Long-term care facilities' response to the COVID-19 pandemic: An international, cross-sectional survey

AIMS

To (i) assess the adherence of long-term care (LTC) facilities to the COVID-19 prevention and control recommendations, (ii) identify predictors of this adherence and (iii) examine the association between the adherence level and the impact of the pandemic on selected unfavourable conditions.

DESIGN

Cross-sectional survey.

METHODS

Managers (n = 212) and staff (n = 2143) of LTC facilities (n = 223) in 13 countries/regions (Brazil, Egypt, England, Hong Kong, Indonesia, Japan, Norway, Portugal, Saudi Arabia, South Korea, Spain, Thailand and Turkey) evaluated the adherence of LTC facilities to COVID-19 prevention and control recommendations and the impact of the pandemic on unfavourable conditions related to staff, residents and residents' families. The characteristics of participants and LTC facilities were also gathered. Data were collected from April to October 2021. The study was reported following the STROBE guidelines.

RESULTS

The adherence was significantly higher among facilities with more pre-pandemic in-service education on infection control and easier access to information early in the pandemic. Residents' feelings of loneliness and feeling down were the most affected conditions by the pandemic. More psychological support to residents was associated with fewer residents' aggressive behaviours, and more psychological support to staff was associated with less work-life imbalance.

CONCLUSIONS

Pre-pandemic preparedness significantly shaped LTC facilities' response to the pandemic. Adequate psychological support to residents and staff might help mitigate the negative impacts of infection outbreaks.

IMPACT

This is the first study to comprehensively examine the adherence of LTC facilities to COVID-19 prevention and control recommendations. The results demonstrated that the adherence level was significantly related to pre-pandemic preparedness and that adequate psychological support to staff and residents was significantly associated with less negative impacts of the pandemic on LTC facilities' staff and residents. The results would help LTC facilities prepare for and respond to future infection outbreaks.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution.

Association Between Neuropsychological Functions and Activities of Daily Living in People with Mild Cognitive Impairment

OBJECTIVE

The aim of this study was to explore the relationship between performance in neurocognitive variables and daily functioning (basic or b- and instrumental or i-ADL) in people with mild cognitive impairment (MCI).

METHODS

A sample of 157 participants with MCI (73.65 ± 7.58 years) completed a battery of tests for assessing ADL and cognitive functions. t-test, Pearson's correlation and multiple linear regression (backward stepwise selection) were used for data analyses.

RESULTS

Significant correlations were found between b- and i-ADL, and several neuropsychological tests (p < .01). Multivariate analysis showed that difficulties in Blessed Rating Scales (BLS) explained 33.2% of the variation in b-ADL and that this variation rises to 42.9% when BLS is associated with Frontal Assessment Battery Flexibility, Trail Making Test A (TMT-A) and BLS Personality. For i-ADL, BLS and Dementia Rating Scale Total (DRS-T) explained 47.7% of the variation and the inclusion in the model of BLS, DRS-IP (Initiation/Perseveration), TMT-A and BLS Personality explained 53.5% of this variation. Executive functions explained 24.8% of the variation in i-ADL.

CONCLUSIONS

Cognitive functions are related to i- and b-ADL in people with MCI. The general indicators and those that assess executive functions and verbal- or visual-spatial memory should be considered to predict i-ADL.

Effects of Aquatic Exercises for Women with Rheumatoid Arthritis: A 12-Week Intervention in a Quasi-Experimental Study with Pain as a Mediator of Depression

BACKGROUND

Rheumatoid arthritis (RA) is characterized by low physical fitness, pain, and depression. The present study aimed to examine the effects of a supervised aquatic exercise program on physical fitness, depression, and pain in women with RA and determine whether decreases in pain mediate depression.

METHODS

Forty-three women with RA, divided into an experimental group (EG; n = 21) and a control group (CG; n = 23), participated in a 12-week exercise program. Treatment effects were calculated via standardized difference or effect size (ES) using ANCOVA adjusted for baseline values (ES, 95% confidence interval (CI)). A simple panel of mediation was executed to determine whether changes in pain mediated improvements in depression after controlling for confounding variables, such as age, physical activity, and body mass index (BMI).

RESULTS

The aquatic exercise program had trivial and small effects on physical fitness, large effects on pain, and moderate effects on depression. The mediation model confirmed the indirect effect of pain on the decrease of depression in the participants of the aquatic exercise program.

CONCLUSIONS

Participants with RA in the aquatic exercise program experienced improvements in physical fitness, depression, and joint pain. Moreover, the improvements in joint pain mediated improvements in depression.

Sex, cognitive state and falls as factors associated with malnutrition: a cross-sectional study of institutionalized older adults living in a rural area of Portugal

BACKGROUND

Malnutrition is an underestimated geriatric problem, with a high prevalence in institutionalized older adults. The identification of risk factors for malnutrition in elderly individuals must be a priority for governmental organizations worldwide.

METHODS

A total of 98 institutionalized seniors were enrolled in a cross-sectional study. For the assessment of risk factors, sociodemographic characteristics and health-related information were collected. The Mini-Nutritional Assessment Short-Form test was used to assess malnutrition in the sample population.

RESULTS

A significantly greater proportion of women than men were malnourished or at risk of malnutrition. In addition, the comparative analysis revealed that comorbidity, arthritis, balance impairment, dementia and fall episodes with serious injuries were significantly more frequent in the older adults categorized as malnourished or at risk of malnutrition than in those categorized as well-nourished.

CONCLUSIONS

Multivariable regression analysis revealed that being female, having a poor cognitive status and experiencing falls with injuries are the main independent factors influencing nutritional status in institutionalized older adults living in a rural area of Portugal.

Phase Angle as a Predictor for Physical Function in Institutionalized Independent Older Adults

The aim of this study was to investigate the relationship between phase angle (PhA) and physical function in institutionalized, independent older adults. Physical function was evaluated using the Senior Fitness Test Battery. PhA was measured by electrical bioimpedance at 50 khz, and body composition parameters were also registered. Results showed that PhA significantly correlated with all physical fitness tests, except for arm curls. Regarding the results of the multivariate analysis, three models were created: Model 1, formed by a dependent variable "PhA" and two predictor variables "8 ft up-and-go" and "6 min walk"; Model 2, formed by a dependent variable "PhA" and three predictor variables "8 ft up-and-go", "6 min walk" and "30-s chair stand"; and Model 3, formed by a dependent variable "PhA" and four predictor variables "8 ft up-and-go", "6 min walk", "30-s chair stand" and "arm curl". Results showed that predictor variables had a significant influence on the PhA for all three models (Model 1: p = 0.001, 12.5%; Model 2: p = 0.002, 12.9%; and Model 3: p = 0.005, 13.1%). For women, Model 1 showed a significant influence of predictor variables on the PhA (p = 0.030, 9.3%). The results for men in Models 1, 2 and 3 showed significant influences on the PhA (p = 0.002, 31.2%; p = 0.006, 31.6%; and p = 0.016, 31.6%; respectively). This study confirmed previous studies regarding to the relationship between PhA and physical function. It also indicates that PhA could be an excellent predictor of physical function.

