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The dynamic changes of 15 parameters (divided into 6 sections in this study) relating to metabolism, platelet function, blood coagulation and hemorrheologic situation under acute exercise loading with the intensity of VO2 max 60% were observed in noninsulin dependent diabetes mellitus (NIDDM) patients. The advantage, safety and feasibility of exercise therapy were discussed.
The purposes of exercise therapy for diabetes are to improve insulin resistance and to prevent diabetic complications. At first, mild aerobic exercise (walking, cycling and swimming), which enhances insulin-signaling pathway, is recommended after medical check-ups. If aerobic exercise alone is not effective, the combination of aerobic and resistance training could be considered. The resistance training consists of rowing, lifting and dumbbells, and increases skeletal muscle volume and strength. This combination therapy would bring about not only improvement of insulin resistance but also restoration of quality of life for aged diabetic subjects.
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In ten patients with essential hypertension who were on a prescribed regimen of supervised mild exercise, we examined serum lipids, HDL cholesterol subfractions (HDL2 and HDL3), and apolipoproteins. The findings were compared with data on age- and sex-matched hypertensives not on this regimen of exercise. Blood samples were obtained from the auricle during the multistage exercise test, and changes in levels of lactate were measured. The exercise was done for 30 minutes three times weekly for 10 weeks. A significant reduction of both systolic and diastolic blood pressure was evident at 10 weeks. Serum concentrations of HDL2 cholesterol increased significantly at 10 weeks, but there were no changes in total and HDL3 cholesterol. No significant changes were observed in serum concentrations of total cholesterol, triglyceride, and apolipoproteins, (apo) A-I, apo A-II, apo B, apo C-II, apo C-III and apo E following 10 weeks of exercise therapy. In the hypertensive controls who were not on exercise therapy, blood pressure as well as all parameters related to lipoproteins remained unchanged. Thus, mild exercise lowers blood pressure and improves the lipoprotein profile.
This study intended in evaluating the effectiveness of exercise therapy in patients with craniomandibular disorders (CMD). Twenty consecutive patients suffering from CMD with anterior disc displacement without reduction consulting a CMD service were included in the study if they met following criteria: (i) pain in the temporomandibular region, (ii) reduced incisal edge clearance (<35 mm), (iii) magnet resonance imaging confirmed anterior disc displacement without reduction and (iv) evidence of postural dysfunction. All patients were assigned to a waiting list, serving as a no-treatment control period, according to a before-after trial. The treatment consisted of active and passive jaw movement exercises, correction of body posture and relaxation techniques. A total of 18 patients completed the study, no adverse effects occurred. Following main outcome measures were evaluated: (1) pain at rest (2) pain at stress (3) impairment (4) mouth opening at base-line, before and after treatment and at 6 month follow-up. As a result of treatment pain, impairment and mouth opening improved significantly more than during control period (paired samples t-test P < 0.05). After treatment four patients had no pain at all (chi-square: P < 0.05) and only seven patients revealed an impaired incisal edge clearance after treatment. (chi-square Test, P < 0.001). At follow up, seven patients had no pain and experienced no impairment. Exercise therapy seems to be useful in the treatment of anterior disc displacement without reduction.
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OBJECTIVE: To adapt and standardize neural tissue mobilization exercises, quantify nerve root movement, and assess the anatomic effects of lumbar spinal nerve and dural mobilization in dogs. ANIMALS: 15 canine cadavers. PROCEDURES: 5 cadavers were used in the preliminary part of the study to adapt 3 neural tissue mobilization physical therapy exercises to canine anatomy. In the other 10 cadavers, the L4 to L7 nerve roots and the dura at the level of T13 and L1 were isolated and marked. Movements during the physical therapy exercises were standardized by means of goniometric control. Movement of the nerve roots in response to each exercise was digitally measured. The effects of body weight and crownrump length on the distance of nerve root movement achieved during each exercise were also assessed. Each exercise was divided into 4 steps, and the overall distance of neural movement achieved was compared with distances achieved between steps. RESULTS: Neural tissue mobilization exercises elicited visible and measurable movement of nerve roots L4 to L7 and of the dura at T13 and L1 in all cadavers. CONCLUSIONS AND CLINICAL RELEVANCE: The physical therapy exercises evaluated had measurable effects on nerve roots L4 to L7 and the dura mater in the T13 and L1 segments. These exercises should be evaluated in clinical trials to validate their efficacy as primary treatments or ancillary postsurgical therapy in dogs with disorders of the thoracolumbar and lumbosacral segments of the vertebral column.
