blood pressure control among patients with hypertension and diabetes, and improvement after the implementation of an intervention in a Chronic Disease Program. All patients with diabetes or hypertension attending seven primary health care centers in Al Ain, UAE during a designated three-week period in July and August 2009. Nurses conducted an audit of patients' adherence to health lifestyle behaviors related to meal planning, smoking, exercise, blood glucose and blood pressure monitoring at home, and foot and eye exams in the Chronic Disease Program clinics after a self-management intervention. A perceived knowledge score and discussion scores (based on the frequency the patients discuss diabetes and hypertension management issues with their providers) were calculated. Data were analyzed using linear regression and odds ratios. Patients reported acceptable rates of adherence to healthy lifestyle behaviors, including a low smoking rate (6% in males), following a meal plan and exercising (88.6% and 78.7%, respectively). Among patients with diabetes, 59% tested their blood glucose levels at least once a week compared to only 15.3% of those with hypertension monitoring their blood pressure levels at home. Only 33% of the participants were following the current physical activity recommendations. Healthy lifestyle behaviors fell into the following clusters: meal planning with exercise (odds ratio (OR): 8.9 [3.3-23.7]), meal planning with foot exams (OR: 10.6 [3.4-32.9]) and exercising and foot exams (OR: 5.2 [1.9-14.2]). This practice-based audit provides an essential assessment for future interventions to improve adherence to healthy life style behaviors among patients with diabetes and hypertension attending primary health clinics in the UAE. © The Author(s) 2014.

Does the addition of two exercise-focussed home visits to usual care improve outcomes for patients with balance impairments? A randomized controlled trial.

PubMed

Whitbourne, Craig; Shields, Nora; Tacey, Mark; Koh, Kenneth Wz; Lawler, Katherine; Hill, Keith D

2018-03-01

To investigate whether two additional home visits improve outcomes for rehabilitation outpatients with balance impairments compared to usual care. Randomized controlled trial. Outpatient rehabilitation. Fifty with balance impairments. Both groups received usual care including weekly group exercise over eight weeks. The intervention group received two home visits to individualize home exercises. Primary outcome measure was the Balance Outcome Measure for Elder Rehabilitation (BOOMER) score, and secondary outcomes included force platform measures using the NeuroCom Balance Master ® , assessed at baseline, after intervention and three-month follow-up. There was no between-group difference for BOOMER score. There were significant between-group differences in favour of the intervention group for limits of stability reaction time at week 9 (mean difference (MD) -0.27, 95% confidence interval (CI) -0.44 to -0.09) and week 22 (MD -0.28, 95% CI -0.45 to -0.10) and for limits of stability maximal excursion at week 9 (MD 8.66, 95% CI 1.67 to 15.65) and week 22 (MD 14.58, 95% CI 7.59 to 21.57). Significant between-group differences favoured the control group for Clinical Test of Sensory Interaction of Balance at week 9 (MD 0.40, 95% CI 0.13 to 0.66) and week 22 (MD 0.45, 95% CI 0.18 to 0.72) and step quick turn time at week 9 (MD 0.56, 95% CI 0.02 to 1.10). Two exercise-focussed home visits improved some dynamic balance outcomes in older patients with balance impairments. Some outcomes showed significant improvements with small effect sizes in favour of the control group which may be chance findings or because they completed a standard home exercise programme.

Emergency department-reported injuries associated with mechanical home exercise equipment in the USA.

PubMed

Graves, Janessa M; Iyer, Krithika R; Willis, Margaret M; Ebel, Beth E; Rivara, Frederick P; Vavilala, Monica S

2014-08-01

The goal of this study was to generate national estimates of injuries associated with mechanical home exercise equipment, and to describe these injuries across all ages. Emergency department (ED)-treated injuries associated with mechanical home exercise equipment were identified from 2007 to 2011 from the National Electronic Injury Surveillance System. Text narratives provided exercise equipment type (treadmill, elliptical, stationary bicycle, unspecified/other exercise machine). Approximately 70 302 (95% CI 59 086 to 81 519) mechanical exercise equipment-related injuries presented to US EDs nationally during 2007-2011, of which 66% were attributed to treadmills. Most injuries among children (≤4 years) were lacerations (34%) or soft tissue injuries (48%); among adults (≥25 years) injuries were often sprains/strains (30%). Injured older adults (≥65 years) had greater odds of being admitted, held for observation, or transferred to another hospital, compared with younger ages (OR: 2.58; 95% CI 1.45 to 4.60). Mechanical exercise equipment is a common cause of injury across ages. Injury awareness and prevention are important complements to active lifestyles. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Pilates for breast cancer: A systematic review and meta-analysis.

PubMed

Espíndula, Roberta Costa; Nadas, Gabriella Barbosa; Rosa, Maria Inês da; Foster, Charlie; Araújo, Florentino Cardoso de; Grande, Antonio Jose

2017-11-01

Breast cancer is the leading type of cancer causing death in women worldwide. The incidence of the disease is expected to grow worldwide due to the aging of the population and risk factors related to lifestyle behaviors. Considering the lifestyle of women with breast cancer before or after surgery, pilates exercise may be a complementary intervention additionally to standard treatment. To analyze the efficacy of pilates compared to other exercises and to no exercise for women with breast cancer diagnosis. We searched Medline via Pubmed, Embase via Ovid, Amed via EBSCO, Biosis via Ovid, Lilacs and the Cochrane Library for relevant publications until March 2017. The keywords used were pilates and "breast cancer," and only randomized controlled trials were included. Critical appraisal was done using Risk of Bias Tool and GRADE score for assessing the quality of evidence. A total of five studies were included in our review. Our results demonstrate that pilates or home-based exercises are better than no exercise in each individual study. We observed significant improvements in the pilates groups compared to home-based exercises. Additionally, in the individual studies, we observed improvements in range of motion, pain and fatigue. The evidence shows that pilates or home-based exercise should be encouraged to women with breast cancer.

Experiences of Older Adults With Mobile Phone Text Messaging as Reminders of Home Exercises After Specialized Manual Therapy for Recurrent Low Back Pain: A Qualitative Study.

PubMed

Lilje, Stina Charlotta; Olander, Ewy; Berglund, Johan; Skillgate, Eva; Anderberg, Peter

2017-03-30

Clinical experience of manual therapy for musculoskeletal pain is that patients often suffer from recurrent pain and disorders, but that they do not continue to perform their physical home exercises when they are free from symptoms. The chance of positive long-term effects of manual therapy would probably increase if patients were reminded that they are to continue to perform their exercises. Mobile phone text messaging (short messaging service, SMS) is increasingly used as an innovative intervention to remind patient to exercise. However, there are only a few studies on such interventions in the field of low back pain (LBP). Qualitative studies of patients' experiences of receiving text messages as reminders of home exercises after manual treatment for recurrent LBP have to the best of our knowledge never been published. The aim of this study was to explore older persons' common experiences of receiving reminders of home exercises through mobile phone text messaging after specialized manual therapy for recurrent LBP. A total of 7 men and 8 women (67-86 years), who had sought specialized manual therapy (Naprapathic manual therapy) for recurrent LBP were included in the study. Individual one-way text messages as reminders of home exercises (to be performed on a daily basis) were sent to each patient every third day for 3 weeks, then once a week for another 2 weeks. Semistructured interviews with 2 broad, open-ended questions were held and data were analyzed with systematic text condensation, based on Giorgi's principles of psychological phenomenological analysis. The participants appreciated the messages, which were perceived as timely and usable, and also stimulated memorizing. The messages made the participants reflect on the aim of the exercise, value of being reminded, and on their improvement in pain. During the interviews, the participants created their own routines for continued adherence to the exercises. It seems plausible that mobile phone text messaging may serve as a useful tool for patient empowerment with regard to recurrent LBP in older persons. Further studies are needed to explore whether future compliance with the exercises will be as large if the participants are not being interviewed. ©Stina Charlotta Lilje, Ewy Olander, Johan Berglund, Eva Skillgate, Peter Anderberg. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 30.03.2017.

Effects of Different Exercise Modalities on Fatigue in Prostate Cancer Patients Undergoing Androgen Deprivation Therapy: A Year-long Randomised Controlled Trial.

PubMed

Taaffe, Dennis R; Newton, Robert U; Spry, Nigel; Joseph, David; Chambers, Suzanne K; Gardiner, Robert A; Wall, Brad A; Cormie, Prue; Bolam, Kate A; Galvão, Daniel A

2017-08-01

Physical exercise mitigates fatigue during androgen deprivation therapy (ADT); however, the effects of different exercise prescriptions are unknown. To determine the long-term effects of different exercise modes on fatigue in prostate cancer patients undergoing ADT. Between 2009 and 2012, 163 prostate cancer patients aged 43-90 y on ADT were randomised to exercise targeting the musculoskeletal system (impact loading+resistance training; ILRT; n=58), the cardiovascular and muscular systems (aerobic+resistance training; ART; n=54), or to usual care/delayed exercise (DEL; n=51) for 12 mo across university-affiliated exercise clinics in Australia. Supervised ILRT for 12 mo, supervised ART for 6 mo followed by a 6-mo home program, and DEL received a printed booklet on exercise information for 6 mo followed by 6-mo stationary cycling exercise. Fatigue was assessed using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 36 and vitality using the Short Form-36. Analysis of variance was used to compare outcomes for groups at 6 mo and 12 mo. Fatigue was reduced (p=0.005) in ILRT at 6 mo and 12 mo (∼5 points), and in ART (p=0.005) and DEL (p=0.022) at 12 mo. Similarly, vitality increased for all groups (p≤0.001) at 12 mo (∼4 points). Those with the highest levels of fatigue and lowest vitality improved the most with exercise (p trend <0.001). A limitation was inclusion of mostly well-functioning individuals. Different exercise modes have comparable effects on reducing fatigue and enhancing vitality during ADT. Patients with the highest levels of fatigue and lowest vitality had the greatest benefits. We compared the effects of different exercise modes on fatigue in men on androgen deprivation therapy. All exercise programs reduced fatigue and enhanced vitality. We conclude that undertaking some form of exercise will help reduce fatigue, especially in those who are the most fatigued. Copyright © 2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Managing knee osteoarthritis with yoga or aerobic/strengthening exercise programs in older adults: a pilot randomized controlled trial.

