Evidence-based Exercise Program Research Articles

Effects of the Vitality Acupunch Exercise Program on Older Adults With Probable Sarcopenia: A Mixed Methods Pilot Study.

Purpose: Age-related loss of muscle mass and strength is a highly prevalent condition in older adults in long-term care (LTC) facilities. This pilot study aimed to test the effects of a vitality acupunch (VA) exercise program on muscle mass, muscle strength, muscle endurance, functional fitness, activities of daily living, quality of life, and sleep quality of older adults in LTC facilities with probable sarcopenia in the United States and understand the experiences of residents who participated in the VA program. Design: A mixed-methods experimental design was used for this study. Methods: The quantitative phase included a sample of 27 participants randomly assigned to the control (n = 13) or VA (n = 14) condition. The VA condition consisted of three weekly 40-minute instructor-led seated exercise sessions over 24 weeks. Measures were obtained at baseline, three, and sixmonth intervals. Semi-structured interviews were conducted to explore participant's experiences of the program. Findings: Statistical comparison revealed significantly higher handgrip strength for the VA group (p = .008). Narrative analysis revealed that the program had a positive impact on participant's daily lives. Conclusions: The VA program offers a holistic, evidence-based exercise program for older adults with probable sarcopenia living in LTC facilities.

Factors influencing older adult community fall prevention exercise implementation: a scoping review.

Exercise that challenges balance is the most effective fall prevention intervention in community-dwelling older adults. Identifying factors influencing implementation of community fall prevention exercise programs is a critical step in developing strategies to support program delivery. To identify implementation facilitators, barriers, and details reported in peer-reviewed publications on community fall prevention exercise for older adults. Scoping review. We searched multiple databases up to July 2023 for English-language publications that reported facilitators and/or barriers to implementing an evidence-based fall prevention exercise program in adults aged 50+ years living independently. At least two reviewers independently identified publications and extracted article, implementation, and exercise program characteristics and coded barriers and facilitators using the Consolidated Framework for Implementation Research (CFIR). We included 22 publications between 2001 and July 2023 that reported factors influencing implementation of 10 exercise programs. 293 factors were reported: 183 facilitators, 91 barriers, 6 described as both a facilitator and barrier, and 13 unspecified factors. Factors represented 33 CFIR constructs across all five CFIR domains: implementation inner setting (n = 95 factors); innovation (exercise program) characteristics (n = 84); individuals involved (n = 54); implementation process (n = 40) and outer setting (n = 20). Eight publications reported implementation strategies used; 6 reported using a conceptual framework; and 13 reported implementation outcomes. The high number of factors reflects the complexity of fall prevention exercise implementation. The low reporting of implementation strategies, frameworks and outcomes highlight the ongoing need for work to implement and sustain community fall prevention exercise programs.

Does combining two evidence-based exercise programs in elderly people with incontinence have a triple effect on incontinence symptoms, balance and functional status?

Improving pelvic floor muscle training (PFMT), balance and functional activity is recommended in the treatment of urinary incontinence (UI) in the elderly people. The aim of this study is to examine whether PFMT combined with Otago exercises is effective on symptoms, balance and functional status in elderly people with UI compared to PFMT alone. This study is an assessor-blinded, randomized controlled trial. Participants with UI aged 65 and over living in a nursing home were randomly assigned to the intervention (IG) and control groups (CG). The intervention group attended an exercise program that included Otago exercises combined with PFMT. The control group was included in the PFMT program with different positions. The duration of exercise for both groups was 45-60min per session three times a week for 12weeks. UI symptoms and severity (Pelvic Floor Distress Inventory-20, bladder diary), PFM muscle function (superficial electromyography), balance (Berg Balance Scale), functional status (Senior Fitness Test) and fear of falling (Falls Efficacy Scale) were measured at baseline and after the intervention. The median age of the IG (n: 22) and CG (n: 21) was 73.5 and 77years, respectively. At baseline and after the intervention within the group, a significant improvement was observed in the PTDE-20 score (IG and CG, p: 0.00) and the 2-min step test in the IG (p: 0.02) and CG (p: 0.01). A significant decrease was found in the 2.45m get up-and-go test, PFM work average onset, and PFM rest MVC EMG values (p: 0.01, p: 0.01, p: 0.00) in the IG. The PFM rest average value decreased (p: 0.04) in the CG. The findings of this study show that combining PFMT with Otago exercises, two evidence-based interventions, is beneficial for effectively treating incontinence symptoms, balance and functional status in elderly people. Thus, a triple effect can be achieved with a single exercise training in the same treatment session and for the same duration. Clinical trial number: NCT06331039.

