Application of research findings in progressive resistance exercise to physical therapy.
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Exercise Therapy↗
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Searching multiple databases for systematic reviews: added value or diminishing returns?
OBJECTIVE: To explore whether searching specialised bibliographic databases identified additional relevant papers to those located by a Medline search for a systematic review of exercise therapy. METHOD: Searches were performed in Medline, two further generalised medical databases (Embase, Cochrane Library) and four specialised databases (CancerLit, Cinahl, PsychInfo, SportDiscus) to identify controlled trials of exercise interventions for cancer patients. RESULTS: A total of 749 different publications were located through the search, of which 18 met inclusion criteria. Fifteen (83%) of these were identified through Medline and three (17%) from three individual specialised databases. A further seven studies meeting inclusion criteria were located through reference lists and contact with experts. CONCLUSION: In this example, searching Medline and additional specialised databases along with checking reference lists and contacting experts was the most effective means of ensuring that all relevant papers were included in the review. Searching Medline alone for systematic reviews of exercise or other unconventional therapies is likely to be inadequate.
Databases, Bibliographic↗
A rational program of exercise for patients with osteoarthritis.
This report provides a history of exercise therapy, gives background for and defines relevant terms, and describes common gross manifestations of osteoarthritis (OA). Bias and dogmatism concerning arthritis treatment are examined. Treatment using exercise and physical medicine modalities with reference to recent pertinent literature is reviewed. Human and animal studies demonstrating the efficacy of conditioning and strengthening in the treatment of OA are analyzed critically, and methods to enhance compliance and directions of future exercise research are discussed.
Exercise↗
Chiropractic spinal manipulation for neck pain: a systematic review.
Chiropractic spinal manipulation (CSM) is often used as a treatment for neck pain. However, its effectiveness is unclear. The aim of this article was to evaluate systematically and critically the effectiveness of CSM for neck pain. Six electronic databases were searched for all relevant randomized clinical trials. Strict inclusion/exclusion criteria had been predefined. Key data were validated and extracted. Methodologic quality was assessed by using the Jadad score. Statistical pooling was anticipated but was deemed not feasible. Four studies met the inclusion/exclusion criteria. Two studies were on single interventions, and 2 included series of CSM treatments, both with a 12-month follow-up. The 2 short-term trials used spinal mobilization as a control intervention. The 2 long-term studies compared CSM with exercise therapy. None of the 4 trials convincingly demonstrated the superiority of CSM over control interventions. In conclusion, the notion that CSM is more effective than conventional exercise treatment in the treatment of neck pain was not supported by rigorous trial data.
Exercise Therapy↗
Early mobilization with walking aids following hospital admission with acute exacerbation of chronic obstructive pulmonary disease.
OBJECTIVE: We hypothesized that early ambulation with a gutter frame (GF) in elderly patients hospitalized for acute exacerbation of chronic obstructive pulmonary disease (AECOPD) may reduce physical disability and allow earlier discharge. DESIGN: Blinded, randomized parallel groups trial. SUBJECTS: One hundred and ten consecutive AECOPD inpatients. INTERVENTIONS: Participants were recruited two days post admission and randomly allocated to four groups: GF with supplemental oxygen (GFSO), GF with supplemental air (GFSA), rollator with supplemental air (RSA) and rollator with supplemental oxygen (RSO) (air/oxygen was double-blinded to patients and investigators). Patients exercised three times daily (maximum of 15 minutes per session) with a physiotherapist or nurse. OUTCOME MEASURES: Physical disability measured by Barthel Index and perceived respiratory effort by Borg Scale. RESULTS: After intervention no significant difference was observed between the four groups in length of hospital stay (F= 0.78; p = 0.50), changes in mean Barthel score (F= 2.08; p = 0.11) and Borg score (F= 0.35; p = 0.79). However, improvement in Barthel score (mean 1.22 combined gutter frame group air/oxygen) was greater than the combined rollator group (mean 0.55; p = 0.003). Baseline Barthel score and nurses' assessment of compliance were associated with improvement in Barthel score (p < 0.0001 and p < 0.002). Barthel score was predicted by use of gutter frame (F = 6.17; p = 0.01), not by use of rollator. Use of air/oxygen group was not related to improvement in Barthel score. CONCLUSION: Short-term exercise therapy with gutter frame after AECOPD admission reduces physical disability in older patients but does not affect length of hospital stay. Use of supplemental oxygen during exercise has no additional benefits.