PubMed

Cheung, Corjena; Wyman, Jean F; Bronas, Ulf; McCarthy, Teresa; Rudser, Kyle; Mathiason, Michelle A

2017-03-01

Although exercise is often recommended for managing osteoarthritis (OA), limited evidence-based exercise options are available for older adults with OA. This study compared the effects of Hatha yoga (HY) and aerobic/strengthening exercises (ASE) on knee OA. Randomized controlled trial with three arms design was used: HY, ASE, and education control. Both HY and ASE groups involved 8 weekly 45-min group classes with 2-4 days/week home practice sessions. Control group received OA education brochures and weekly phone calls from study staff. Standardized instruments were used to measure OA symptoms, physical function, mood, spiritual health, fear of falling, and quality of life at baseline, 4 and 8 weeks. HY/ASE adherences were assessed weekly using class attendance records and home practice video recordings. Primary analysis of the difference in the change from baseline was based on intent-to-treat and adjusted for baseline values. Eight-three adults with symptomatic knee OA completed the study (84% female; mean age 71.6 ± 8.0 years; mean BMI 29.0 ± 7.0 kg/m 2 ). Retention rate was 82%. Compared to the ASE group at 8 weeks, participants in the HY group had a significant improvement from baseline in perception of OA symptoms (-9.6 [95% CI -15.3, -4]; p = .001), anxiety (-1.4 [95% CI -2.7, -0]; p = .04), and fear of falling (-4.6 [-7.5, -1.7]; p = .002). There were no differences in class/home practice adherence between HY and ASE. Three non-serious adverse events were reported from the ASE group. Both HY and ASE improved symptoms and function but HY may have superior benefits for older adults with knee OA. Trial registration The full trial protocol is available at clinicaltrials.gov (NCT02525341).

The effect of a movement-to-music video program on the objectively measured sedentary time and physical activity of preschool-aged children and their mothers: A randomized controlled trial.

PubMed

Tuominen, Pipsa P A; Husu, Pauliina; Raitanen, Jani; Kujala, Urho M; Luoto, Riitta M

2017-01-01

Regular physical activity (PA) and the avoidance of prolonged sitting are essential for children's healthy growth, and for the physical and mental wellbeing of both children and adults. In the context of exercise, music may promote behavioral change through increased exercise adherence and participation. The purpose of this study was to determine whether a movement-to-music video program could reduce sedentary behavior (SB) and increase PA in mother-child pairs in the home environment. A randomized controlled trial was conducted in the Pirkanmaa region, Finland, in 2014-2016. The participants consisted of 228 mother-child pairs (child age 5-7 years). The primary outcomes of interest were tri-axial accelerometer-derived SB and PA, which were measured in weeks one (baseline), two, and eight in both the intervention and control groups. Further, the mothers and children in the intervention group used a movement-to-music video program from the beginning of week two to the end of week eight. Secondary outcomes included self-reported screen time. The statistical methods employed comprised an intention-to-treat and linear mixed effects model design. No statistically significant differences between groups were found in primary or secondary outcomes. Among the children in the control group, light PA decreased significantly over time and screen time increased from 89 (standard deviation, SD 37) to 99 (SD 41) min/d. Among mothers and children in the intervention group, no statistical differences were found. In supplementary analysis, the children who stayed at home instead of attending daycare/preschool had on average 25 (95% confidence interval, CI 19-30) min/d more sedentary time and 11 (95% CI 8-14) min/d less moderate-to-vigorous PA than those who were at daycare/preschool. The higher body mass index of mothers was related with 5 (95% CI 2-7) min/d more sedentary time and 1 (95% CI 0-2) min/d less moderate-to-vigorous PA. The movement-to-music video program did not change the objectively measured SB or PA of the mother-child pairs. However, mothers and children seemed to be more sedentary at home, and therefore interventions for decreasing SB and increasing PA should be targeted in the home environment.

The effect of a movement-to-music video program on the objectively measured sedentary time and physical activity of preschool-aged children and their mothers: A randomized controlled trial

PubMed Central

Husu, Pauliina; Raitanen, Jani; Kujala, Urho M.; Luoto, Riitta M.

2017-01-01

Regular physical activity (PA) and the avoidance of prolonged sitting are essential for children’s healthy growth, and for the physical and mental wellbeing of both children and adults. In the context of exercise, music may promote behavioral change through increased exercise adherence and participation. The purpose of this study was to determine whether a movement-to-music video program could reduce sedentary behavior (SB) and increase PA in mother-child pairs in the home environment. A randomized controlled trial was conducted in the Pirkanmaa region, Finland, in 2014–2016. The participants consisted of 228 mother-child pairs (child age 5–7 years). The primary outcomes of interest were tri-axial accelerometer-derived SB and PA, which were measured in weeks one (baseline), two, and eight in both the intervention and control groups. Further, the mothers and children in the intervention group used a movement-to-music video program from the beginning of week two to the end of week eight. Secondary outcomes included self-reported screen time. The statistical methods employed comprised an intention-to-treat and linear mixed effects model design. No statistically significant differences between groups were found in primary or secondary outcomes. Among the children in the control group, light PA decreased significantly over time and screen time increased from 89 (standard deviation, SD 37) to 99 (SD 41) min/d. Among mothers and children in the intervention group, no statistical differences were found. In supplementary analysis, the children who stayed at home instead of attending daycare/preschool had on average 25 (95% confidence interval, CI 19–30) min/d more sedentary time and 11 (95% CI 8–14) min/d less moderate-to-vigorous PA than those who were at daycare/preschool. The higher body mass index of mothers was related with 5 (95% CI 2–7) min/d more sedentary time and 1 (95% CI 0–2) min/d less moderate-to-vigorous PA. The movement-to-music video program did not change the objectively measured SB or PA of the mother-child pairs. However, mothers and children seemed to be more sedentary at home, and therefore interventions for decreasing SB and increasing PA should be targeted in the home environment. PMID:28859091

Remotely Delivered Exercise-Based Cardiac Rehabilitation: Design and Content Development of a Novel mHealth Platform.

PubMed

Rawstorn, Jonathan C; Gant, Nicholas; Meads, Andrew; Warren, Ian; Maddison, Ralph

2016-06-24

Participation in traditional center-based cardiac rehabilitation exercise programs (exCR) is limited by accessibility barriers. Mobile health (mHealth) technologies can overcome these barriers while preserving critical attributes of center-based exCR monitoring and coaching, but these opportunities have not yet been capitalized on. We aimed to design and develop an evidence- and theory-based mHealth platform for remote delivery of exCR to any geographical location. An iterative process was used to design and develop an evidence- and theory-based mHealth platform (REMOTE-CR) that provides real-time remote exercise monitoring and coaching, behavior change education, and social support. The REMOTE-CR platform comprises a commercially available smartphone and wearable sensor, custom smartphone and Web-based applications (apps), and a custom middleware. The platform allows exCR specialists to monitor patients' exercise and provide individualized coaching in real-time, from almost any location, and provide behavior change education and social support. Intervention content incorporates Social Cognitive Theory, Self-determination Theory, and a taxonomy of behavior change techniques. Exercise components are based on guidelines for clinical exercise prescription. The REMOTE-CR platform extends the capabilities of previous telehealth exCR platforms and narrows the gap between existing center- and home-based exCR services. REMOTE-CR can complement center-based exCR by providing an alternative option for patients whose needs are not being met. Remotely monitored exCR may be more cost-effective than establishing additional center-based programs. The effectiveness and acceptability of REMOTE-CR are now being evaluated in a noninferiority randomized controlled trial.

Does vigorous exercise have a neuroprotective effect in Parkinson disease?

PubMed Central

2011-01-01

Parkinson disease (PD) is progressive, with dementia and medication-refractory motor problems common reasons for late-stage nursing-home placement. Increasing evidence suggests that ongoing vigorous exercise/physical fitness may favorably influence this progression. Parkinsonian animal models reveal exercise-related protection from dopaminergic neurotoxins, apparently mediated by brain neurotrophic factors and neuroplasticity (predicted from in vitro studies). Similarly, exercise consistently improves cognition in animals, also linked to enhanced neuroplasticity and increased neurotrophic factor expression. In these animal models, immobilization has the opposite effect. Brain-derived neurotrophic factor (BDNF) may mediate at least some of this exercise benefit. In humans, exercise increases serum BDNF, and this is known to cross the blood–brain barrier. PD risk in humans is significantly reduced by midlife exercise, documented in large prospective studies. No studies have addressed whether exercise influences dementia risk in PD, but exercised patients with PD improve cognitive scores. Among seniors in general, exercise or physical fitness has not only been associated with better cognitive scores, but midlife exercise significantly reduces the later risk of both dementia and mild cognitive impairment. Finally, numerous studies in seniors with and without dementia have reported increased cerebral gray matter volumes associated with physical fitness or exercise. These findings have several implications for PD clinicians. 1) Ongoing vigorous exercise and physical fitness should be highly encouraged. 2) PD physical therapy programs should include structured, graduated fitness instruction and guidance for deconditioned patients with PD. 3) Levodopa and other forms of dopamine replenishment therapy should be utilized to achieve the maximum capability and motivation for patients to maintain fitness. PMID:21768599

Is high-intensity interval cycling feasible and more beneficial than continuous cycling for knee osteoarthritic patients? Results of a randomised control feasibility trial

