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At least 973 records · Page 54Linked to original sources
PubMed2006

Effect of weight loss and exercise on frailty in obese older adults.

BACKGROUND: Obesity exacerbates the age-related decline in physical function and causes frailty in older persons. However, appropriate treatment for obese older persons is unknown. We evaluated the effects of weight loss and exercise therapy on physical function and body composition in obese older persons. METHODS: We screened 40 obese older volunteers and eventually randomized 27 frail obese older volunteers to treatment or control groups. Treatment consisted of 6 months of weekly behavioral therapy for weight loss in conjunction with exercise training 3 times per week. Physical function was evaluated with measurements of frailty (Physical Performance Test, peak oxygen consumption, and Functional Status Questionnaire); strength, gait, and balance tests; body composition with dual-energy x-ray absorptiometry; and quality of life using the Medical Outcomes Survey 36-Item Short-Form Health Survey. Results are reported as mean +/- SD. RESULTS: Two subjects in the treatment group did not comply with the intervention, and 1 subject in the control group withdrew. Analyses included all 27 subjects originally randomized to the treatment and control groups. The treatment group lost 8.4% +/- 5.6% of body weight, whereas weight did not change in the control group (+0.5% +/- 2.8%; P<.001). Compared with the control group, fat mass decreased (-6.6 +/- 3.4 vs +1.7 +/- 4.1 kg; P<.001), without a change in fat-free mass (-1.2 +/- 2.1 vs -1.0 +/- 3.5 kg; P = .75) in the treatment group. The Physical Performance Test score (2.6 +/- 2.5 vs 0.1 +/- 1.0; P = .001), peak oxygen consumption (1.7 +/- 1.6 vs 0.3 +/- 1.1 mL/min per kilogram; P = .02), and Functional Status Questionnaire score (2.9 +/- 3.7 vs -0.2 +/- 3.9; P = .02) improved in treated subjects compared with control subjects. Treatment also improved strength, walking speed, obstacle course, 1-leg limb stance time, and health survey physical subscale scores (all P<.05). CONCLUSION: These findings suggest that weight loss and exercise can ameliorate frailty in obese older adults. Trial Registration clinicaltrials.gov Identifier: NCT00146133.

Activities of Daily Living↗
PubMed1985

Therapeutic exercise in patients with chronic obstructive pulmonary disease.

Therapeutic exercise in patients with severe COPD improves useful exercise performance-endurance. This results in an improved quality of life, decreased hospitalization, and decreased costs. Therapeutic exercise is only one modality of the general care of the patient with COPD who often requires the coordinated skills of a multidisciplinary health care team to achieve maximal rehabilitation. These benefits will accrue to most but not all patients receiving exercise therapy. In patient with severe COPD, therapeutic exercise does not improve pulmonary, hemodynamic, or peripheral (muscle) indices. Such patients are rarely able to reach a VO2max or achieve the necessary threshold of exercise level, duration, and frequency required for cardiopulmonary conditioning. Such patients do improve mechanical skills in the trained muscles and benefit psychologically. Supplemental oxygen will improve exercise performance in patients with COPD. This is particularly evident in those who become hypoxemic or who develop overwhelming dyspnea with exercise. Others who benefit when studied cannot be otherwise identified. The respiratory muscles in severe COPD are subject to an increased work of breathing because of increased flow resistance in the airways and a compromise in respiratory muscle contractility owing to the shortened length-tension relationship of the diaphragm because of lung hyperinflation. In addition, they are weak. As in normal persons, the inspiratory muscles are of paramount importance. The respiratory muscles in severe COPD can become fatigued. Hyperpneic eucapnea or inspiratory resistive training can improve respiratory and general exercise endurance. Therapeutic exercise should be prescribed only after a solid general care program is instituted: discontinuation of smoking; moderation in activity; patient and family education; immunization; bronchodilators; early treatment of infections; corticosteroids if efficacious; long-term continuous O2 if indicated; and general rehabilitation. In patients with mild disease and few symptoms, encouragement to participate in general conditioning activities may suffice.(ABSTRACT TRUNCATED AT 400 WORDS)

Breathing Exercises↗
PubMed2005

The Cochrane review of physiotherapy interventions for ankylosing spondylitis.