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An object-oriented, knowledge-based system for cardiovascular rehabilitation--phase II.
The Heart Monitor is an object-oriented, knowledge-based system designed to support the clinical activities of cardiovascular (CV) rehabilitation. The original concept was developed as part of graduate research completed in 1992. This paper describes the second generation system which is being implemented in collaboration with a local heart rehabilitation program. The PC UNIX-based system supports an extensive patient database organized by clinical areas. In addition, a knowledge base is employed to monitor patient status. Rule-based automated reasoning is employed to assess risk factors contraindicative to exercise therapy and to monitor administrative and statutory requirements.
Artificial Intelligence↗
Exercise treatment for osteoarthritis disability.
Osteoarthritis (OA) is a chronic prevalent condition that affects the synovial joints and can lead to disability. There is no single treatment that is known to cure OA. Most treatments have aimed at reducing symptoms or slowing the progression of the disease and its consequences. Exercise therapy is a common intervention in treating OA, with primary aims of improving functional movement and managing the problems associated with abnormal functional movement. We review the underlying process of exercise treatment and its importance for OA disability. A brief description of OA disease and an OA disability model are introduced, and then the importance of exercise and trends in prescribing exercises for OA are discussed. Finally, future directions and suggestions for research in this field are described.
Exercise Therapy↗
Crosstalk of the heart and periphery: skeletal and cardiac muscle as therapeutic targets in heart failure.
Heart failure syndrome is initiated as the body's metabolic needs temporarily exceed the pumping capacity of the heart. In most cases, this phenomenon tends to occur during physical exercise. Although not always subjectively recognized, limited exercise capacity remains the clinical hallmark of congestive heart failure. It can be measured objectively as reduced skeletal muscle performance and maximal whole-body oxygen uptake, which are not necessarily explained by central haemodynamic abnormalities. In fact, the initial cardiac condition sets forth a series of peripheral adaptations that are potentially life-saving during acute decompensation but become disadvantageous and symptom-generating in stable heart failure. Inodilator drugs were theoretically ideal to revert the adverse haemodynamic crosstalk between the heart and periphery. However, these drugs failed to improve prognosis in congestive heart failure, whereas drugs that did so showed typically unimpressive haemodynamic effects. Exercise therapy has recently emerged as a safe and effective way to enhance physical performance and subjective well-being in congestive heart failure. A dual therapeutic approach is suggested, consisting of exercise training to improve the periphery and the use of cardioprotective drugs to limit cardiac cellular damage from neurohormonal activation.
Adrenergic beta-Antagonists↗
Benign course of glycogen storage disease type IIb in two brothers: nature or nurture?
Two brothers with the childhood variant of type II glycogenosis (GSD-IIb) treated with nutrition and exercise therapy (NET) from a young age showed an unusually benign course. Muscle biopsy from the older brother, which showed characteristic vacuolar glycogen accumulation at age 2, had reverted to normal by age 16. A muscle biopsy from the younger brother was normal at 5 years. It is uncertain whether this anomalous evolution was spontaneous (nature) or due to the symptomatic therapy (nurture), but NET should be considered in patients with GSD-IIb until enzyme replacement or gene therapy become generally available.
DNA↗
[Acupuncture massage vs Swedish massage and individual exercise vs group exercise in low back pain sufferers--a randomized controlled clinical trial in a 2 x 2 factorial design].
