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PubMed1991

Evaluating the safety and potential use of a weight-bearing exercise, Tai-Chi Chuan, for rheumatoid arthritis patients.

The safety of a traditional Chinese exercise, Tai-Chi Chuan, on rheumatoid arthritis (RA) patients was evaluated. RA patients, who received 1 h of Tai-Chi Chuan instruction once (n = 20) and twice (n = 15) a week for 10 consecutive wk in two separate studies, showed no deterioration in their clinical disease activities compared with the corresponding controls (n = 11 and 9, respectively). Testing parameters included joint tenderness, joint swelling, time to walk 50 feet, handgrip strength and a written functional assessment. No significant exacerbation of joint symptoms using this weight-bearing form of exercise was observed. Tai-Chi Chuan exercise appears to be safe for RA patients and may serve as an alternative for their exercise therapy and part of their rehabilitation program. Weight-bearing exercises have the potential advantages of stimulating bone growth and strengthening connective tissue, but this effect needs to be documented in long-term studies.

Adult↗

PubMed2000

Influence of water exercise and land stretching on salivary cortisol concentrations and anxiety in chronic low back pain patients.

Land stretching exercises are common exercise therapy for low back pain (LBP) patients. However, recently, water exercise became a popular rehabilitation for LBP patients, and many studies have reported the physical benefits of water exercise. This study compared the psychological and endocrinological effects of water exercise and land stretching by measuring salivary cortisol concentration and anxiety in chronic LBP patients. Seven volunteers (4 female and 3 male, mean age: 61.9 +/- 11.8 yrs) who suffered from chronic LBP (pain duration: 4.5 +/- 1.3 yrs) participated in the sessions of water exercise and land stretching programs (90 minutes) on different days. The land stretching program consisted mainly of stretching, and the water exercise program contained not only stretching, but also walking, jogging, muscle strengthening, swimming and relaxation. After both exercise programs, the subjective pain scores of the patients showed a significant decrease. Salivary cortisol concentrations were also significantly decreased during pre- to post-90 minute water exercise. (P < 0.05). With land stretching, salivary cortisol concentrations also decreased significantly (P < 0.05). State anxiety decreased significantly (P < 0.05) after both water exercise and land stretching compared with pre-exercise scores (P < 0.05), though no significant changes were found in the patients' trait anxiety scores. No significant correlation was found between salivary cortisol concentrations and state anxiety with water exercise and land stretching. The findings of the present study suggested both exercises showed similar tendencies, and had decreased salivary cortisol level and state anxiety.

Anxiety↗

PubMed1987

[Experience with the risk factor-based prevention of ischemic heart disease at a Pyatigorsk health resort].

Methods and efficacy of correction of kinesitherapy, body mass and cholesterolemia in CHD prevention were studied in 162 patients with pathology of the locomotor system combined with obesity in the Pyatigorsk health resort area. Various methods of exercise therapy and special diets (low-caloric and subcaloric--6694-10460 kJ) combined with methods of balneotherapy were used. Favorable shifts in the clinical status of patients, an increase in their physical activity 2-fold and more, a decrease in excess body mass, a decrease in the blood level of total cholesterol (in 78%), an increase in alpha-lipoprotein cholesterol (65%), and a decrease in cholesterol atherogenic index (in all patients with initial pathology) were noted.

Adult↗

PubMed1989

The role of physical exercise in prevention and management of osteoporosis.

The effect of exercises on vertebral trabecular bone mineral content (BMC) was investigated in 24 women with osteoporosis (OP) diagnosed by Quantitative Computed Tomography (QCT). Two groups were formed: an exercise and a control group with no exercise. Subjects in the exercise group exercised for one hour, twice weekly for a period of 6 months under the supervision of a physical therapist. A home exercise program which included the same exercises used in the hospital plus walking for half an hour every day was also assigned. Initial lumbar X-ray films, values obtained from laboratory investigations, physical activity scores and spinal BMC measurements were compared with those obtained after 6 months. The increase in the level of physical activity in the exercise group after exercise therapy was found statistically significant (p less than 0.001). After the exercise period, BMC values showed a 4.76% increase whereas in the control group, a decrease of 2.7% was found. The results demonstrated the beneficial effect of exercise in the prevention and management of OP.

