A 30-s chair-stand test as a measure of lower body strength in community-residing older adults

Utility of the late life function and disability instrument as an outcome measure in patients participating in outpatient cardiac rehabilitation: a preliminary study

PURPOSE

The purpose of this study was to examine the concurrent validity of the Late Life Function and Disability Instrument (LLFDI) in patients with coronary heart disease (CHD) and to evaluate the accuracy of information obtained through self-report questionnaire versus interview formats.

METHODS

The study included 29 patients older than 60 years attending an outpatient cardiac rehabilitation program. Participants completed the LLFDI, three additional self-report criterion measures, and six performance-based tests; they completed the LLFDI a second time via interview. We used descriptive statistics, correlations, and t-tests to analyze the data.

RESULTS

All LLFDI components were correlated (rs=0.36-0.83) with the self-report criterion measures. The Function Component of the LLFDI was moderately correlated with the 6-Minute Walk Test (r=0.62), timed up-and-go (r=-0.58), walking speed (r=-0.57), and timed sit-to-stand (r=-0.56) scores. The LLFDI demonstrated a ceiling effect (10%) only in the Disability Limitation component. All LLFDI component scores obtained via self-report questionnaire were correlated with scores obtained via interview; except in a single subcategory, there was no difference between LLFDI scores obtained through self-report questionnaire and those obtained through interview.

CONCLUSIONS

RESULTS indicate that the LLFDI has appropriate validity for older patients (>60 years) with CHD and can be completed independently by patients rather than administered by clinicians.

Mobility of Vulnerable Elders (MOVE): study protocol to evaluate the implementation and outcomes of a mobility intervention in long-term care facilities

Background

Almost 90% of residents living in long-term care facilities have limited mobility which is associated with a loss of ability in activities of daily living, falls, increased risk of serious medical problems such as pressure ulcers, incontinence and a significant decline in health-related quality of life. For health workers caring for residents it may also increase the risk of injury. The effectiveness of rehabilitation to facilitate mobility has been studied with dedicated research assistants or extensively trained staff caregivers; however, few investigators have examined the effectiveness of techniques to encourage mobility by usual caregivers in long-term care facilities.

Methods/Design

This longitudinal, quasi-experimental study is designed to demonstrate the effect of the sit-to-stand activity carried out by residents in the context of daily care with health care aides. In three intervention facilities health care aides will prompt residents to repeat the sit-to-stand action on two separate occasions during each day and each evening shift as part of daily care routines. In three control facilities residents will receive usual care. Intervention and control facilities are matched on the ownership model (public, private for-profit, voluntary not-for-profit) and facility size. The dose of the mobility intervention is assessed through the use of daily documentation flowsheets in the health record. Resident outcome measures include: 1) the 30-second sit-to-stand test; 2) the Functional Independence Measure; 3) the Health Utilities Index Mark 2 and 3; and, 4) the Quality of Life - Alzheimer's Disease.

Discussion

There are several compelling reasons for this study: the widespread prevalence of limited mobility in this population; the rapid decline in mobility after admission to a long-term care facility; the importance of mobility to quality of life; the increased time (and therefore cost) required to care for residents with limited mobility; and, the increased risk of injury for health workers caring for residents who are unable to stand. The importance of these issues is magnified when considering the increasing number of people living in long-term care facilities and an aging population.

Trial Registration

This clinical trial is registered with ClinicalTrials.gov (trial registration number: NCT01474616).

Comparison of postdischarge physiotherapy versus usual care following primary total knee arthroplasty for osteoarthritis: an exploratory pilot randomized clinical trial

Objective: To evaluate a pilot trial of a postdischarge physiotherapy intervention to improve patient function versus usual physiotherapy in patients undergoing total knee arthroplasty aiming to assess: recruitment rate, feasibility and acceptability of the intervention and control, suitability of outcomes, retention and adverse events and to inform sample size calculation for a definitive trial.

Design: Exploratory pilot randomized controlled trial using independent assessment.

Setting: Mixed urban and rural, UK.

Participants: Patients undergoing primary, elective unilateral knee arthroplasty for osteoarthritis.

Intervention: Two additional home physiotherapy visits of functional weight-bearing exercises, functional task-specific training versus treatment as usual.

Main outcome: Oxford Knee Score at 12 months. Secondary outcomes: completion rates, adverse events, Knee Injury and Osteoarthritis Outcome Score, leg extensor power, timed 10-m walk, timed sit-to-stand, resource use diaries. Assessments completed at baseline (pre-operatively), 3, 6 and 12 months.

Results: Of 181 eligible participants 107 (59.1%) were randomized over 13 months, one participant withdrew, no adverse events. Intervention group n = 56 (mean age 67.8), control group n = 51 (mean age 70.8). The difference in mean change of Oxford Knee Scores between groups (intervention – control) at 12 months was 0.2 (95% confidence interval (CI) –3.8, 4.2), P = 0.94. Patient diaries revealed non-trial additional physiotherapy requires improved measurement.

Conclusions: Successful recruitment and retention rates were achieved. The intervention appeared feasible and acceptable but may be suboptimal in intensity given recent research. A sample size of 1271 participants would be required for a fully powered randomized controlled trial using the main outcome. However new outcomes, potentially of greater validity and responsiveness, require consideration.

The effect of combined exercise training in adolescents who are overweight or obese with intellectual disability: the role of training frequency

Data about effects of exercise training in adolescents with intellectual disability (ID) are very limited. This study investigated the effect of 2 different frequencies of the same intensity and total training volume of combined exercise training on indices of body composition, physical fitness, and lipid profile in overweight and obese adolescents with ID. A total of 45 overweight and obese adolescents with ID aged 14-22 years with a total IQ 45-70 received combined exercise training 3 times a week (CET3) for 30 sessions (10 weeks; n = 15), twice a week (CET2) for 30 sessions (15 weeks; n = 15), or no training (10 weeks; n = 15). Groups were matched for age, sex, and education form. Before and after the intervention period, indices of body composition, physical fitness and lipid profile have been evaluated. Compared to the control group, CET3 resulted in a significant improvement of physical fitness, obesity indices, and lipid profile of the participants. Comparing CET2 with CET3, no significantly different evolutions were noticed, except for lower limb strength in favor of exercising 3 times a week. In conclusion, exercising 2 times a week, which is more feasible and practical for participants and guidance, has the same health beneficial effects as 3 times per week in overweight and obese adolescents with ID in short-term training.

A comparison of the relationship of 14 performance-based measures with frailty in older women

The purpose of this study was to determine which performance measures of physical function are most closely related to frailty and whether physical function is different across levels of frailty. Fifty-three community-dwelling Greek women (63-100 years) participated in this study. Participants were divided into 3 tertiles based on level of frailty as calculated from a frailty index (FI): lowest FI group (<0.19 FI), intermediate FI group (0.19-0.36 FI), and highest FI group (>0.36 FI). Performance measures tested were handgrip and knee extension muscle strength and fatigue, upper and lower body muscular endurance, walking performance, agility, and dynamic balance. The greatest proportion of variance in the FI was explained by combining all performance-based measures of physical function. The performance measures that were most closely related to frailty yet different across levels of frailty were ambulatory mobility, lower body muscular endurance, and nondominant handgrip strength. Walking at a preferred pace had the strongest relationship to frailty rather than walking at maximal pace. Grip strength of the nondominant hand had a stronger correlation with frailty compared with the dominant hand. The FI was a better predictor of physical function than chronological age. The decline in physical function accelerated after the intermediate FI tertile. Definitions of frailty need to combine performance-based measures that can identify impairments in various domains of physical function. The assessment protocols of these measures are important.

Therapeutic riding followed by rhythmic auditory stimulation to improve balance and gait in a subject with orthopedic pathologies

OBJECTIVES

The study objectives were to investigate the effect of therapeutic riding with a subject who had an orthopedic diagnosis.

DESIGN

This is a single-subject case report.

LOCATION

The study was conducted at an equestrian facility with an indoor riding arena.