Heart Rate Variability and Salivary Biomarkers Differences between Fibromyalgia and Healthy Participants after an Exercise Fatigue Protocol: An Experimental Study

Previous studies showed that people with Fibromyalgia (FM) suffer from dysautonomia. Dysautonomia consists of persistent autonomic nervous system hyperactivity at rest and hyporeactivity during stressful situations. There is evidence that parameters reflecting the complex interplay between the autonomic nervous system and the cardiovascular system during exercise can provide significant prognostic information. Therefore, this study aimed to investigate the differences between people with FM and healthy controls on heart rate variability (HRV) and salivary parameters (such as flow, protein concentration, enzymatic activities of amylase, catalase and glutathione peroxidase) in two moments: (1) at baseline, and (2) after an exercise fatigue protocol. A total of 37 participants, twenty-one were people with fibromyalgia and sixteen were healthy controls, participated in this cross-sectional study. HRV and salivary samples were collected before and after an exercise fatigue protocol. The fatigue protocol consisted of 20 repetitions of knee extensions and flexions of the dominant leg at 180 °·s⁻¹ (degrees per second). Significant differences were found in the HRV (stress index, LF and HF variables) and salivary biomarkers (with a higher concentration of salivary amylase in people with FM compared to healthy controls). Exercise acute effects on HRV showed that people with FM did not significantly react to exercise. However, significant differences between baseline and post-exercise on HRV significantly induce alteration on the HRV of healthy controls. Catalase significantly increased after exercise in healthy controls whereas salivary flow significantly increased in women with FM after an exercise fatigue protocol. Our study suggests that a higher α-amylase activity and an impaired HRV can be used as possible biomarkers of fibromyalgia, associated with a reduction in salivary flow without changes in HRV and catalase activity after a fatigue exercise protocol. More studies should be carried out in the future to evaluate this hypothesis, in order to find diagnostic biomarkers in fibromyalgia.

Acute physiological response to a normobaric hypoxic exposure: sex differences

Although preliminary studies suggested sex-related differences in physiological responses to altitude/hypoxia, controlled studies from standardised exposures to normobaric hypoxia are largely lacking. Hence, the goals of this study were to provide information on cardiorespiratory responses to a 7-h normobaric hypoxia exposure and to explore potential differences between men and women. In this crossover study, a total of 15 men and 14 women were subjected to a 7-h exposure in normoxia (FiO₂: 21%) and normobaric hypoxia (FiO₂: 15%). Values of peripheral oxygen saturation, heart rate, systolic and diastolic blood pressure and respiratory gases were recorded every hour (8 time points), and oxygen saturation every 30 min (15 time points). Compared to normoxia, exposure to hypoxia significantly increased minute ventilation from baseline to hour 7 in males (+ 71%) and females (+ 40%), significantly greater in men (p < 0.05). A steeper decrease in peripheral oxygen saturation until 2.5 h in hypoxia was seen in females compared to males (p < 0.05). In conclusion, the ventilatory response to hypoxia was more pronounced in men compared to women. Moreover, during the first hours in hypoxia, peripheral oxygen saturation dropped more markedly in women than in men, likely due an initially lower and/or less efficient ventilatory response to moderate hypoxia. Those findings should be considered when performing interventions for therapy or prevention in normobaric hypoxia. Nevertheless, further large-scaled and well-controlled studies are needed.

Effects of respiratory muscle training on respiratory efficiency and health-related quality of life in sedentary women with fibromyalgia: a randomised controlled trial

OBJECTIVES

Fibromyalgia syndrome (FM) is a complex disease that is mainly characterised by chronic pain, fatigue, and sleep disturbances and may be precipitated or worsened by many stressors. The aim of this study was to examine the effects of respiratory muscle training (RMT) on respiratory efficiency and health-related quality of life (HRQoL) in women with FM.

METHODS

A total of 30 women with FM were included in the intention to treat analyses: 15 were assigned to the RMT group and 15 to the control group. The intervention consisted of 12 weeks of RMT. The primary outcome was the change in pulmonary function assessed by global body plethysmography at 12 weeks compared with baseline. Secondary outcomes included changes of scores in HRQoL assessed by the Short Form 36 Health Survey-Portuguese version.

RESULTS

The maximal inspiratory pressure (MIP) improved by 17.5% (p-value = .033), maximal expiratory pressure (MEP) improved 21.6% (p-value = 0.045) and maximum occlusion pressure (P0.1 max) increased 27.7% (p-value = 0.007). HRQoL improved in the dimensions of physical function, physical role, bodily pain and vitality (p-value <0.05).

CONCLUSIONS

RMT results in a significant improvement of respiratory efficiency and HRQoL after 12 weeks. RMT could be an effective therapy to enhance respiratory function and quality of life in women with FM.

What Mathematical Models Are Accurate for Prescribing Aerobic Exercise in Women with Fibromyalgia?

Simple Summary

Intensity prescription for cardiorespiratory exercises is crucial for achieving health/fitness benefits. However, not all of the population can access a cardiopulmonary exercise test, either for economic reasons or location resources, to determine their ventilatory thresholds. Therefore, different mathematical models can predict the intensity based on the maximum or reserve heart rate. Exercise prescription guidelines indicate that people with fibromyalgia should exercise at 60% of their VO₂max. However, people with fibromyalgia suffer from dysautonomia, which could lead to chronotropic incompetence, the inability to increase heart rate with increasing exercise intensities. Therefore, this study aimed to investigate the relationship and level of agreement between different mathematical models and the heart rate obtained from a cardiopulmonary exercise test at their ventilatory threshold 1. The results showed that the well-known “220 − age” at 76% and the mathematical model designed for people with fibromyalgia “209 − 0.85 × age” at 76% showed a significant level of agreement. However, Tanaka and Karvonen’s formula did not show a significant level of agreement. Thus, the “220 − age” at 76% and “209 − 0.85 × age” at 76% can be used in people with FM to prescribe aerobic exercise.