OBJECTIVE: Rehabilitation programs for low back pain (LBP) almost always contain massage and exercise therapy in one form or another. AIM: This study aimed to quantify the effectiveness of therapeutic 'Acupuncture' massage (APM; i.e. tonic stimulation of entire meridians) according to Penzel versus Swedish massage (SM) and individual medical exercises (IE) versus group exercises (GE) in LBP sufferers. PATIENTS AND METHODS: 109 patients participating in a complex in-patient rehabilitation program were randomised to four groups in a 2 x 2 factorial design. Main outcome measures were functional ability/disability (Functional Questionnaire Hanover, FFbH) and pain intensity (10 cm visual analogue scale, VAS). Pre/post changes were evaluated by means of 2-way analysis of variance (ANOVA). Additionally, lumbar motility was measured by a 2-inclinometer technique. RESULTS: Baseline mean FFbH score was 66 (SD = 18)%, mean pain intensity on VAS was 4.5 (SD = 2.4) cm. Lumbar flexion and extension were 49 (13) and 13 (7). Because of some differences between groups at baseline, group-standardized outcomes were used for analysis. APM showed beneficial effects for both disability and pain compared with SM (group differences: delta FFbH 7.0% [95% confidence interval (CI) 2.5-11.6], p = 0.003; delta VAS 0.8 cm [95% CI: 2-15], p = 0.024). Standardized response means were SRMFFbH = 0.5 and SRMVAS = 0.8 for APM, as opposed to SRMFFbH = -0.01 and SRMVAS = 0.4 for SM. Neither significant group differences between both exercise groups [delta FFbH -0.5% (95% CI -5.2 to 4.2); delta Vas 0.4 cm (95% CI 0.3 to 1.1)] nor significant interactions between medical exercise and massage were found. CONCLUSIONS: Given the fact that even the treatments considered to be the best available achieve at best moderate effects, the observed effect sizes with APM are promising and warrant further investigation in replication studies. In contrast to common view, no superiority of individual versus group exercises could be found in the present study.
Acupuncture Therapy↗
How much exercise does the enhanced gait-oriented physiotherapy provide for chronic stroke patients?
BACKGROUND AND PURPOSE: Physical exercise therapy in sensorimotor rehabilitation of stroke patients includes active and repetitive exercise and task-specific training. The time spent in active practice is fundamental. The purpose of this study was to analyse what was the actual amount of exercise and content of the performed exercise of the three-week gait-oriented physiotherapy program for chronic stroke patients in an in-patient setting. METHODS: Twenty ambulatory post-stroke patients participated in an in-patient rehabilitation period during which a special effort was made to enhance gait training and the amount of therapy and its contents were recorded in structured form. Baseline and postintervention gait ability assessments were made, but the analysis concentrated on participation records in different forms of therapy. RESULTS: Patients received 19 hours of instructed physiotherapy in three weeks and together with self-initiated training they practised for 28 hours. The practice time in the upright position was 62% of the total duration of the instructed physiotherapy and 35% was performed while sitting. This amount of exercise resulted in improvement of the gait tests. CONCLUSIONS: In order to improve gait in the chronic state of disease, a sufficient amount of gait rehabilitation practice can be obtained with a combination of electromechanical gait trainer exercises, physiotherapy, instructed exercise groups and self-initiated training.
Adult↗
[New therapeutic methods of relaxation and invigoration].
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Electric Stimulation Therapy↗
Use and abuse of physical therapy in industry.
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Electric Stimulation Therapy↗
Efficacy of different therapy regimes of low-power laser in painful osteoarthritis of the knee: a double-blind and randomized-controlled trial.
BACKGROUND AND OBJECTIVES: A prospective, double-blind, randomized, and controlled trial was conducted in patients with knee osteoarthritis (OA) to evaluate the efficacy of infrared low-power Gallium-Arsenide (Ga-As) laser therapy (LPLT) and compared two different laser therapy regimes. STUDY DESIGN/MATERIALS AND METHODS: Ninety patients were randomly assigned to three treatment groups by one of the nontreating authors by drawing 1 of 90 envelopes labeled 'A' (Group I: actual LPLT consisted of 5 minutes, 3 J total dose + exercise; 30 patients), 'B' (Group II: actual LPLT consisted of 3 minutes, 2 J total dose + exercise; 30 patients), and 'C' (Group III: placebo laser group + exercise; 30 patients). All patients received a total of 10 treatments, and exercise therapy program was continued during study (14 weeks). Subjects, physician, and data analysts were unaware of the code for active or placebo laser until the data analysis was complete. All patients were evaluated with respect to pain, degree of active knee flexion, duration of morning stiffness, painless walking distance and duration, and the Western Ontario and Mc Master Universities Osteoarthritis Index (WOMAC) at week 0, 6, 10, and 14. RESULTS: Statistically significant improvements were indicated in respect to all parameters such as pain, function, and quality of life (QoL) measures in the post-therapy period compared to pre-therapy in both active laser groups (P < 0.01). Improvements in all parameters of the Group I and in parameters, such as pain and WOMAC of the Group II, were more statistically significant when compared with placebo laser group (P < 0.05). CONCLUSIONS: Our study demonstrated that applications of LPLT in different dose and duration have not affected results and both therapy regimes were a safe and effective method in treatment of knee OA.
