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At least 883 records · Page 49Linked to original sources
PubMed1989

Effects of left ventricular shape and captopril therapy on exercise capacity after anterior wall acute myocardial infarction.

The importance of left ventricular (LV) shape in determining exercise capacity was assessed in 40 male patients with LV dysfunction after anterior acute myocardial infarction (AMI). Because captopril therapy is known to improve exercise capacity in this patient population, the potential interaction between LV shape and captopril therapy was also evaluated. Patients underwent cardiac catheterization 2 to 4 weeks after AMI followed by randomization to receive placebo or captopril. LV shape was defined from biplane ventriculography by a sphericity index (volume observed/volume of sphere using long axis as diameter). Quarterly clinical assessments and maximal exercise testing were performed. A cumulative heart failure score, specific activity scale and average exercise time for the year were calculated. A greater shape distortion (increasing sphericity index) was associated with increased LV volumes, decreased ejection fraction and a larger abnormally contracting segment. Sphericity index was the only independent predictor of average exercise duration in the placebo group. Placebo-treated patients in the tercile with the most spherical ventricles had not only the lowest exercise capacity (p less than 0.01), but also accumulated the highest heart failure (p less than 0.05) and specific activity scale (p less than 0.05) scores. Captopril-treated patients with the same baseline distortion of LV shape did not manifest these shape-dependent objective and subjective measures of reduced functional capacity.

Adult↗
PubMed2000

Effectiveness of manual physical therapy and exercise in osteoarthritis of the knee. A randomized, controlled trial.

BACKGROUND: Few investigations include both subjective and objective measurements of the effectiveness of treatments for osteoarthritis of the knee. Beneficial interventions may decrease the disability associated with osteoarthritis and the need for more invasive treatments. OBJECTIVE: To evaluate the effectiveness of physical therapy for osteoarthritis of the knee, applied by experienced physical therapists with formal training in manual therapy. DESIGN: Randomized, controlled clinical trial. SETTING: Outpatient physical therapy department of a large military medical center. PATIENTS: 83 patients with osteoarthritis of the knee who were randomly assigned to receive treatment (n = 42; 15 men and 27 women [mean age, 60 +/- 11 years]) or placebo (n = 41; 19 men and 22 women [mean age, 62 +/- 10 years]). INTERVENTION: The treatment group received manual therapy, applied to the knee as well as to the lumbar spine, hip, and ankle as required, and performed a standardized knee exercise program in the clinic and at home. The placebo group had subtherapeutic ultrasound to the knee at an intensity of 0.1 W/cm2 with a 10% pulsed mode. Both groups were treated at the clinic twice weekly for 4 weeks. MEASUREMENTS: Distance walked in 6 minutes and sum of the function, pain, and stiffness subscores of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). A tester who was blinded to group assignment made group comparisons at the initial visit (before initiation of treatment), 4 weeks, 8 weeks, and 1 year. RESULTS: Clinically and statistically significant improvements in 6-minute walk distance and WOMAC score at 4 weeks and 8 weeks were seen in the treatment group but not the placebo group. By 8 weeks, average 6-minute walk distances had improved by 13.1% and WOMAC scores had improved by 55.8% over baseline values in the treatment group (P < 0.05). After controlling for potential confounding variables, the average distance walked in 6 minutes at 8 weeks among patients in the treatment group was 170 m (95% CI, 71 to 270 m) more than that in the placebo group and the average WOMAC scores were 599 mm higher (95% CI, 197 to 1002 mm). At 1 year, patients in the treatment group had clinically and statistically significant gains over baseline WOMAC scores and walking distance; 20% of patients in the placebo group and 5% of patients in the treatment group had undergone knee arthroplasty. CONCLUSIONS: A combination of manual physical therapy and supervised exercise yields functional benefits for patients with osteoarthritis of the knee and may delay or prevent the need for surgical intervention.