The Effects of Exercise Intervention on Physical Fitness and Problem Behaviors in Children with Developmental Disabilities: Focused on the Development of Evidencebased Exercise Program

PURPOSE: Developmental disabilities often result in decreased physical fitness and problematic behaviors. Participating in regular physical activity and exercise is one of the main ways to improve problems associated with developmental disabilities. In this study, we aimed to develop an evidence-based exercise program tailored to the characteristics, disability level, and functional level of children with developmental disabilities.METHODS: The development process is composed of the following nine steps: preliminary literature review, survey of physical activity participation, first expert group discussion, development of the first exercise program, feasibility study, focus group interview, second expert group discussion, development of the evidence-based exercise program, the validation of the developed exercise program.RESULTS: Participating in the evidence-based exercise program developed in this study was found to significantly improve cardiovascular fitness (6-minute walk), agility (standing long jump), and muscular function (sit-ups), but did not yield significant results in terms of flexibility (sit-and-reach). Additionally, the exercise program showed significant results in terms of reducing problem behaviors. The parents of children with developmental disabilities were all satisfied with the exercise program and its outcomes.CONCLUSIONS: The evidence-based exercise program developed in this study had positive effects on the physical fitness and behavior of children with developmental disabilities. This study provides a basis for the development of exercise programs through a safe and effective means for children with developmental disabilities.

Advances in Exercise in the Clinical Trials of Migraine: A Scoping Review.

This review aimed to investigate emerging evidence regarding the effectiveness of exercise for migraines, focusing on the results of recent trials. Additionally, it explored the possibility of exercise as a treatment for migraines. Between 2020 and 2023, five, four, one, and two trials were conducted regarding the effect of aerobic exercise, anaerobic exercise, Tai Chi, and yoga, respectively, on migraine; all studies showed significant effects. Two trials on aerobic exercise showed that high-intensity exercise was similar to or slightly more effective than moderate-intensity exercise as a treatment for migraines. Three trials on anaerobic exercise reported its effectiveness in preventing migraines. Regarding efficacy, side effects, and health benefits, aerobic exercises and yoga are potentially beneficial strategies for the prevention of migraines. Further studies are needed to develop evidence-based exercise programs for the treatment of migraines.

A Community Needs Assessment and Implementation Planning for a Community Exercise Program for Survivors of Stroke: Protocol for a Pilot Hybrid Type I Clinical Effectiveness and Implementation Study.

Physical activity and exercise are important aspects of maintaining health. People with mobility impairments, including survivors of stroke, are less likely to exercise and at greater risk of developing or worsening chronic health conditions. Increasing accessible, desired options for exercise may address the gap in available physical activity programs, provide an opportunity for continued services after rehabilitation, and cultivate social connections for people after stroke and others with mobility impairments. Existing evidence-based community programs for people after stroke target cardiovascular endurance, mobility, walking ability, balance, and education. While much is known about the effectiveness of these programs, it is important to understand the local environment as implementation and sustainment strategies are context-specific. This study protocol aims to evaluate community needs and resources for exercise for adults living with mobility impairments with initial emphasis on survivors of stroke in Richland County, South Carolina. Results will inform a hybrid type I effectiveness and implementation pilot of an evidence-based group exercise program for survivors of stroke. The exploration and preparation phases of the EPIS (Exploration, Preparation, Implementation, and Sustainment) implementation model guide the study. A community needs assessment will evaluate the needs and desires of survivors of stroke through qualitative semistructured interviews with survivors of stroke, rehabilitation professionals, and fitness trainers serving people with mobility impairments. Additional data will be collected from survivors of stroke through a survey. Fitness center sites will be assessed through interviews and the Accessibility Instrument Measuring Fitness and Recreation Environments inventory. Qualitative data will be evaluated using content analysis and supported by mean survey results. Data will be categorized by the community (outer context), potential participants (outer context), and fitness center (inner context) and evaluate needs, resources, barriers, and facilitators. Results will inform evidence-based exercise program selection, adaptations, and specific local implementation strategies to influence success. Pilot outcome measures for participants (clinical effectiveness), process, and program delivery levels will be identified. An implementation logic model for interventions will be created to reflect the design elements for the pilot and their complex interactions. The study was reviewed by the institutional review board and exempt approved on December 19, 2023. The study data collection began in January 2024 and is projected to be completed in June 2024. A total of 17 participants have been interviewed as of manuscript submission. Results are expected to be published in early 2025. Performing a needs assessment before implementing it in the community allows for early identification of complex relationships and preplanning to address problems that cannot be anticipated in controlled effectiveness research. Evaluation and preparation prior to implementation of a community exercise program enhance the potential to be successful, valued, and sustained in the community. DERR1-10.2196/55432.