Adult↗

PubMed2000

Strength and physiological response to exercise in patients with chronic fatigue syndrome.

OBJECTIVE: To measure strength, aerobic exercise capacity and efficiency, and functional incapacity in patients with chronic fatigue syndrome (CFS) who do not have a current psychiatric disorder. METHODS: Sixty six patients with CFS without a current psychiatric disorder, 30 healthy but sedentary controls, and 15 patients with a current major depressive disorder were recruited into the study. Exercise capacity and efficiency were assessed by monitoring peak and submaximal oxygen uptake, heart rate, blood lactate, duration of exercise, and perceived exertion during a treadmill walking test. Strength was measured using twitch interpolated voluntary isometric quadriceps contractions. Symptomatic measures included physical and mental fatigue, mood, sleep, somatic amplification, and functional incapacity. RESULTS: Compared with sedentary controls, patients with CFS were physically weaker, had a significantly reduced exercise capacity, and perceived greater effort during exercise, but were equally unfit. Compared with depressed controls, patients with CFS had significantly higher submaximal oxygen uptakes during exercise, were weaker, and perceived greater physical fatigue and incapacity. Multiple regression models suggested that exercise incapacity in CFS was related to quadriceps muscle weakness, increased cardiovascular response to exercise, and body mass index. The best model of the increased exercise capacity found after graded exercise therapy consisted of a reduction in submaximal heart rate response to exercise. CONCLUSIONS: Patients with CFS were weaker than sedentary and depressed controls and as unfit as sedentary controls. Low exercise capacity in patients with CFS was related to quadriceps muscle weakness, low physical fitness, and a high body mass ratio. Improved physical fitness after treatment was associated with increased exercise capacity. These data imply that physical deconditioning helps to maintain physical disability in CFS and that a treatment designed to reverse deconditioning helps to improve physical function.

Adult↗

PubMed1993

[Conservative therapy of backache. Part 3: Physical therapy].

Physical exercise is accepted by many as the first line of treatment of low back pain. Nevertheless, hard data published so far have failed to demonstrate its benefit as clearly as we would wish. A wealth of exercise programs is available that escape systematic classification. The authors differentiate between general endurance training, and stretching, flexion and extension exercises. Whether endurance training is of benefit has not yet been unequivocally established. In contrast, stretching exercises have been shown to be effective. Flexion exercises have both proponents and opponents, while most randomized studies on extension exercises appear to demonstrate their effectiveness. Thus, physical exercise may be considered, at least in part, an effective form of treatment. Further research is needed to define the optimal exercise program for the individual patient as accurately as possible.

Exercise Therapy↗

PubMed1990

Rehabilitation therapy for patients with long-term spinal cord injuries.

The functional effects of three types of therapy for subjects with long-term incomplete cervical spinal cord injuries were investigated. Men and women, aged 18 to 45 years, were assigned to one of four groups using a restricted randomization process. The training period was divided into two consecutive eight-week time blocks where subjects received either (1) supervised physical exercise therapy (PET), (2) neuromuscular stimulation (NMS), or (3) electromyographic (EMG) biofeedback. Group 1 received EMG biofeedback followed by PET; Group 2 received EMG biofeedback followed by NMS; Group 3 received NMS followed by PET; and Group 4 received 16 weeks of PET. Dependent measures (manual muscle tests, self-care scores, mobility measures, and voluntary EMG activity) were assessed before training, at eight weeks, and after 16 weeks of training. A significant improvement (p less than .05) across time was found on all dependent measures except voluntary EMG. No difference was found on comparisons between groups.

Adolescent↗

PubMed2005

Managing time: an interpretative phenomenological analysis of patients' and physiotherapists' perceptions of adherence to therapeutic exercise for low back pain.