OBJECTIVE: To update the Cochrane review on the effectiveness of physiotherapy interventions in the management of ankylosing spondylitis (AS). METHODS: All randomized studies available in systematic searches (electronic databases, contact with authors, reference lists) up to February 2004 were included. Two reviewers independently selected trials for inclusion, assessed the validity of included trials, and extracted data. Investigators were contacted to obtain missing information. RESULTS: Six trials with a total of 561 participants were included. Two trials compared individualized home exercise programs with no intervention. Low quality evidence for effects in favor of the home exercise program was found in physical function and spinal mobility [absolute benefit 10.3 cm on fingertip to floor distance; relative percentage difference (RPD) 37%)]. Further, the trials showed low quality evidence for no group differences in pain. Three trials compared supervised group physiotherapy with an individualized home exercise program. Moderate quality evidence for effectiveness was found in patient global assessment and spinal mobility in favor of the supervised group. The trials showed moderate quality evidence for no differences in pain intensity between the groups. One trial compared a 3-week inpatient spa-exercise therapy followed by weekly outpatient group physiotherapy with weekly outpatient group physiotherapy alone. Moderate quality evidence was found for effects in pain (absolute benefit 0.9 cm on visual analog scale; RPD 19%), physical function (absolute benefit 1 cm; RPD 24%), and patient global assessment (absolute benefit 1.3 cm; RPD 27%), in favor of the combined spa-exercise therapy. CONCLUSION: The current best available evidence suggests that physiotherapy is beneficial for people with AS. However, it is still not clear which treatment protocol should be recommended in the management of AS.

Ambulatory Care↗
PubMed2005

Thr54 allele of the FABP2 gene affects resting metabolic rate and visceral obesity.

We investigated the relationship between Ala54Thr variant allele of the fatty acid-binding protein 2 (FABP2) gene (Ala54Thr) and development of obesity in Japanese obese women. FABP2 genotypes were determined with a fluorescent allele-specific DNA primer assay system. Body weight, waist and hip circumference, amounts of visceral and subcutaneous white adipose tissue measured by computed tomography (CT) were compared between subjects with Thr allele and without Thr allele before and after the diet and exercise therapy in 80 Japanese obese women. The frequency of the Thr54 allele did not differ between obese and control subjects (0.388 versus 0.329, respectively). In subjects with Ala/Thr and Thr/Thr genotype, adjusted resting metabolic rate (RMR) was significantly lower than the subjects with Ala/Ala genotype. Subjects with the Thr54 allele showed significantly greater waist circumference after diet and exercise therapy than subjects with Ala/Ala genotype. They also demonstrated greater body weight at 20 years of age compared to subjects with Ala/Ala genotype. In conclusion, Thr54 allele of FABP2 has associations with lower adjusted resting metabolic rate, resistance in reducing visceral white adipose tissue (WAT) and early onset of obesity in Japanese obese women.

Age of Onset↗
PubMed1994

Influences on weight loss in type 2 diabetic patients: little long-term benefit from group behaviour therapy and exercise training.

The aim of our study was to assess the long-term (24 months) efficacy of a comprehensive weight reduction programme as compared to that of a conventional programme. The Comprehensive Programme comprised, besides the Conventional Programme (diet counselling), behavioural modification and exercise training. The 2-year follow-up period was completed by 53 patients (19M/34F; 88.3%). The differences (95% confidence intervals; CI) between the change in body weight of patients in the Comprehensive Programme compared to the Conventional Programme after 6 and 24 months of treatment were -2.2 (-4.0, -0.3) kg, p = 0.03 and -1.3 (-3.3, 0.7) kg, p = 0.21, respectively. In comparison to the Conventional Programme, the Comprehensive Programme resulted in a greater decrease (95% CI) of HbA1c after 6 months: -0.8 (-1.2, -0.2)%, p = 0.01, but not after 2 years: -0.4 (-1.0, 0.1)%, p = 0.12. The effects on blood pressure and serum lipids of the Comprehensive Programme and the Conventional Programme were comparable. Changes in body weight at 6 months correlated well with changes in HbA1c, fasting plasma insulin, and blood pressure, whereas at 24 months no such correlation was found with HbA1c. Pretreatment variates that were associated with the greatest 2-year weight loss were a high HbA1c value, a low energy per cent carbohydrate intake and a low percentage of obese subjects within the family. In conclusion, the long-term outcome of the Comprehensive Programme was not different from that of the Conventional Programme. The achieved body weight reduction was associated with a sustained fall in blood pressure, but with only a transient beneficial effect on the glycaemic control in the Type 2 diabetic patient.