Aged↗
PubMed2004

A behavioural treatment for chronic shoulder complaints: concepts, development, and study design.

This paper discusses the rationale for and content of a newly developed treatment for shoulder complaints, and describes a randomised study which is currently being conducted to test effectiveness of the treatment. In current practice, approximately 50% of all patients with shoulder complaints mention limitations in the performance of daily activities and persisting pain after six months. To improve the functional ability of patients with chronic shoulder complaints, despite their pain, we have developed an operant behavioural and time-contingent graded exercise therapy programme for use in a primary care setting. We present the theory and conceptual model underlying this programme, report on its development and content, and describe the design of a randomised clinical trial to evaluate the programme's effectiveness and cost-effectiveness. One hundred and thirty-two patients who suffer from shoulder complaints for at least 3 months are being recruited in general practice. After inclusion in the study, patients are allocated randomly to the graded exercise therapy programme or to usual care. Questionnaires will be used to measure factors like severity of the main complaint, functional limitations of daily activities, perceived recovery, global health status, shoulder pain, generic health-related quality of life, and costs. These factors will be assessed at baseline, during treatment (6 weeks), and after treatment (12, 26, and 52 weeks).

Behavior Therapy↗
PubMed1996

[Expired gas analysis--focused on VO2 max and anaerobic threshold].

Recently, expired gas analysis(EGA) during exercise testing is broadly performed. It has been recognized that anaerobic threshold(AT) and maximal oxygen uptake(VO2 max) may be useful in identifying one's exercise tolerance. AT especially has a good correlation with endurance capacity. In the field of sports medicine, the purposes of EGA are: 1) evaluation of endurance exercise capacity. 2) decision of intensity and frequency for exercise training, and 3) prevention of overtraining syndrome. In the clinical fields, EGA is frequently performed with cardiovascular patients, for example, myocardial infarction(MI), and congestive heart failure(CHF). The purposes are: 1) decision of intensity for exercise therapy with the patients of old MI. 2) evaluation of exercise capacity with the patients' of CHF. 3) index of exercise therapy for hypertension, hyperlipidemia, and diabetes, and 4) evaluation of drug effects including vasodilators and cardiotonics.

Anaerobic Threshold↗
PubMed1985

Effect of steroid therapy on exercise performance in patients with irreversible chronic obstructive pulmonary disease.

Many patients with irreversible chronic obstructive pulmonary disease (COPD) claim symptomatic improvement with steroid therapy, despite a lack of objective improvement in their spirometric data. To determine if steroids actually increase the exercise capacity of these individuals, 13 clinically stable patients (mean age, 63 +/- 4 years; 12 male patients) were given methylprednisolone (32 mg once daily) or placebo in a randomized double-blind crossover fashion. Spirometric data and minute ventilation, oxygen consumption (VO2), carbon dioxide production, and heart rate during incremental exercise were measured at each visit. Methylprednisolone did not produce a significant change in any of the measured parameters. Three patients had an increase in maximal VO2 of greater than 2 ml/kg/min during therapy with methylprednisolone, while two experienced a decline in maximal VO2 of similar magnitude. The change in exercise capacity was unrelated to the change in the forced expiratory volume in one second in individual patients (r = 0.08). We conclude that in the absence of any improvement in the usual tests of airway mechanics, steroid therapy does not improve exercise performance in patients with COPD.

Adrenal Cortex Hormones↗
PubMed2002

[Training of back and neck in the year of 2002].

The aim of this review was to determine the relevance of exercise therapy in the total treatment strategy of low back pain (LBP). The review is based on the results of randomised clinical trials, meta-analysis, consensus reports, and medical technology assessments. There is strong evidence for the effectiveness of exercise therapy for subacute and chronic LBP. There is some evidence that exercise is not effective for acute LBP. The most effective exercise programme and the optimal combination of exercise and other effective treatment modalities for different subgroups of LBP patients remain to be determined. Insights regarding the biological mechanisms of the positive effect of exercise are not yet established.