SUBJECT

The subject was a 59-year-old woman with grade I spondylolisthesis at L4/L5 and multilevel lumbar spinal stenosis in central and foraminal canals. The subject had an anterior cervical fusion of C3-C7.

EVALUATION

The subject has been ambulating with a straight cane due to her history of frequent falls. Gait, agility, strength, range of motion, and balance testing were performed. The subject had impairments of bilateral lower extremities with an ataxic gait pattern and was at risk for continued falls according to the balance measures.

INTERVENTIONS

The intervention comprised therapeutic riding sessions 3 times a week for 20 minutes for 4 weeks. Each riding session was immediately followed by a 10-minute independent walking program with a metronome for rhythmic auditory stimulation.

OUTCOME MEASURES

The outcome measures were as follows: Manual muscle testing and range of motion of the lower extremities, Gait Speed Test, Dynamic Gait Index, Four-Square Step Test, Chair Stand Test, Single Leg Stance.

RESULTS

Improvements were seen in lower extremity strength and range of motion and balance. The subject improved on balance scores, placing her out of the risk for falls category.

CONCLUSIONS

Therapeutic riding followed by rhythmic auditory stimulation improved lower extremity range of motion, strength, and balance with this subject.

Medication use and functional status decline in older adults: a narrative review

BACKGROUND

Functional status is the cornerstone of geriatric care and serves as an indicator of general well-being. A decline in function can increase health care use, worsen quality of life, threaten independence, and increase the risk of mortality. One of several risk factors for decline in functional status is medication use.

OBJECTIVE

Our aim was to critically review published articles that have examined the relationship between medication use and functional status decline in the elderly.

METHODS

The MEDLINE and EMBASE databases were searched for English-language articles published from January 1986 to June 2011. Search terms included aged, humans, drug utilization, polypharmacy, inappropriate prescribing, anticholinergics, psychotropics, antihypertensives, drug burden index, functional status, function change or decline, activities of daily living, gait, mobility limitation, and disability. A manual search of the reference lists of the identified articles and the authors' article files, book chapters, and recent reviews was conducted to retrieve additional publications. Only articles that used rigorous observational or interventional designs were included. Cross-sectional studies and case series were excluded from this review.

RESULTS

Nineteen studies met the inclusion criteria. Five studies addressed the impact of suboptimal prescribing on function, 3 of which found an increased risk of worse function in community-dwelling subjects receiving polypharmacy. Three of the 4 studies that assessed benzodiazepine use and functional status decline found a statistically significant association. One cohort study identified no relationship between antidepressant use and functional status, whereas a randomized trial found that amitriptyline, but not desipramine or paroxetine, impaired certain measures of gait. Two studies found that increasing anticholinergic burden was associated with worse functional status. In a study of hospitalized rehabilitation patients, users of hypnotics/anxiolytics (eg, phenobarbital, zolpidem) had lower relative Functional Independence Measure motor gains than nonusers. Use of multiple central nervous system (CNS) drugs (using different definitions) was linked to greater declines in self-reported mobility and Short Physical Performance Battery (SPPB) scores in 2 community-based studies. Another study of nursing home patients did not report a significant decrease in SPPB scores in those taking multiple CNS drugs. Finally, 2 studies found mixed effects between antihypertensive use and functional status in the elderly.

CONCLUSIONS

Benzodiazepines and anticholinergics have been consistently associated with impairments in functional status in the elderly. The relationships between suboptimal prescribing, antidepressants, and antihypertensives and functional status decline were mixed. Further research using established measures and methods is needed to better describe the impact of medication use on functional status in older adults.

Nonsteroidal anti-inflammatory drug or glucosamine reduced pain and improved muscle strength with resistance training in a randomized controlled trial of knee osteoarthritis patients

OBJECTIVES

To investigate the effect of 12 weeks of strength training in combination with a nonsteroidal anti-inflammatory drug (NSAID), glucosamine, or placebo on muscle cross-sectional area (CSA), strength (primary outcome parameters), and function, power, pain, and satellite cell number (secondary outcome parameters) in patients with knee osteoarthritis (OA).

DESIGN

Double-blinded, randomized controlled trial.

SETTING

Hospital.

PARTICIPANTS

Patients (N=36; 20 women, 16 men; age range, 50-70y) with bilateral tibiofemoral knee OA. A total of 181 patients were approached, and 145 were excluded.

INTERVENTIONS

Patients were randomly assigned to treatment with the NSAID ibuprofen (n=12), glucosamine (n=12), or placebo (n=12) during 12 weeks of quadriceps muscle strength training.

MAIN OUTCOME MEASURES

Muscle CSA and strength.

RESULTS

No differences between groups were observed in gains in muscle CSA. Training combined with ibuprofen increased maximal isometric strength by an additional .22Nm/kg (95% confidence interval [CI], .01-.42; P=.04), maximal eccentric muscle strength by .38Nm/kg (95% CI, .05-.70; P=.02), and eccentric muscle work by .27J/kg (95% CI, .01-.53; P=.04) in comparison with placebo. Training combined with glucosamine increased maximal concentric muscle work by an additional .24J/kg versus placebo (95% CI, .06-.42; P=.01).

CONCLUSIONS

In patients with knee OA, NSAID or glucosamine administration during a 12-week strength-training program did not improve muscle mass gain, but improved maximal muscle strength gain in comparison with treatment with placebo. However, we do not find that the benefits are large enough to justify taking NSAIDs or glucosamine.

The Relationship between Falls Efficacy and Improvement in Fall Risk Factors Following an Exercise Plus Educational Intervention for Older Adults with Hip Osteoarthritis

PURPOSE

Older adults with decreased confidence in their ability to prevent a fall may benefit from an exercise programme that includes self-efficacy-enhancing education. The objectives of this study were to explore differences in fall-risk outcomes in older adults with higher vs. lower levels of falls efficacy and to evaluate the relationship between baseline falls-efficacy status and changes in fall risk factors following two interventions.

METHOD

Fifty-four older adults with hip osteoarthritis and at least one risk factor for falls received aquatic exercise twice weekly plus education once weekly (EE) or aquatic exercise only, twice weekly (EO), for 11 weeks.

RESULTS

EE participants with low baseline falls efficacy demonstrated significantly (p<0.05) greater improvement in balance and falls efficacy compared to EE participants with high baseline falls efficacy. In the EE group only, baseline falls-efficacy status (low vs. high median split on the Activities-specific Balance Confidence Scale) was significantly (p<0.05) correlated with positive balance and falls-efficacy change scores (Spearman rank r=0.45 and 0.63 respectively).

CONCLUSIONS

Individuals with one or more fall-risk factors and low falls efficacy may benefit from receiving an intervention that combines exercise with self-efficacy-enhancing education. Falls-efficacy screening may be important for decisions regarding referral to fall-prevention programmes.

Fatigue, muscle strength and vitamin D status in women with systemic lupus erythematosus compared with healthy controls

Recent studies have demonstrated an inverse relationship between vitamin D levels and fatigue in systemic lupus erythematosus (SLE). The aims of this study were to evaluate proximal muscle strength, fatigue and vitamin D levels in women with SLE compared with healthy controls and to investigate relationships between these factors in a cohort of women with SLE. Forty-five women (24 SLE, 21 healthy controls) participated. Primary outcome measures were the fatigue severity scale (FSS), isometric muscle strength of dominant limbs using hand held dynamometry, two functional tests – the 30-second chair stand test and the 1-kg arm lift test, with vitamin D status measured using 25(OH)D. Overall 25(OH)D levels were 68.4 (22.4) nmol/L with no difference between SLE and control groups. There was a statistically and clinically significant difference in fatigue, 1-kg arm lift, 30-second sit to stand, knee extension, hip flexion, hip abduction, shoulder flexion and grip strength in the SLE group compared with the control group ( p < 0.05). In the SLE group FSS was moderately correlated with both functional measures (1-kg arm lift r = −0.42, 30-second chair stand r = −0.44, p < 0.05). However, no statistically significant correlation between dynamometry measures and fatigue was evident. There was no association between fatigue and 25(OH)D level ( r = −0.12). In summary, women with SLE were weaker and demonstrated reduced physical function and higher fatigue levels than healthy controls. Fatigue was related to physical function but not vitamin D status or maximal isometric strength in vitamin D replete individuals with SLE.