PubMed Central

Grigg, Josephine

2018-01-01

Background Knee osteoarthritis (OA) patients often suffer joint pain and stiffness, which contributes to negative changes in body composition, strength, physical performance (function), physical activity and health-related quality of life. To reduce these symptoms and side effects of knee OA, moderate-intensity continuous training (MICT) cycling is often recommended. While resistance training is considered the optimal form of training to improve sarcopenic outcomes, it imposes higher joint loads and requires supervision, either initially or continuously by trained exercise professionals. Therefore, this pilot study sought to gain some insight into the feasibility and potential benefits of high-intensity interval training (HIIT) cycling as an alternative exercise option to MICT cycling for individuals with knee OA. Methods Twenty-seven middle-aged and older adults with knee OA were randomly allocated to either MICT or HIIT, with both programs involving four unsupervised home-based cycling sessions (∼25 min per session) each week for eight weeks. Feasibility was assessed by enrolment rate, withdrawal rate, exercise adherence and number of adverse effects. Efficacy was assessed by health-related quality of life (Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Lequesne index), physical function (Timed Up and Go (TUG), Sit to Stand (STS) and preferred gait speed) and body composition (body mass, BMI, body fat percentage and muscle mass). Results Twenty-seven of the interested 50 potential participants (54%) enrolled in the study, with 17 of the 27 participants completing the trial (withdrawal rate of 37%); with the primary withdrawal reasons being unrelated injuries or illness or family related issues. Of the 17 participants who completed the trial, exercise adherence was very high (HIIT 94%; MICT 88%). While only three individuals (one in the MICT and two in the HIIT group) reported adverse events, a total of 28 adverse events were reported, with 24 of these attributed to one HIIT participant. Pre–post-test analyses indicated both groups significantly improved their WOMAC scores, with the HIIT group also significantly improving in the TUG and STS. The only significant between-group difference was observed in the TUG, whereby the HIIT group improved significantly more than the MICT group. No significant changes were observed in the Lequesne index, gait speed or body composition for either group. Discussion An unsupervised home-based HIIT cycle program appears somewhat feasible for middle-aged and older adults with knee OA and may produce similar improvements in health-related quality of life but greater improvements in physical function than MICT. These results need to be confirmed in larger randomised controlled trials to better elucidate the potential for HIIT to improve outcomes for those with knee OA. Additional research needs to identify and modify the potential barriers affecting the initiation and adherence to home-based HIIT cycling exercise programs by individuals with knee OA. PMID:29761054

Is high-intensity interval cycling feasible and more beneficial than continuous cycling for knee osteoarthritic patients? Results of a randomised control feasibility trial.

PubMed

Keogh, Justin W; Grigg, Josephine; Vertullo, Christopher J

2018-01-01

Knee osteoarthritis (OA) patients often suffer joint pain and stiffness, which contributes to negative changes in body composition, strength, physical performance (function), physical activity and health-related quality of life. To reduce these symptoms and side effects of knee OA, moderate-intensity continuous training (MICT) cycling is often recommended. While resistance training is considered the optimal form of training to improve sarcopenic outcomes, it imposes higher joint loads and requires supervision, either initially or continuously by trained exercise professionals. Therefore, this pilot study sought to gain some insight into the feasibility and potential benefits of high-intensity interval training (HIIT) cycling as an alternative exercise option to MICT cycling for individuals with knee OA. Twenty-seven middle-aged and older adults with knee OA were randomly allocated to either MICT or HIIT, with both programs involving four unsupervised home-based cycling sessions (∼25 min per session) each week for eight weeks. Feasibility was assessed by enrolment rate, withdrawal rate, exercise adherence and number of adverse effects. Efficacy was assessed by health-related quality of life (Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Lequesne index), physical function (Timed Up and Go (TUG), Sit to Stand (STS) and preferred gait speed) and body composition (body mass, BMI, body fat percentage and muscle mass). Twenty-seven of the interested 50 potential participants (54%) enrolled in the study, with 17 of the 27 participants completing the trial (withdrawal rate of 37%); with the primary withdrawal reasons being unrelated injuries or illness or family related issues. Of the 17 participants who completed the trial, exercise adherence was very high (HIIT 94%; MICT 88%). While only three individuals (one in the MICT and two in the HIIT group) reported adverse events, a total of 28 adverse events were reported, with 24 of these attributed to one HIIT participant. Pre-post-test analyses indicated both groups significantly improved their WOMAC scores, with the HIIT group also significantly improving in the TUG and STS. The only significant between-group difference was observed in the TUG, whereby the HIIT group improved significantly more than the MICT group. No significant changes were observed in the Lequesne index, gait speed or body composition for either group. An unsupervised home-based HIIT cycle program appears somewhat feasible for middle-aged and older adults with knee OA and may produce similar improvements in health-related quality of life but greater improvements in physical function than MICT. These results need to be confirmed in larger randomised controlled trials to better elucidate the potential for HIIT to improve outcomes for those with knee OA. Additional research needs to identify and modify the potential barriers affecting the initiation and adherence to home-based HIIT cycling exercise programs by individuals with knee OA.

Enhancing Cognitive Training Through Aerobic Exercise After a First Schizophrenia Episode: Theoretical Conception and Pilot Study.

PubMed

Nuechterlein, Keith H; Ventura, Joseph; McEwen, Sarah C; Gretchen-Doorly, Denise; Vinogradov, Sophia; Subotnik, Kenneth L

2016-07-01

Cognitive training (CT) and aerobic exercise have separately shown promise for improving cognitive deficits in schizophrenia. Aerobic exercise releases brain-derived neurotrophic factor, which promotes synaptic plasticity and neurogenesis. Thus, aerobic exercise provides a neurotrophic platform for neuroplasticity-based CT. The combination of aerobic exercise and CT may yield more robust effects than CT alone, particularly in the initial course of schizophrenia. In a pilot study, 7 patients with a recent onset of schizophrenia were assigned to Cognitive Training & Exercise (CT&E) and 9 to CT alone for a 10-week period. Posit Science programs were used for CT. Neurocognitive training focused on tuning neural circuits related to perceptual processing and verbal learning and memory. Social cognitive training used the same learning principles with social and affective stimuli. Both groups participated in these training sessions 2d/wk, 2h/d. The CT&E group also participated in an aerobic conditioning program for 30 minutes at our clinic 2d/wk and at home 2d/wk. The effect size for improvement in the MATRICS Consensus Cognitive Battery Overall Composite score for CT&E patients relative to CT patients was large. Functional outcome, particularly independent living skills, also tended to improve more in the CT&E than in the CT group. Muscular endurance, cardiovascular fitness, and diastolic blood pressure also showed relative improvement in the CT&E compared to the CT group. These encouraging pilot study findings support the promise of combining CT and aerobic exercise to improve the early course of schizophrenia. © The Author 2016. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Exercise and fall prevention self-management to reduce mobility-related disability and falls after fall-related lower limb fracture in older people: protocol for the RESTORE (Recovery Exercises and STepping On afteR fracturE) randomised controlled trial.

PubMed

Sherrington, Catherine; Fairhall, Nicola; Kirkham, Catherine; Clemson, Lindy; Howard, Kirsten; Vogler, Constance; Close, Jacqueline C T; Moseley, Anne M; Cameron, Ian D; Mak, Jenson; Sonnabend, David; Lord, Stephen R

2016-02-02

Lasting disability and further falls are common and costly problems in older people following fall-related lower limb and pelvic fractures. Exercise interventions can improve mobility after fracture and reduce falls in older people, however the optimal approach to rehabilitation after fall-related lower limb and pelvic fracture is unclear. This randomised controlled trial aims to evaluate the effects of an exercise and fall prevention self-management intervention on mobility-related disability and falls in older people following fall-related lower limb or pelvic fracture. Cost-effectiveness of the intervention will also be investigated. A randomised controlled trial with concealed allocation, assessor blinding for physical performance tests and intention-to-treat analysis will be conducted. Three hundred and fifty people aged 60 years and over with a fall-related lower limb or pelvic fracture, who are living at home or in a low care residential aged care facility and have completed active rehabilitation, will be recruited. Participants will be randomised to receive a 12-month intervention or usual care. The intervention group will receive ten home visits from a physiotherapist to prescribe an individualised exercise program with motivational interviewing, plus fall prevention education through individualised advice from the physiotherapist or attendance at the group based "Stepping On" program (seven two-hour group sessions). Participants will be followed for a 12-month period. Primary outcome measures will be mobility-related disability and falls. Secondary outcomes will include measures of balance and mobility, falls risk, physical activity, walking aid use, frailty, pain, nutrition, falls efficacy, mood, positive and negative affect, quality of life, assistance required, hospital readmission, and health-system and community-service contact. This study will determine the effect and cost-effectiveness of this exercise self management intervention on mobility-related disability and falls in older people who have recently sustained a fall-related lower limb or pelvic fracture. The results will have implications for the design and implementation of interventions for older people with fall related lower limb fractures. The findings of this study will be disseminated in peer-reviewed journals and through professional and scientific conferences. Australian New Zealand Clinical Trials Registry: ACTRN12610000805077.

Reversal of childhood idiopathic scoliosis in an adult, without surgery: a case report and literature review

PubMed Central

2009-01-01

Background Some patients with mild or moderate thoracic scoliosis (Cobb angle <50-60 degrees) suffer disproportionate impairment of pulmonary function associated with deformities in the sagittal plane and reduced flexibility of the spine and chest cage. Long-term improvement in the clinical signs and symptoms of childhood onset scoliosis in an adult, without surgical intervention, has not been documented previously. Case presentation A diagnosis of thoracic scoliosis (Cobb angle 45 degrees) with pectus excavatum and thoracic hypokyphosis in a female patient (DOB 9/17/52) was made in June 1964. Immediate spinal fusion was strongly recommended, but the patient elected a daily home exercise program taught during a 6-week period of training by a physical therapist. This regime was carried out through 1992, with daily aerobic exercise added in 1974. The Cobb angle of the primary thoracic curvature remained unchanged. Ongoing clinical symptoms included dyspnea at rest and recurrent respiratory infections. A period of multimodal treatment with clinical monitoring and treatment by an osteopathic physician was initiated when the patient was 40 years old. This included deep tissue massage (1992-1996); outpatient psychological therapy (1992-1993); a daily home exercise program focused on mobilization of the chest wall (1992-2005); and manipulative medicine (1994-1995, 1999-2000). Progressive improvement in chest wall excursion, increased thoracic kyphosis, and resolution of long-standing respiratory symptoms occurred concomitant with a >10 degree decrease in Cobb angle magnitude of the primary thoracic curvature. Conclusion This report documents improved chest wall function and resolution of respiratory symptoms in response to nonsurgical approaches in an adult female, diagnosed at age eleven years with idiopathic scoliosis. PMID:20003501

Exercise training guidelines for the elderly.

