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Marriott KA, Birmingham TB. Fundamentals of osteoarthritis. Rehabilitation: Exercise, diet, biomechanics, and physical therapist-delivered interventions. Osteoarthritis Cartilage 2023; 31:1312-1326. [PMID: 37423596 DOI: 10.1016/j.joca.2023.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 06/02/2023] [Accepted: 06/05/2023] [Indexed: 07/11/2023]
Abstract
Insights related to the pathogenesis of osteoarthritis (OA) have informed rehabilitative treatments that aim to mitigate the influence of several known impairments and risk factors for OA, with the goal to improve pain, function, and quality of life. The purpose of this invited narrative review is to provide fundamental knowledge to non-specialists about exercise and education, diet, biomechanical interventions, and other physical therapist-delivered treatments. In addition to summarizing the rationale for common rehabilitative therapies, we provide a synthesis of current core recommendations. Robust evidence based on randomized clinical trials supports exercise with education and diet as core treatments for OA. Structured, supervised exercise therapy is advised. The mode of exercise may vary but should be individualized. The dose should be based on an initial assessment, the desired physiological changes, and progressed when appropriate. Diet combined with exercise is strongly recommended and studies demonstrate a dose-response relationship between the magnitude of weight loss and symptom improvement. Recent evidence suggests the use of technology to remotely deliver exercise, diet and education interventions is cost-effective. Although several studies support the mechanisms for biomechanical interventions (e.g., bracing, shoe inserts) and physical therapist-delivered (passive) treatments (e.g., manual therapy, electrotherapeutic modalities) fewer rigorous randomized trials support their clinical use; these therapies are sometimes recommended as adjuncts to core treatments. The mechanisms of action for all rehabilitative interventions include contextual factors such as attention and placebo effects. These effects can challenge our interpretation of treatment efficacy from clinical trials, yet also provide opportunities to maximize patient outcomes in clinical practice. When evaluating rehabilitative interventions, the field may benefit from increased emphasis on research that considers contextual factors while evaluating mechanistic, longer-term, clinically-important and policy-relevant outcome measures.
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Affiliation(s)
- Kendal A Marriott
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada.
| | - Trevor B Birmingham
- School of Physical Therapy, Faculty of Health Sciences, Bone and Joint Institute, University of Western Ontario, London, Ontario, Canada.
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Atrial Fibrillation Specific Exercise Rehabilitation: Are We There Yet? J Pers Med 2022; 12:jpm12040610. [PMID: 35455726 PMCID: PMC9029299 DOI: 10.3390/jpm12040610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/25/2022] [Accepted: 03/31/2022] [Indexed: 11/26/2022] Open
Abstract
Regular physical activity and exercise training are integral for the secondary prevention of cardiovascular disease. Despite recent advances in more holistic care pathways for people with atrial fibrillation (AF), exercise rehabilitation is not provided as part of routine care. The most recent European Society of Cardiology report for AF management states that patients should be encouraged to undertake moderate-intensity exercise and remain physically active to prevent AF incidence or recurrence. The aim of this review was to collate data from primary trials identified in three systematic reviews and recent real-world cohort studies to propose an AF-specific exercise rehabilitation guideline. Collating data from 21 studies, we propose that 360–720 metabolic equivalent (MET)-minutes/week, corresponding to ~60–120 min of exercise per week at moderate-to-vigorous intensity, could be an evidence-based recommendation for patients with AF to improve AF-specific outcomes, quality of life, and possibly prevent long-term major adverse cardiovascular events. Furthermore, non-traditional, low-moderate intensity exercise, such as Yoga, seems to have promising benefits on patient quality of life and possibly physical capacity and should, therefore, be considered in a personalised rehabilitation programme. Finally, we discuss the interesting concepts of short-term exercise-induced cardioprotection and ‘none-response’ to exercise training with reference to AF rehabilitation.