Contraindications↗
PubMed2004

[Practical guidelines for the prevention of chronic symptoms after a whiplash injury, based on published evidence].

Recently, systematic reviews and evidence-based guidelines on whiplash have appeared, from which preventive recommendations can be derived. Fear of moving, catastrophic thoughts and avoidance of activity seem to play an important role in the transition from acute to chronic symptoms. Early reassurance and the advice to remain active can prevent the development of chronic symptoms following whiplash. In the acute and subacute phase, if there is still no recovery despite information designed to reduce anxiety, referral to a physiotherapist for active exercise therapy and management is indicated. In the chronic phase, depending on which factors play a role in the given patient, referral to active exercise therapy or a multi-disciplinary training programme may be considered.

Anxiety↗
PubMed2001

[Physiotherapy in osteoarthritis--a review of literature on conservative therapy of knee and hip osteoarthritis].

In this review, 18 studies have been evaluated about the effectiveness of exercise therapy in the physiotherapy in osteoarthritis of hip or knee. All studies emphasised the general profit of exercise therapy compared to alternative programs (such as "health education", etc.). The effect sizes were mostly indicated to be moderate to large. There were no study comparing two or more alternative exercise programs in regard to the size of effectiveness. Only two studies gave informations about the radiographic grade of the OA. Today the effectiveness is proved only for aerobic, dynamic strengthening exercises. There were no study about the effectiveness of physiotherapy in Hip-OA.

Humans↗
PubMed1984

Cardiac exercise programs: role of continuous electrocardiographic monitoring.

The purpose of the present study was to determine the value of telemetry monitoring for detection of new and significant electrocardiographic (ECG) or blood pressure abnormalities during outpatient cardiac exercise therapy. Following preliminary graded exercise testing, 177 cardiac patients underwent a four-week monitored exercise program three days per week. During 2248 training sessions, 12 of the 177 patients (7%) showed significant ECG or blood pressure abnormalities not evident on initial exercise testing, eight (5%) requiring change in medical therapy. Abnormalities included significant (greater than 2mm) ST-T displacement (two patients), ventricular arrhythmias (seven patients), and hypertensive exercise response (three patients). Eleven of the abnormalities (92%) appeared during the first three weeks of the program. Results indicated that continuous ECG and blood pressure monitoring offered a small but significant diagnostic yield not evident on preliminary graded exercise testing. One-year experience suggested that short-term (four weeks) exercise monitoring may be adequate for cardiac patients who undergo careful preliminary screening.

Adult↗
PubMed1983

Clinical exercise trial for stroke patients.

This investigation evaluated the effectiveness of the traditional and facilitation approaches to therapeutic exercise in stroke patients. A total of 42 adults (24 men and 18 women) with a mean age of 61.6 years (SD = 21) were selected from a larger population of hospitalized stroke victims. Stroke patients were classified by CT scan information and judged medically fit to participate in a nonrestrictive program by neurologic examinations and laboratory tests. The Barthel Index and the manual muscle test were administered at admission and discharge. Both facilitation and traditional exercise therapies improved functional and motor performance, but there were no significant differences between these approaches. The lack of differences between the facilitation and traditional exercise therapies may be due to heterogeneity of the stroke population, the small sample size, and the measurements used. The study demonstrates the need for a measurement instrument capable of reliably assessing the facilitation approach. Future investigations should incorporate lesion type, site, and side along with global measurements in evaluating differences among motor remediation approaches.

Activities of Daily Living↗
PubMed1987

[Results of using acupuncture and therapeutic physical exercise for preventing the development of arterial hypertension in persons with borderline arterial pressure].

Altogether 63 patients with border-line arterial pressure were followed-up. In 44 of them preventive measures included acupuncture and exercise therapy, in 19 patients-acupuncture only. In 3 yrs after treatment initiation arterial hypertension developed in 6.3% of the patients versus 26.7% in the control group, arterial pressure got back to normal in 42.4% versus 28.3% in the control group. As compared to acupuncture used alone the combination of this method with exercise therapy resulted in lowered diastolic arterial pressure and a prolonged antihypertensive effect.