Abstract

Objectives: This article aims to verify the agreement between the standard method to determine the heart rate achieved in the ventilatory threshold 1 in the cardiopulmonary exercise testing (VT1) and the mathematical models with exercise intensities suggested by the literature in order to check the most precise for fibromyalgia (FM) patients. Methods: Seventeen women with FM were included in this study. The VT1 was used as the standard method to compare four mathematical models applied in the literature to calculate the exercise intensity in FM patients: the well-known “220 − age” at 76%, Tanaka predictive equation “208 − 0.7 × age” at 76%, the FM model HRMax “209 – 0.85 × age” at 76%, and Karvonen Formula at 60%. Bland–Altman analysis and correlation analyses were used to explore agreement and correlation between the standard method and the mathematical models. Results: Significant correlations between the heart rate at the VT1 and the four mathematical estimation models were observed. However, the Bland-Altman analysis only showed agreement between VT1 and “220 − age” (bias = −114.83 + 0.868 × x; 95% LOA = −114.83 + 0.868 × x + 1.96 × 7.46 to −114.83 + 0.868 × x − 1.96 × 7.46, where x is the average between the heart rate obtained in the CPET at VT1 and “220 − age”, in this case 129.15; p = 0.519) and “209 − 0.85 × age”(bias = −129.58 + 1.024 × x; 95% LOA = −129.58 + 1.024 × x + 1.96 × 6.619 to −129.58 + 1.024 × x − 1.96 × 6.619, where x is the average between the heart rate obtained in the CPET at VT1 and “209 − 0.85 × age”, in this case 127.30; p = 0.403). Conclusions: The well-known predictive equation “220 − age” and the FM model HRMax (“209 − 0.85 × age”) showed agreement with the standard method (VT1), revealing that it is a precise model to calculate the exercise intensity in sedentary FM patients. However, proportional bias has been detected in all the mathematical models, with a higher heart rate obtained in CPET than obtained in the mathematical model. The chronotropic incompetence observed in people with FM (inability to increase heart rate with increasing exercise intensities) could explain why methods that tend to underestimate the HRmax in the general population fit better in this population.

Development and validation of a continuous fall risk score in community-dwelling older people: an ecological approach

BACKGROUND

Fall risk assessment in older people is of major importance for providing adequate preventive measures. Current predictive models are mainly focused on intrinsic risk factors and do not adjust for contextual exposure. The validity and utility of continuous risk scores have already been demonstrated in clinical practice in several diseases. In this study, we aimed to develop and validate an intrinsic-exposure continuous fall risk score (cFRs) for community-dwelling older people through standardized residuals.

METHODS

Self-reported falls in the last year were recorded from 504 older persons (391 women: age 73.1 ± 6.5 years; 113 men: age 74.0 ± 6.1 years). Participants were categorized as occasional fallers (falls ≤1) or recurrent fallers (≥ 2 falls). The cFRs was derived for each participant by summing the standardized residuals (Z-scores) of the intrinsic fall risk factors and exposure factors. Receiver operating characteristic (ROC) analysis was used to determine the accuracy of the cFRs for identifying recurrent fallers.

RESULTS

The cFRs varied according to the number of reported falls; it was lowest in the group with no falls (- 1.66 ± 2.59), higher in the group with one fall (0.05 ± 3.13, p < 0.001), and highest in the group with recurrent fallers (2.82 ± 3.94, p < 0.001). The cFRs cutoff level yielding the maximal sensitivity and specificity for identifying recurrent fallers was 1.14, with an area under the ROC curve of 0.790 (95% confidence interval: 0.746-0.833; p < 0.001).

CONCLUSIONS

The cFRs was shown to be a valid dynamic multifactorial fall risk assessment tool for epidemiological analyses and clinical practice. Moreover, the potential for the cFRs to become a widely used approach regarding fall prevention in community-dwelling older people was demonstrated, since it involves a holistic intrinsic-exposure approach to the phenomena. Further investigation is required to validate the cFRs with other samples since it is a sample-specific tool.

Normobaric Hypoxia Exposure on Substrate Oxidation Pattern: Sex Differences

CONTEXT

Hypoxic exposure has been associated with a metabolic perturbation that might affect basal energy expenditure (BEE).

OBJECTIVE

The aim was to examine the metabolic response during hypoxic exposure of men and women adults.

DESIGN

Crossover design with two experimental trials: normoxic and hypoxic exposure.

SUBJECTS AND METHODS

Twenty-nine healthy subjects (14 women) participated in (1) control study (NOR), subjected first to normoxic exposure (FiO₂ = 20.9%) and (2) after that, to passive normobaric hypoxic exposure study (HYP) (FiO₂ = 15%). Respiratory gases and blood glucose samples were recorded every hour in hypoxia chamber (8 points in total), and blood lactate samples were collected at baseline, at 4 and 7 h to exposure.

RESULTS

In females, basal energy expenditure was significantly higher at 2h, 4h, 6h and 7h compared with NOR group. Also, BEE was lower in females compared with men from 2h of hypoxia exposure. In the HYP group the blood lactate concentration increased significantly at 4h and 7 h relative to NOR group (P < 0.05) in males.

CONCLUSION

An exposure to moderate normobaric hypoxia did not alter metabolic response, but induced a different response on substrate oxidation in adults men and women.

Factors influencing physical activity: A cross-sectional study of the community-dwelling older adults in a Portuguese rural area

BACKGROUND

There are a variety of intrinsic determinants which are key to understand the reasons for older people to stay (or not) active.

OBJECTIVES

To identify and analyse the factors underlying the physical activity engagement in older Portuguese living in a rural area.

METHODS

A total of 504 community-dwelling older adults (aged ≥65 years) were enrolled in this cross-sectional study. Sociodemographic data, physical activity levels, physical fitness and body composition were analysed.

RESULTS

Gender, age, income level, lower body strength, overweight, muscle mass and sedentarism (sitting time) were significantly associated with different physical activity levels. The multinomial logistic regression pointed out that dynamic balance, BMI and sitting time for moderate levels, as well as muscle mass for high levels, were the main independent factors that seem to influence the engagement in these levels compared to low physical activity levels. Additionally, classification tree analysis confirmed sitting time, dynamic balance and gender as discriminating factors for physical activity levels.

CONCLUSION

Physical fitness-related variables seem to mainly determine the levels of physical activity in the studied population. Thus, nursing care must promote the integration of physical activity into daily life routines of community-dwelling older adults, especially in rural areas.

IMPLICATIONS FOR PRACTICE

The diverse nature of factors influencing physical activity must be taken into account in primary health care, particularly in rural areas. Nursing care for older people must promote the integration of physical activity into daily life routines of community-dwelling older adults.

High Levels of Physical Activity May Promote a Reduction in Bone Mineral Density in Peritoneal Dialysis

Background and objectives: Peritoneal dialysis (PD) patients are expected to present lower levels of physical activity, unhealthy changes at the body composition level, and low levels of strength. Firstly, this study aimed to report the sex differences in physical activity, body composition and muscle strength and the relations among these variables. Secondly, we analyze the relationship between physical activity and biochemical parameters. Materials and Methods: Thirty-four patients (13 women and 21 men) participated in this study. Body composition was assessed by bioimpedance and dual-energy X-ray absorptiometry (DXA), and maximum isokinetic unilateral strength, analytical parameters and physical activity levels were evaluated. Results: The men showed higher values for weight, height, lean body mass, bone mineral content, bone mineral density (BMD) and total body water, while women showed higher values for the percentage of fat mass and hydration of lean body mass (p < 0.05). No differences between the sexes were found in different levels of physical activity; however, males registered significantly higher values for isokinetic strength variables except for knee extensor strength. BMD was positively related to sedentary activity and negatively related to moderate and vigorous activity (r = 0.383 and r = -0.404, respectively). Light physical activity was negatively correlated with albumin (r = -0.393) and total protein (r = -0.410) levels, while moderate/vigorous activity was positively correlated with urea distribution volume (r = 0.446) and creatinine clearance (r = 0.359) and negatively correlated with the triglyceride level (r = -0.455). Conclusions: PD patients with higher levels of physical activity present better results in terms of body composition and biochemical parameters. Additional studies should be conducted to clarify the relation between physical activity level and BMD.

