[Role of the nurse in exercise therapy].
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The purpose of this study was to compare the therapeutic efficacy of three exercise therapy approaches. Three groups of adult stroke patients (N = 131) participated in the study. The first group received conventional treatment that consisted of traditional exercises and functional activities. The treatment of the second group was based on proprioceptive neuromuscular facilitation techniques. The third group was treated using the Bobath approach. The improvement of each patient was evaluated after six weeks of treatment in terms of functional gains in activities of daily living as measured using the Barthel index, changes in the muscle tone of the involved limbs as measured using a five-point ordinal scale, changes in the isolated motor control of the ankle and wrist as measured by tests of muscle strength and range of motion, and changes in the patients' ambulatory status as measured using a nominal scale of four categories. The therapeutic effects of exercise according to each of the three approaches were compared using descriptive and nonparametric statistical methods. No substantial advantage could be attributed to any one of the three therapeutic approaches.
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It is well known that patients suffering from rheumatoid arthritis have a reduced muscular function. The positive effect of physical training on rheumatic patients has been shown. In this study the effect of exercise therapy performed in a heated swimming pool has been evaluated for eight patients in a non-acute stage of rheumatoid arthritis. The median pre-treatment maximal isometric and isokinetic quadriceps strength was 88 Nm (44-146) and 99 Nm (62-149) respectively, which was 61% and 70% of that found in a control group of healthy persons. After 2 months exercise therapy the median maximal isometric and isokinetic quadriceps strength increased by 38% and 16% compared to the pre-treatment value (p less than 0.02 and p less than 0.05). All patients, except one who developed cardiac arrhythmia during the second test, accomplished a submaximal bicycle test (a.m. Astrand). An increase in the aerobic capacity was observed in all patients after the training period.
In chronic heart failure of CAD, therapeutic approach will be available either with drugs or exercise. With exercise, coronary risk factors such as BP, lipid, DM and obesity will be controlled. In addition, ischemia will also be controlled by decreasing oxygen demand related to BP and HR, and with increasing oxygen supply by increased ECNOS gene expression, collateral formation and regression of coronary stenosis. Infarct size is also reported to be decreased by increasing MnSOD in the cell by exercise. Prognosis of CHF is also good in various evidence of exercise therapy. Recent advances of molecular biology have revealed various mechanisms of exercise effect. Thus, exercise if properly prescribed without provoking ischemia will be basically and clinically effective therapy for patients with CHF.
BACKGROUND: In the absence of randomized controlled trials that directly compare medical versus surgical treatment of morbid obesity, decision analysis is a useful tool to help determine the optimal treatment strategy. Using decision analysis we simulated a trial comparing diet and exercise therapy to laparoscopic gastric bypass surgery to determine which approach resulted in longer life expectancy. STUDY DESIGN: A Markov decision analysis model was constructed to evaluate survival after laparoscopic Roux-en-Y gastric bypass surgery compared with a diet and exercise program for a 45-year-old woman with a body mass index (BMI) of 40 kg/m(2). Baseline mortality data were derived from published tables of vital statistics, and the relative risks of death associated with obesity (relative to normal weight) were taken from epidemiologic studies. We assumed that successful surgery resulted in a reduction of BMI to 30 kg/m(2). The baseline assumptions were: an operative mortality of 0.4%; a probability of weight loss after surgery of 80%; a rate of weight loss on a diet and exercise program, 20% at two years; a rate of regain of lost weight, 95% at two years; a relative risk of death for a BMI of 40 kg/m(2), 2.70; and a relative risk of death for a BMI of 30 kg/m(2), 1.51. RESULTS: The undiscounted life expectancy after surgery was 69.7 years compared with 67.3 years for a diet and exercise program (an absolute increase in life expectancy of 2.4 years, a relative increase in life expectancy of 10.8%). Sensitivity analyses assumed discounting at 5%/y, and showed that surgery was associated with a longer expectation of life when the risk of operative mortality was less than 10%, and when the probability of weight loss after surgery was greater than 4%. CONCLUSIONS: In a decision analysis model, laparoscopic gastric bypass surgery for morbid obesity was associated with a substantially longer survival than diet and exercise therapy.