Leveraging Knowledge Management Techniques for Developing Multimedia Exercise Guides for Elderly Fall Prevention

In this research study, the primary objective was to develop a comprehensive exercise program specifically designed for elderly individuals. The focus was on evaluating various exercise postures and validating their impact on muscle groups. By integrating knowledge management systems with knowledge engineering methodologies, the aim was to optimize the design of exercise postures and promote optimal health outcomes for the elderly. Divided into three distinct experiments, the study employed a systematic approach to acquire, represent, and validate knowledge related to exercise postures for the elderly population. The use of knowledge management systems and engineering methodologies facilitated the design of effective exercise postures tailored to meet the unique needs and capabilities of elderly individuals. Experiment I focused on knowledge acquisition through structured interviews with physical therapists. The acquired knowledge was used to screen and prioritize exercise postures suitable for elderly individuals. Expert recommendations and analysis were employed to select a set of exercise postures. Using a matrix combination approach, 189 possible exercise postures were generated by combining aerobic and dance postures. Through a screening process, 52 postures were selected as suitable for elderly individuals. Experiment II utilized kinesthetic representation techniques to visually represent the 52 selected exercise postures for the elderly. Additionally, frame representation was employed to capture muscle specifications associated with each posture. The representation design was validated by physical exercise experts. In the first step of Experiment III, a total of 52 exercise postures were implemented and evaluated with elderly participants. The implementation and validation process aimed to identify the best and most appropriate postures for the elderly, considering factors such as satisfaction levels, difficulty levels, and safety considerations. Through this rigorous evaluation, the initial selection of 52 postures was narrowed down to a final set of 21 suitable postures. The validation results provided valuable insights into the effectiveness of the exercise postures and their impact on the elderly participants. It ensured that the chosen postures were not only effective in promoting optimal health outcomes but also minimized the risk of injury. The iterative assessment and refinement process contributed to the development of an evidence-based exercise program specifically tailored to the unique needs and capabilities of elderly individuals. For the second step of Experiment III, the effects of the selected exercise postures on different muscle groups were validated. Three physical exercise experts evaluated the impact on upper limb, trunk, and lower limb muscles. Specific muscle groups, such as brachioradialis, deltoid, quadriceps, and hamstring, were found to be strongly focused on during the exercises, while trunk muscles were rated as poor overall. The evaluation involved implementing and evaluating a total of 52 exercise postures with elderly participants. The selection of the final 21 postures was based on the evaluation results and provided insights into satisfaction levels, difficulty levels, and safety considerations for each exercise posture. The validation outcomes showed a high level of agreement among the experts, ranging from 79% to 91%. For conclusion, this research aimed to enhance exercise programs for the elderly by developing more effective methodologies for designing exercise postures. By considering the specific requirements of the elderly population and utilizing knowledge management systems, the study successfully created exercise postures that maximize health benefits and overall well-being. Through the implementation of knowledge engineering methodologies and the utilization of knowledge management systems, the research optimized the design of exercise postures for elderly individuals. The division of the study into three experiments enabled a comprehensive analysis of the acquired knowledge, leading to the development of exercise postures specifically tailored to the needs of the elderly population.