Differences between two types of dual tasks according to the educational level in older adults

INTRODUCTION

For dual-task paradigms, the timed up and go (TUG) test along with other cognitive or motor tasks has been used to evaluate and predict the risk of falling in older adults. However, the interference between motor-cognitive tasks can differ by the cognitive task.

OBJECTIVE

To evaluate the performance of the TUG test under a single task condition and two dual-task conditions in older adults and to explore the effect of educational level on task performance.

METHODS

A total of 418 older adults (328 females) voluntarily participated in this study. The TUG test was administered as a single task and a dual task with one secondary simultaneous task: counting aloud backward from 100 or naming animals. Comparisons were performed to determine the interference caused by each cognitive task on the motor task, and correlation analysis was performed to explore the role of educational level.

RESULTS

The animal task led to a poorer TUG performance and a higher dual-task cost than did the counting task. Furthermore, the motor task led to a higher percentage of errors and cognitive stops in the animal task. Educational level plays a significant role in the interaction between tasks.

CONCLUSIONS

Between-task interference differs by the type of cognitive task performed and the educational level of the participants. The results of the present study should be considered when dual-task assessments are planned for older adults.

Impact of Active and Passive Hypoxia as Re-Warm-Up Activities on Rugby Players' Performance

The aim of this study was to analyse the effect of four types of re-warm-up (R-WU) activity, namely rest in normoxia (RN) at FiO2 = 20.9%, rest in hypoxia (RH) at FiO2 = 15%, activity (4 × 5 jumps/15 s) in normoxia (AN) and activity in hypoxia (AH) on physical performance. Ten elite male rugby players completed a 15-min warm-up followed by one of the 15-min randomized R-WU strategies. After R-WU, countermovement jump (CMJ), 20 m sprint and repeat sprint ability (RSA) tests were assessed. Compared to passive strategies (RN and RH), tympanic temperature was higher after active R-WU (AN and AH) (p = 0.016). Higher values of CMJ height (p = 0.037) and 20 m sprint (p = 0.02) were found in AH than in RN. In addition, mean RSA was lower (p = 0.008) in AH than in RN and RH. Blood lactate concentration was higher (p = 0.007) after RN and AN strategies than after AH. Muscle O2 saturation (p = 0.021) and total Hb (p = 0.042) were higher after AH than after the other three conditions and after RN, respectively. Therefore, an active R-WU under hypoxia could be useful to elite rugby players, once it had attenuated the decline in tympanic temperature during a 15-min period after warm-up, improving jump, sprint and RSA performance.

Effects of whole-body vibration under hypoxic exposure on muscle mass and functional mobility in older adults

BACKGROUND

Ageing is accompanied by a loss of muscle mass and function, which are associated with decrease of functional capacity. Combination of WBV training with normobaric hypoxic exposure could augment the beneficial effects due to synergic effects of both treatments.

AIMS

The purpose of this study was to examine the effects of 36 sessions of the combined WBV training and normobaric hypoxic exposure on muscle mass and functional mobility in older adults.

METHODS

Nineteen elderly people were randomly assigned to a: vibration normoxic exposure group (NWBV; n = 10; 20.9% FiO₂) and vibration hypoxic exposure group (HWBV; n = 9). Participants developed 36 sessions of WBV training along 18 weeks, which included 4 bouts of 30 s (12.6 Hz in frequency and 4 mm in amplitude) with 60 s of rest between bouts, inside a hypoxic chamber for the HWBV. The "Timed Up and Go Test" evaluated functional mobility. Percentages of lean mass were obtained with dual-energy X-ray absorptiometry.

RESULTS

Neither statistically significant within group variations nor statistically significant differences between both groups were detected to any parameter.

DISCUSSION

Baseline characteristics of population, training protocol and the level of hypoxia employed could cause different adaptations on muscle mass and function.

CONCLUSIONS

The combination of WBV training and hypoxic exposure did not cause any effect on either legs lean mass or functional mobility of older adults.

Risk for physical dependence in community-dwelling older adults: The role of fear of falling, falls and fall-related injuries

BACKGROUND

Falls and fall-related injuries along with fear of falling (FoF) seem to restrict activities of daily living (ADL), resulting in physical dependence. However, it is still unclear how falls and related injuries or FoF by themselves explain general and specific ADL dependence.

OBJECTIVES

To investigate the relationships between falls and related injuries, FoF and physical dependence on ADL in community-dwelling older adults, controlling for age, gender, physical activity and physical fitness as confounders.

METHODS

This cross-sectional descriptive study assessed 588 community-dwelling older adults. Falls and fall-related injuries, ADL dependence on basic, instrumental and advanced activities, FoF, demographic characteristics and health conditions were assessed through a questionnaire. Physical activity was measured through the International Physical Activity Questionnaire. Physical fitness was assessed by the Senior Fitness Test and the Fullerton Advanced Balance Scale. Body composition was measured through bioimpedance.

RESULTS

Severe injuries occurrence increased the likelihood of moderate and high physical dependence by 3 and 6 times, while FoF increased this likelihood by 3 and 7 times, respectively. Also, the occurrence of previous falls, resulting in severe injuries, increased the likelihood of dependence in two instrumental ADL (3 and 4 times), while FoF increased this likelihood in numerous basic, instrumental and advanced ADL (2-3 times). The FoF was shown to explain overall physical functioning dependence, by itself, representing a constraint on the performance of most basic, instrumental and advanced ADL.

CONCLUSION

The FoF showed to be a greater threat to ADL dependence than falls and related injuries. Assessment guidelines for older adults living in the community should include the FoF in clinical evaluation.

IMPLICATIONS FOR PRACTICE

Understand the isolated interplay of FoF and previous falls and injuries on ADL dependence among older adults allows healthcare professionals to perform more accurate clinical evaluations and develop more successful interventions to prevent further dependence.