PubMed

Evans, W J

1999-01-01

The capacity of older men and women to adapt to increased levels of physical activity is preserved, even in the most elderly. Aerobic exercise results in improvements in functional capacity and reduced risk of developing Type II diabetes in the elderly. High-intensity resistance training (above 60% of the one repetition maximum) has been demonstrated to cause large increases in strength in the elderly. In addition, resistance training result in significant increases in muscle size in elderly men and women. Resistance training has also been shown to significantly increase energy requirements and insulin action of the elderly. We have recently demonstrated that resistance training has a positive effect on multiple risk factors for osteoporotic fracture in previously sedentary postmenopausal women. Because the sedentary lifestyle of a long-term care facility may exacerbate losses of muscle function, we have applied this same training program to frail, institutionalized elderly men and women. In a population of 100 nursing home residents, a randomly assigned high-intensity strength-training program resulted in significant gains in strength and functional status. In addition, spontaneous activity, measured by activity monitors, increased significantly in those participating in the exercise program whereas there was no change in the sedentary control group. Before the strength training intervention, the relationship of whole body potassium and leg strength was seen to be relatively weak (r2 = 0.29, P < 0.001), indicating that in the very old, muscle mass is an important but not the only determining factor of functional status. Thus, exercise may minimize or reverse the syndrome of physical frailty, which is so prevalent among the most elderly. Because of their low functional status and high incidence of chronic disease, there is no segment of the population that can benefit more from exercise than the elderly.

A feasibility study and pilot randomised trial of a tailored prevention program to reduce falls in older people with mild dementia.

PubMed

Wesson, Jacqueline; Clemson, Lindy; Brodaty, Henry; Lord, Stephen; Taylor, Morag; Gitlin, Laura; Close, Jacqueline

2013-09-03

People with dementia have a disproportionately high rate of falls and fractures and poorer outcomes, yet there is currently no evidence to guide falls prevention in this population. A randomised trial design was used to test feasibility of study components and acceptability of a home hazard reduction and balance and strength exercise fall prevention program. The program was tailored to participant's individual cognitive levels and implemented as a carer-supported intervention. Feasibility of recruitment, retention and implementation of intervention were recorded through observation and documented in field notes. Adherence, carer burden and use of task simplification strategies were also monitored. Outcome measures, collected at 12 weeks included physiological, fear of falling, cognitive and functional measures. Recruitment was achievable but may be more challenging in a multisite trial. Twenty two dyads of persons with mild dementia and their carers were randomised to intervention or usual care control group. Of 38 dyads referred to the study, there was a high rate of willingness to participate, with 6 (16%) declining and 10 (26%) not meeting inclusion criteria. The intervention was well received by participants and carers and adherence to both program components was very good. All participants implemented some home safety recommendations (range 19-80%) with half implementing 50% or more. At the end of 12 weeks, 72% of the intervention group were exercising. Both the rate of falling and the risk of a fall were lower in the intervention group but these findings were not significant (RR= 0.50 (95% CI 0.11-2.19). There were no differences in physiological outcome measures between the control and intervention groups. However results were influenced by the small study size and incomplete data primarily in the intervention group at follow up. The pilot study was feasible and acceptable to people with mild dementia and their carers. The lessons learnt included: recruitment for a larger trial will require multiple approaches; home safety recommendations should provide a greater emphasis on environmental use compared with behavioural change; strategies to ensure an adequate dosage of exercise should be further explored. We recommend that intervention delivery incorporate an integrated occupational therapy and physiotherapy approach and that carers be provided with an individualised session to enhance dementia-specific skills in management and communication. A refined intervention should be tested in a randomised trial with an adequately powered sample size. Australia and New Zealand Clinical Trials Registry 126100001049066.

A feasibility study and pilot randomised trial of a tailored prevention program to reduce falls in older people with mild dementia

PubMed Central

2013-01-01

Background People with dementia have a disproportionately high rate of falls and fractures and poorer outcomes, yet there is currently no evidence to guide falls prevention in this population. Methods A randomised trial design was used to test feasibility of study components and acceptability of a home hazard reduction and balance and strength exercise fall prevention program. The program was tailored to participant’s individual cognitive levels and implemented as a carer-supported intervention. Feasibility of recruitment, retention and implementation of intervention were recorded through observation and documented in field notes. Adherence, carer burden and use of task simplification strategies were also monitored. Outcome measures, collected at 12 weeks included physiological, fear of falling, cognitive and functional measures. Results Recruitment was achievable but may be more challenging in a multisite trial. Twenty two dyads of persons with mild dementia and their carers were randomised to intervention or usual care control group. Of 38 dyads referred to the study, there was a high rate of willingness to participate, with 6 (16%) declining and 10 (26%) not meeting inclusion criteria. The intervention was well received by participants and carers and adherence to both program components was very good. All participants implemented some home safety recommendations (range 19-80%) with half implementing 50% or more. At the end of 12 weeks, 72% of the intervention group were exercising. Both the rate of falling and the risk of a fall were lower in the intervention group but these findings were not significant (RR= 0.50 (95% CI 0.11-2.19). There were no differences in physiological outcome measures between the control and intervention groups. However results were influenced by the small study size and incomplete data primarily in the intervention group at follow up. Conclusions The pilot study was feasible and acceptable to people with mild dementia and their carers. The lessons learnt included: recruitment for a larger trial will require multiple approaches; home safety recommendations should provide a greater emphasis on environmental use compared with behavioural change; strategies to ensure an adequate dosage of exercise should be further explored. We recommend that intervention delivery incorporate an integrated occupational therapy and physiotherapy approach and that carers be provided with an individualised session to enhance dementia-specific skills in management and communication. A refined intervention should be tested in a randomised trial with an adequately powered sample size. Trial registration Australia and New Zealand Clinical Trials Registry 126100001049066 PMID:24004682

Repeated 3-minute stair climbing-descending exercise after a meal over 2 weeks increases serum 1,5-anhydroglucitol levels in people with type 2 diabetes

PubMed Central

Honda, Hiroto; Igaki, Makoto; Hatanaka, Yuki; Komatsu, Motoaki; Tanaka, Shin-Ichiro; Miki, Tetsuo; Matsuki, Yumika; Takaishi, Tetsuo; Hayashi, Tatsuya

2017-01-01

[Purpose] The purpose of this study was to examine the hypoglycemic effect of a postprandial exercise program using brief stair climbing-descending exercise in people with type 2 diabetes. [Subjects and Methods] Seven males with uncomplicated type 2 diabetes (age 68.0 ± 3.7 years) performed two sets of stair climbing-descending exercise 60 and 120 min after each meal for the first 2 weeks but not for the following 2 weeks. Each set of exercise comprised 3-min of continuous repetition of climbing briskly to the second floor followed by slow waking down to the first floor in their home. A rest period of 1–2 min was allowed between each set. [Results] Serum 1,5-anhydroglucitol level was significantly higher by 11.5% at the end of the 2-week exercise period than at the baseline. By contrast, the 1,5-anhydroglucitol level at the end of the following 2-week period did not differ from the baseline value. Fasting blood glucose level and insulin resistance index at the end of the exercise period did not differ from the baseline value. [Conclusion] Repeated 3-min bouts of stair climbing-descending exercise after a meal may be a promising method for improving postprandial glycemic control in people with type 2 diabetes. PMID:28210043

A randomized study of new sling exercise treatment vs traditional physiotherapy for patients with chronic whiplash-associated disorders with unsettled compensation claims.

PubMed

Vikne, John; Oedegaard, Arit; Laerum, Even; Ihlebaek, Camilla; Kirkesola, Gitle

2007-04-01

Many patients with chronic whiplash-associated disorders have reduced neuromuscular control of the neck and head. It has been proposed that a new sling exercise therapy may promote neuromuscular control of the neck. To compare the effects of traditional physiotherapy vs traditional physiotherapy combined with a new sling exercise therapy on discomfort and function in patients with chronic whiplash-associated disorders who have unsettled compensation claims; and to investigate possible additional effects of guided, long-term home training. A randomized multi-centre trial with 4 parallel groups. A total of 214 patients were assigned randomly to 4 treatment groups, and received either traditional physiotherapy with or without home training, or new sling exercise therapy with or without home training. Outcome measures were pain, disability, psychological distress, sick leave and physical tests. A total of 171 patients (80%) completed the study. There were no important statistical or clinical differences between the groups after 4 months of treatment. There was a small statistically significant effect at 12-month follow-up in both groups with home training regarding pain during rest (p = 0.05) and reported fatigue in the final week (p = 0.02). No statistically significant differences were found between the traditional physiotherapy group and the new sling exercise group, with or without home training. Since the groups were not compared with a control group without treatment, we cannot conclude that the studied treatments are effective for patients with whiplash-associated disorder, only that they did not differ in our study.

ICT-based system to predict and prevent falls (iStoppFalls): results from an international multicenter randomized controlled trial.

PubMed

Gschwind, Yves J; Eichberg, Sabine; Ejupi, Andreas; de Rosario, Helios; Kroll, Michael; Marston, Hannah R; Drobics, Mario; Annegarn, Janneke; Wieching, Rainer; Lord, Stephen R; Aal, Konstantin; Vaziri, Daryoush; Woodbury, Ashley; Fink, Dennis; Delbaere, Kim

2015-01-01

Falls and fall-related injuries are a serious public health issue. Exercise programs can effectively reduce fall risk in older people. The iStoppFalls project developed an Information and Communication Technology-based system to deliver an unsupervised exercise program in older people's homes. The primary aims of the iStoppFalls randomized controlled trial were to assess the feasibility (exercise adherence, acceptability and safety) of the intervention program and its effectiveness on common fall risk factors. A total of 153 community-dwelling people aged 65+ years took part in this international, multicentre, randomized controlled trial. Intervention group participants conducted the exercise program for 16 weeks, with a recommended duration of 120 min/week for balance exergames and 60 min/week for strength exercises. All intervention and control participants received educational material including advice on a healthy lifestyle and fall prevention. Assessments included physical and cognitive tests, and questionnaires for health, fear of falling, number of falls, quality of life and psychosocial outcomes. The median total exercise duration was 11.7 h (IQR = 22.0) over the 16-week intervention period. There were no adverse events. Physiological fall risk (Physiological Profile Assessment, PPA) reduced significantly more in the intervention group compared to the control group (F1,127 = 4.54, p = 0.035). There was a significant three-way interaction for fall risk assessed by the PPA between the high-adherence (>90 min/week; n = 18, 25.4 %), low-adherence (<90 min/week; n = 53, 74.6 %) and control group (F2,125 = 3.12, n = 75, p = 0.044). Post hoc analysis revealed a significantly larger effect in favour of the high-adherence group compared to the control group for fall risk (p = 0.031), postural sway (p = 0.046), stepping reaction time (p = 0.041), executive functioning (p = 0.044), and quality of life (p for trend = 0.052). The iStoppFalls exercise program reduced physiological fall risk in the study sample. Additional subgroup analyses revealed that intervention participants with better adherence also improved in postural sway, stepping reaction, and executive function. Australian New Zealand Clinical Trials Registry Trial ID: ACTRN12614000096651 International Standard Randomised Controlled Trial Number: ISRCTN15932647.