Abstract P256: Rationale, Development, and Implementation of a Multidisciplinary Digital Lifestyle Health Education Program for Older Adults With Cardiovascular Disease and Osteoarthritis

Introduction: Cardiovascular disease (CVD) is the leading cause of death worldwide. Globally, osteoarthritis (OA) affects 654 million. In 2018, of the 1.2 million Australians who had CVD, half also had arthritis, with the most common form in Australia being OA. Ongoing pain and physical limitations from OA can affect lifestyle choices, contributing to the shared risk factor profile of CVD and OA (physical inactivity, overweight/obesity, poor diet, high medication use). This contributes further to the burden of both diseases including reduced 6-minute walk (6MW) performance, which is directly related to increased CVD mortality. This project outlines the rationale for and development of a multidisciplinary digital lifestyle health education program for the treatment and secondary prevention of CVD and its common comorbidity of OA. Methods: This study is a cross-sectional analysis of older adults in Sydney. Class was classified based on the Australian socioeconomic index for areas. Conditions were defined according to Australian national guidelines. Medical history, body mass index (BMI), waist measurement, muscle strength, and 6MW measurements were assessed. Differences between those with and without OA were determined via one-way analysis of variance. Simple linear regressions assessed potential relationships. Results: In a cohort of 532 adults; n=341 (64.1%) had diagnosed CVD; 48.4% of which had OA (mean age 66±12 years; 73.3% female). Socioeconomic index was deemed high. In the OA cohort mean BMI and waist were above healthy heart recommendations according to the World Health Organisation. There were no significant differences between those with OA and those without for cardiovascular risk factors of body weight, BMI, waist measurement, blood pressure, 6MW, or muscle strength. However, in those with CVD and OA, the relationship between age and 6MW was stronger and age accounted for more of the variance in performance (r=-0.44; r 2 =0.19; p<0.001) than those without OA (r=-0.37; r 2 =0.17; p<0.001), indicating a greater reduction in walking ability in those with OA as they get older. Conclusion: With 6MW performance being related to CVD mortality, interventions are needed to improve health and fitness in this cohort. International guidelines for CVD and OA recommend treatment should prioritise lifestyle changes, including a healthy diet, regular physical activity, and interventions that address all risk factors. Lifestyle LIFEMAP will assess the efficacy of a widely translatable multidisciplinary digital evidence-based 10-module lifestyle, food, exercise, medication, and park prescription education program for adults with the comorbidity of CVD and OA. We expect this program to improve knowledge, and healthy lifestyle choices, thereby improving physical activity and health outcomes in this highly vulnerable population.

PERCEIVED FEASIBILITY TO IMPLEMENT A TASK-ORIENTED EXERCISE PROGRAM BY FITNESS STAFF AT SENIOR LIVING COMMUNITIES

Abstract Older adults who relocate to senior living communities have a desire to maintain their independence. The fitness infrastructure within these communities is a great platform to deliver evidence-based exercise programs to support residents’ independence, especially for those who have experienced activity limitations. Task-oriented exercise incorporates daily activities into exercise strategies and has been recommended as an approach to reduce late-life disability. The current study used an interview research design to determine the feasibility of implementing 3-Step Workout for Life, a task-oriented program, in senior living communities. The 3-Step Workout for Life program consists of gym-based group resistance exercise and home-based one-on-one activity exercise. Fourteen fitness instructors from different communities, with independent living units, in the state of Florida completed the study. Interviews were transcribed, coded, and underwent thematic analysis. Instructors perceived the screening procedure to select and enroll residents in this program could help match residents to the right fitness program. The gym-based group resistance exercise is compatible with existing instructor-led fitness programs. Although instructors perceived the home-based one-on-one activity exercise positively, such as the potential benefits for frail residents who do not attend the gym, they acknowledged several barriers to implementing this exercise. Major barriers include their job responsibility restricting them from working in the resident’s home, their belief that activity exercise should be better delivered by a rehabilitation professional, and limited staff to support the one-on-one format. The next step is to collaborate with community stakeholders to address these barriers and build capacity to implement task-oriented exercise programs.

Stakeholder involvement in the optimization of a patient-centered exercise intervention for people with restless legs syndrome.