Effects of Whole-Body Vibration Training Combined With Cyclic Hypoxia on Bone Mineral Density in Elderly People

Prevention and treatment of osteoporosis are an issue of great concern in public health so that the increase/maintenance of whole-body bone mineral density (BMD) is clinically relevant and could reduce the financial burden. Whole-body vibration (WBV) has been recently proposed as a potential alternative to bone stimulation, which combined with therapies, could provide a new treatment for osteoporosis prevention. In this sense, moderate cyclic hypoxia protocols may help to restrain osteoclastic activity and/or stimulate osteoblastic activity, enhance the effects of whole-body vibration alone. So, the present study investigated the effects of cyclic hypoxic exposure combined with WBV training on BMD of the elderly. Healthy elderly persons (n = 30) were randomly assigned to a (1) Hypoxia-Whole Body Vibration group (HWBV; n = 10), (2) Normoxic-Whole Body Vibration group (NWBV; n = 10) or (3) Control group (CON; n = 10). During 18 weeks, HWBV performed WBV treatment under normobaric hypoxic conditions (16.1% FiO₂). A vibration session included 4 bouts of 30 s (12.6 Hz–4 mm) with 1 min rest between bouts. NWBV performed the same vibration treatment as HWBV but under normoxic conditions. Whole-body and proximal femur BMD (g⋅cm⁻²) were measured using dual-energy X-ray absorptiometry. Two-way ANOVA indicated a borderline significant (p = 0.07) time x group interaction for total BMD; post hoc analysis revealed a slight but significant (p = 0.021) increase of BMD after treatment in the HWBV group. In conclusion, 18-week WBV training with hypoxic stimuli has shown positive effects for the participants of the current study. As changes did not differ significantly between groups, future large-scale studies will be necessary to confirm these findings.

Can Hypoxic Conditioning Improve Bone Metabolism? A Systematic Review

Among other functions, hypoxia-inducible factor plays a critical role in bone–vascular coupling and bone formation. Studies have suggested that hypoxic conditioning could be a potential nonpharmacological strategy for treating skeletal diseases. However, there is no clear consensus regarding the bone metabolism response to hypoxia. Therefore, this review aims to examine the impact of different modes of hypoxia conditioning on bone metabolism. The PubMed and Web of Science databases were searched for experimental studies written in English that investigated the effects of modification of ambient oxygen on bone remodelling parameters of healthy organisms. Thirty-nine studies analysed the effect of sustained or cyclic hypoxia exposure on genetic and protein expression and mineralisation capacity of different cell models; three studies carried out in animal models implemented sustained or cyclic hypoxia; ten studies examined the effect of sustained, intermittent or cyclic hypoxia on bone health and hormonal responses in humans. Different modes of hypoxic conditioning may have different impacts on bone metabolism both in vivo and in vitro. Additional research is necessary to establish the optimal cyclical dose of oxygen concentration and exposure time.

Evaluation of 18-Week Whole-Body Vibration Training in Normobaric Hypoxia on Lower Extremity Muscle Strength in an Elderly Population

Therapeutic benefits of hypoxic training have been suggested for clinical populations, such as elderly who could suffer loss of lower limb muscle strength and higher risk of falling. This study investigated the effects of 18 weeks of whole-body vibration (WBV) training in normobaric hypoxia on the strength parameters of an elderly population. Thirty-one healthy elderly participants were randomly assigned to a hypoxic whole-body vibration group (HWBV; n = 10), normoxic whole-body vibration group (NWBV; n = 11), or control group (n = 10). The experimental groups received the same vibration treatment in a hypoxia chamber (HWBV: 16.1% fraction of inspired oxygen [FiO₂]; NWBV: 21.0% FiO₂). Isokinetic leg muscle strength was evaluated using a Biodex System-3 isokinetic dynamometer. Body composition was obtained with dual-energy X-ray absorptiometry. There were no significant differences between groups in either strength or body composition parameters. The NWBV group showed statistically significant improvements in the maximal strength of knee extensors, with a small effect size (p = 0.004; d = 0.54). No significant differences were found in any variable of the HWBV group. The combination of WBV training and exposure to normobaric cyclic hypoxia carried out in the present study did not have an effect on strength parameters in healthy elderly subjects.

Non-supervised breathing exercise regimen in women with fibromyalgia: A quasi-experimental exploratory study

OBJECTIVES

To know the effectiveness and safety of non-supervised breathing exercise regimen by promoting patients' self-management, and to investigate if non-supervised breathing exercise regimen shows similar benefits to supervised regimen in improving pain and fibromyalgia (FM) impact on daily life.

MATERIAL AND METHODS

Fifty-one women with FM were assigned to: supervised breathing exercise regimen group, non-supervised breathing exercise regimen group, and control group. Pain thresholds tolerance on tender points and FM impact on daily life were evaluated.

RESULTS

After 12-weeks of breathing exercises statistical differences were not found between supervised and non-supervised regimen. However, supervised regimen showed additional improvements in pain thresholds tolerance and in pain-FIQ subscale.

CONCLUSION

Our results suggest that performing a non-supervised breathing exercise program could be as safe and effective as the supervised regimen. However, it was observed that there could be a tendency of supervised exercise regimen to show additional benefits in terms of pain.

Breathing Exercises Must Be a Real and Effective Intervention to Consider in Women with Fibromyalgia: A Pilot Randomized Controlled Trial

BACKGROUND/OBJECTIVE

Respiratory problems can aggravate pain located in the coincident areas with tender points in the upper half of the body in patients with fibromyalgia (FM) and easily become fatigued, thus can lead to a decrease in the functionality of daily activities. The purpose of this study was to examine the effects of a breathing exercises program on pain thresholds tolerance on tender points and FM impact on daily life.

METHODS/DESIGN

Thirty-five women with FM (age 34-67 years) were randomly assigned to an exercise group (n = 18), performing breathing exercises (30 min/session, 7 times/week; for 12 weeks), or to a control group (n = 17). Pain thresholds tolerance on tender points were measured by the physician using digital pressure algometer and FM impact on daily life was evaluated with the Portuguese version of the Fibromyalgia Impact Questionnaire (FIQ).

RESULTS

After 12 weeks of breathing exercises significant improvements were observed in the mean values of the treatment effects on pain thresholds tolerance on tender points and in the functional capacity to perform daily life, pain, and fatigue in favor of the exercise group. Gains in second rib, occiput, and supraspinatus pairs of the tender points predict improvements in the functional capacity, pain, and fatigue.

CONCLUSION

Our study demonstrated that breathing exercises produced relevant benefits on pain thresholds tolerance on tender points located in the upper half of the body, some of which predicted improvements in the impact of FM in the functional capacity to perform daily life, pain, and fatigue. These results provide further support of an idea that breathing exercises are a real and effective intervention to consider in women with FM.

TRIAL REGISTRATION

International Standard Randomized Controlled Trial Number ISRCTN37081460, available information in www.isrctn.com/ ISRCTN37081460.

Effects of a respiratory functional training program on pain and sleep quality in patients with fibromyalgia: A pilot study

OBJECTIVE

To evaluate the effect of 8-week respiratory functional training program on pain tolerance, sleep, and urinary antioxidant and cortisol levels in 18 patients with fibromyalgia.

METHODS

Participants underwent a 12-week intervention: 4 weeks as control and 8 weeks of breathing exercises. Pain tolerance assay was done by using an algometer, whereas sleep quality was evaluated by actigraphy and by the Pittsburgh Sleep Quality Index. Cortisol and antioxidant levels were determined using commercial assay kits.