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[Mechanical force exercised on the elbow joint in olecranon fractures (author's transl)].
Opinion is fairly unanimous on the need for surgical treatment of disclocated olecranon fractures. However, opinions differ regarding the mechanical backgrounds and practical application of the presently widely used tension wiring. The article attempts to clarify the picture of the forces involved in the humero-ulnar joint. Basing on the points of attack of these forces and on the influence of the ligamentum collaterale ulnare, the fractures are subdivided into three groups with individual demands on the respective fixation method and the permissible post-operative exercise therapy. Post-operative plaster immobilisation is not indicated in these cases.
Elbow Joint↗
Seasonal variation in effect of spa therapy on chronic pain.
This study sought to investigate whether the effects of spa therapy are subject to seasonal variation as suggested by conventional spa therapy research. A total of 268 female (age 31-90 yr) and 119 male (age 35-85 yr) patients with noninflammatory chronic pain were studied. Patients stayed at an Austrian spa for 3 wk and received 2-4 treatments per day, including mudpacks, massages, and exercise therapy. In different groups of patients for 2 yr, pain (self-assessed by questionnaire and Likert scales) and associated variables (mood, fatigue) were measured at the beginning, end, and 6 wk after spa therapy. Data were analyzed by multivariate analysis of covariance controlling for possible group differences between seasons and cosinor analysis. The effect of spa therapy on pain was seasonally dependent; short-term decrease of pain was best between April and June and medium-term decrease of pain was best between October and November, with a second minor peak in fall and spring, respectively. The magnitude of the seasonal variation was greater for back (approximately 30%) than for joint (approximately 20%) pain. Positive mood also improved most between April and June. The observed semi-annual variations of pain do not correspond to the well-known annual change in many physiological and psychological variables. The results suggest that the effects of spa therapy and possibly other related treatments, such as physical and alternative therapies, are subject to seasonal variation.
Adult↗
Cardiovascular consequences of primary antihypertensive therapy with prazosin hydrochloride.
Ten patients with essential hypertension who had no end-organ damage were treated with prazosin, starting with a dose of 1 mg/day. The dose was titrated to a maximal tolerated dose not exceeding 20 mg/day in divided doses or until diastolic blood pressure decreased to 90 mm Hg or lower. Among this study population a statistically significant decrease in blood pressures was achieved in the supine, sitting and standing positions. Baseline studies were repeated after 8 weeks of continuous therapy. There was no significant change in peripheral plasma renin activity, serum aldosterone or urinary sodium excretion. Plasma volume increased significantly and the patient weight increased proportionately. Cardiac ejection fraction at rest did not change significantly after prazosin therapy. Exercise ejection fraction also was not changed significantly from baseline during therapy, and the exercise-induced increase in blood pressure was significantly blunted. No adverse effects of prazosin on cardiac function were detected in this short-term study.
Adult↗
[Factors contributing to exercise-induced hypoxemia in patients with chronic lung diseases].
Arterial oxygen tension (PaO2) was found to decrease linealy during incremental exercise in patients with chronic lung diseases. The slopes of PaO2 during increasing workload (delta PaO2/delta VO2) in patients with COPD were closely and negatively correlated with diffusing capacity of the lung (DLco). In patients with IPF, the values of delta PaO2/delta VO2 were much higher, and were more strongly correlated with DLco than those in patients with COPD. Therefore, exercise-induced hypoxemia (EIH) was found to be related to three factors: PaO2 at rest, PaO2 slope predicted from %DLco, and exercise workload. The most important factor in EIH in patients with COPD was the decrease in PvO2 during exercise, which was caused by right heart failure and venous admixture. In patients with IPF, EIH was caused by abnormal O2 diffusion during exercise, decreased PvO2, and venous admixture. In conclusion, the factors contributing to EIH depend on the workload, so exercise testing is needed to decide on exercise therapy and O2 therapy in patients with chronic lung diseases.
Aged↗