Previous research supports exercise as a behavioral approach to manage symptoms of restless legs syndrome (RLS); however, completion rates in exercise studies are low. This study obtained key stakeholder feedback from people with RLS to modify and optimize a 12-week, evidence-based exercise program for RLS. Participants with RLS (n = 513) completed a nationwide survey to provide feedback on the necessity, interest, feasibility, and efficacy of the program as well as perceived barriers and proposed modifications to improve the exercise program. Most respondents (67%) expressed the need for an exercise program designed specifically for people with RLS and 64% were interested in the program. Only 6% of participants thought the program would not be well tolerated and 6% responded that it would likely exacerbate symptoms. However, only 58% said they would be likely to participate in the program if it was available to them locally. Key barriers to participation were (1) accessibility, (2) personal factors, (3) trustworthiness, and (4) fear of injury, illness, or symptom exacerbations. Respondents highlighted modification considerations for the individualization of exercise features, adaptations for specific impairments/personal factors, inclusion of flexibility and balance exercises, and flexibility for more home-based activities. Interest in the program was driven by the desire to reduce medications and improve overall quality of life. Appropriately educated and trained exercise providers knowledgeable about RLS are integral to buy-in from stakeholders. This study provides an imperative step in clinical research that can increase the success of subsequent implementation efforts and may accelerate the adoption of exercise programs into practice. Cederberg KLJ, Sikes EM, Mignot E. Stakeholder involvement in the optimization of a patient-centered exercise intervention for people with restless legs syndrome. J Clin Sleep Med. 2024;20(4):535-543.

Abstract A024: Mind Your BEAT: A culturally adapted intervention to increase physical activity and reduce psychosocial distress among rural breast cancer survivors

Abstract Purpose: Rural cancer survivors are less likely to meet physical activity recommendations than urban cancer survivors, contributing to physical inactivity-related cancer health disparities. Evidence-based interventions to reduce psychosocial distress and increase physical activity in cancer survivors were developed in urban or clinical settings and often fail when implemented in rural community settings. The purpose of this study was to use a community-engaged approach to develop and evaluate an intervention to reduce psychosocial stress and increase physical activity in rural breast cancer survivors in Northeast Texas. Method: We conducted interviews with community partners and rural breast cancer survivors to adapt an evidence-based program for rural cancer survivors and for implementation in a rural community setting. The Mind Your BEAT (MYB) intervention combined aerobic exercise, group education, and mind-body strategies to increase physical activity and reduce psychosocial distress in rural breast cancer survivors. Participants were recruited through FitSteps for Life, an existing evidence-based exercise program, and randomized to participate in MYB or FitSteps as usual (control group). Self-reported weekly leisure time physical activity (WLA) was assessed using the Godin Leisure-Time Exercise Questionnaire, and psychosocial distress was assessed using the NCCN distress thermometer. All measures were completed at baseline and following the 3-month intervention. Participants were categorized as meeting physical activity recommendations or not (WLA score ≥24 or <24) and reporting high or low psychosocial distress (NCCN score ≥4 or <4). Results: To date, 29 rural breast cancer survivors (M age=65.8±10.3 years) have enrolled in the study, and 24 (83%) were retained at post-intervention. Most participants completed a bachelor degree or more (62%), reported an annual household income >$40,000 (80%), reported their cancer stage at diagnosis was 0-II (95.9%), and were over 5 years post-treatment (M=5.9±8.4 years). In the MYB intervention, the percent of rural breast cancer survivors who met physical activity recommendations increased from 53.3 to 90.9% compared to the control group, which decreased from 64.3 to 50%. The percent of rural cancer survivors who reported high psychosocial distress decreased from 66.7 to 27.3% in the MYB group and from 57.1 to 41.7% in the control group. Conclusions: MYB integrates physical and psychological health and wellbeing and is feasible among rural breast cancer survivors who are insufficiently active. Furthermore, MYB improved physical activity and reduced psychosocial distress among rural cancer survivors who experience poorer cancer survivorship outcomes and are at greater risk of recurrence, comorbidity and death. Findings from this study fill a critical gap in the literature on the translation of evidence-based interventions into sustained practice in rural community settings. Citation Format: Scherezade K. Mama, Lily Ju, Brandy Friendly, Ian Leavitt, Laura Q. Rogers, Kathryn H. Schmitz, Lorna H. McNeill. Mind Your BEAT: A culturally adapted intervention to increase physical activity and reduce psychosocial distress among rural breast cancer survivors [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A024.