Acupuncture Therapy↗
PubMed2000

[Cesar therapy is temporarily more effective in patients with chronic low back pain than the standard treatment by family practitioner: randomized, controlled and blinded clinical trial with 1 year follow-up].

OBJECTIVE: To determine the effectiveness of a special form of exercise therapy ('Cesar therapy') on self reported recovery and improvement of posture amongst patients with chronic aspecific lower back pain. DESIGN: Prospective randomized controlled and blinded investigation. METHOD: After informed consent had been obtained, patients with chronic aspecific lower back pain were given, on a randomized basis, either an exercise therapy (experimental group, n = 112) or a standard treatment by their general practitioner (control group, n = 110). Outcome measures were self reported recovery of back pain and improvement of posture (thoracic and lumbar spine, pelvis). Self reported recovery was determined by means of a dichotomized 7-point scale (questionnaire). Posture was measured qualitatively by a panel of 11 Cesar therapists (blinded) and quantitatively by an optical-electronic posture recording system (Vicon). Measurements were taken at baseline (pre-randomization) and at 3, 6 and 12 months after randomization. RESULTS: Three months after randomization, patients who were treated according to Cesar therapy, reported an improvement in their back symptoms (80%) significantly more often than the control group (47%). In both groups, however, only small improvements in posture were found. The judgement of the Cesar panel exhibited a significant difference between the two groups, with respect to the spine, in favour of Cesar therapy. Differences between the groups were still present 6 months after randomization, but could no longer be detected at 12 months after randomization. CONCLUSION: Cesar therapy was significantly more effective than standard treatment among patients with chronic lower back pain for a period of 6 months after randomization.

Adult↗
PubMed2003

Therapeutic modalities in the management of nonspecific neck pain.

This article has surveyed several therapeutic modalities, including physical modalities, thermal modalities, electrical modalities, exercise therapy, behavioral therapy, education, and laser therapy. Of these, exercise, mobilization, and manipulation have the greatest support in the literature, whereas thermal treatments (including therapeutic ultrasound), and electrical therapies (including TENS) have little evidence of effectiveness and no evidence for more than a transient benefit. There is a need for well-controlled studies of educational programs and behavioral interventions specifically for patients with chronic neck pain, particularly because these interventions are often employed as part of a multimodal treatment program. Low-power laser treatment and magnetic therapy require some well-controlled studies before they can be recommended to neck pain patients or discarded as worthless interventions. Cervical traction and soft collars seem to be generally ineffective for nonspecific neck pain.

Cervical Vertebrae↗
PubMed2000

Early aggressive exercise for postoperative rehabilitation after discectomy.

STUDY DESIGN: A randomized clinical trial of postoperative medical exercise therapy in patients after operation for lumbar disc herniation with blind assessment of clinical outcomes. OBJECTIVE: To assess the effect of an early regimen of vigorous medical exercise compared with an ordinary care program. SUMMARY OF BACKGROUND DATA METHODS: Patients offered an operation for lumbar disc herniation were consecutively randomized to a training group or to a control group. The training consisted of an 8-week active rehabilitation program including a regimen of vigorous lumbar stabilizing exercises. The control subjects participated in a mild program of 2 to 3 back exercises at home, after relaxing and resting their backs for 2 months after the surgery. The outcomes were evaluated 6 and 12 months after the operation. The results are based on intention-to-treat analyses. RESULTS: Sixty-three of 65 eligible patients agreed to participate in the trial. Fifty-eight and 53 patients attended for evaluation at 6 and 12 months, respectively. There was a significantly larger improvement in the mean Roland's disability index (from 8.9 to 5.4 [P = 0.02] at 6 months and from 8. 7 to 5.3 [P = 0.03] at 12 months) and in reported pain (from 3.7 to 2.0 [P = 0.04] at 6 months and from 3.2 to 1.8 [P = 0.09] at 12 months) in the training group. A significantly (P = 0.05) higher proportion of the training group reported that they participated in daily activities as usual. There were more patients in the training group who reported improvement in self-evaluated health after surgery at both 6 (P = 0.02) and at 12 months (P = 0.05). Finally, no differences in clinical end points were observed between the groups. CONCLUSIONS: Vigorous medical exercise therapy, started 4 weeks after surgery for lumbar disc herniation, reduced disability and pain after surgery. Because no differences in clinical end points were observed, there is hardly any danger associated with early and vigorous training after operation for disc herniation.