Effect of a Home-Based Exercise Intervention of Wearable Technology and Telephone Coaching on Walking Performance in Peripheral Artery Disease: The HONOR Randomized Clinical Trial.

PubMed

McDermott, Mary M; Spring, Bonnie; Berger, Jeffrey S; Treat-Jacobson, Diane; Conte, Michael S; Creager, Mark A; Criqui, Michael H; Ferrucci, Luigi; Gornik, Heather L; Guralnik, Jack M; Hahn, Elizabeth A; Henke, Peter; Kibbe, Melina R; Kohlman-Trighoff, Debra; Li, Lingyu; Lloyd-Jones, Donald; McCarthy, Walter; Polonsky, Tamar S; Skelly, Christopher; Tian, Lu; Zhao, Lihui; Zhang, Dongxue; Rejeski, W Jack

2018-04-24

Clinical practice guidelines support home-based exercise for patients with peripheral artery disease (PAD), but no randomized trials have tested whether an exercise intervention without periodic medical center visits improves walking performance. To determine whether a home-based exercise intervention consisting of a wearable activity monitor and telephone coaching improves walking ability over 9 months in patients with PAD. Randomized clinical trial conducted at 3 US medical centers. Patients with PAD were randomized between June 18, 2015, and April 4, 2017, to home-based exercise vs usual care for 9 months. Final follow-up was on December 5, 2017. The exercise intervention group (n = 99) received 4 weekly medical center visits during the first month followed by 8 months of a wearable activity monitor and telephone coaching. The usual care group (n = 101) received no onsite sessions, active exercise, or coaching intervention. The primary outcome was change in 6-minute walk distance at 9-month follow-up (minimal clinically important difference [MCID], 20 m). Secondary outcomes included 9-month change in subcomponents of the Walking Impairment Questionnaire (WIQ) (0-100 score; 100, best), SF-36 physical functioning score, Patient-Reported Outcomes Measurement Information System (PROMIS) mobility questionnaire (higher = better; MCID, 2 points), PROMIS satisfaction with social roles questionnaire, PROMIS pain interference questionnaire (lower = better; MCID range, 3.5-4.5 points), and objectively measured physical activity. Among 200 randomized participants (mean [SD] age, 70.2 [10.4] years; 105 [52.5%] women), 182 (91%) completed 9-month follow-up. The mean change from baseline to 9-month follow-up in the 6-minute walk distance was 5.5 m in the intervention group vs 14.4 m in the usual care group (difference, -8.9 m; 95% CI, -26.0 to 8.2 m; P = .31). The exercise intervention worsened the PROMIS pain interference score, mean change from baseline to 9 months was 0.7 in the intervention group vs -2.8 in the usual care group (difference, 3.5; 95% CI, 1.3 to 5.8; P = .002). There were no significant between-group differences in the WIQ score, the SF-36 physical functioning score, or the PROMIS mobility or satisfaction with social roles scores. Among patients with PAD, a home-based exercise intervention consisting of a wearable activity monitor and telephone coaching, compared with usual care, did not improve walking performance at 9-month follow-up. These results do not support home-based exercise interventions of wearable devices and telephone counseling without periodic onsite visits to improve walking performance in patients with PAD. clinicaltrials.gov Identifier: NCT02462824.

Designing a Mobile Health App for Patients With Dysphagia Following Head and Neck Cancer: A Qualitative Study

PubMed Central

Constantinescu, Gabriela; Loewen, Irene; King, Ben; Brodt, Chris; Hodgetts, William

2017-01-01

Background Adherence to swallowing rehabilitation exercises is important to develop and maintain functional improvement, yet more than half of head and neck cancer (HNC) patients report having difficulty adhering to prescribed regimens. Health apps with game elements have been used in other health domains to motivate and engage patients. Understanding the factors that impact adherence may allow for more effective gamified solutions. Objective The aim of our study was to (1) identify self-reported factors that influence adherence to conventional home therapy without a mobile device in HNC patients and (2) identify appealing biofeedback designs that could be used in a health app. Methods A total of 10 (4 females) HNC patients (mean=60.1 years) with experience completing home-based rehabilitation programs were recruited. Thematic analysis of semi-structured interviews was used to answer the first objective. Convergent interviews were used to obtain reactions to biofeedback designs. Results Facilitators and barriers of adherence to home therapy were described through 6 themes: patient perceptions on outcomes and progress, clinical appointments, cancer treatment, rehabilitation program, personal factors, and connection. App visuals that provide feedback on performance during swallowing exercises should offer an immediate representation of effort relative to a goal. Simple, intuitive graphics were preferred over complex, abstract ones. Continued engagement with the app could be facilitated by tracking progress and by using visuals that build structures with each use. Conclusions This is a detailed documentation of the initial steps in designing a health app for a specific patient group. Results revealed the importance of patient engagement in early stages of app development. PMID:28582245

Feasibility of a Smartphone-Based Exercise Program for Office Workers With Neck Pain: An Individualized Approach Using a Self-Classification Algorithm.

PubMed

Lee, Minyoung; Lee, Sang Heon; Kim, TaeYeong; Yoo, Hyun-Joon; Kim, Sung Hoon; Suh, Dong-Won; Son, Jaebum; Yoon, BumChul

2017-01-01

To explore the feasibility of a newly developed smartphone-based exercise program with an embedded self-classification algorithm for office workers with neck pain, by examining its effect on the pain intensity, functional disability, quality of life, fear avoidance, and cervical range of motion (ROM). Single-group, repeated-measures design. The laboratory and participants' home and work environments. Offices workers with neck pain (N=23; mean age ± SD, 28.13±2.97y; 13 men). Participants were classified as having 1 of 4 types of neck pain through a self-classification algorithm implemented as a smartphone application, and conducted corresponding exercise programs for 10 to 12min/d, 3d/wk, for 8 weeks. The visual analog scale (VAS), Neck Disability Index (NDI), Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), Fear-Avoidance Beliefs Questionnaire (FABQ), and cervical ROM were measured at baseline and postintervention. The VAS (P<.001) and NDI score (P<.001) indicated significant improvements in pain intensity and functional disability. Quality of life showed significant improvements in the physical functioning (P=.007), bodily pain (P=.018), general health (P=.022), vitality (P=.046), and physical component scores (P=.002) of the SF-36. The FABQ, cervical ROM, and mental component score of the SF-36 showed no significant improvements. The smartphone-based exercise program with an embedded self-classification algorithm improves the pain intensity and perceived physical health of office workers with neck pain, although not enough to affect their mental and emotional states. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

The Efficacy of Electronic Health–Supported Home Exercise Interventions for Patients With Osteoarthritis of the Knee: Systematic Review

PubMed Central

Zalpour, Christoff; von Piekartz, Harry; Hall, Toby Maxwell; Paelke, Volker

2018-01-01

Background Osteoarthritis of the knee is the most common cause for disability and limited mobility in the elderly, with considerable individual suffering and high direct and indirect disease-related costs. Nonsurgical interventions such as exercise, enhanced physical activity, and self-management have shown beneficial effects for pain reduction, physical function, and quality of life (QoL), but access to these treatments may be limited. Therefore, home therapy is strongly recommended. However, adherence to these programs is low. Patients report lack of motivation, feedback, and personal interaction as the main barriers to home therapy adherence. To overcome these barriers, electronic health (eHealth) is seen as a promising opportunity. Although beneficial effects have been shown in the literature for other chronic diseases such as chronic pain, cardiovascular disease, and diabetes, a systematic literature review on the efficacy of eHealth interventions for patients with osteoarthritis of knee is missing so far. Objective The aim of this study was to compare the efficacy of eHealth-supported home exercise interventions with no or other interventions regarding pain, physical function, and health-related QoL in patients with osteoarthritis of the knee. Methods MEDLINE, CENTRAL, CINAHL, and PEDro were systematically searched using the keywords osteoarthritis knee, eHealth, and exercise. An inverse variance random-effects meta-analysis was carried out pooling standardized mean differences (SMDs) of individual studies. The Cochrane tool was used to assess risk of bias in individual studies, and the quality of evidence across studies was evaluated following the Grading of Recommendations, Assessment, Development, and Evaluation approach. Results The literature search yielded a total of 648 results. After screening of titles, abstracts, and full-texts, seven randomized controlled trials were included. Pooling the data of individual studies demonstrated beneficial short-term (pain SMD=−0.31, 95% CI −0.58 to −0.04, low quality; QoL SMD=0.24, 95% CI 0.05-0.43, moderate quality) and long-term effects (pain −0.30, 95% CI −0.07 to −0.53, moderate quality; physical function 0.41, 95% CI 0.17-0.64, high quality; and QoL SMD=0.27, 95% CI 0.06-0.47, high quality). Conclusions eHealth-supported exercise interventions resulted in less pain, improved physical function, and health-related QoL compared with no or other interventions; however, these improvements were small (SMD<0.5) and may not make a meaningful difference for individual patients. Low adherence is seen as one limiting factor of eHealth interventions. Future research should focus on participatory development of eHealth technology integrating evidence-based principles of exercise science and ways of increasing patient motivation and adherence. PMID:29699963

Are Virtual Rehabilitation Technologies Feasible Models to Scale an Evidence-Based Fall Prevention Program? A Pilot Study Using the Kinect Camera