RESULTS

Increases in the pain tolerance threshold were detected in the occiput point after one month of intervention as well as in the low cervical and second rib points after one and two months. Actigraphy revealed a decrease in sleep latency, whereas sleep questionnaire showed improvements in sleep quality, sleep duration and sleep efficiency. No changes in cortisol and antioxidant levels were detected.

CONCLUSION

The 8-week breathing exercise intervention reduced pain and improved sleep quality.

Portuguese translation, cross-cultural adaptation and reliability of the questionnaire «Start Back Screening Tool» (SBST)

OBJECTIVE

To translate and perform the cross-cultural adaptation of the StarT Back Screening Tool (SBST) questionnaire to assessment and screening low back pain for Portuguese application, and test their reliability.

METHOD

To establish conceptual equivalence in item, semantic and operational concern, there were performed two translations into Portuguese in a independently way. A combined version was obtained by consensus among the authors of the translations in order to be achieved a noticeable version in semantic terms and easy to understand. The synthesis version was administered to 40 subjects distributed by gender, young and older adults, with and without low back pain. Through cognitive interviews with the subjects of the sample, clarity, the acceptability, as well as the familiarization of the Portuguese version was evaluated, promoting the changes necessary for a better understanding. The final Portuguese version of the questionnaire was then back-translated into the original language. To evaluate the SBST-Portugal psychometric properties, 31 subjects with low back pain performed two interviews.

RESULTS

Participants interviewees reported that in general the items were clear and comprehensible achieving face validity. The reliability of the SBST-Portugal showed a Kappa value of 0,74 (95%IC 0,53-0,95), and the internal consistency (Cronbach's alpha) was 0,93 for the total score and 0,93 for the psychosocial subscale.

CONCLUSION

The Portuguese version of SBST questionnaire proved to be equivalent to the original English version and reliable for the Portuguese population with low back pain. Being an instrument of easy access and application it could be use in primary care.

Increased Physical Activity and Fitness above the 50(th) Percentile Avoid the Threat of Older Adults Becoming Institutionalized: A Cross-sectional Pilot Study

The objective of this study was to analyze the impact of physical fitness and physical activity on the threat of older adults without cognitive impairment becoming institutionalized. This cross-sectional study involved 195 non-institutionalized (80.1 ± 4.4 years) and 186 institutionalized (83.8 ± 5.2years) participants. Cognitive impairment was assessed using Mini-Mental State Examination, measures of physical fitness were determined by the Senior Fitness Test, and physical activity was assessed using the International Physical Activity Questionnaire. Multivariate binary logistic analysis selected four main determinants of institutionalization in both genders: The likelihood of becoming institutionalized increased by +18.6% for each additional year of age, whereas it decreased by -24.8% by each fewer kg/m(2) in body mass index (BMI), by -0.9% for each additional meter performed in the aerobic endurance test, and by -2.0% for each additional 100 metabolic equivalent of task (MET)-min/week of physical activity expenditure (p < 0.05). Values ≤50(th) percentile (age ≥81 years, BMI ≥26.7 kg/m(2), aerobic endurance ≤367.6 meters, and physical activity ≤693 MET-min/week) were computed using receiver operating characteristics analysis as cutoffs discriminating institutionalized from non-institutionalized older adults. The performance of physical activity, allied to an improvement in physical fitness (mainly BMI and aerobic endurance), may avoid the threat of institutionalization of older adults without cognitive impairment only if they are above the 50(th) percentile. The following parameters are highly recommended: Expending ≥693 MET-min/week on physical activity, having a BMI ≤26.7 kg/m(2), and being able to walk ≥367.6 meters in the aerobic endurance test, especially above the age of 80 years. The discovery of this trigger justifies the development of physical activity programs targeting the pointed cutoffs in old and very old adults.

A randomized controlled trial on the effects of combined aerobic-resistance exercise on muscle strength and fatigue, glycemic control and health-related quality of life of type 2 diabetes patients

BACKGROUND

The aim of this paper was to evaluate the effects of a 12-weeks combined aerobic-resistance exercise therapy on fatigue and isokinetic muscle strength, glycemic control and health-related quality of life (HRQoL) in moderately affected type 2 diabetes (T2DM) patients.

METHODS

A randomized controlled trial design was employed. Forty-three T2DM patients were assigned to an exercise group (N.=22), performing 3 weekly sessions of 60 minutes of combined aerobic-resistance exercise for 12-weeks; or a no exercise control group (N.=21). Both groups were evaluated at a baseline and after 12-weeks of exercise therapy for: 1) muscle strength and fatigue by isokinetic dynamometry; 2) plasma glycated hemoglobin A1C (HbA1C); and 3) HRQoL utilizing the SF-36 questionnaire.

RESULTS

The exercise therapy led to improvements in muscle fatigue in knee extensors (-55%) and increased muscle strength in knee flexors and extensors (+15 to +30%), while HbA1C decreased (-18%). In addition, the exercising patients showed sizeable improvements in HRQoL: physical function (+53%), vitality (+21%) and mental health (+40%).

CONCLUSIONS

Twelve-weeks of combined aerobic-resistance exercise was highly effective to improve muscle strength and fatigue, glycemic control and several aspects of HRQoL in T2DM patients. These data encourage the use of aerobic and resistance exercise in the good clinical care of T2DM.

Does a land-based compensatory strength-training programme influences the rotator cuff balance of young competitive swimmers?

During the repeated execution of the swimming strokes, the shoulder adductor and internal rotator muscles have a tendency to become proportionally stronger when compared to their antagonist group. This can lead to muscle imbalances. The aim of this study was to examine the effects of a compensatory training programme on the strength and balance of shoulder rotator muscles in young swimmers. A randomized controlled trial design was used. Forty male swimmers took part in the study and were randomly divided into two groups: an experimental group (n = 20) and a training group (n = 20). A control group (n = 16) of young sedentary male students was also evaluated. The experimental group subjects participated in a 16-week shoulder-strength programme with Thera-Band® elastic bands; the training group was restricted to aquatic training. Peak torque of shoulder internal rotator and external rotator (ER) was measured at baseline and after 16 weeks. Concentric action at 1.04 rad s(-1) (3 reps) and 3.14 rad s(-1) (20 reps) was measured using an isokinetic dynamometer. The strength-training programme led to an improvement of the ER strength and shoulder rotator balance in the experimental group (data from both shoulders at 1.04 rad s(-1)). Moreover, concentric action at 3.14 rad s(-1) presented significant differences only for the dominant shoulder. Findings suggest that the prescribed shoulder-strengthening exercises could be a useful training option for young competitive swimmers. They can produce an increase in absolute strength values and greater muscle balance in shoulder rotators.