Efectividad de una aplicación de telerrehabilitación para tableta en pacientes con fractura de extremo distal del radio

IntroductionTo assess whether, in patients with distal radius fracture feedback-guided exercises performed on a tablet touchscreen reduce healthcare usage and improve clinical recovery, more than the conventional home exercise program prescribed on paper. Material and methodsA multicentre, parallel, two-group, pragmatic, controlled trial with assessor blinding and intention-to-treat analysis. Forty-six patients with distal radius fracture were recruited in Andalusian Public Health System. Participants in the experimental and control groups received the same in-patient physiotherapy sessions. Experimental group received a home exercise program using the ReHand tablet application and control group received an evidence-based home exercise program on paper. The primary outcome was the number of physiotherapy sessions tallied from hospitals data management system. Secondary outcomes included: the face-to-face rehabilitation consultations with a physiatrist, and clinical outcomes such as functional ability, grip strength, dexterity, pain intensity and range of motion. ResultsThe experimental group required fewer physiotherapy sessions (MD: −16.94; 95%CI: −32.5 to −1.38) and rehabilitation consultations (MD: −1.7; 95%CI: −3.39 to −0.02) compared to the control group. ConclusionsIn patients with distal radius fracture, prescribing feedback-guided exercises performed on a tablet touchscreen provided by ReHand reduced number of physiotherapy sessions and rehabilitation consultations.

Addressing unmet needs for evidence-based and protocol-driven upper limb exercise programs to improve hemodialysis fistula maturation

Addressing unmet needs for evidence-based and protocol-driven upper limb exercise programs to improve hemodialysis fistula maturation

Implementing a guideline-based education and exercise program for people with knee and hip osteoarthritis-Practical experiences of providers and clinic leaders: Aqualitative study.

The Good Life with osteoArthritis: Denmark (GLA:DTM ) program is an evidence-based education and exercise program designed for individuals with symptomatic hip and knee osteoarthritis. Launched in Denmark, it has been implemented across Europe, Australia, and North America. The authors assessed the feasibility of GLADTM implementation in Canada (Alberta) by applying the RE-AIM framework. An evaluation objective was to identify factors impacting the implementation of the program in both publicly funded and private rehabilitation settings, based on the experience of the initial cohort of providers and clinic leaders who set up and delivered the program. Semi-structured telephone interviews were conducted with GLA:DTM -trained providers, managers, or directors of clinics across Alberta. Braun and Clarke's thematic approach was used to code the data and identify emergent categories and themes. Those relevant to the implementation were identified and by consensus, categorized as facilitators of and challenges to the implementation process. Eighteen GLA:DTM -trained providers and three clinic leaders from a range of clinical settings completed an interview. Seven common themes emerged in relation to implementation across the study settings. Three themes reflect facilitators of implementation (program acceptability by providers, multi-level support mechanisms, and program flexibility) and four implementation challenges (direct and indirect costs, lack of external referrals, program access issues, and lack of suitable space). The initial implementation of the program was exploratory with limited focus on long-term sustainability. The GLA:DTM program is a translatable program that can be implemented with relative ease in both public and private rehabilitation settings; however, costs, space constraints, and having an adequate referral base were noted challenges. Further work is warranted to explore equitable access across public and private settings and program sustainability.

Development of an Evidence-Based Exercise Program for Childhood Cancer Survivors: A Feasibility and Pilot Study

This study aimed to develop an exercise program for childhood cancer survivors and examine its feasibility and effects on improvements in physical fitness, muscle strength, and body composition. A tailored exercise program for childhood cancer survivors was developed through 8 systematic procedures, including a review of literature, physical activity survey, qualitative study, the first expert panel discussion, drafting an evidence-based exercise program, secondary expert panel discussion, revising the exercise program, and conducting feasibility and pilot study. For the feasibility and pilot study, 10 childhood cancer survivors (mean age 16.30 ± 1.77 years) participated, divided into either an exercise or a control group. Participants in the exercise group participated in the exercise program for 6 weeks. Based on preliminary studies, the exercise programs consisted of home-based and supervised exercise programs, including resistance and sports, conducted for 6 weeks. The body composition was measured, and a 6-minute walk test, grip strength, vertical jump, sit-up, push-up, chair stand test, and sit and reach test was conducted. After completing the exercise program, muscular endurance (sit-up test, p-value = 0.039) and lower body strength (chair stand test, p-value = 0.010) were significantly increased in the exercise group compared to the control group. Fat mass significantly decreased in the exercise group compared to the control group (p-value = 0.010). In conclusion, the exercise program developed in this study demonstrated feasibility and effectiveness in reducing body fat mass and improving muscular endurance and lower body strength in childhood cancer survivors.