PURPOSE: Physiotherapy for low back pain (LBP) includes exercise therapy. Unfortunately adherence is problematic. This study explores patients' and physiotherapists' perceptions of exercise adherence. METHOD: Nine LBP patients and eight physiotherapists were interviewed. Interpretative Phenomenological Analysis (IPA) was used to explore transcript data. RESULTS: The main theme 'managing time', reveals how pressure on time reflects society's view of time as a commodity. Theme components include 'the bargaining process': physiotherapists spend time listening, exploring patient beliefs, but modify patients' expectations of quick cures with the need to own their back care. 'Reviewing the future' identifies fears about long-term disability, highlighting the importance of recovery time knowledge. CONCLUSIONS: Interpreting participants' stories illustrates how investing in routine exercise could help re-interpret LBP as part of everyday life.

Adult↗

PubMed2005

Effects of eight weeks of exercise training and orlistat therapy on body composition and maximal exercise capacity in obese females.

A comparative assessment was made of the short-term effects of orlistat therapy and exercise training on body composition and aerobic fitness in obese females. A total of 24 obese patients were enrolled in to the study; 12 received orlistat therapy (DO) and 12 participated in a regular aerobic exercise-training programme (DE). All patients were on hypocaloric diets. Each patient performed three incremental ramp exercise tests (one at Week 0, one at the end of Week 4 and one at the end of Week 8) to exhaustion using an electromagnetically braked cycle ergometer to determine their anaerobic threshold and maximal exercise (Wmax) capacity. Patients in the DE group performed continuous exercise at a work rate that corresponded to the anaerobic threshold. Weight loss and loss of fat mass after 8 weeks were -6.4% (P=0.002) and -13.4% (DE) vs -5.8% (P=0.002) and -6.4% (P=0.008) (DO), respectively. Wmax capacity was 90.8+/-5 W (basal) vs 92.9+/-5 W (Week 4, P=0.1) and 100.4+/-6 W (Week 8, 10.5%, P=0.04) in the DO group, and 96.2+/-6 W (basal) vs 129.1+/-4 W (Week 4, 34.1%, P=0.002) and 137.5+/-5 W(Week 8, 42.9%, P=0.002) in the DE group. Despite similar decreases in body weight in both groups, patients in the DE group achieved a markedly higher level of Wmax, reflecting a better improvement in cardiopulmonary fitness, compared with patients in the DO group. Considering the improvement of aerobic fitness in the short term, an aerobic exercise-training programme should be considered for sedentary obese patients to improve their aerobic fitness and thereby reduce the negative outcomes of obesity.

Anaerobic Threshold↗

PubMed2005

Acrophobia and pathological height vertigo: indications for vestibular physical therapy?

BACKGROUND AND PURPOSE: Acrophobia (fear of heights) may be related to a high degree of height vertigo caused by visual dependence in the maintenance of standing balance. The purpose of this case report is to describe the use of vestibular physical therapy intervention following behavioral therapy to reduce a patient's visual dependence and height vertigo. CASE DESCRIPTION: Mr N was a 37-year-old man with agoraphobia (fear of open spaces) that included symptoms of height phobia. Exposure to heights triggered symptoms of dizziness. Intervention. Mr N underwent 8 sessions of behavioral therapy that involved exposure to heights using a head-mounted virtual reality device. Subsequently, he underwent 8 weeks of physical therapy for an individualized vestibular physical therapy exercise program. OUTCOMES: After behavioral therapy, the patient demonstrated improvements on the behavioral avoidance test and the Illness Intrusiveness Rating Scale, but dizziness and body sway responses to moving visual scenes did not decrease. After physical therapy, his dizziness and sway responses decreased and his balance confidence increased. DISCUSSION: Symptoms of acrophobia and sway responses to full-field visual motion appeared to respond to vestibular physical therapy administered after completion of a course of behavioral therapy. Vestibular physical therapy may have a role in the management of height phobia related to excessive height vertigo.

Adult↗

PubMed2002

A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache.