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West DWD, Doering TM, Thompson JLM, Budiono BP, Lessard SJ, Koch LG, Britton SL, Steck R, Byrne NM, Brown MA, Peake JM, Ashton KJ, Coffey VG. Low responders to endurance training exhibit impaired hypertrophy and divergent biological process responses in rat skeletal muscle. Exp Physiol 2021; 106:714-725. [PMID: 33486778 DOI: 10.1113/ep089301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 01/19/2021] [Indexed: 12/11/2022]
Abstract
NEW FINDINGS What is the central question of this study? The extent to which genetics determines adaptation to endurance versus resistance exercise is unclear. Previously, a divergent selective breeding rat model showed that genetic factors play a major role in the response to aerobic training. Here, we asked: do genetic factors that underpin poor adaptation to endurance training affect adaptation to functional overload? What is the main finding and its importance? Our data show that heritable factors in low responders to endurance training generated differential gene expression that was associated with impaired skeletal muscle hypertrophy. A maladaptive genotype to endurance exercise appears to dysregulate biological processes responsible for mediating exercise adaptation, irrespective of the mode of contraction stimulus. ABSTRACT Divergent skeletal muscle phenotypes result from chronic resistance-type versus endurance-type contraction, reflecting the principle of training specificity. Our aim was to determine whether there is a common set of genetic factors that influence skeletal muscle adaptation to divergent contractile stimuli. Female rats were obtained from a genetically heterogeneous rat population and were selectively bred from high responders to endurance training (HRT) or low responders to endurance training (LRT; n = 6/group; generation 19). Both groups underwent 14 days of synergist ablation to induce functional overload of the plantaris muscle before comparison to non-overloaded controls of the same phenotype. RNA sequencing was performed to identify Gene Ontology biological processes with differential (LRT vs. HRT) gene set enrichment. We found that running distance, determined in advance of synergist ablation, increased in response to aerobic training in HRT but not LRT (65 ± 26 vs. -6 ± 18%, mean ± SD, P < 0.0001). The hypertrophy response to functional overload was attenuated in LRT versus HRT (20.1 ± 5.6 vs. 41.6 ± 16.1%, P = 0.015). Between-group differences were observed in the magnitude of response of 96 upregulated and 101 downregulated pathways. A further 27 pathways showed contrasting upregulation or downregulation in LRT versus HRT in response to functional overload. In conclusion, low responders to aerobic endurance training were also low responders for compensatory hypertrophy, and attenuated hypertrophy was associated with differential gene set regulation. Our findings suggest that genetic factors that underpin aerobic training maladaptation might also dysregulate the transcriptional regulation of biological processes that contribute to adaptation to mechanical overload.
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Affiliation(s)
- Daniel W D West
- Department of Physiology and Membrane Biology, University of California Davis, Davis, California, USA.,Toronto Rehabilitation Institute, Toronto, Ontario, Canada.,Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Thomas M Doering
- Faculty of Health Sciences and Medicine, Bond University, Robina, Gold Coast, Queensland, Australia.,School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Queensland, Australia
| | - Jamie-Lee M Thompson
- Faculty of Health Sciences and Medicine, Bond University, Robina, Gold Coast, Queensland, Australia
| | - Boris P Budiono
- School of Community Health, Charles Sturt University, Port Macquarie, New South Wales, Australia
| | - Sarah J Lessard
- Research Division, Joslin Diabetes Center, Boston, Massachusetts, USA.,Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Lauren G Koch
- Department of Physiology and Pharmacology, University of Toledo, Toledo, Ohio, USA
| | - Steven L Britton
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Roland Steck
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Nuala M Byrne
- School of Health Sciences, University of Tasmania, Launceston, Tasmania, Australia
| | - Matthew A Brown
- Guy's & St Thomas' NHS Foundation Trust and King's College London NIHR Biomedical Research Centre, London, UK
| | - Jonathan M Peake
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Kevin J Ashton
- Faculty of Health Sciences and Medicine, Bond University, Robina, Gold Coast, Queensland, Australia
| | - Vernon G Coffey
- Faculty of Health Sciences and Medicine, Bond University, Robina, Gold Coast, Queensland, Australia
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Green DJ, Marsh CE, Thomas HJ, Naylor LH, Scurrah KJ. Exercise: One size does not fit all: authors' response. J Physiol 2020; 598:4131-4132. [PMID: 32725899 DOI: 10.1113/jp280579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 07/24/2020] [Indexed: 11/08/2022] Open
Affiliation(s)
- Daniel J Green
- School of Human Sciences, Exercise and Sport Science, The University of Western Australia, Perth, WA, Australia
| | - Channa E Marsh
- School of Human Sciences, Exercise and Sport Science, The University of Western Australia, Perth, WA, Australia
| | - Hannah J Thomas
- School of Human Sciences, Exercise and Sport Science, The University of Western Australia, Perth, WA, Australia
| | - Louise H Naylor
- School of Human Sciences, Exercise and Sport Science, The University of Western Australia, Perth, WA, Australia
| | - Katrina J Scurrah
- Twins Research Australia, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, VIC, Australia
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