Physical therapy and rehabilitation for improvement of quality of life of breast cancer patients.

e18711 Background: One of the most critical factors that cancer patients need to consider when it comes to their rehabilitation is the availability of effective and personalized rehabilitation programs. Aside from being a vital part of cancer rehabilitation, exercise can also improve the quality of life for cancer patients and help them maintain a healthy and balanced lifestyle. The purpose of this study is to adapt an evidence-based exercise program and rehabilitation techniques for breast cancer patients undergoing adjuvant chemotherapy and test the efficacy of this approach combining physical therapy, massage therapy, equine therapy (intervention group) compared to chemotherapy only (control group) for improving quality of life. Methods: This is two-armed, randomized controlled trial to test the efficacy of physical therapy and rehabilitation for improving quality of life of breast cancer patients undergoing adjuvant chemotherapy. The intervention program included physical therapy, massage therapy, equine therapy. Control group received standard care, treatment group received standard care plus intervention. All patients completed the quality of life questionnaire (EORTC-QLQ-C30) at baseline and at 4 months. All participants randomized to treatment group first received one-on-one consultation with oncologist, Physical Medicine and Rehabilitation (PM&R) physicians and physical therapists. The intervention components include tri-weekly program that included physical therapy, massage therapy and equine therapy. Statistical methods (STATA) were used to analyze the data. We began data analyzes with observational statistics and independent variable analyzes. Results: Even though we did not find any difference in some aspects of intervention group during observational study, we saw a significant difference in DID model which showed significant improvement in data. Compared to control group, intervention group showed improved Quality of life (43.57***), improved PF (48.76***), RF (53.3***), EF (56***), CF (37.66**) and SF (52.85***). Another important observation is a fact that age and stage of the disease had no effect on quality of life or affected any aspect of this study, reasons of which has to be further analyzed. Conclusions: Our study proved that physical therapy and rehabilitation can be useful in improving the quality of life of breast cancer patients undergoing chemotherapy.

The relative activation of pelvic floor muscles during selected yoga poses

BackgroundIndividuals with pelvic floor muscle (PFM) dysfunction can benefit from core stabilization exercises. Yoga is a popular activity that can generate moderate to high trunk activity and has been shown to benefit this patient population. No data exist regarding PFM activity during yoga. Determining PFM activity will provide important information for developing an evidence-based exercise program. ObjectivesTo determine the relative activation of the PFM during select yoga poses. Study designCross-sectional design. MethodsPerianal surface EMG sensors were used to capture levator ani (LA) activation. Peak activity of a maximum voluntary isometric contraction (MVIC) represented 100% activity. For testing, subjects held the following poses for 30 s: locust; modified side plank; side angle; and hands-clasped front plank. The average EMG activity, expressed as a 100% percent of the MVIC (%MVIC), from 5 to 25 s of each pose was analyzed. ResultsSubjects generated the most activity (63.5 %MVIC) during the locust. Side angle (35.3 %MVIC) required greater activity than the side (29.1 %MVIC) and front planks (26.3 %MVIC). Locust activity was significantly greater (P < 0.001) than all poses; side angle activity was significantly greater (P < 0.01) than the front and side planks. ConclusionLA activation during locust was very high and sufficient for strength gains. LA activation during side angle, front plank, and side plank would be best for improving endurance and/or neuromuscular control of the PFM. Findings from this study showed differing levels of PFM activation across yoga poses that may benefit patients with pathology associated with PFM dysfunction.

An 8-step approach for the systematic development of an evidence-based exercise program for patients undergoing hematopoietic stem cell transplantation.