[Relationships between widespread pain and thresholds pain tolerance on tender points in Portuguese women with fibromyalgia: impact on daily life]

OBJECTIVES

to establish a relationship between widespread pain subjectively perceived and threshold pain tolerance on tender points, and to determine whether there are differences in threshold pain tolerance on tender points between the upper and lower body, as well as between the dominant and non-dominant side, and whether these differences have an impact on the daily life of Portuguese women with fibromyalgia (FM).

MATERIAL & METHODS

thirty-one women with FM aged between 34 and 67 years volunteered for the study. Threshold pain tolerance was assessed at critical points using a digital algometer pressure; the widespread pain index (WPI) was constructed by the addition of 19 painful body regions; and the impact on the daily life assessed by the Portuguese version of the Fibromyalgia Impact Questionnaire (FIQ), with individual interviews.

RESULTS

significant differences between the percentage of threshold pain tolerance of the whole body and the scales of widespread pain subjectively perceived were observed, showing that the widespread pain subjectively perceived by patients was between +25.9% and +27.5%. Also, significant differences between threshold pain tolerance of tender points located on the upper and lower body (1.9 ± 0.5 kg/cm2 vs. 2.6 ± 0.7 kg/cm2; respectively) were observed. However, no significant differences were found between threshold pain tolerance of tender points located on dominant and non-dominant sides (2.1 ± 0.5 kg/cm2 e 2.1 ± 0.6 kg/cm2; respectively). Additionally, the analysis showed significant correlations between pain and patient`s daily life in: FIQ total score, physical function, feel good, job ability and fatigue.

CONCLUSIONS

the women with FM show higher widespread pain subjectively perceived than threshold pain tolerance on tender points. Furthermore, the pain suffered by the patients with FM, especially that located on the upper body, either on the dominant or on the non-dominant side, has a negative influence on physical function, job ability, fatigue and feel good, affecting daily life.

Does an in-season detraining period affect the shoulder rotator cuff strength and balance of young swimmers?

Imbalance in shoulder rotator muscles is a well-documented problem in swimmers, and it is important to implement land-based strength training programs. Meanwhile, the effects of a detraining period on swimmers' shoulder rotator muscles are unknown. The purpose of this study was to analyze the effects of a strength training program and detraining on the strength and balance of shoulder rotator cuff muscles in young swimmers, despite the continuity of usual water training. An experimental group (n = 20) and a control group (n = 20) of young male swimmers with the same characteristics (age, body mass, height, training volume, and maturational state) were evaluated. In both groups, the peak torques of shoulder internal (IR) and external (ER) rotators were assessed during preseason, midseason (16 weeks), and postseason (32 weeks). The experimental group underwent a strength training regimen from baseline to 16 weeks and a detraining period from 16 to 32 weeks. Concentric action at 60°·s-1 and 180°·s-1 was measured using an isokinetic dynamometer. The ER/IR strength ratios were obtained. At 60°·s-1, there were significant increments in IR strength and the ER/IR ratio in both shoulders. This trend was the same throughout the competitive season. The tendency was the same at 180°·s-1 because training effects were noted primarily in IR and ER/IR ratios. Moreover, the absence of land-based strength training, from 16 to 32 weeks, revealed a reduction in the ER/IR ratio values in both shoulders. Our findings suggest that young swimmers' coaches should use dry-land strength training protocols, and that it is recommended that these should be conducted on a regular basis (during the whole season).

A randomized controlled trial on the effects of combined aerobic-resistance exercise on muscle strength and fatigue, glycemic control and health-related quality of life of type 2 diabetes patients

AIM

to evaluate the effects of a 12--weeks combined aerobic--resistance exercise therapy on fatigue and isokinetic muscle strength, glycemic control and health--related quality of life (HRQoL) in moderately affected type 2 diabetes (T2DM) patients.

METHODS

a randomized controlled trial design was employed. Forty--three T2DM patients were assigned to an exercise group (n = 22), performing 3 weekly sessions of 60 minutes of combined aerobic--resistance exercise for 12--weeks; or a no exercise control group (n = 21). Both groups were evaluated at a baseline and after 12--weeks of exercise therapy for: 1) muscle strength and fatigue by isokinetic dynamometry; 2) plasma glycated hemoglobin A1C (HbA1C); and 3) HRQoL utilizing the SF--36 questionnaire.

RESULTS

the exercise therapy led to improvements in muscle fatigue in knee extensors (--55%) and increased muscle strength in knee flexors and extensors (+15 to +30%), while HbA1C decreased (--18%). In addition, the exercising patients showed sizeable improvements in HRQoL: physical function (+53%), vitality (+21%) and mental health (+40%).

CONCLUSION

12--weeks of combined aerobic--resistance exercise was highly effective to improve muscle strength and fatigue, glycemic control and several aspects of HRQoL in T2DM patients. These data encourage the use of aerobic and resistance exercise in the good clinical care of T2DM.

Health-related quality of life and physical activity in persons at high risk for type 2 diabetes

PURPOSE

The aim of this study was to compare the health-related quality of life (HRQOL) of persons at risk for type 2 diabetes to that of the Finnish general population. In addition, the associations between physical activity and HRQOL at-risk persons were studied.

METHODS

One hundred thirty-two at-risk persons were recruited from health care centres in Central Finland. Participants filled out questionnaires including demographic characteristics, HRQOL (SF-36), frequency of vigorous physical activity (< or =2 times a week, once a week, less than once a week) and comorbidities.

RESULTS

HRQOL of at-risk persons differed significantly from that of the Finnish population in four of the eight dimensions of SF-36. Compared with reference values of the general population, the values of at-risk persons were worse for general health and pain, but better for mental health and role limitation (emotional) dimensions. Among at-risk persons those physically more active had less depressiveness and lower body weight. HRQOL decreased linearly with decreasing physical activity in all dimensions.

CONCLUSIONS

People with elevated risk for type 2 DM have reduced HRQOL in general health and body pain dimensions, but mental health and emotional role dimensions were better compared with that of the population. Among at-risk persons, the benefits of physical activity on HRQOL were seen in all HRQOL dimensions. Regular exercise and body weight control may improve subjective health and reduce risk for type 2 DM and its consequences.

Improvements of muscle strength predicted benefits in HRQOL and postural balance in women with fibromyalgia: an 8-month randomized controlled trial

OBJECTIVE

To evaluate whether changes in muscle strength due to 32 weeks of supervised aquatic training predicted improvements on health-related quality of life (HRQOL).

METHODS

Thirty women with FM aged 50.8 +/- 8.7 years were randomly assigned to an experimental group (n = 15), performing 3 weekly sessions of 60 min of warm-water exercise; or to a control group (n = 15). HRQOL was evaluated using the Short Form 36 Health Survey (SF-36). Maximal unilateral isokinetic strength was measured at 60 degrees/s and 210 degrees/s in the knee extensors and flexors in concentric action and at 60 degrees/s in knee extensors eccentric action. Postural balance was evaluated using the one-leg stance, eyes closed.