STUDY DESIGN: A multicenter, randomized controlled trial with unblinded treatment and blinded outcome assessment was conducted. The treatment period was 6 weeks with follow-up assessment after treatment, then at 3, 6, and 12 months. OBJECTIVES: To determine the effectiveness of manipulative therapy and a low-load exercise program for cervicogenic headache when used alone and in combination, as compared with a control group. SUMMARY OF BACKGROUND DATA: Headaches arising from cervical musculoskeletal disorders are common. Conservative therapies are recommended as the first treatment of choice. Evidence for the effectiveness of manipulative therapy is inconclusive and available only for the short term. There is no evidence for exercise, and no study has investigated the effect of combined therapies for cervicogenic headache. METHODS: In this study, 200 participants who met the diagnostic criteria for cervicogenic headache were randomized into four groups: manipulative therapy group, exercise therapy group, combined therapy group, and a control group. The primary outcome was a change in headache frequency. Other outcomes included changes in headache intensity and duration, the Northwick Park Neck Pain Index, medication intake, and patient satisfaction. Physical outcomes included pain on neck movement, upper cervical joint tenderness, a craniocervical flexion muscle test, and a photographic measure of posture. RESULTS: There were no differences in headache-related and demographic characteristics between the groups at baseline. The loss to follow-up evaluation was 3.5%. At the 12-month follow-up assessment, both manipulative therapy and specific exercise had significantly reduced headache frequency and intensity, and the neck pain and effects were maintained (P < 0.05 for all). The combined therapies was not significantly superior to either therapy alone, but 10% more patients gained relief with the combination. Effect sizes were at least moderate and clinically relevant. CONCLUSION: Manipulative therapy and exercise can reduce the symptoms of cervicogenic headache, and the effects are maintained.

Adult↗

PubMed2000

Acquired immunodeficiency syndrome wasting, functional performance, and quality of life.

Unintentional loss of weight and lean body mass (wasting) is a major cause of morbidity and mortality in patients with acquired immunodeficiency syndrome (AIDS). Patients with AIDS wasting (AW) often experience reductions in lean body mass, muscle strength, and the ability to perform functions of daily living. Dependence on assistance with activities of daily living may be associated with a lower quality of life (QOL) and higher risk of mortality. These factors suggest that slowing or reversing the loss of lean body mass in AW can improve well-being. Nutritional support or appetite stimulants in the absence of exercise therapy or growth hormone supplementation can increase fat without improving body composition, whereas appropriate exercise programs, androgen therapy, and recombinant human growth hormone (rhGH) therapy may increase lean body mass in patients with AW. Resistance exercise programs can increase muscle strength and lean body mass. In addition, both resistance and endurance (aerobic) exercise augment endogenous growth hormone levels, decrease depression, enhance self-esteem, and may improve immune response. Randomized, double-blind trials have shown that rhGH therapy increases total body weight, lean body mass, exercise capacity, and QOL. In summary, interventions that improve exercise capacity and functional performance may enhance QOL in patients with AW and may reduce mortality in this group.

Activities of Daily Living↗

PubMed1994

Treatment compliance in adults with cystic fibrosis.

BACKGROUND: The study comprised three interrelated aims: (1) to ascertain (a) patient compliance with physiotherapy, exercise, enzyme and vitamin regimens, (b) how compliance was perceived by patients, and (c) the reasons for poor compliance (2) to identify demographic and clinical variables associated with compliance; and (3) to determine how accurately patient compliance can be predicted by carers. METHODS: Demographic and medical history data were obtained from medical records and a patient questionnaire. The data obtained included age, sex, employment status, inpatient or outpatient status, frequency of contact with the clinic, age at diagnosis, and the number of years practising physiotherapy. Measures of clinical status, including FEV1 and FVC percentage predicted, Shwachman score, and 24 hour sputum weight were recorded before completion of the questionnaire. The questionnaire, administered by a psychologist, assessed the reported degree of patient compliance, their perception of compliance, and their reasons for poor compliance. RESULTS: Sixty patients participated in the study and 51/60 and 41/55 patients were considered compliant with enzyme and exercise therapies, respectively. Compliance was lower with physiotherapy (32/60) and vitamin treatment (21/45). Patients reporting immediate benefits following exercise and physiotherapy were more compliant than those reporting no improvement. The perception by patients that compliance was sufficient ("about right") was physiotherapy 67%, exercise 37%, enzymes 78%, and vitamins 9%. Compliance was not influenced by demographic details nor by severity of disease, although patients producing large amounts of sputum and receiving help with physiotherapy were more compliant with physiotherapy. The physiotherapist and physician judged correctly the degree of compliance with physiotherapy in 83% and 75% of cases, respectively, and with exercise in 68% and 67% of cases, respectively. CONCLUSIONS: The reported degree of compliance and reasons for poor compliance were treatment specific. Demographic and disease severity variables were not associated with compliance. Those involved in the care of patients with cystic fibrosis were able to predict patient compliance.