Activities of Daily Living↗
PubMed2006

Non-pharmacological interventions in older people with heart failure: effects of exercise training and relaxation therapy.

BACKGROUND: Effective management of heart failure relies on optimal use of non-pharmacological therapy alongside medical treatment. Yet, there is an inadequate use of non-pharmacological therapy in caring for older people with heart failure. OBJECTIVE: To examine the effects of relaxation therapy and exercise training on psychological outcomes and disease-specific quality of life of older heart failure patients. METHODS: Subjects undertook relaxation (n = 59), exercise training (n = 32) or received attention placebo (n = 62) for 12 weeks. The relaxation group attended two training sessions, one revision workshop, and continued with twice-daily taped-directed home relaxation practice, with support from the intervener through bi-weekly telephone contact, for 12 weeks. The exercise group undertook 12 weekly sessions of resistance training and aerobic exercise and thrice weekly home exercise. The control group received regular telephone calls for general 'greetings'. RESULTS: The relaxation and exercise groups reported a significantly greater improvement in psychological [F(2, 149) = 6.69, p = 0.002] and various disease-specific quality of life outcomes [dyspnea: F(2, 149) = 5.72, p = 0.004; fatigue: F(2, 149) = 3.78, p = 0.25; emotion: F(2, 149) = 6.68, p = 0.001], compared with those who received the attention placebo. While relaxation therapy was more effective to reduce psychological distress, with depression in particular (p < 0.001), exercise therapy worked better to control fatigue symptoms (p = 0.03). CONCLUSION: Relaxation therapy and exercise training are effective to improve the psychological and physical health of older heart failure patients. They should be used as an individual treatment modality, or as care components of a disease management program.

Aged↗
PubMed2005

Outcome of non-invasive treatment modalities on back pain: an evidence-based review.

At present, there is an increasing international trend towards evidence-based health care. The field of low back pain (LBP) research in primary care is an excellent example of evidence-based health care because there is a huge body of evidence from randomized trials. These trials have been summarized in a large number of systematic reviews. This paper summarizes the best available evidence from systematic reviews conducted within the framework of the Cochrane Back Review Group on non-invasive treatments for non-specific LBP. Data were gathered from the latest Cochrane Database of Systematic Reviews 2005, Issue 2. The Cochrane reviews were updated with additional trials, if available. Traditional NSAIDs, muscle relaxants, and advice to stay active are effective for short-term pain relief in acute LBP. Advice to stay active is also effective for long-term improvement of function in acute LBP. In chronic LBP, various interventions are effective for short-term pain relief, i.e. antidepressants, COX2 inhibitors, back schools, progressive relaxation, cognitive-respondent treatment, exercise therapy, and intensive multidisciplinary treatment. Several treatments are also effective for short-term improvement of function in chronic LBP, namely COX2 inhibitors, back schools, progressive relaxation, exercise therapy, and multidisciplinary treatment. There is no evidence that any of these interventions provides long-term effects on pain and function. Also, many trials showed methodological weaknesses, effects are compared to placebo, no treatment or waiting list controls, and effect sizes are small. Future trials should meet current quality standards and have adequate sample size.

Anti-Inflammatory Agents, Non-Steroidal↗