Adult↗
PubMed2003

Older adults with chronic disease: benefits of group-mediated counseling in the promotion of physically active lifestyles.

In this 12-month trial standard exercise training was compared with a group-mediated cognitive-behavioral (GMCB) intervention with respect to effects on long-term adherence and change in physical function of older adults who were either at risk for or had cardiovascular disease. Participants (147 older men and women) were randomized to the 2 treatments. Outcomes included self-reportedphysical activity, fitness, and self-efficacy. The GMCB treatment produced greater improvements on all outcomes than did standard exercise therapy. Regardless of treatment assignment, men had more favorable change on the study outcomes than did women. Analysis of a self-regulatory process measure in the GMCB group revealed that change in barriers efficacy was related to change in physical activity and fitness. Results suggest that teaching older adults to integrate physical activity into their lives via GMCB leads to better long-term outcomes than standardized exercise therapy.

Aged↗
PubMedDate not supplied

[Hormone content of the blood in juvenile osteoporosis].

Juvenile osteoporosis should be regarded as a polyetiological disease developing against the background of constitutional osteopathy in which endocrine disorders play a certain role. A tendency to a decrease in the levels of calcitonin and parathyroid hormone was found in juvenile osteoporosis; mild signs of hypogonadism (secondary) and a relative decrease in hypophyseal somatotropic activity promoted its detection. Two groups of patients were defined: I--with raised AP activity and a normal or lowered level of serum inorganic phosphorus without hormonal disorders; II--with lowered or normal AP activity and a normal level of phosphorus, mild hormonal disorders. Prolonged multimodality therapy with calcitonin, anabolic steroids, active forms of Vitamin D3, calcium agents, physiotherapy and exercise therapy was found effective in juvenile osteoporosis.

Adolescent↗
PubMedDate not supplied

Nateglinide is useful for nonalcoholic steatohepatitis (NASH) patients with type 2 diabetes.

BACKGROUND/AIMS: In the present study we administered nateglinide to nonalcoholic steatohepatitis (NASH) patients with type 2 diabetes who had failed to respond adequately to diet and exercise therapy, and we compared the resulting changes in insulin kinetics and improvements in blood glucose levels, as well as the concomitant changes in hepatic function, diagnostic liver images and liver histology, with the results from a non-treated control group. METHODOLOGY: Subjects for this study consisted of 10 patients with NASH. They all suffered from diabetes and they were all diagnosed with fatty liver by abdominal ultrasonography (US) and computed tomography (CT). Nonalcoholic steatohepatitis was diagnosed as the result of liver biopsy. The subjects were randomly divided into two groups, the nateglinide-treated group and the non-treated control group. Each group contained five patients. The members of the nateglinide-treated group were administered nateglinide every day (270mg/day) before each meal for a period of 20 weeks. Both groups continued to receive diet and exercise therapy. Body mass index (BMI), blood chemistry, plasma glucose and HbAlc, abdominal US and CT were measured before treatment, and every four weeks thereafter. Liver biopsy was performed over again at 16 weeks af terinitiating treatment. RESULTS: The results were compared. Postprandial blood glucose, HbA1c, a 75-g oral glucose tolerance test, liver function, abdominal US and CT imaging tests and liver histological findings were all improved after treatment with nateglinide. CONCLUSIONS: From these results we concluded that nateglinide is useful in the treatment of NASH in patients with type 2 diabetes.