Adolescent↗

PubMed1996

Improved gas exchange during exercise after weight loss in morbid obesity.

The aim of this study was to determine the effect of weight loss induced by 6 weeks very-low-calorie-diet (VLCD) and behavioural intervention on pulmonary gas exchange during exercise in non-smoking morbid obese (BMI>40 kg/m2) otherwise healthy patients. Seven obese patients underwent a maximal bicycle ergometer test with continuous analysis of expired air and arterial blood sampling before and after a mean weight loss of 18% (25.7 kg, range: 10-50 kg). Body mass index (BMI) decreased with weight loss from 46.6 (6.3) kg/m2 to 38.0 (4.7) kg/m2 (P<0.01). Oxygen consumption (VO2) at low and submaximal exercise levels decreased after weight reduction, but the change was not statistically significant. The peak oxygen consumption related to body weight (VO2/kg) increased 22% from the initial 16.2 (3.6) ml/min/kg to 19.8 (3.1) ml/min/kg (P<0.05). Decrease in VCO2 was significant at submaximal exercise level. Ventilatory equivalent for CO2 increased significantly after weight reduction (P<0.05). Standing up and light exercise resulted in a significant increase in the mean arterial oxygen tension (PaO2) (P<0.05) and a significant decrease in the mean alveolar-arterial difference P(A-a)O2 (P<0.05) when compared to supine values. The mean increase in PaO2 with weight loss was not significant. The peak P(A-a)O2 decreased significantly after weight reduction. In conclusion, weight reduction induced by VLCD and behavioural intervention without exercise therapy can improve gas exchange during exercise in morbid obesity. Increased wasted ventilation, and a tendency to alveolar hyperventilation, after weight loss may reflect a delay in the adaptation of regulation of breathing to rapid weight loss.

Adult↗

PubMed1987

Exercise and antihypertensive therapy.

The effects of exercise on central hemodynamic mechanisms and the changes induced by treatment have been studied invasively in approximately 500 men with essential hypertension. In patients with mild hypertension, the increase in blood pressure (BP) during dynamic exercise is similar to that seen in normal subjects, but in patients with severe hypertension it is steeper. During dynamic exercise total peripheral resistance is increased in all categories of hypertensive patients, including young subjects with apparently "normal" resistance at rest. The increase in stroke volume in transition from rest to exercise is subnormal, probably reflecting increased stiffness in the left ventricle. Static exercise causes dramatic increase in systolic as well as diastolic BP. Most antihypertensive agents control BP similarly during exercise and at rest. The hemodynamic mechanisms, however, differ greatly. The beta blockers induce a long-term reduction in cardiac output, muscle blood flow and, frequently, endurance capacity. In contrast, alpha-receptor blockers, calcium antagonists and angiotensin converting enzyme inhibitors all reduce total peripheral resistance and do not decrease blood flow. Increase in endurance time has been reported with long-term calcium antagonist treatment. It would seem logical to select an antihypertensive drug that does not reduce exercise capacity when treating physically active patients with mild and moderate hypertension.

Adrenergic alpha-Antagonists↗

PubMedDate not supplied

The effectiveness of multidisciplinary rehabilitation in the treatment of fibromyalgia: a randomized controlled trial.