PubMed Central

Basnett, Jeanna; Chokshi, Anang; Barrett, Mark; Komatireddy, Ravi

2015-01-01

Background Falls in older adults are a significant public health issue. Interventions have been developed and proven effective to reduce falls in older adults, but these programs typically last several months and can be resource intensive. Virtual rehabilitation technologies may offer a solution to bring these programs to scale. Off-the-shelf and custom exergames have demonstrated to be a feasible adjunct to rehabilitation with older adults. However, it is not known if older adults will be able or willing to use a virtual rehabilitation technology to participate in an evidence-based fall prevention program. To have the greatest impact, virtual rehabilitation technologies need to be acceptable to older adults from different backgrounds and level of fall risk. If these technologies prove to be a feasible option, they offer a new distribution channel to disseminate fall prevention programs. Objective Stand Tall (ST) is a virtual translation of the Otago Exercise Program (OEP), an evidence-based fall prevention program. Stand Tall was developed using the Virtual Exercise Rehabilitation Assistant (VERA) software, which uses a Kinect camera and a laptop to deliver physical therapy exercise programs. Our purpose in this pilot study was to explore if ST could be a feasible platform to deliver the OEP to older adults from a variety of fall risk levels, education backgrounds, and self-described level of computer expertise. Methods Adults age 60 and over were recruited to participate in a one-time usability study. The study included orientation to the program, navigation to exercises, and completion of a series of strength and balance exercises. Quantitative analysis described participants and the user experience. Results A diverse group of individuals participated in the study. Twenty-one potential participants (14 women, 7 men) met the inclusion criteria. The mean age was 69.2 (± 5.8) years, 38% had a high school education, 24% had a graduate degree, and 66% classified as “at risk for falls”. Eighteen participants agreed they would like to use ST to help improve their balance, and 17 agreed or strongly agreed they would feel confident using the system in either the senior center or the home. Thirteen participants felt confident they could actually set up the system in their home. The mean System Usability Scale (SUS) score was 65.5 ± 21.2 with a range of 32.5 to 97.5. Ten participants scored ST as an above average usability experience compared to other technologies and 5 participants scored a less than optimal experience. Exploratory analysis revealed no significant relationships between user experience, education background, self-described computer experience, and fall risk. Conclusions Results support the virtual delivery of the OEP by a Kinect camera and an avatar may be acceptable to older adults from a variety of backgrounds. Virtual technologies, like Stand Tall, could offer an efficient and effective approach to bring evidence-based fall prevention programs to scale to address the problem of falls and fall-related injuries. Next steps include determining if similar or better outcomes are achieved by older adults using the virtual OEP, Stand Tall, compared to the standard of care. PMID:28582244

Are Virtual Rehabilitation Technologies Feasible Models to Scale an Evidence-Based Fall Prevention Program? A Pilot Study Using the Kinect Camera.

PubMed

Shubert, Tiffany E; Basnett, Jeanna; Chokshi, Anang; Barrett, Mark; Komatireddy, Ravi

2015-11-05

Falls in older adults are a significant public health issue. Interventions have been developed and proven effective to reduce falls in older adults, but these programs typically last several months and can be resource intensive. Virtual rehabilitation technologies may offer a solution to bring these programs to scale. Off-the-shelf and custom exergames have demonstrated to be a feasible adjunct to rehabilitation with older adults. However, it is not known if older adults will be able or willing to use a virtual rehabilitation technology to participate in an evidence-based fall prevention program. To have the greatest impact, virtual rehabilitation technologies need to be acceptable to older adults from different backgrounds and level of fall risk. If these technologies prove to be a feasible option, they offer a new distribution channel to disseminate fall prevention programs. Stand Tall (ST) is a virtual translation of the Otago Exercise Program (OEP), an evidence-based fall prevention program. Stand Tall was developed using the Virtual Exercise Rehabilitation Assistant (VERA) software, which uses a Kinect camera and a laptop to deliver physical therapy exercise programs. Our purpose in this pilot study was to explore if ST could be a feasible platform to deliver the OEP to older adults from a variety of fall risk levels, education backgrounds, and self-described level of computer expertise. Adults age 60 and over were recruited to participate in a one-time usability study. The study included orientation to the program, navigation to exercises, and completion of a series of strength and balance exercises. Quantitative analysis described participants and the user experience. A diverse group of individuals participated in the study. Twenty-one potential participants (14 women, 7 men) met the inclusion criteria. The mean age was 69.2 (± 5.8) years, 38% had a high school education, 24% had a graduate degree, and 66% classified as "at risk for falls". Eighteen participants agreed they would like to use ST to help improve their balance, and 17 agreed or strongly agreed they would feel confident using the system in either the senior center or the home. Thirteen participants felt confident they could actually set up the system in their home. The mean System Usability Scale (SUS) score was 65.5 ± 21.2 with a range of 32.5 to 97.5. Ten participants scored ST as an above average usability experience compared to other technologies and 5 participants scored a less than optimal experience. Exploratory analysis revealed no significant relationships between user experience, education background, self-described computer experience, and fall risk. Results support the virtual delivery of the OEP by a Kinect camera and an avatar may be acceptable to older adults from a variety of backgrounds. Virtual technologies, like Stand Tall, could offer an efficient and effective approach to bring evidence-based fall prevention programs to scale to address the problem of falls and fall-related injuries. Next steps include determining if similar or better outcomes are achieved by older adults using the virtual OEP, Stand Tall, compared to the standard of care. ©Tiffany E Shubert, Jeanna Basnett, Anang Chokshi, Mark Barrett, Ravi Komatireddy. Originally published in JMIR Rehabilitation and Assistive Technology (http://rehab.jmir.org), 05.11.2015.

Perceptions of exercise for older people living with dementia in Bangkok, Thailand: an exploratory qualitative study.

PubMed

Karuncharernpanit, Sirikul; Hendricks, Joyce; Toye, Christine

2016-09-01

Dementia is a significant issue globally, including in Thailand, and exercise is known to have health benefits for people living with dementia. However, little is known about exercise acceptable to, and feasible for, this population group in low-to-middle income countries although, more broadly, it is recognised that health-related behaviours are influenced by the perceptions of the individual, which exist within a cultural context. To explore and describe perceptions of appropriate exercise for people living with dementia in Bangkok, Thailand. Qualitative exploratory descriptive. Bangkok, Thailand. Nine professionals - experts in exercise, dementia care and relevant policy development - and nine dyads of people with dementia and their family caregivers all recruited using purposive sampling. Semi-structured interviews subjected to thematic analysis. Three themes emerged: how exercise was defined, perceived benefits of exercise and how exercise should be implemented. Professionals recognised three exercise elements: aerobic exercise plus balance and strength training. Dyads recognised home-based activities (e.g., housework) and walking. Both groups recognised benefits of exercise in maintaining health and function and improving mood and sleep. Only health professionals identified falls risk reduction. There was limited appreciation of benefits for caregivers by maintaining function in care recipients. Professionals deemed that exercise should address all three elements, using easily accessible low-cost resources. The need for safety was emphasised, and there was agreement that in-home exercise was appropriate. Family/cultural values were evident that could present barriers to exercise implementation. Changing health-related behaviours requires an understanding of individual perspectives, which exist within a cultural context. This study has illuminated the Thai context and has implications beyond this. Findings emphasise a need for potential benefits to be sufficiently understood by family caregivers to overcome any culturally based reluctance to promote exercise in older people. Nurses have a key role in supporting care givers of older persons with dementia supervise home based exercise. Nurses need to develop knowledge of aerobic exercise to teach caregivers and the older person with dementia. Muscle strength and aerobic exercise assists in the older person's ability to undertake ADL. © 2015 John Wiley & Sons Ltd.

Sustainable impact of an individualized exercise program on physical activity level and fatigue syndrome on breast cancer patients in two German rehabilitation centers.

PubMed

Baumann, Freerk T; Bieck, Oliver; Oberste, Max; Kuhn, Rafaela; Schmitt, Joachim; Wentrock, Steffen; Zopf, Eva; Bloch, Wilhelm; Schüle, Klaus; Reuss-Borst, Monika

2017-04-01

Although physical activity has been demonstrated to increase cancer survival in epidemiological studies, breast cancer patients tend toward inactivity after treatment. Breast cancer patients were quasi-randomly allocated to two different groups, intervention (IG) and control (CG) groups. The intervention group (n = 111) received an individual 3-week exercise program with two additional 1-week inpatient stays after 4 and 8 months. At the end of the rehabilitation, a home-based exercise program was designed. The control group (n = 83) received a 3-week rehabilitation program and did not obtain any follow-up care. Patients from both groups were measured using questionnaires on physical activity, fatigue, and quality of life (QoL) at five time points, 4 months (t1), 8 months (t2), 12 months (t3), 18 months (t4), and 24 months (t5) after the beginning of the rehabilitation. After 2 years, the level of physical activity (total metabolic rate) increased significantly from 2733.16 ± 2547.95 (t0) to 4169.71 ± 3492.27 (t5) metabolic equivalent (MET)-min/week in the intervention group, but just slightly changed from 2858.38 ± 2393.79 (t0) to 2875.74 ± 2590.15 (t5) MET-min/week in the control group (means ± standard deviation). Furthermore, the internal group comparison showed significant differences after 2 years as well. These results came along with a significantly reduced fatigue syndrome and an increased health-related quality of life. The data indicate that an individual, according to their preferences, and physical-resource-adapted exercise program has a more sustainable impact on the physical activity level in breast cancer patients than the usual care. It is suggested that the rehabilitation program should be personalized for all breast cancer patients.

The Penn State Heart Assistant: A pilot study of a web-based intervention to improve self-care of heart failure patients.

PubMed

Lloyd, Tom; Buck, Harleah; Foy, Andrew; Black, Sara; Pinter, Antony; Pogash, Rosanne; Eismann, Bobby; Balaban, Eric; Chan, John; Kunselman, Allen; Smyth, Joshua; Boehmer, John

2017-05-01

The Penn State Heart Assistant, a web-based, tablet computer-accessed, secure application was developed to conduct a proof of concept test, targeting patient self-care activities of heart failure patients including daily medication adherence, weight monitoring, and aerobic activity. Patients (n = 12) used the tablet computer-accessed program for 30 days-recording their information and viewing a short educational video. Linear random coefficient models assessed the relationship between weight and time and exercise and time. Good medication adherence (66% reporting taking 75% of prescribed medications) was reported. Group compliance over 30 days for weight and exercise was 84 percent. No persistent weight gain over 30 days, and some indication of weight loss (slope of weight vs time was negative (-0.17; p value = 0.002)), as well as increased exercise (slope of exercise vs time was positive (0.08; p value = 0.04)) was observed. This study suggests that mobile technology is feasible, acceptable, and has potential for cost-effective opportunities to manage heart failure patients safely at home.