Physical exercise for cancer patients with advanced disease: a randomized controlled trial

BACKGROUND

Physical exercise can improve cancer patients' functioning and reduce their symptom levels. A randomized, controlled trial was launched to test the hypothesis that physical exercise reduces fatigue and improves physical performance in cancer patients with advanced and incurable disease.

METHODS

Cancer patients (n = 231) with a life expectancy ≤2 years were randomized to a physical exercise group (PEG, n = 121) or a control usual care group (UCG, n = 110). The PEG exercised under supervision 60 minutes twice a week for 8 weeks. Assessments were performed before and after the intervention. The primary outcome was physical fatigue (PF) measured by the Fatigue Questionnaire. Physical performance was a secondary outcome measured by the Shuttle Walk Test (SWT) and hand grip strength (HGS) test. Analyses were performed after multiple imputations for missing data. The trial is registered with ClinicalTrials.gov (identifier, NCT00397774).

FINDINGS

Thirty-six percent of the PEG were lost to follow-up compared with 23% of the UCG, primarily as a result of disease progression. Seventy-eight PEG and 85 UCG patients completed the intervention. Analyses showed no significant between-group effects in PF. However, clinically and statistically significant between-group effects were found for the SWT and HGS test.

INTERPRETATION

Fatigue was not reduced but physical performance (SWT and HGS test) was significantly improved after 8 weeks of physical exercise. Physical exercise might therefore be a suitable approach for maintaining physical capacity in cancer patients with incurable and advanced disease.

Five-repetition sit-to-stand test: usefulness for older patients in a home-care setting

The usefulness of the five-repetition sit-to-stand (FRSTS) test was assessed with older patients in a home-care setting. Records of 45 patients (> or = 65 years old) were examined for information on FRSTS test performance. 5 patients were excluded. 23 patients were unable to complete the test. For the 17 able to complete the FRSTS test, the time required was statistically significantly greater than age-stratified norms. For patients treated in a home-care setting, inability to complete the FRSTS test clearly underscores the test's limitations and the need for alternatives.

Strength training following hematopoietic stem cell transplantation

BACKGROUND

Patients receiving high-dose chemotherapy and hematopoietic stem cell transplantation (HSCT) experience considerable reductions in physical activity and deterioration of their health status.

OBJECTIVE

The purpose of this pilot study was to test the effects of strength training compared with usual activity on physical activity, muscle strength, fatigue, health status perceptions, and quality of life following HSCT.

METHODS

Nineteen subjects were randomized to the exercise or control group. Moderate-intensity strength training began following discharge from the hospital. Dependent variables included physical activity, muscle strength, fatigue, health status perceptions, and quality of life. Variables were measured prior to admission to the hospital for HSCT, day 8 following HSCT, and 6 weeks following discharge from the hospital.

RESULTS

Significant time effects were noted for many variables with anticipated declines in physical activity, muscle strength, fatigue, and health status perceptions immediately after HSCT with subsequent improvements 6 weeks following hospital discharge. One group effect was noted with subjects in the exercise group reporting less fatigue than subjects in the control group. Although no significant interactions were detected, the trends suggest that the exercise group may be more physically active following the intervention compared with the usual-activity group.

CONCLUSIONS

This study demonstrates the potential positive effects of strength training on physical activity, fatigue, and quality of life in people receiving high-dose chemotherapy and HSCT.

IMPLICATIONS FOR PRACTICE

Preliminary evidence is provided for using strength training to enhance early recovery following HSCT. Elastic resistance bands are easy to use and relatively inexpensive.

Effect of combined exercise training on physical and metabolic fitness in adults with intellectual disability: a controlled trial

OBJECTIVE

Investigating the effect of combined aerobic and strength training on metabolic and physical fitness in adults with intellectual disabilities compared to endurance training and no training.

DESIGN

A controlled trial with patients receiving either combined (COM), endurance (END) or no training (C).

SETTING

Two centres for intellectual disabilities (Sterrenhuis, Brasschaat and Emiliani, Lokeren, Belgium).

SUBJECTS

Forty-five adults with intellectual disabilities (mean age: 42 (9,2), mean body mass index (BMI): 24 (3,9), mean IQ: 56 (5,6)).

INTERVENTION

Combined exercise training (n = 15) and endurance training (n = 15) twice a week for 70  minutes per session for 20 weeks and no training (n = 15). Groups were matched for age, sex and intellectual disability.

MAIN MEASURES

Lipid profile, physical fitness (primary); blood pressure and body composition.

RESULTS

Compared to no training, combined exercise training has significant positive effects on total cholesterol levels, aerobic capacity, muscle strength and resting systolic blood pressure, while endurance exercise training has significant effects on aerobic capacity and resting systolic blood pressure. Compared to endurance training, combined exercise training resulted in a significant better evolution of total cholesterol (mean differences: -18 versus -3 mg/dl), 1RM upper (+6 versus +1  kg) and lower limb (+25 versus +8  kg) and abdominal muscles (+15 versus +1  kg), hand grip strength (+9 versus +2  kg), muscle fatigue resistance (+11 versus +5  sec), sit-to-stand (+5 versus +2/30   sec) and systolic blood pressure (-15 versus -10 mmHg).

CONCLUSION

This study revealed a tendency towards more beneficial effects of combined exercise training in adults with intellectual disability.

The effect of regular walks on various health aspects in older people with dementia: protocol of a randomized-controlled trial

BACKGROUND

Physical activity has proven to be beneficial for physical functioning, cognition, depression, anxiety, rest-activity rhythm, quality of life (QoL), activities of daily living (ADL) and pain in older people. The aim of this study is to investigate the effect of walking regularly on physical functioning, the progressive cognitive decline, level of depression, anxiety, rest-activity rhythm, QoL, ADL and pain in older people with dementia.

METHODS/DESIGN

This study is a longitudinal randomized controlled, single blind study. Ambulatory older people with dementia, who are regular visitors of daily care or living in a home for the elderly or nursing home in the Netherlands, will be randomly allocated to the experimental or control condition. Participants of the experimental group make supervised walks of 30 minutes a day, 5 days a week, as part of their daily nursing care. Participants of the control group will come together three times a week for tea or other sedentary activities to control for possible positive effects of social interaction. All dependent variables will be assessed at baseline and after 6 weeks, and 3, 6, 9, 12 and 18 months of intervention. The dependent variables include neuropsychological tests to assess cognition, physical tests to determine physical functioning, questionnaires to assess ADL, QoL, level of depression and anxiety, actigraphy to assess rest-activity rhythm and pain scales to determine pain levels. Potential moderating variables at baseline are: socio-demographic characteristics, body mass index, subtype of dementia, apolipoprotein E (ApoE) genotype, medication use and comorbidities.

DISCUSSION

This study evaluates the effect of regular walking as a treatment for older people with dementia. The strength of this study is that 1) it has a longitudinal design with multiple repeated measurements, 2) we assess many different health aspects, 3) the intervention is not performed by research staff, but by nursing staff which enables it to become a routine in usual care. Possible limitations of the study are that 1) only active minded institutions are willing to participate creating a selection bias, 2) the drop-out rate will be high in this population, 3) not all participants will be able to perform/understand all tests.

TRIAL REGISTRATION

NTR1482.

Postural control deficits in people with fibromyalgia: a pilot study

INTRODUCTION

Postural instability and falls are increasingly recognized problems in patients with fibromyalgia (FM). The purpose of this study was to determine whether FM patients, compared to age-matched healthy controls (HCs), have differences in dynamic posturography, including sensory, motor, and limits of stability. We further sought to determine whether postural instability is associated with strength, proprioception and lower-extremity myofascial trigger points (MTPs); FM symptoms and physical function; dyscognition; balance confidence; and medication use. Last, we evaluated self-reported of falls over the past six months.