We compared the efficacy of two antihyperlipidemic drugs and the efficacy of diet plus exercise therapy in the treatment of patients with moderate hypercholesterolemia. The study included 48 patients with moderate hypercholesterolemia (serum total cholesterol [TC], 250 to 320 mg/dL). Patients were divided into three groups: group A--patients administered 10 mg/d of pravastatin; group B--patients administered 500 mg/d of probucol and 600 mg/d of pantethine; and group C--patients administered diet plus exercise therapy. The serum TC and serum high-density lipoprotein cholesterol (HDL-C) values were determined via enzymatic methods before initiation of each therapy and after 4 and 8 weeks of therapy. An atherogenic index (AI) was also calculated. The results indicated that TC showed a statistically significant decrease in all three groups at 4 and 8 weeks (P < 0.001 and P < 0.05, respectively); the HDL-C value did not change significantly in groups A and C, but it had a statistically significant decrease in group B at 4 and 8 weeks. The AI showed a statistically significant decrease in group A at 4 and 8 weeks of treatment and group C at 8 weeks; there were no significant changes in AI in group B. It may be concluded that as an antihyperlipidemic agent, pravastatin is more useful than probucol and that appropriate exercise and strict dietary management for 8 weeks achieve an efficacy close to that achieved by drug therapy.
Twenty-two patients with intermittent claudication were prospectively enrolled in a 12-week program of supervised, graded treadmill exercise therapy. Severity and distribution of arterial occlusive disease were ascertained by noninvasive determination of segmental lower extremity blood pressures and waveforms. No attempt was made to modify risk factors for atherosclerotic occlusive disease. The exercise-induced reduction of the ankle pressure and its recovery were recorded over time, and the area under this curve, the "ischemic window," represents the severity of the ischemic deficit. Absolute systolic ankle pressure, ankle-brachial index, maximum walking time, claudication pain time, and the ischemic window were measured before and after exercise training in all subjects. Maximum walking time and claudication pain time increased 659% and 846%, respectively, among the 19 patients completing the 12-week program (p = 0.001; p = 0.0002). These patients underwent a mean reduction of 58.7% in the ischemic window after a standardized workload (p less than 0.05), and this correlated with the degree of symptomatic improvement. Absolute ankle pressure and ankle-brachial index were unchanged after exercise training. This study confirms the utility of supervised exercise therapy in the treatment of intermittent claudication. The ischemic window is a useful method for quantifying the ischemic deficit produced by exercise and provides a reproducible means of documenting functional improvement in patients undergoing exercise training.
To assess the efficacy of exercise therapy for acute low back pain, a randomized, placebo-controlled trial was performed in 40 Dutch general practices. Patients received either exercise instruction with advice for daily life by a physiotherapist; placebo ultrasound therapy by a physiotherapist; or usual care by the general practitioner. All patients received analgesic agents and information on low back pain before randomization. Four hundred seventy-three patients were included. No differences in number of recurrences, functional health status, or medical care usage could be found among the three groups. In the exercise group, duration of recurrences was shorter and patients were less tired during the first 3 months than in the usual care group, but no differences were found between the exercise and placebo groups. It was concluded that exercise therapy for patients with acute low back pain has no advantage over usual care from the general practitioner.
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Twenty-one patients with essential hypertension were treated with aerobic (lactate threshold) exercise (n = 21) and the change in blood pressure was compared with that in a non-exercising hypertensive control group (n = 10). After 10 weeks of exercise therapy blood pressure in the exercise group was significantly reduced, from 154 +/- 3/100 +/- 2 to 141 +/- 3/93 +/- 3 mmHg, and there was a significant reduction in plasma volume, cardiac index and plasma noradrenaline whereas there were no changes in the non-exercise group. Responders (10 mmHg or more fall in mean blood pressure) in the exercise group had a significantly higher cardiac index, serum Na:K ratio and lower total peripheral resistance in pretraining studies than non-responders. In conclusion, exercise at lactate threshold is effective in lowering blood pressure in those mild hypertensives with higher cardiac index and serum Na:K ratio.
To clarify the present state of exercise therapy for diabetes mellitus, we conducted a survey of 570 diabetic outpatients by written questionnaires. The results revealed that approximately 30% of the patients did not implement the prescribed exercise regimen. The principal reasons for low compliance were 'lack of time to do' and 'lack of mind to do'. 'Lack of time to do' was particularly numerous in male patients. Other reasons were 'lack of guidance by physician', 'lack of interest', 'lack of understanding of procedure'. These findings indicated that the patients should be motivated adequately when they are diagnosed as having diabetes and subsequently encouraged to reinforce their intentions by the physician and co-medical staff. Furthermore, they showed that specific approaches suitable for each individual patient and not standardized guidelines should be devised. As regards the daily environment of patients, the cooperation of the patient's family would be effective and the exercise facilities and the exercise guidance personnel should be augmented.