A tailored and reliable intervention program developed based on evidence is necessary for patients with serious health conditions. We describe the development of an exercise program for HSCT patients based on evidence from a systematic process. We developed the exercise program for HSCT patients using eight systematic steps: (1) a literature review, (2) understanding patient characteristics, (3) first expert group discussion, (4) development of the first draft of the exercise program, (5) a pre-test, (6) second expert group discussion, (7) a pilot randomized controlled trial (n=21), and (8) a focus group interview. The developed exercise program was unsupervised and consisted of different exercises and intensities according to the patients' hospital room and health condition. Participants were provided with instructions for the exercise program, exercise videos via smartphone, and prior education sessions. In the pilot trial, the adherence to the exercise program was only 44.7%, however, some changes in physical functioning and body composition favored the exercise group despite the small sample size. Strategies to improve adherence to this exercise program and larger sample sizes are needed to adequately test if the developed exercise program may help patients improve physical and hematologic recovery after HSCT. This study may help researchers develop a safe and effective evidence-based exercise program for their intervention studies. Moreover, the developed program may benefit the physical and hematological recovery in patients undergoing HSCT in larger trials, if exercise adherence is improved. https://cris.nih.go.kr/cris/search/detailSearch.do?seq=24233&search_page=L, identifier KCT 0008269.

Dutch prostate cancer patients' views about exercise and experience with exercise advice: a national survey

PurposeTo support the development and implementation of exercise programming for people with prostate cancer (PC), we investigated their views on exercise.MethodsOnline survey with open recruitment. We collected data on clinical and sociodemographic variables, experiences with exercise advice, outcome expectations, and preferences. We explored determinants of (1) having been counselled about exercise and (2) preferring supervised exercise.ResultsThe survey was completed by 171 patients (mean age = 70 years, SD = 6.5) from all PC treatment pathways. Sixty-three percent of the respondents reported never having been informed about the potential benefits of exercise. Forty-nine percent preferred exercise to be supervised. Respondents generally reported a positive attitude towards exercise. Seventy-four percent indicated barriers to exercising, including fatigue and lack of access to specific programmes. Outcome expectations were generally positive but moderately strong. Receiving hormonal therapy and younger age were significantly associated with having received exercise advice. Being insured and having higher fatigue levels contributed significantly to the preference for supervised exercise.ConclusionDutch people with PC report receiving insufficient effective exercise counselling. Yet, they are open to exercise and expect exercise to improve their health, although they experience various barriers that limit their ability to exercise.Implications for Cancer SurvivorsThe moderate outcome expectations for exercise of people with PC and their limited recall of exercise counselling highlight the need for better integration of exercise in clinical pathways. The lack of access to specific programming limits the use of evidence-based exercise programmes for people with PC.

Effectiveness of a Telerehabilitation Evidence-Based Tablet App for Rehabilitation in Traumatic Bone and Soft Tissue Injuries of the Hand, Wrist, and Fingers

ObjectiveTo assess whether feedback-guided exercises performed on a tablet touchscreen improve clinical recovery and reduce health care usage more than the conventional home exercise program prescribed on paper in patients with bone and soft tissue injuries of the wrist, hand, and/or fingers treated by public health services. DesignA multicenter assessor-blinded, parallel, 2-group controlled trial. SettingTrauma and rehabilitation services of 4 hospitals. ParticipantsSix hundred sixty-three patients with limited functional ability due to bone and soft tissue injuries of the wrist, hand, and/or fingers (N=663). InterventionsThe experimental group received a home exercise program using a tablet-based application with feedback, monitoring, and progression; the control group received an evidence-based home exercise program on paper. Main Outcome MeasuresThe primary outcome was functional ability through Patient Rated Wrist Evaluation for wrist conditions and the short version of Disabilities of the Arm, Shoulder and Hand for all other hand pathologies. Secondary outcomes included dexterity, pain intensity, grip strength, and health care usage (number of patients referred to rehabilitation service and number of clinical appointments). ResultsThe experimental group showed a significant improvement on the Patient Rated Wrist Evaluation (P=.001) and the short version of Disabilities of the Arm, Shoulder and Hand (P=.001) with medium effect sizes (η2=0.066-0.067) when compared with the control group. Regarding health care usage, the experimental group presented a reduction of 41% in the rate of referrals to face-to-face rehabilitation service consultations, a reduction of rehabilitation consultations (mean difference=−1.64; 95% confidence interval, −2.64 to −0.65) and physiotherapy sessions (mean difference=−8.52, 95% confidence interval, −16.92 to −0.65) compared to the control group. ConclusionsIn patients with bone and soft tissue injuries of the wrist, hand, and/or fingers, prescribing feedback-guided exercises performed on a tablet touchscreen was more effective for improving patients’ functional ability and reduced the number of patients referred to rehabilitation consultation and number of clinical appointments.