RESULTS

After 32 weeks of water exercise therapy, statistically significant improvements occurred in concentric knee flexors and extensors strength at 60 degrees/s, in eccentric knee extensors and in postural balance. The treatment led to additional improvements in physical function, role physical problems, body pain, general health, vitality, role emotional problems and mental health dimensions of SF-36. Gains in the concentric knee flexors strength predicted improvements in role of physical problems, whereas those in concentric knee extensors did the same for mental health and role emotional problems. Gains in eccentric knee extensors strength predicted improvements in postural balance.

CONCLUSIONS

A long-lasting exercise therapy in warm water produced relevant gains in muscle strength at low velocities of movements, some of which predicted improvements in physical problems, emotional problems, mental health and balance.

TRIAL REGISTRATION

International Standard Randomized Controlled Trial Number ISRCTN53367487, information available in http://www.controlled-trials.com/ISRCTN53367487.

Eight months of physical training in warm water improves physical and mental health in women with fibromyalgia: a randomized controlled trial

OBJECTIVE

To evaluate the feasibility of 8 months of supervised exercise therapy in warm water and its effects on the impact of fibromyalgia on physical and mental health and physical fitness in affected women.

METHODS

Thirty women with fibromyalgia were randomly assigned to an exercise therapy group (n = 15) or a control group (inactive) (n = 15). The impact of fibromyalgia on physical and mental health was assessed using the Fibromyalgia Impact Questionnaire and the anxiety state with State-Trait Anxiety Inventory. Physical fitness was measured using the following tests: Canadian Aerobic Fitness; hand-grip dynamometry; 10-metre walking; 10-step stair-climbing and blind 1-leg stance.

RESULTS

After 8 months of training, the exercise therapy group improved compared with the control group in terms of physical function (20%), pain (8%), stiffness (53%), anxiety (41%), depression (27%), Fibromyalgia Impact Questionnaire total scores (18%), State-Trait Anxiety Inventory score (22%), aerobic capacity (22%), balance (30%), functional capacity for walking (6%), stair-climbing with no extra weight (14%) and stair-climbing 10 kg-weighted (25%).

CONCLUSION

Eight months of supervised exercise in warm water was feasible and led to long-term improvements in physical and mental health in patients with fibromyalgia at a similar magnitude to those of shorter therapy programmes.

Cost-utility of an 8-month aquatic training for women with fibromyalgia: a randomized controlled trial

Introduction

Physical therapy in warm water has been effective and highly recommended for persons with fibromyalgia, but its efficiency remains largely unknown. Should patients or health care managers invest in this therapy? The aim of the current study was to assess the cost-utility of adding an aquatic exercise programme to the usual care of women with fibromyalgia.

Methods

Costs to the health care system and to society were considered in this study that included 33 participants, randomly assigned to the experimental group (n = 17) or a control group (n = 16). The intervention in the experimental group consisted of a 1-h, supervised, water-based exercise sessions, three times per week for 8 months. The main outcome measures were the health care costs and the number of quality-adjusted life-years (QALYs) using the time trade-off elicitation technique from the EuroQol EQ-5D instrument. Sensitivity analyses were performed for variations in staff salary, number of women attending sessions and time spent going to the pool. The cost effectiveness acceptability curves were created using a non-parametric bootstrap technique.

Results

The mean incremental treatment costs exceeded those for usual care per patient by € 517 for health care costs and € 1,032 for societal costs. The mean incremental QALY associated with the intervention was 0.131 (95% CI: 0.011 to 0.290). Each QALY gained in association with the exercise programme cost an additional € 3,947/QALY (95% CI: 1,782 to 47,000) for a health care perspective and € 7,878/QALY (3,559 to 93,818) from a societal perspective. The curves showed a 95% probability that the addition of the water-based programme is a cost-effective strategy if the ceiling of inversion is € 14,200/QALY from a health care perspective and € 28,300/QALY from a societal perspective.

Conclusion

The addition of an aquatic exercise programme to the usual care regime for fibromyalgia in women is cost effective in terms of both health care costs and societal costs. However, the characteristics of facilities (distance from the patients' homes and number of patients that can be accommodated per session) are major determinants to consider before investing in such a programme.

Trial registration

Current controlled trials ISRCTN53367487.

Aquatic training and detraining on fitness and quality of life in fibromyalgia

PURPOSE

To evaluate the effects of a 12-wk period of aquatic training and subsequent detraining on health-related quality of life (HRQOL) and physical fitness in females with fibromyalgia.

METHODS

Thirty-four females with fibromyalgia were randomly assigned into two groups: an exercise group, who exercised for 60 min in warm water, three times a week (N = 17); and a control group, who continued their habitual leisure-time activities (N = 17). HRQOL was assessed using the Short Form 36 questionnaire and the Fibromyalgia Impact Questionnaire. Physical fitness was measured using the following tests: Canadian Aerobic Fitness, hand grip dynamometry, 10-m walking, 10-step stair climbing, and blind one-leg stance. Outcomes were measured at baseline, after treatment, and after 3 months of detraining.

RESULTS

After 12 wk of aquatic exercise, significant positive effects of aquatic training were found in physical function, body pain, general health perception, vitality, social function, role emotional problems and mental health, balance, and stair climbing. After the detraining period, only the improvements in body pain and role emotional problems were maintained.

CONCLUSION

The present water exercise protocol improved some components of HRQOL, balance, and stair climbing in females with fibromyalgia, but regular exercise and higher intensities may be required to preserve most of these gains.

Exercise in waist-high warm water decreases pain and improves health-related quality of life and strength in the lower extremities in women with fibromyalgia

OBJECTIVE

To evaluate the short- and long-term efficacy of exercise therapy in a warm, waist-high pool in women with fibromyalgia.

METHODS

Thirty-four women (mean +/- SD tender points 17 +/- 1) were randomly assigned to either an exercise group (n = 17) to perform 3 weekly sessions of training including aerobic, proprioceptive, and strengthening exercises during 12 weeks, or to a control group (n = 17). Maximal unilateral isokinetic strength was measured in the knee extensors and flexors in concentric and eccentric actions at 60 degrees /second and 210 degrees /second, and in the shoulder abductors and adductors in concentric contractions. Health-related quality of life (HRQOL) was assessed using the EQ-5D questionnaire; pain was assessed on a visual analog scale. All were measured at baseline, posttreatment, and after 6 months.

RESULTS

The strength of the knee extensors in concentric actions increased by 20% in both limbs after the training period, and these improvements were maintained after the de-training period in the exercise group. The strength of other muscle actions measured did not change. HRQOL improved by 93% (P = 0.007) and pain was reduced by 29% (P = 0.012) in the exercise group during the training, but pain returned close to the pretraining level during the subsequent de-training. However, there were no changes in the control group during the entire period.

CONCLUSION

The therapy relieved pain and improved HRQOL and muscle strength in the lower limbs at low velocity in patients with initial low muscle strength and high number of tender points. Most of these improvements were maintained long term.