Moving Forward in Fall Prevention: An Intervention to Improve Balance Among Older Adults in Real-World Settings

PubMed Central

Robitaille, Yvonne; Laforest, Sophie; Fournier, Michel; Gauvin, Lise; Parisien, Manon; Corriveau, Hélène; Trickey, Francine; Damestoy, Nicole

2005-01-01

Objectives. We investigated the effectiveness of a group-based exercise intervention to improve balancing ability among older adults delivered in natural settings by staff in local community organizations. Methods. The main component of the intervention consisted of biweekly group-based exercise sessions conducted over 12 weeks by a professional, coupled with home-based exercises. In a quasiexperimental design, 10 community organizations working with older adults offered the intervention to groups of 5 to 15 persons concerned about falls, while 7 organizations recruited similar groups to participate in the control arm of the study. Participants (98 experimental and 102 control) underwent balance assessments by a physiotherapist at registration and 3 months later. Results. Eighty-nine percent of participants attended the 3-month measurement session (n=177). A linear regression analysis showed that after adjusting for baseline levels of balance and demographic and health characteristics, the intervention significantly improved static balance and mobility. Conclusion. Structured, group-based exercise programs offered by community organizations in natural settings can successfully increase balancing ability among community-dwelling older adults concerned about falls. PMID:16195514

A Three Month Home Exercise Programme Augmented with Nordic Poles for Patients with Intermittent Claudication Enhances Quality of Life and Continues to Improve Walking Distance and Compliance After One Year.

PubMed

Oakley, C; Spafford, C; Beard, J D

2017-05-01

The objective of this study was to collect 1 year follow-up information on walking distance, speed, compliance, and cost in patients with intermittent claudication who took part in a previously reported 12 week randomised clinical trial of a home exercise programme augmented with Nordic pole walking versus controls who walked normally. A second objective was to look at quality of life and ankle brachial pressure indices (ABPIs) after a 12 week augmented home exercise programme. Thirty-two of the 38 patients who completed the original trial were followed-up after 6 and 12 months. Frequency, duration, speed, and distance of walking were recorded using diaries and pedometers. A new observational cohort of 29 patients was recruited to the same augmented home exercise programme. ABPIs, walking improvement, and quality of life questionnaire were recorded at baseline and 12 weeks (end of the programme). Both groups in the follow-up study continued to improve their walking distance and speed over the following year. Compliance was excellent: 98% of the augmented group were still walking with poles at both 6 and 12 months, while 74% of the control group were still walking at the same point. The augmented group increased their mean walking distance to 17.5 km by 12 months, with a mean speed of 4.2 km/hour. The control group only increased their mean walking distance from 4.2 km to 5.6 km, and speed to 3.3 km/hour. Repeated ANOVA showed the results to be highly significant (p = .002). The 21/29 patients who completed the observational study showed a statistically significant increase in resting ABPIs from baseline (mean ± SD 0.75 ± 0.12) to week 12 (mean ± SD 0.85 ± 0.12) (t = (20) -8.89, p = .000 [two-tailed]). All their walking improvement and quality of life parameters improved significantly (p = .002 or less in the six categories) over the same period and their mean health scores improved by 79%. Following a 12 week augmented home exercise programme, most patients with intermittent claudication continued to significantly improve their walking distance and walking speed at 1 year compared with normal walking. Quality of life and ABPIs improved significantly after only 12 weeks and it is postulated that the improvement in ABPI was due to collateral development. These results justify the belief that an augmented home exercise programme will be as clinically effective as existing supervised exercise programmes, with the added benefits of lower cost and better compliance. Funding for a multicentre trial comparing an augmented home exercise programme with existing supervised exercise programme is now urgently required. Copyright © 2017 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

Isometric Exercise for the Cervical Extensors Can Help Restore Physiological Lordosis and Reduce Neck Pain: A Randomized Controlled Trial.

PubMed

Alpayci, Mahmut; İlter, Server

2017-09-01

The aim of this study was to investigate whether isometric neck extension exercise restores physiological cervical lordosis and reduces pain. Sixty-five patients with loss of cervical lordosis were randomly assigned to exercise (27 women, 7 men; mean age, 32.82 ± 8.83 yrs) and control (26 women, 5 men; mean age, 33.48 ± 9.67 yrs) groups. Both groups received nonsteroidal anti-inflammatory drugs for 10 days. The exercise group received additional therapy as a home exercise program, which consisted of isometric neck extension for 3 mos. Neck pain severity and cervical lordosis were measured at baseline and at 3 mos after baseline. Compared with baseline levels, cervical lordosis angle was significantly improved in the exercise group (P < 0.001) but not in the control group (P = 0.371) at the end of 3 mos. Moreover, the exercise group was significantly superior to the control group considering the number of patients in whom cervical lordosis angle returned to physiological conditions (85.2% vs. 22.5%; P < 0.001). At the end of 3 mos, pain intensity was significantly reduced in both groups compared with baseline levels (for all, P < 0.001). Nevertheless, considering the change from baseline to month 3, the reduction in pain was about twice in the exercise group compared with the control group (P < 0.001). Isometric neck extension exercise improves cervical lordosis and pain.

A Preliminary Exploration of the Effects of a 6-week Interactive Video Dance Exercise Program in an Adult Population

PubMed Central

Fruth, Stacie J; Clifford, Anne; Hine, Stephanie; Huckstep, Jeremy; Merkel, Heidi; Wilkinson, Hilary; Yoder, Jason

2011-01-01

Purpose: The purpose of this study was to determine the effects of a 6-week interactive video dance game (IVDG) program on adult participants’ cardiorespiratory status and body mass index (BMI). Methods: Twenty-seven healthy adult participants attended IVDG sessions over a 6-week period. Participants completed pre- and post-testing consisting of a submaximal VO2 treadmill test, assessment of resting heart rate (RHR) and blood pressure (BP), BMI, and general health questionnaires. Data were analyzed using descriptives, paired t-tests to assess pre-to post-testing differences, and one-way ANOVAs to analyze variables among select groups of participants. Questionnaire data was manually coded and assessed. Results: Twenty participants attended at least 75% of available sessions and were used in data analysis. Mean BMI decreased significantly (from 26.96 kg/m2 to 26.21 kg/m2; 2.87%) and cardiorespiratory fitness measured by peak VO2 increased significantly (from 20.63 ml/kg/min to 21.69 ml/kg/min; 5.14%). Most participants reported that the IVDG program was a good workout, and that they were encouraged to continue or start an exercise routine. Forty percent reported improvements in sleep, and nearly half stated they had or were considering purchasing a home version of a video dance game. Conclusions: Interactive video dance game is an effective and enjoyable exercise program for adults who wish to decrease their BMI and improve components of cardiorespiratory fitness. PMID:22163175

Developing the Stroke Exercise Preference Inventory (SEPI)

PubMed Central

Bonner, Nicholas S.; O’Halloran, Paul D.; Bernhardt, Julie; Cumming, Toby B.

2016-01-01

Background Physical inactivity is highly prevalent after stroke, increasing the risk of poor health outcomes including recurrent stroke. Tailoring of exercise programs to individual preferences can improve adherence, but no tools exist for this purpose in stroke. Methods We identified potential questionnaire items for establishing exercise preferences via: (i) our preliminary Exercise Preference Questionnaire in stroke, (ii) similar tools used in other conditions, and (iii) expert panel consultations. The resulting 35-item questionnaire (SEPI-35) was administered to stroke survivors, along with measures of disability, depression, anxiety, fatigue and self-reported physical activity. Exploratory factor analysis was used to identify a factor structure in exercise preferences, providing a framework for item reduction. Associations between exercise preferences and personal characteristics were analysed using multivariable regression. Results A group of 134 community-dwelling stroke survivors (mean age 64.0, SD 13.3) participated. Analysis of the SEPI-35 identified 7 exercise preference factors (Supervision-support, Confidence-challenge, Health-wellbeing, Exercise context, Home-alone, Similar others, Music-TV). Item reduction processes yielded a 13-item version (SEPI-13); in analysis of this version, the original factor structure was maintained. Lower scores on Confidence-challenge were significantly associated with disability (p = 0.002), depression (p = 0.001) and fatigue (p = 0.001). Self-reported barriers to exercise were particularly prevalent in those experiencing fatigue and anxiety. Conclusions The SEPI-13 is a brief instrument that allows assessment of exercise preferences and barriers in the stroke population. This new tool can be employed by health professionals to inform the development of individually tailored exercise interventions. PMID:27711242

Exploring physical activity behaviour - needs for and interest in a technology-delivered, home-based exercise programme among patients with intermittent claudication.

PubMed

Cornelis, Nils; Buys, Roselien; Fourneau, Inge; Dewit, Tijl; Cornelissen, Véronique

2018-02-01

Supervised walking is a first line therapy in peripheral arterial disease (PAD) with complaints of intermittent claudication. However, uptake of supervised programmes is low. Home-based exercise seems an appealing alternative; especially since technological advances, such as tele-coaching and tele-monitoring, may facilitate the process and support patients when adopting a physically active lifestyle. To guide the development of such an intervention, it is important to identify barriers of physical activity and the needs and interests for technology-enabled exercise in this patient group. PAD patients were recruited at the vascular centre of UZ Leuven (Belgium). A questionnaire assessing PA (SF-International Physical Activity Questionnaire), barriers to PA, and interest in technology-supported exercise (Technology Usage Questionnaire) was completed. Descriptive and correlation analyses were performed. Ninety-nine patients (76 men; mean age 69 years) completed the survey. Physical activity levels were low in 48 %, moderate in 29 %, and high in 23 %. Intermittent claudication itself is the most important barrier for enhanced PA, with most patients reporting pain (93 %), need for rest (92 %), and obstacles worsening their pain (74 %) as barriers. A total of 93 % participants owned a mobile phone; 76 % had Internet access. Eighty-seven reported the need for an exercise programme, with 67 % showing interest in tele-coaching to support exercise. If technology was available, three-quarter stated they would be interested in home-based tele-coaching using the Internet (preferably e-mails, 86 %); 50 % via mobile phone, 87 % preferred text messages. Both were inversely related to age (rpb = 0.363 and rpb = 0.255, p < 0.05). Acquaintance with elastic bands or gaming platforms was moderate (55 and 49 %, respectively), but patients were interested in using them as alternatives (84 and 42 %). Interest in platforms was age-dependent (rs = -0.508, p < 0.01). PAD patients show significant interest in technology-delivered exercise, offering opportunities to develop a guided home-based exercise programme.