Adult↗
PubMed1983

Improvement in exercise capacity despite cardiac deteriora tion: nonivasive assessment of long-term therapy with amrinone in severe heart failure.

Seven patients with severe congestive heart failure (CHF) were treated with oral amrinone for a mean duration of 39 weeks (range 16 to 72). During the first week of therapy, exercise capacity as assessed on a treadmill using the Naughton protocol, increased substantially from 7.6 +/- 4.2 to 12.1 +/- 4.4 minutes (p less than 0.01). At an early period of follow-up (8 to 12 weeks), a further significant increase in exercise capacity to 14.7 +/- 5.0 minutes (p less than 0.05) was demonstrated, while at a later follow-up exercise capacity had decreased to 11.4 +/- 6.8 minutes (p less than 0.05). This was still significantly greater than prior to amrinone therapy (p less than 0.01). Left ventricular ejection fraction was increased from 14 +/- 4 to 19 +/- 4% (p less than 0.05) during the first week of therapy, but was not significantly different from control at the early and late periods of follow-up. Left ventricular end-diastolic dimension index increased from control value of 43 +/- 5 to 47 +/- 7 mm/m2 (p less than 0.01) at the late period of follow-up. Thus long-term amrinone therapy resulted in a substantial improvement in exercise capacity despite a slow, but progressive decline in cardiac performance.

Adult↗
PubMed1986

Studies on the impaired metabolism of uric acid in obese subjects: marked reduction of renal urate excretion and its improvement by a low-calorie diet.

Uric acid metabolism was investigated in 27 overweight subjects, 11 men (176 +/- 30 percent of ideal body weight) and 16 women (169 +/- 20 percent of ideal body weight). They were all hospitalized and treated with low-calorie diets (1,500-800 kcal/day) with gradual reduction of total calorie intake; exercise therapy (walking, and riding a bicycle ergometer) was added to this regimen afterwards. On admission, serum levels of uric acid were significantly elevated to 9.2 +/- 1.9 mg/dl in males (control 5.1 +/- 0.8 mg/dl) (P less than 0.001) and 6.8 +/- 1.9 mg/dl in females (control 4.4 +/- 1.0 mg/dl) (P less than 0.001), while the ratios (percentages) of uric acid clearance (CuA) to creatinine clearance (Ccr) were significantly reduced to 4.0 +/- 2.1 percent in males (control 10.8 +/- 2.2 percent) (P less than 0.001) and 5.2 +/- 3.1 percent in females (control 11.8 +/- 2.9 percent) (P less than 0.001). Urinary urate excretions were also lower in obese subjects than in controls. These data suggest that hyperuricemia in obese people is mainly attributed to an impaired renal clearance of uric acid rather than overproduction. In the course of weight reduction by a low-calorie diet, CuA/Ccr ratios gradually rose up to almost normal levels and serum levels of uric acid fell without significant changes in creatinine clearance. This increase of CuA/Ccr ratio was also preserved after starting exercise therapy. The normalization of urate excretion was observed even at the phase when their body weight was not fully reduced. Although the underlying mechanism of the impaired urate excretion in obese patients and its improvement during weight reduction is as yet unclear, hyperuricemia associated with obesity can be treated very well only with appropriate diet therapy and in most cases there is no need for drug therapy.

Adolescent↗
PubMed1963

OSTEOARTHRITIS.

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Diet↗
PubMed1986

Calcitonin and reflex sympathetic dystrophy syndrome.

Reflex sympathetic dystrophy syndrome is a difficult condition to treat. Many modalities have been proposed, all of them being clinically effective but whose efficacy is often difficult to assess, and has not been properly compared. A regimen of physical therapy (pressure therapy, antalgic electrotherapy and exercise therapy) with or without calcitonin was investigated in 24 patients randomly assigned to 2 groups, one given physical therapy alone (Group I) and the other physical therapy plus salmon calcitonin 100 MRC units daily for 3 weeks (Group II). Efficacy assessment was based on clinical (pain, oedema and movement in the affected parts), biochemical (blood and urinary phosphorus and calcium levels, plasma 25-OH-D, plasma parathyroid hormone (PTH), creatinin, alkaline phosphatases and urinary hydroxyproline) and scintigraphic parameters, as well as on the patient's ability to resume working. There was significant improvement in pain in the Group II patients after one week of treatment. As a result the authors advocate the use of calcitonin in addition to physical therapy in reflex sympathetic dystrophy syndrome - and even of calcitonin alone where physical therapy is not possible.