METHODS

In this cross-sectional study, we compared middle-aged FM patients and age-matched HCs who underwent computerized dynamic posturography testing and completed the Fibromyalgia Impact Questionnaire-Revised (FIQR) and balance and fall questionnaires. All subjects underwent a neurological and musculoskeletal examination. Descriptive statistics were used to characterize the sample and explore the relationships between variables. The relationships between subjective, clinical and objective variables were evaluated by correlation and regression analyses.

RESULTS

Twenty-five FM patients and twenty-seven HCs (combined mean age ± standard deviation (SD): 48.6 ± 9.7 years) completed testing. FM patients scored statistically lower on composite sensory organization tests (primary outcome; P < 0.010), as well as with regard to vestibular, visual and somatosensory ratio scores on dynamic posturography. Balance confidence was significantly different between groups, with FM patients reporting less confidence than HCs (mean ± SD: 81.24 ± 19.52 vs. 98.52 ± 2.45; P < 0.001). Interestingly, 76% to 84% of FM patients had gastrocnemius and/or anterior tibialis MTPs. Postural stability was best predicted by dyscognition, FIQR score and body mass index. Regarding falls, 3 (11%) of 27 HCs had fallen only once during the past 6 months, whereas 18 (72%) of 25 FM patients had fallen at least once. Fifteen FM patients (60%) reported falling at least three times in the past six months.

CONCLUSIONS

In this study, we report that middle-aged FM patients have consistent objective sensory deficits on dynamic posturography, despite having a normal clinical neurological examination. Further study is needed to determine prospective fall rates and the significance of lower-extremity MTPs. The development of interventions to improve balance and reduce falls in FM patients may need to combine balance training with exercise and cognitive training.

A computerized dynamic posturography (CDP) program to reduce fall risk in a community dwelling older adult with chronic stroke: a case report

A systematic review by Barclay-Goddard et al (2004) reported that force platform feedback improved stance symmetry but not sway, clinical balance outcomes, or measures of independence in adults with stroke. However, the role of computerized dynamic posturography (CDP) systems was not explored. The purpose of this case report was to describe a CDP training program to improve balance and reduce fall risk in a patient with a diagnosis of chronic stroke. A 61-year-old patient 8 years poststroke participated in 1 hour of CDP training, three times a week over a period of 6 weeks. Examination was conducted before and after intervention using the Sensory Organization Test (SOT), Limits of Stability (LOS) test, and Weight Bearing/Squat Symmetry test on a CDP system, and clinical testing with the Berg Balance Scale (BBS), Timed Up and Go (TUG), Activities-specific Balance Confidence (ABC) scale, 30-second Chair Stand (CS), and range of motion of the ankle joints. The patient improved in sensory integration abilities on the SOT for conditions 4, 5, and 6, and maximum excursion abilities improved by a range of 23-103% on the LOS test. Scores on the BBS increased from 37/56 to 47/56, which indicated reduced fall risk and her ABC score improved from 50% to 70%. Ankle ROM improved bilaterally by 6 to 8 degrees. This CDP training program showed promise as a systematic, objective method to reduce fall risk with improved overground performance of balance tasks in an individual with chronic stroke.

Exploring the feasibility of a physical activity intervention for midlife African American men

BACKGROUND

This study tested the initial efficacy of implementing a physical activity (PA) behavior change intervention for midlife African American (AA) men.

METHODS

Intervention components were based on information gathered during formative research preceding the intervention. Eligible participants were underactive AA men ages 45-66 years. In a quasi-experimental pre-post design, participants attended 90-min program sessions twice weekly for 8 weeks. Session topics specific to PA included overcoming barriers, gaining social support, setting goals, tracking progress and integrating into one's lifestyle. Participants were assigned to teams to facilitate group discussion, problem solving, accountability and camaraderie.

RESULTS

25 AA men (mean age = 54.7 ± 4.8 years) completed the intervention. After 8 weeks, significant (P < 0.05) positive changes were observed for moderate to vigorous-intensity PA (+7.3 hour week(-1)) and overall PA (+9.4 hour week(-1)), self-efficacy for PA (+12%), social support for PA from family (+28%) and friends (+53%), self-regulation for planning (+33%) and goal setting (+48%) and each fitness component (+9 to +144%). Based on a post-intervention satisfaction survey, participants rated the program very positively.

CONCLUSION

These positive results attest to the feasibility of successfully engaging midlife AA men in a tailored PA behavior change program.

Exercise in patients receiving hematopoietic stem cell transplantation: lessons learned and results from a feasibility study

PURPOSE/OBJECTIVES

To test the feasibility and acceptability of a strength-training intervention in patients receiving hematopoietic stem cell transplantation (HSCT).

DESIGN

One-group prospective, repeated-measures design.

SETTING

Academic medical center in the midwestern United States.

SAMPLE

Convenience sample of 10 patients receiving HSCT.

METHODS

The strength-training intervention consisted of a comprehensive program of progressive resistance to strengthen the upper body, lower body, and abdominal muscles using elastic resistance bands. Instruction and low-intensity training began while the patients were hospitalized and progressed to a moderate level immediately following discharge from the hospital. Training continued for six weeks following hospital discharge.

MAIN RESEARCH VARIABLES

Acceptability of the strength-training intervention was evaluated via subjective assessment and by determining the patient's ability to perform the exercises. Feasibility was evaluated by determining the number of patients who were able to complete the prescribed strength intervention and whether the patients used elastic resistance bands.

FINDINGS

The strength-training intervention was refined from an unsupervised, home-based program to a combination supervised and unsupervised program with weekly clinic visits. Patients reported that the exercises were very acceptable, although some started out at a very low intensity.

CONCLUSIONS

This pilot study demonstrates the feasibility and acceptability of the strength-training intervention. The level of supervision required for the strength-training intervention was higher than expected.

IMPLICATIONS FOR NURSING

Strength training may be an effective intervention to alleviate problems with decreased physical activity, reduced muscle mass, and fatigue in HSCT recipients. Additional research is needed.

Centella asiatica Improves Physical Performance and Health-Related Quality of Life in Healthy Elderly Volunteer

Recently, oxidative stress has been reported to contribute an important role in the decline of physical function as age advances. Numerous antioxidants can improve both physical and psychological performances resulting in the increase of health-related quality of life (HQOL). Therefore, we hypothesized that Centella asiatica, a medicinal plant reputed for nerve tonic, strength improvement and antioxidant activity, could improve the physical performance and HQOL especially in the physical satisfaction aspect, of the healthy elderly volunteer. To test this hypothesis, a double-blind, placebo-controlled, randomized trial was performed. Eighty healthy elderly were randomly assigned to receive placebo or standardized extract of C. asiatica at doses of 250, 500 and 750 mg once daily for 90 days. The subjects were evaluated to establish baseline data of physical performance using 30-s chair stand test, hand grip test and 6-min walk test. The health-related quality of life was assessed using SF-36. These assessments were repeated every month throughout the 3-month experimental period using the aforementioned parameters. Moreover, 1 month after the cessation of C. asiatica treatment, all subjects were also evaluated using these parameters again. The results showed that after 2 months of treatment, C. asiatica at doses of 500 and 750 mg per day increased lower extremity strength assessed via the 30-s chair stand test. In addition, the higher doses of C. asiatica could improve the life satisfaction subscale within the physical function subscale. Therefore, the results from this study appear to support the traditional reputation of C. asiatica on strength improvement, especially in the lower extremities of the elderly. C. asiatica also possesses the potential to be a natural resource for vigor and strength increase, in healthy elderly persons. However, further research is essential.