A home program of strength training, movement strategy training and education did not prevent falls in people with Parkinson's disease: a randomised trial.

PubMed

Morris, Meg E; Taylor, Nicholas F; Watts, Jennifer J; Evans, Andrew; Horne, Malcolm; Kempster, Peter; Danoudis, Mary; McGinley, Jennifer; Martin, Clarissa; Menz, Hylton B

2017-04-01

For people with idiopathic Parkinson's disease, does a 6-week, comprehensive, home exercise program reduce falls and disability and improve health-related quality of life? Is the program cost-effective? Randomised, controlled trial with concealed allocation and assessor blinding. One hundred and thirty-three community-dwelling adults with Parkinson's disease. The experimental group completed a 6-week home program comprising progressive resistance strength training, movement strategy training and falls education. The control group completed 6 weeks of non-specific life skills training. Participants in both groups received weekly therapist-guided sessions for 6 consecutive weeks and a weekly self-directed home program. The primary outcome was the rate of falls, documented for the 12-month period immediately after therapy. Secondary outcomes were disability and health-related quality of life, assessed before and after intervention and at a 12-month follow-up. A total of 2255 falls were reported by the 12-month follow-up. The proportion of fallers in the experimental and control groups was 61 and 72%, respectively, which was not statistically significantly different (RR=0.85, 95% CI 0.66 to 1.09). There was no significant between-group difference in the rate of falls (incidence rate ratio=1.58, 95% CI 0.73 to 3.43). A survival analysis of participant time to first fall did not show a significant between-group difference (log-rank test χ 2 =0.79, p=0.37). No significant between-group differences occurred for mobility, disability or quality of life. The mean cost of delivering the experimental intervention was AUD1596. A home program of strength and movement strategy training and falls education does not prevent falls when applied at the dose used in this study. Arguably, the dosage of therapy was insufficient. Future trials need to explore further therapy content, repetitions and duration, in order to optimise outcomes and cost-effectiveness. [Morris ME, Taylor NF, Watts JJ, Evans A, Horne M, Kempster P, Danoudis M, McGinley J, Martin C, Menz HB (2017) A home program of strength training, movement strategy training and education did not prevent falls in people with Parkinson's disease: a randomised trial. Journal of Physiotherapy 63: 94-100]. Crown Copyright © 2017. Published by Elsevier B.V. All rights reserved.

Identifying Continuous Quality Improvement Priorities in Maternal, Infant, and Early Childhood Home Visiting.

PubMed

Preskitt, Julie; Fifolt, Matthew; Ginter, Peter M; Rucks, Andrew; Wingate, Martha S

2016-01-01

The purpose of this article was to describe a methodology to identify continuous quality improvement (CQI) priorities for one state's Maternal, Infant, and Early Childhood Home Visiting program from among the 40 required constructs associated with 6 program benchmarks. The authors discuss how the methodology provided consensus on system CQI quality measure priorities and describe variation among the 3 service delivery models used within the state. Q-sort methodology was used by home visiting (HV) service delivery providers (home visitors) to prioritize HV quality measures for the overall state HV system as well as their service delivery model. There was general consensus overall and among the service delivery models on CQI quality measure priorities, although some variation was observed. Measures associated with Maternal, Infant, and Early Childhood Home Visiting benchmark 1, Improved Maternal and Newborn Health, and benchmark 3, Improvement in School Readiness and Achievement, were the highest ranked. The Q-sort exercise allowed home visitors an opportunity to examine priorities within their service delivery model as well as for the overall First Teacher HV system. Participants engaged in meaningful discussions regarding how and why they selected specific quality measures and developed a greater awareness and understanding of a systems approach to HV within the state. The Q-sort methodology presented in this article can easily be replicated by other states to identify CQI priorities at the local and state levels and can be used effectively in states that use a single HV service delivery model or those that implement multiple evidence-based models for HV service delivery.

Falls prevention advice and visual feedback to those at risk of falling: study protocol for a pilot randomized controlled trial

PubMed Central

2013-01-01

Background Studies have shown that functional strength and balance exercises can reduce the risk of falling in older people if they are done on a regular basis. However, the repetitive nature of these exercises; combined with the inherent lack of feedback of progress may discourage seniors from exercising in the home, thereby rendering such an intervention ineffective. This study hypothesizes that the use of visual feedback and multimodal games will be more effective in encouraging adherence to home rehabilitation than standard care; thereby promoting independence and improving the quality of life in older adults at risk of falling. Methods A pllel-group pilot randomized controlled trial with 3 groups of participants will be conducted in the home for 12 weeks. Participants will include older adults who have been identified as at risk of falling (n = 48), over the age of 65, living in the community, and suitable for a home exercise intervention. The primary outcome is adherence to exercise. Secondary outcomes include: variability in stride length, stride time and double support time (DST); walking speed; Timed up and go test (TUG); Falls Efficacy Scale International (FES-I); CONFbal scale; Romberg’s test; and quality of life measures (SF-12 and EuroQol EQ-5D). Qualitative assessments on personal experiences with rehabilitation tools will be done before and after the trial. Discussion This study will investigate the use of visual feedback and engaging multimodal activities to address the problem of non-compliance to home exercises for falls rehabilitation. One of the unique qualities of this study is the adaptation of special participatory design methods through which the end users (fallers) will be involved in the design of the proposed rehabilitation tools at various stages of the design process. Trial registration ISRCTN79967470 PMID:23510162

Effects of home-based exercise on pre-dialysis chronic kidney disease patients: a randomized pilot and feasibility trial.

PubMed

Hiraki, Koji; Shibagaki, Yugo; Izawa, Kazuhiro P; Hotta, Chiharu; Wakamiya, Akiko; Sakurada, Tsutomu; Yasuda, Takashi; Kimura, Kenjiro

2017-06-17

Only a few research is available on the effects of home-based exercise training on pre-dialysis chronic kidney disease (CKD) patients. Therefore, we aimed to elucidate the effect of home-based exercise therapy on kidney function and arm and leg muscle strength in pre-dialysis CKD patients. Thirty-six male stage 3-4 pre-dialysis CKD patients (age, 68.7 ± 6.8 years; estimated glomerular filtration rate (eGFR), 39.0 ± 11.6 ml/min/1.73 m 2 ) who were being treated as outpatients were included. The subjects were randomly assigned to an exercise intervention group (Ex group: 18) and a control group (C group: 18). The Ex group wore accelerometer pedometers and were instructed to perform home-based aerobic and resistance exercises, such as brisk walking for 30 min per day, for 12 months. The C group subjects wore accelerometer pedometers but received no exercise therapy guidance; the number of steps covered during normal daily activities was recorded for the C group. The outcome measures were changes in kidney function and handgrip and knee extension muscle strength. Values at the baseline (T1) and 12 months later (T2) were compared. There were no significant differences in baseline characteristics between the two groups; however, the C group was more physically active than the Ex group. Eight subjects dropped out, and 28 subjects (14 in each group) were included in the final analysis. Physical activity increased significantly only in the Ex group. Grip strength (F = 7.0, p = 0.01) and knee extension muscle strength (F = 14.3, p < 0.01) were found to improve only in the Ex group. Further, the changes in eGFR were not significantly different between the two groups (F = 0.01, p = 0.93). Home-based exercise therapy for pre-dialysis CKD patients was feasible and improved arm and leg muscle strength without affecting kidney function. UMIN Clinical Trials Registry ( UMIN000005091 ). Registered 2/15/2011.

SQUID: sensorized shirt with smartphone interface for exercise monitoring and home rehabilitation.

PubMed

Farjadian, Amir B; Sivak, Mark L; Mavroidis, Constantinos

2013-06-01

Stroke is a leading cause of serious long-term disability in the United States. There is a need for new technological adjuncts to expedite patients' scheduled discharge from hospital and pursue rehabilitation procedure at home. SQUID is a low-cost, smart shirt that incorporates a six-channel electromyography (EMG) and heart rate data acquisition module to deliver objective audiovisual and haptic biofeedback to the patient. The sensorized shirt is interfaced with a smartphone application, for the subject's usage at home, as well as the online database, for the therapist's remote supervision from hospital. A single healthy subject was recruited to investigate the system functionality during improperly performed exercise. The system can potentially be used in automated, remote monitoring of variety of physical therapy exercises, rooted in strength or coordination training of specific muscle groups.

Evaluation of an Outpatient Rehabilitative Program to Address Mobility Limitations Among Older Adults

PubMed Central

Brown, Lorna G.; Ni, Meng; Schmidt, Catherine T.; Bean, Jonathan F.

2017-01-01

Abstract Live Long Walk Strong is a clinical demonstration program for community-dwelling older patients. It was designed to be consistent with current fall prevention guidelines and reimbursed under the Medicare model. Patients were screened within primary care and referred to a physiatrist followed by systematic assessment and treatment within an outpatient rehabilitative care setting. The treatment included behavioral modification, fall prevention education, community/home exercise integration, and exercise targeting strength, power, flexibility, balance, and endurance. Treatment duration and frequency varied with each patient based on baseline presentation, clinical judgment, and patient preference. Program feasibility and preliminary effectiveness were evaluated by assessing participation and changes in physical performance, respectively. There were 266 patients referred to the program, and 147 were willing to participate. Of these, 116 patients completed all scheduled visits (10.8 ± 3.9 visits). The noncompleters (n = 31) had a higher rate of falls in the previous 6 months and lower baseline Short Physical Performance Battery composite score. At the completion of care, the adjusted mean change in Short Physical Performance Battery was 1.66 units, surpassing a large clinically meaningful threshold (1 unit). The Live Long Walk Strong program appears to be feasible to implement and demonstrates preliminary effectiveness in enhancing mobility among older adults. PMID:28079616