OBJECTIVES: To assess the effectiveness of multidisciplinary rehabilitation in the treatment of fibromyalgia in comparison to standard medical care. METHODS: Seventy-nine men and women were randomly assigned to one of two groups. The intervention group consisted of a rheumatologist and physical therapist intake and discharge, 18 group supervised exercise therapy sessions, 2 group pain and stress management lectures, 1 group education lecture, 1 group dietary lecture, and 2 massage therapy sessions. The control group consisted of standard medical care with the patients' family physician. Outcome measures included self-perceived health status, pain-related disability, average pain intensity, depressed mood, days in pain, hours in pain, prescription and nonprescription medication usage, and work status. Outcomes were measured at the end of the 6-week intervention and at 15-month follow-up. RESULTS: Thirty-five out of 43 patients from the intervention group and 36 out of 36 patients from the control group completed the study. There were no statistically significant differences between the 2 groups prior to intervention. Intention-to-treat analysis revealed that the intervention group, in comparison to the control group, experienced statistically significant changes at intervention completion in self-perceived health status, average pain intensity, pain related disability, depressed mood, days in pain, and hours in pain, but no significant differences in nonprescription drug use, prescription drug use, or work status. At 15 months, all health outcomes retained their significance except health status. Nonprescription and prescription drug use demonstrated significant reductions at 15 months. Binary logistic regression indicated that long-term changes in Pain Disability Index were influenced by long-term exercise adherence and income status. CONCLUSIONS: Positive health-related outcomes in this mostly unresponsive condition can be obtained with a low-cost, group multidisciplinary intervention in a community-based, nonclinical setting.

Combined Modality Therapy↗

PubMed2006

Are "structural abnormalities" on magnetic resonance imaging a contraindication to the successful conservative treatment of chronic nonspecific low back pain?

STUDY DESIGN: Prospective study. OBJECTIVE: To examine the association between structural abnormalities recorded on magnetic resonance imaging (MRI) and outcome after evidence-based conservative treatment in patients with chronic nonspecific low back pain (LBP). SUMMARY OF BACKGROUND DATA: In most guidelines for the management of LBP, MRI is not recommended unless the diagnostic triage suggests serious spinal pathology or nerve root involvement for which surgical treatment is foreseen. This is because many structural changes seen on MRI appear to be as common in asymptomatic individuals as in people with LBP and are, therefore, considered of little value in either explaining the cause of pain or deciding the subsequent course of management. However, to our knowledge, no studies have assessed whether the presence of such MRI abnormalities influences the outcome of the conservative treatment that patients with chronic nonspecific LBP typically receive. METHODS: T2-weighted, 4-mm spin-echo MRI sequences of the lumbar spine were obtained from 53 patients with chronic nonspecific LBP before a 3-month program of exercise therapy. Disc degeneration, disc bulging, high intensity zones, and endplate/bone marrow changes were assessed for each lumbar segment. Back pain (average and worst) and disability (Roland Morris score) were assessed before and after therapy, and 12 months later, and the improvements were examined in relation to the presence or absence of baseline MRI "abnormalities." RESULTS: Eighty-nine percent of patients had severe disc degeneration (grade 4 or 5), 74% had disc bulging, 60% had high intensity zones, and 62% had endplate/bone marrow changes in at least 1 lumbar segment. Only 11% patients had none of these changes at any level. The MRI abnormalities showed only minimal association with baseline symptoms. In multivariate regression analyses, in which age, gender, and baseline symptoms were controlled for, only 1 significant association between the MRI variables and outcome was observed: the presence of a high intensity zone in any vertebral segment was associated with lower average pain at the 12-month follow-up (standardized beta -0.376, P = 0.006, 16.5% variance accounted for). CONCLUSION: In the patient group examined, the presence of common "structural abnormalities" on MRI had no significant negative influence on the outcome after therapy.

Adult↗

PubMed2005

A randomized controlled graded exercise trial for chronic fatigue syndrome: outcomes and mechanisms of change.

The aim of this study was to investigate the potential mechanisms underlying the efficacy of graded exercise therapy for chronic fatigue syndrome (CFS). Forty-nine CFS patients were randomized to a 12-week graded exercise programme or to standard medical care. At the end of treatment the exercise group rated themselves as significantly more improved and less fatigued than the control group. A decrease in symptom focusing rather than an increase in fitness mediated the treatment effect. Graded exercise appears to be an effective treatment for CFS and it operates in part by reducing the degree to which patients focus on their symptoms.

Adolescent↗