Percentage height of center of mass is associated with the risk of falls among elderly women: A case-control study

Falls are a serious health problem for aged people, causing social and economic burden. Despite being an important determinant of balance, the positioning of the center of mass (COM) has not been evaluated as a risk factor for falls. This study examined the association between the percentage height of COM (%COM) and the risk of falls in the elderly. Healthy women aged 60 years and older were consecutively selected in a case-control study. Forty-eight individuals classified as "fallers" (having suffered two or more falls in the previous year) were the cases while 48 age and weight-matched women with one fall or no falls in the previous year were the controls ("non-fallers"). Body composition and bone mineral density (BMD) by DXA, 30-second chair stand test, abdominal circumference, Berg's balance scale and %COM using the reaction board method were evaluated in all participants. Body composition parameters were not significantly different between groups. Spine and hip BMD tended to be lower in the fallers, but the difference was significant only at the femoral neck (0.80±0.10g/cm(2) versus 0.87±0.76g/cm(2); p<0.01). Berg's balance scale scores were lower among fallers than non-fallers (p<0.05). Percentage height of COM was significantly higher among fallers (p<0.001) and this was associated with a higher number of fractures (p<0.05). Percentage height of COM is significantly higher in the elderly with frequent falls. Further work is needed in order to determine the value of board reaction measurements in a clinical setting to identify patients at high risk.

Reference values for the Timed Up and Go test in healthy Japanese elderly people: determination using the methodology of meta-analysis

AIM

The purpose of this study was to determine the reference value for the Timed Up and Go test (TUG) in healthy Japanese elderly people using the methodology of meta-analysis, and to determine the value for different measurement protocols.

METHODS

Relevant research articles were identified from electronic databases: MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Igaku-cyuouzasshi. The search was conducted from January 1991 to June 2010, and the terms "timed up and go" and "elderly" were used in combination in the search. Furthermore, the searches were limited to articles involving Japanese healthy elderly people aged 60years and older. Weighted means of TUG were calculated by a fixed effect model and a random effect model to estimate reference values. Furthermore, the 95% confidence interval (CI) for the weighted mean of TUG was also estimated.

RESULTS

Twelve studies fulfilled the inclusion criteria: eight provided data for maximum effort, and five provided data related to usual pace. When weighted means of TUG were estimated by the fixed effect model, there was significant heterogeneity. Therefore, a random effect model was used for re-estimation. As a result, the weighted mean of TUG with maximum effort was 6.60s (95% CI=6.18-7.02s), and that at usual pace was 8.86s (95% CI=7.99-9.72s).

CONCLUSION

The reference values of TUG in Japanese healthy elderly people calculated in this study are certainly shorter than in African-Americans and Caucasians. The reference values of TUG estimated by our study appear to be specific for healthy, elderly, Japanese people.

Prehabilitation before total knee arthroplasty increases strength and function in older adults with severe osteoarthritis

Preparing for the stress of total knee arthroplasty (TKA) surgery by exercise training (prehabilitation) may improve strength and function before surgery and, if effective, has the potential to contribute to postoperative recovery. Subjects with severe osteoarthritis (OA), pain intractable to medicine and scheduled for TKA were randomized into a usual care (UC) group (n = 36) or usual care and exercise (UC + EX) group (n = 35). The UC group maintained normal daily activities before their TKA. The UC + EX group performed a comprehensive prehabilitation program that included resistance training using bands, flexibility, and step training at least 3 times per week for 4-8 weeks before their TKA in addition to UC. Leg strength (isokinetic peak torque for knee extension and flexion) and ability to perform functional tasks (6-minute walk, 30 second sit-to-stand repetitions, and the time to ascend and descend 2 flights of stairs) were assessed before randomization at baseline (T1) and 1 week before the subject's TKA (T2). Repeated-measures analysis of variance indicated a significant group by time interaction (p < 0.05) for the 30-second sit-to-stand repetitions, time to ascend the first flight of stairs, and peak torque for knee extension in the surgical knee. Prehabilitation increased leg strength and the ability to perform functional tasks for UC + EX when compared to UC before TKA. Short term (4-8 weeks) of prehabilitation was effective for increasing strength and function for individuals with severe OA. The program studied is easily transferred to a home environment, and clinicians working with this population should consider prehabilitation before TKA.

A comparison of 3 methodological approaches to defining major clinically important improvement of 4 performance measures in patients with hip osteoarthritis

STUDY DESIGN

Prospective cohort study.

OBJECTIVES

To establish the major clinically important improvement (MCII) of the timed up-and-go test (TUG), 40-meter self-paced walk test (40-m SPWT), 30-second chair stand (30 CST), and a 20-cm step test in patients with hip osteoarthritis (OA) undergoing physiotherapy treatment. As a secondary aim, a comparison of methods was employed to evaluate the effect of method on the reported MCII.

BACKGROUND

Minimal clinically important difference scores are commonly used by rehabilitation professionals to determine patient response following treatment. A gold standard for calculating MCII has yet to be determined, which has resulted in problems of interpretation due to varied results.

METHODS

As part of a randomized controlled trial, 65 patients were randomized into a physiotherapy treatment group for hip OA, in which they completed 4 physical performance measures at baseline and 9 weeks. Upon completion of physiotherapy, patients assessed their response to treatment on a 15-point global rating of change scale (GRCS). MCII was estimated using 3 variations of an anchor-based method, based on the patient's opinion.

RESULTS

A comparison of 3 methods resulted in the following change scores being best associated with our definition of MCII: a reduction equal to or greater than 0.8, 1.4, and 1.2 seconds for the TUG; an increase equal to or greater than 0.2, 0.3, and 0.2 m/s for the 40-m SPWT; an increase equal to or greater than 2.0, 2.6, and 2.1 repetitions for the 30 CST; an increase equal to or greater than 5.0, 12.8, and 16.4 steps for the 20-cm step test.

CONCLUSION

The variation in methods provided very different results. This illustrates the importance of comparing methodologies and reporting a range of values associated with the MCII, as such values vary, depending upon the methodology chosen.

Six-minute walk test for persons with mild or moderate disability from multiple sclerosis: performance and explanatory factors

PURPOSE

The primary purpose of this study was to determine the extent to which health factors, functional measures, and pulmonary impairment explain performance on 6-Minute Walk Test (6MWT) distance in ambulatory persons with multiple sclerosis (MS). Another purpose was to determine the effect of disability and age on 6MWT performance and explanatory factors.

METHODS

A cross-sectional study design was used to evaluate factors that explain performance on the 6MWT in 64 community-dwelling persons with MS-related disability (Expanded Disability Status Scale [EDSS] 3.8±1.6). Of the 64 participants, 43 (67.2%) exhibited mild disability (EDSS <4.0) and 21 (32.8%) had moderate disability (EDSS 4.0-6.5). A regression analysis compared 6MWT performance to measures of health factors (EDSS, number of medications, number of comorbidities, resting HR, systolic and diastolic blood pressure [BP]); physical performance (functional stair test [FST], sit-to-stand test [SST], static standing balance [BAL], Fatigue Severity Scale [FSS], Activities-specific Balance Confidence [ABC] Scale); and pulmonary function (forced expiratory volume in 1 second [FEV(1)], forced vital capacity [FVC], maximal voluntary ventilation [MVV], maximal inspiratory pressure [MIP], maximal expiratory pressure [MEP]).

RESULTS

EDSS, ABC, FST, SST, BAL, MVV, MIP, and MEP were significantly associated with 6MWT distance after adjusting for age. Multiple step-wise linear regression analysis revealed that ABC, FST, and BAL were significant and independent explanatory factors of 6MWT distance. ABC and FST explained 75% of the variance in 6MWT performance (R(2)=0.75). Curvilinear regression analysis revealed that the FST is the most significant explanatory factor for 6MWT distance, explaining 79% of the variance (R(2)=0.79).

CONCLUSIONS

6MWT performance in persons with MS was explained by balance confidence (ABC) and stair-climbing ability (FST). The ABC and FST may be practical clinical measures for explaining walking ability and determining risk for disablement in persons with MS.

The Five-Times-Sit-to-Stand test, a marker of global cognitive functioning among community-dwelling older women

OBJECTIVE

To determine whether there was an association between the Five-Times-Sit-to-Stand test (FTSS) and the global cognitive function assessed with Short-Portable-Mental-State-Questionnaire (SPMSQ) among the EPIDOS cohort.

DESIGN

Cross-sectional study corresponding to the baseline assessment of the EPIDOS study.

SETTING

Five French cities including Amiens, Lyon, Montpellier, Paris and Toulouse.