BACKGROUND: Regular physical activity has been consistently related to improvements in health- related quality of life (HRQL) in older adults. Nevertheless, systematic investigations of the influence of exercise therapy on older men and women enrolled in cardiac rehabilitation remain sparse. PURPOSE: The primary purpose of this investigation was to compare the effects of a group-mediated cognitive behavioral physical activity intervention program (GMCB) to a traditional cardiac rehabilitation program (CRP) with regard to changes in HRQL in a community-dwelling sample of older adults. METHODS: This randomized clinical trial assigned 147 participants who were eligible for inclusion in cardiac rehabilitation to the GMCB or traditional CRP arms. Changes in HRQL at 3 and 12 months were assessed using the Short Form-36 (SF-36) from the Medical Outcomes Study. RESULTS: Mixed-model analyses yielded significant Baseline x Gender x Treatment interactions for the self-reported mental health component and the Vitality subscale of the SF-36. Decomposition of these interactions revealed that men in both exercise therapy groups and women in the GMCB treatment with low baseline values demonstrated more favorable improvements in the HRQL perceived mental health measures than women in the CRP treatment. CONCLUSIONS: Improvements in HRQL among older adults enrolled in cardiac rehabilitation differ as a function of treatment, gender, and initial mental health status. Results are discussed in terms of the implications for the design of future physical activity interventions among older adults with cardiovascular disease and the measurement of their HRQL.
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Two groups of middle-aged men, one with and one without overt cardiovascular disease, were studied while they were taking part in a specially designed course of exercise therapy in a gymnasium. The "patients" group had at least two months pre-treatment to allow physical recovery and mental re-education before their initial very small test dose of exercise. Using short periods of progressive, mainly weight-loaded, isotonic exercises carefully regulated by control of pulse rate and avoidance of symptoms of over-exertion, both groups showed large increases in effort capacity and reductions in resting pulse rate, blood pressure and plasma lipid levels within two months. The safety of this particular form of exercise was shown in this high-risk population by the low drop-out rate and the absence of cardiovascular accidents in the gymnasium over a ten year period. It is suggested that, given suitable training of the staff and using the safeguards described, the presence of doctors and a cardiac resuscitation team is unnecessary in a gymnasium specializing in cardiac rehabilitation. This makes it possible for rehabilitation and physiotherapy departments throughout the country to carry out this effective and positive form of exercise therapy.
Prone immersion physical exercise therapy has been used successfully in the physical rehabilitation of middle-aged adults with moderate to severe chronic obstructive pulmonary disease. The purpose of this pilot project was to evaluate the effects of PIPE therapy in children with cystic fibrosis. Three children with CF, two boys aged 6 and 14 years and one girl aged 15 years, voluntarily participated in the experimental training program. The patients performed individualized group exercise three times a week on alternate days for 28 consecutive weeks at an intensity of approximately 75 percent aerobic capacity. Duration of exercise gradually increased from 15 (3 x 5 minutes) to 60 (3 x 20 minutes) minutes while the rest period after each exercise was constant at two minutes. PIPE training resulted in increased physical work capacity and maximal oxygen consumption in all three subjects. Curiously, these changes were not accompanied by training bradycardia.
OBJECTIVES: To determine whether ethnicity was associated with baseline and 18-month health status within a merged sample of older adults with knee osteoarthritis (OA) from the Fitness Arthritis in Seniors Trial and the Arthritis, Diet, and Activity Promotion Trial. DESIGN: Cross-sectional and prospective study. SETTING: Center-based exercise therapy at two universities. PARTICIPANTS: A total of 584 African-American (n=143) and Caucasian-American (n=441) adults aged 60 and older with knee OA were examined for baseline and 18-month health status. MEASUREMENTS: Six-minute-walk distance, 36-item Short Form General Health Scale (SF-36 GHS), and Physical Functioning Questionnaire index score. Ethnicity was obtained via self-report. RESULTS: Analyses of covariance testing the effect of ethnicity, adjusted for demographic and health status covariates, revealed significant effects for ethnicity upon baseline 6-minute-walk distance and SF-36 GHS, with Caucasian Americans reporting better scores (P=.001), although these differences were not significant after 18 months of exercise therapy. CONCLUSION: Ethnicity and baseline function are important factors that should not be overlooked in knee OA research involving exercise interventions. Moreover, not only should physical activity be recommended to improve functional outcomes, it may also be a useful strategy in reducing health disparities.