Adult↗
PubMed2004

A review of treatment interventions in whiplash-associated disorders.

In recent years, there has been much debate on the treatment of whiplash-associated disorders (WAD). It is not clear if the treatments commonly employed are effective, and concerns have been raised on the available scientific evidence of many of these treatments. The aim of this study was to review the literature systematically to analyze the evidence basis of many commonly used treatments for patients suffering from WAD, both in the acute and the chronic state. A computer-assisted search of the databases Medline (from 1962 to May 2003), CINAHL (1960-2003), Embase (1976-2003), and Psychinfo (1960-2003) was conducted as well as a check of the reference lists of relevant studies. All randomized controlled trials (RCTs) were retrieved and systematically analyzed with three common instruments of measurement of methodological quality. A qualitative analysis ("best-evidence synthesis") was performed. The methodological quality of 26 RCTs was analyzed. The median quality scores for all three instruments were poor. Based on the degrees of evidence and the practical obstacles, the following treatments can be recommended: Early physical activity in acute WAD, radiofrequency neurotomy, combination of cognitive behavioral therapy with physical therapy interventions, and coordination exercise therapy in chronic WAD. High-quality RCTs are not common in the field of WAD. More research is needed, particularly on the treatment of chronic WAD.

Humans↗
PubMed1993

[The neurophysiological basis of exercise physical therapy in patients with central hemiparesis].

According to everyday experience in rehabilitation, stroke patients suffering from central hemiparesis physiotherapy is efficacious in reducing the degree of motor impairment. This paper describes the various therapeutic techniques used in the traditional physiotherapeutic concepts (Rood, Bobath, Brunnstrom, proprioceptive neuromuscular facilitation, Vojta) and their basic neurophysiological mechanisms, as far as they are known today. Furthermore, the significant role of treating impaired sensation and perception for movement execution is discussed and various therapeutic concepts (traditional sensibility training, methods according to Affolter and Perfetti, forced use) are described.

Cerebrovascular Disorders↗
PubMed2000

Chiropractic patients in the Netherlands: a descriptive study.

BACKGROUND: Despite the worldwide popularity of chiropractic, there is still relatively little known about the patients who visit chiropractors in the Netherlands and other European countries. OBJECTIVE: To describe in-depth the patient population of new patients to chiropractors in the Netherlands. DESIGN: Study population consisted of 10 consecutive new patients per participating chiropractor. A retrospective-type questionnaire was used. SETTING: Private practice. OUTCOME MEASURES: Mode of referral, area, and nature of the complaints; related to the chief complaint: previous treatments, examinations, type of referral, days lost at work, level of pain, and treatment expectations. RESULTS: Of the 130 chiropractors registered with the Netherlands Chiropractors'Association, 94 chiropractors(78%) participated. Eight hundred thirty-three patients (89%) returned questionnaires. By far, the greatest reason that patients visit chiropractors in the Netherlands is for neuromusculoskeletal (NMS) complaints. At the time of examination, 86% of the patients had spinal-related complaints, of which 12% involved multiple areas of the spine. Non-NMS complaints are minimal (<2%). Seventy-seven percent of patients with NMS complaints have chronic complaints (>12 weeks). Three-quarters of these patients have undergone previous conservative therapy for their complaint, which includes physical and manual therapy, postural correction, and exercise therapy. Despite the chronic nature of their complaints, patients have high expectations that their treatment will be effective. CONCLUSIONS: Most patients who see chiropractors in the Netherlands have chronic NMS-related complaints. Chiropractors are not a part of the normal referral system in this country, with the result that the patients have rather long histories, including previous evaluations by medical specialists and other previous forms of (conservative) care.

Adolescent↗