PARTICIPANTS

7421 community-dwelling older women (mean age 80.41 ± 0.04 years).

MEASUREMENTS

Time to achieve FTSS, and SPMSQ score. Age, body mass index, high number of comorbidities, cardiovascular risk factors, depression, regular physical activity, joint pain, quadriceps strength, visual acuity, use of psychoactive drugs, serum albumin, vitamin D deficiency (i.e., serum concentration < 10 ng/mL), and the influence of seasons and study centers were used as covariables. Subjects were divided into 2 groups according to SPMSQ score (either impaired < 8/10 or normal ≥ 8/10).

RESULTS

Compared to their counterparts, the women with cognitive impairment (n=1190, mean 81.51 ± 0.45 years) took more time in performing FTSS (17.8± 0.9 seconds versus 16.1 ± 0.3 seconds, P < 0.001). There was a significant negative association of SPMSQ score with FTSS (Unadjusted β=-0.02(95%CI -0.03;-0.01), P< 0.001; Fully Adjusted β=-0.03(95%CI -0.05;-0.01), P=0.003; Stepwise Backward Adjusted β=-0.02(95%CI -0.04;-0.01), P=0.005), as well as with advance in age (β=-0.04, P=0.006) and vitamin D deficiency (β=-0.34, P=0.011). The FTSS limit value in predicting moderate cognitive impairment was set at 15 seconds by a sensitivity analysis (negative predictive value=86%).

CONCLUSION

We found a negative association of FTSS with global cognitive performance. Achieving FTSS in less than 15 seconds made unlikely the existence of a moderate cognitive impairment. FTSS could be used as a tool in primary care medicine to exclude moderate cognitive decline.

Predictors of response to physical therapy intervention in patients with primary hip osteoarthritis

BACKGROUND

Few studies have investigated or identified common clinical tests and measures as being associated with progression of hip osteoarthritis (OA); fewer still are longitudinal studies exploring prognostic variables associated with long-term outcome following physical therapy treatment.

OBJECTIVE

The purpose of this study was to determine a set of prognostic factors that maximize the accuracy of identifying patients with hip osteoarthritis (OA) likely to demonstrate a favorable response to physical therapy intervention.

DESIGN

This was a prognostic study.

METHODS

Ninety-one patients with a clinical diagnosis of hip OA were analyzed to determine which clinical measures, when clustered together, were most predictive of a favorable response to physical therapy intervention. Responders were determined based on OMERACT-OARSI response criteria, which included percent and absolute changes in pain, function, and global rating of change over 1 year. These data served as the reference standard for determining the predictive validity of baseline clinical examination variables. Using multivariate regression analyses and calculations for sensitivity, specificity, and positive and negative likelihood ratios, a cluster was identified.

RESULTS

Five baseline variables (unilateral hip pain, age of ≤58 years, pain of ≥6/10 on a numeric pain rating scale, 40-m self-paced walk test time of ≤25.9 seconds, and duration of symptoms of ≤1 year) were retained in the final model. Failure to exhibit a condition of 1 of the 5 predictor variables decreased the posttest probability of responding favorably to physical therapy intervention from 32% to <1% (negative likelihood ratio=0.00, 95% confidence interval=0.00-0.70). Having at least 2 out of 5 predictor variables at baseline increased the posttest probability of success with physical therapy intervention from 32% to 65% (positive likelihood ratio=3.99, 95% confidence interval=2.66-4.48), and having 3 or more of 5 predictor variables increased the posttest probability of success to 99% or higher. A comparison with a control group that did not receive physical therapy further substantiated the cluster.

LIMITATIONS

The small sample size and the number of variables entered into the logistic regression model may have resulted in spurious findings. This study must be validated in replication studies before it can be considered for use in clinical practice.

CONCLUSIONS

This study completed the first step in the development of a preliminary cluster of baseline variables that identify patients with hip OA as positive responders to physical therapy intervention.

Effects of dual task balance training on dual task performance in elderly people: a randomized controlled trial

OBJECTIVE

To investigate the effects of dual task balance training in the elderly on standing postural control while performing a cognitive task.

DESIGN

A randomized two-group parallel controlled trial.

PARTICIPANTS

Forty-three subjects (all >65 years old) were enrolled in the study and were assigned randomly to either an experimental group (n = 21) or a control group (n = 22).

INTERVENTIONS

Subjects in the experimental group were given strength and balance training while performing cognitive tasks simultaneously. Subjects in the control group were given strength and balance training only. The training was administered twice a week for three months.

MEASUREMENTS

The Chair Stand Test, Functional Reach Test, Timed Up and Go Test and Trail Making Test were measured. The sway length of the centre of gravity was measured during standing while performing the Stroop task. The rate of Stroop task was also measured. All measurements were collected at baseline and after the training period.

RESULTS

There were no significant differences in Functional Reach Test, Timed Up and Go Test and sway length at baseline and after training between the two groups. However, the rate of Stroop task (P < 0.05) was significantly higher after training in the experimental group than in the control group.

CONCLUSIONS

These results suggest that dual task balance training in elderly people improves their dual task performance during standing postural control.

Effect of elastic-band-based resistance training on leg blood flow in elderly women

The age-related decline in basal limb blood flow appears to be related to the pathogenesis of metabolic syndrome, noninsulin-dependent diabetes, and cardiovascular disease. Resistance training improves basal limb blood flow and vascular conductance in middle-aged men and women, but it is unknown whether similar vascular effects of training occur in the elderly. This study aimed to examine the effects of a 12-week progressive resistance training program using elastic bands on basal leg blood flow, vascular conductance, and functional performance in postmenopausal elderly women. Sixteen healthy postmenopausal females (age, 67 ± 5 years) were randomly assigned to a control (n = 8) or resistance training (n = 8) group, where they underwent 2 supervised strength sessions per week for 12 weeks. Prior to and at completion of this 12-week period, functional and strength performance and leg haemodynamic responses were measured. The training intervention produced significant increases in basal leg blood flow (31%), vascular conductance (34%), and a significant reduction in cardiac work (i.e., rate pressure product) at rest, as well as significant improvements in the 3 functional ability tests performed (30-s bicep curl, 30-s sit to stand, and back scratch). Haemodynamic or functional performance responses were not altered after the 12 weeks in the control group. This study demonstrates that a resistance training program using elastic bands elicits significant improvements in basal leg blood flow in postmenopausal elderly women.

Independent static balance training contributes to increased stability and functional capacity in community-dwelling elderly people: a randomized controlled trial

OBJECTIVE

To evaluate the effectiveness of independently conducted static balance exercises within a fall-safe environment in elderly participants engaging in independent training.

DESIGN

Randomized two-group parallel controlled study.

SETTING

Retirement center, community dwelling.

SUBJECTS

Subjects, 25 male and female volunteers (aged 82.6  ±  6.1 years; weight 69.9  ±  97  kg; height 165  ±  6.9 cm; body mass index (BMI) 25.6  ±  2.6) residing in independent living facilities were randomly assigned to an experimental group or a control group.

INTERVENTION

The experimental group engaged in standing, static balancing, and mild leg exercise 12 minutes per session, three times per week for 12 weeks. Exercises were done independent of spotters within a rigid frame consisting of tethers connected to the subject so that he or she could not fall. The control group were given literature on prevention of falls.

MAIN OUTCOME MEASURES

Functional ability and balance was assessed using the following tests: 30-second chair stand test, 8-foot up and go test, Berg Balance Scale, and a step-up test.

RESULTS

Comparison by repeated-measures ANOVA of the performance before and after the 12-week intervention yielded significant (P  <  0.01) improvement for the experimental group over the control group in the 30-second chair test repetitions, in the 8-foot up and go test, in the balance assessment and in the leg function assessments.

CONCLUSION

Standing, static balance exercises conducted independently without safety supervision led to improvements in balance, functional ability, and leg functioning in frail elderly people.

A randomized controlled trial of home telerehabilitation for post-knee arthroplasty

We compared the effectiveness of home telerehabilitation with conventional rehabilitation following knee replacement surgery (total knee arthroplasty, TKA). Forty-eight patients (mean age 66 years) who received TKA were recruited prior to discharge from hospital after surgery and were randomly assigned to telerehabilitation or usual care. Telerehabilitation sessions (16 per participant over two months) were conducted by trained physiotherapists using videoconferencing to the patient's home via an Internet connection (512 kbit/s upload speed). Disability and function were measured using standardized outcome measures in face-to-face evaluations at three times (prior to and at the end of treatment, and four months after the end of treatment). Clinical outcomes improved significantly for all subjects in both groups between endpoints. Some variables showed larger improvements in the usual care group two months post-discharge from therapy than in the telerehabilitation group. Home telerehabilitation is at least as effective as usual care, and has the potential to increase access to therapy in areas with high speed Internet services.

Test–retest reliability of hand-held dynamometry and functional tests in systemic lupus erythematosus

The aim of this study was to evaluate the test–retest reliability and determine the degree of measurement error of tests of isometric muscle strength and upper and lower limb function in women with systemic lupus erythematosus (SLE). Twelve women with SLE (age 39.8 ± 10 years) were assessed on two occasions separated by a 7–10-day interval. Strength of six muscle groups was measured using a hand-held dynamometer; function was measured by the 30-s sit to stand test and the 30-s 1 kg arm lift. Relative reliability was estimated using the intraclass correlation coefficient (ICC), model 2,1 (ICC2,1). Absolute reliability was estimated using standard error measurement and the minimal detectable difference was calculated. All ICCs were greater than 0.87. Muscle strength would need to increase by between 18% and 39% in women with SLE to be 95% confident of detecting real changes. The functional tests demonstrated a systematic bias between trials. This study demonstrates that hand-held dynamometry in SLE can be performed with excellent reliability. Further work needs to be completed to determine the number of trials necessary for both the 30-s sit to stand and 30-s 1 kg arm lift to decrease the systematic bias.

Randomised controlled trial examining the effect of exercise in people with rheumatoid arthritis taking anti-TNFα therapy medication

Abstract

Methods/Design

Six hundred and eighteen individuals with RA, on anti-TNFα therapy medication, will be randomised into one of 3 groups: a land-based exercise group; a water-based exercise group or a control group. The land and water-based groups will exercise for one hour, twice a week for eight weeks. The control group will receive no intervention and will be asked not to alter their exercise habits for the duration of the study. The primary outcome measure, the Stanford Health Assessment Questionnaire Disability Index (HAQ-DI) which measures functional ability, and secondary measures of pain, fatigue and quality of life, will be assessed at baseline, eight and 24 weeks by an independent assessor unaware of group allocation. Changes in outcome from 0 to 8 weeks and 0 to 24 weeks in the 'land-based exercise group versus control group' and the 'water-based exercise group versus control group' will be examined. Analysis will be conducted on an intention to treat basis.

Discussion

This trial will evaluate the effectiveness of group exercise therapy on land or in water, for people with RA taking anti-TNFα therapy medication. If these exercise groups are found to be beneficial, they could be conducted in local community facilities thus making these forms of exercise more easily accessible for individuals and potentially reduce the burden on health services.

Trial Registration

This trial is registered with ClinicalTrials.gov (a service of the United States National Institutes of Health) identifier: NCT00855322.

Determinants of overweight and obesity in lung transplant recipients

BACKGROUND

Obesity-related diseases have been shown to affect post-lung transplantation survival. An estimated 30% of lung transplant recipients develop overweight.

OBJECTIVE

The aim of this study was to examine the possible determinants of large increases in weight after lung transplantation. The contribution of physical activity, food intake, and resting energy expenditure was examined in lung transplant recipients.

METHODS

In this cross-sectional study 21 overweight lung transplant recipients (11 men, mean age 57 ± 7 years; BMI 30 ± 3) and 21 normal-weight lung transplant recipients (11 men, mean age 56 ± 5 years; BMI 22 ± 3) were matched for disease, gender, age, prescribed medication, and time since lung transplantation. Physical activity was measured by a pedometer and a questionnaire; resting energy expenditure was measured by the ventilated-hood technique, and daily food intake by a dietician. Additionally, fat-free mass, lower-body strength, and fatigue were measured.

RESULTS

The overweight lung transplant recipients had a significantly lower number of steps per day (4,686 ± 3,266 vs. 7,524 ± 3,448 steps/day, p = 0.01) and a lower fat-free mass (64 ± 9 vs. 75 ± 6%, p < 0.05) compared to normal-weight recipients. Obese subjects had a lower percentage of predicted resting energy expenditure level compared to normal-weight recipients (90 ± 14 vs. 100 ± 14% predicted, p = 0.04).

CONCLUSION

Our data suggest that overweight in lung transplant recipients is associated with a lower fat-free mass and lower levels of physical activity and resting energy expenditure compared to normal-weight recipients.

Effects of a 10-week inspiratory muscle training program on lower-extremity mobility in people with multiple sclerosis: a randomized controlled trial

Pulmonary muscle weakness is common in ambulatory people with multiple sclerosis (MS) and may lead to deficits in mobility function. The purpose of this study was to examine the effect of a 10-week home-based exercise program using an inspiratory muscle threshold trainer (IMT) on the results of four lower-extremity physical performance tests in people with MS. The study design was a two-group (experimental-control), pretest-posttest study. Outcome measures consisted of pulmonary function measures including maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), and maximal voluntary ventilation (MVV), and the following lower-extremity physical performance measures: the 6-Minute Walk (6MW) distance, gait velocity (GV), the Sit-to-Stand Test (SST), the Functional Stair Test (FST), and a balance test (BAL). A total of 46 ambulatory participants (Expanded Disability Status Scale [EDSS] score, 2.0-6.5) with MS were randomly assigned to an intervention group (mean EDSS score, 4.1) that received 10 weeks of home-based inspiratory muscle training or a nontreatment control group (mean EDSS score, 3.2). Of the original 46 participants, 20 intervention group participants and 19 control group participants completed the study. Compared with the control group, the intervention group made significantly greater gains in inspiratory muscle strength (P = .003) and timed balance scores (P = .008). A nonsignificant improvement in 6MW distance (P = .086) was also noted in the IMT-trained group as compared with the control group. This is the first study directly linking improvement in respiratory function to improvement in physical performance function in people with mild-to-moderate disability due to MS.

Resistência aeróbia e força de membros inferiores de idosos praticantes e não-praticantes de ginástica recreativa em um centro de convivência

OBJETIVO: Analisar a resistência aeróbia e força de membros inferiores de idosos praticantes e não-praticantes de um programa de ginástica recreativa em um centro de convivência. MÉTODOS: Fizeram parte do estudo 54 voluntários - 26 não-praticantes (71,2 ± 6 anos e 26 ± 4,7 kg/m²) e 28 praticantes de ginástica recreativa (68,6 ± 7,7 anos e 27,5 ± 4,5 kg/m²). Todos foram submetidos ao teste de sentar-levantar da cadeira em 30 segundos (avaliação da força de membros inferiores) e teste de caminhada de seis minutos (avaliação da resistência aeróbia). RESULTADOS: O grupo participante do programa de ginástica obteve melhor média tanto no teste de sentar-levantar da cadeira em 30 segundos (16,1 ± 2,8 vs. 12,1 ± 2,7 execuções - p < 0,001), quanto no teste de caminhada de seis minutos (439,2 ± 46,1 vs. 373,1 ± 58,5 metros - p < 0,001). CONCLUSÃO: De acordo com os resultados obtidos, é possível concluir que os idosos participantes do programa de ginástica recreativa do centro de convivência analisado apresentaram melhores indicadores de resistência aeróbia e força de membros inferiores, sugerindo melhor nível de capacidade funcional em relação aos não-participantes.

Design of the Physical exercise during Adjuvant Chemotherapy Effectiveness Study (PACES): a randomized controlled trial to evaluate effectiveness and cost-effectiveness of physical exercise in improving physical fitness and reducing fatigue

Background

Cancer chemotherapy is frequently associated with a decline in general physical condition, exercise tolerance, and muscle strength and with an increase in fatigue. While accumulating evidence suggests that physical activity and exercise interventions during chemotherapy treatment may contribute to maintaining cardiorespiratory fitness and strength, the results of studies conducted to date have not been consistent. Additional research is needed to determine the optimal intensity of exercise training programs in general and in particular the relative effectiveness of supervised, outpatient (hospital- or physical therapy practice-based) versus home-based programs.

Methods

This multicenter, prospective, randomized trial will evaluate the effectiveness of a low to moderate intensity, home-based, self-management physical activity program, and a high intensity, structured, supervised exercise program, in maintaining or enhancing physical fitness (cardiorespiratory fitness and muscle strength), in minimizing fatigue and in enhancing the health-related quality of life (HRQoL). Patients receiving adjuvant chemotherapy for breast or colon cancer (n = 360) are being recruited from twelve hospitals in the Netherlands, and randomly allocated to one of the two treatment groups or to a 'usual care' control group. Performance-based and self-reported outcomes are assessed at baseline, at the end of chemotherapy and at six month follow-up.

Discussion

This large, multicenter, randomized clinical trial will provide additional empirical evidence regarding the effectiveness of physical exercise during adjuvant chemotherapy in enhancing physical fitness, minimizing fatigue, and maintaining or enhancing patients' quality of life. If demonstrated to be effective, exercise intervention programs will be a welcome addition to the standard program of care offered to patients with cancer receiving chemotherapy.

Trial registration

This study is registered at the Netherlands Trial Register (NTR 2159)

Design of the Resistance and Endurance exercise After ChemoTherapy (REACT) study: a randomized controlled trial to evaluate the effectiveness and cost-effectiveness of exercise interventions after chemotherapy on physical fitness and fatigue

BACKGROUND

Preliminary studies suggest that physical exercise interventions can improve physical fitness, fatigue and quality of life in cancer patients after completion of chemotherapy. Additional research is needed to rigorously test the effects of exercise programmes among cancer patients and to determine optimal training intensity accordingly. The present paper presents the design of a randomized controlled trial evaluating the effectiveness and cost-effectiveness of a high intensity exercise programme compared to a low-to-moderate intensity exercise programme and a waiting list control group on physical fitness and fatigue as primary outcomes.

METHODS

After baseline measurements, cancer patients who completed chemotherapy are randomly assigned to either a 12-week high intensity exercise programme or a low-to-moderate intensity exercise programme. Next, patients from both groups are randomly assigned to immediate training or a waiting list (i.e. waiting list control group). After 12 weeks, patients of the waiting list control group start with the exercise programme they have been allocated to.Both interventions consist of equal bouts of resistance and endurance interval exercises with the same frequency and duration, but differ in training intensity. Additionally, patients of both exercise programmes are counselled to improve compliance and achieve and maintain an active lifestyle, tailored to their individual preferences and capabilities.Measurements will be performed at baseline (t = 0), 12 weeks after randomization (t = 1), and 64 weeks after randomization (t = 2). The primary outcome measures are cardiorespiratory fitness and muscle strength assessed by means of objective performance indicators, and self-reported fatigue. Secondary outcome measures include health-related quality of life, self-reported physical activity, daily functioning, body composition, mood and sleep disturbances, and return to work. In addition, compliance and satisfaction with the interventions will be evaluated. Potential moderation by pre- and post-illness lifestyle, health and exercise-related attitudes, beliefs and motivation will also be assessed. Finally, the cost-effectiveness of both exercise interventions will be evaluated.

DISCUSSION

This randomized controlled trial will be a rigorous test of effects of exercise programmes for cancer patients after chemotherapy, aiming to contribute to evidence-based practice in cancer rehabilitation programmes.

TRIAL REGISTRATION

This study is registered at the Netherlands Trial Register (NTR2153).

Influence of combined aerobic and resistance training on metabolic control, cardiovascular fitness and quality of life in adolescents with type 1 diabetes: a randomized controlled trial

OBJECTIVE

To evaluate the effect of combined exercise training on metabolic control, physical fitness and quality of life in adolescents with type 1 diabetes.

DESIGN

A double-blind randomized controlled trial with patients receiving combined aerobic and strength or no training.

SETTING

University Hospital Ghent (Belgium).

SUBJECTS

Sixteen children with type 1 diabetes were randomized into a control group (n = 8) and an intervention group (n = 8).

INTERVENTIONS

Patients participated twice a week for 20 weeks in the combined aerobic and strength group. The control group continued their normal daily activities.

MAIN MEASURES

Before and after the intervention anthropometric variables (weight, length, BMI, body composition), metabolic control (glycaemia, HbA1c, daily insulin injected), aerobic capacity (peak Vo(2), peak power, peak heart rate, 6-minute walk distance), strength (1 repetition maximum of upper and lower limb, hand grip strength, muscle fatigue resistance, sit-to-stand) and quality of life (SF-36) were assessed.

RESULTS

At baseline, none of the measured parameters differed significantly between the two groups. There was no significant evolution in the groups concerning anthropometric indices, glycaemia and HbA1c. However, the daily doses of insulin injected were significantly lowered in the training group (0.96 IU/kg.day pre versus 0.90 IU/kg.day post; P < 0,05), while it was increased in the control group. Physical fitness increased significantly in the training group. General health, vitality and role emotional had a tendency to improve.

CONCLUSION

Combined exercise training seemed to lower daily insulin requirement and improve physical fitness, together with better well-being.

Prehabilitation versus usual care before total knee arthroplasty: A case report comparing outcomes within the same individual

This case report compared pre- and postoperative functional ability, knee strength, and pain of a female who underwent two separate total knee arthroplasty (TKA) procedures. The female patient was part of a larger research study. The first surgery on the right knee was preceded with usual care and the second surgery on the left knee was preceded by prehabilitation. Functional ability was assessed by a 6-minute walk, chair raises, and the time required to ascend and descend stairs. Knee extension and flexion isokinetic strength was assessed using the KinCom Isokinetic Dynamometer. Pain was assessed using the Western Ontario and McMasters Universities Osteoarthritis Index (WOMAC). Functional abilities, knee strength, and pain were assessed at baseline measurements 4 weeks before surgery, 1 week before surgery, and at 1 and 3 months post surgery during each TKA procedure. Results indicate that the prehabilitation intervention had a favorable impact on improving functional ability up to 30%, increasing knee strength by 50% and decreasing pain prior to the left knee TKA. For this patient, prehabilitation increased functional ability and strength prior to surgery. Gains in strength were maintained in the nonsurgical knee after surgery. These findings indicate that prehabilitation may be effective at facilitating the rehabilitation following a TKA.

Sit-to-stand test: Performance and determinants across the age-span

Although the validity of the sit-to-stand (STS) test as a measure of lower limb strength has been questioned, it is widely used as such among older adults. The purposes of this study were: 1) to describe five-repetition STS test (FRSTST) performance (time) by adolescents and adults and 2) to determine the relationship of isometric knee extension strength (force and torque), age, gender, weight, and stature with that performance. Participants were 111 female and 70 male (14-85 years) community-dwelling enrollees in the NIH Toolbox Assessment of Neurological and Behavioral Function. The FRSTST was conducted using a standard armless chair. Knee extension force was measured using a belt-stabilized hand-held dynamometer; knee extension torque was measured using a Biodex dynamometer. The mean times for the FRSTST ranged from 6.0 sec (20-29 years) to 10.8 sec (80-85 years). For both the entire sample and a sub-sample of participants 50-85 years, knee extension strength (r = -0.388 to -0.634), age (r = 0.561 and 0.466), and gender (r = 0.182 and 0.276) were correlated significantly with FRSTST times. In all multiple regression models, knee extension strength provided the best explanation of FRSTST performance, but age contributed as well. Bodyweight and stature were less consistent in explaining FRSTST performance. Gender did not add to the explanation of FRSTST performance. Our findings suggest, therefore, that FRSTST time reflects lower limb strength, but that performance should be interpreted in light of age and other factors.