Exercise-based Treatment Research Articles

Clinical Outcomes and Tendon Structure at 3- to 4-Year Follow-up After Exercise-Based Treatment of Patellar Tendinopathy: A Prospective Study.

The long-term recovery (in years) of patellar tendinopathy treated with loading-based rehabilitation remains largely unknown. To examine the clinical outcome and tendon structure years after exercise-based treatment of chronic patellar tendinopathy. Case series; Level of evidence, 4. This was a 3- to 4-year follow-up evaluation of participants (N = 28) from a previous randomized clinical trial by the author group. All participants received loading-based rehabilitation for 12 weeks with either moderate-slow resistance (55% of 1 repetition maximum) or heavy-slow resistance (up to 90% of 1 repetition maximum). Both groups showed similar improvements after 3 and 12 months and were therefore collapsed in the present analysis. Function and symptoms (the Victorian Institute of Sport Assessment-Patella [VISA-P] questionnaire), tendon pain (numeric rating scale [NRS] during activity and during a single-leg decline squat test), and tendon structure (tendon vascularization and thickness on ultrasound) were assessed. The mean follow-up was 3.6 ± 0.4 years after the baseline assessment in the original clinical trial. The VISA-P score was 83.9 ± 11.9 (95% CI, 79.3-88.5) at the latest follow-up and did not differ from the 1-year follow-up score (P = .54). Similarly, NRS score during preferred sport (1.6 ± 1.7; 95% CI, 0.9-2.2) and single-leg decline squat (1.0 ± 1.8; 95% CI, 0.3-1.7) did not differ from the 1-year values and remained elevated. Power Doppler area and tendon thickness decreased significantly from 1 year to latest follow-up (P < .0001 and P = .02, respectively), but power Doppler area >1 mm2 was still present in 43% of the participants after 3 to 4 years, and the tendon thickness was still mildly elevated (6.4 ± 1.8 mm; 95% CI, 5.7-7.1 mm). Sports participation after 3 to 4 years (3.9 ± 2.7 h/wk; 95% CI, 2.9-7.1 h/wk) was significantly lower compared with preinjury levels (P < .0001). Clinical symptoms remained even years after loading-based treatment for patellar tendinopathy, whereas some but not all tendon structures normalized in this longer term follow-up.

Exercise-Based Dysphagia Treatment: A Proposed Checklist.

Oropharyngeal swallowing exercise-based interventions are frequently utilized to target physiologic mechanisms with the goal of improving swallowing function. However, study replicability and evidence synthesis regarding effects of interventions are limited due to inconsistent reporting on factors known to influence treatment delivery. In order to promote consistency of reporting factors associated with replicability, the authors constructed a set of preferred parameters focused on dysphagia as part of the initial version of the larger tool (Framework for RigOr aNd Transparency In REseaRch on Swallowing or FRONTIERS). Thirty-eight initial questions were assembled by the authors as part of the treatment subsection. Questions were then reviewed by individuals in the FRONTIERS collaborative who have expertise in research, clinical practice, or both. Twenty-four questions were removed following review, reducing the final set of treatment-focused questions to 14 questions. The revised set of questions provides users of the exercise-based treatment section of the FRONTIERS checklist with an initial checklist to promote transparency and rigor to improve study replicability and evidence synthesis. We intend for this treatment section of FRONTIERS to undergo further refinement following commentary and feedback.

Effectiveness of bracing combined with exercise-based treatment of adolescent idiopathic scoliosis: Assessing the synergistic benefits: A systematic review

The purpose of this study was to evaluate evidence on the effectiveness of combined bracing and exercise on adolescent idiopathic scoliosis (AIS). From inception to April 28, 2022, PubMed and Web of Science searched for randomized clinical and nonrandomized prospective studies reporting Cobb angle (CA), angle of trunk rotation (ATR), quality of life (QoL), and pulmonary function (PF) in AIS patients treated with exercise and braces (10 years-skeletal maturity). Two authors analyzed and extracted data for this review. The PEDro scale was used to assess the risk of bias (RoB). Therapy protocols and basic data have been collected. Each CA, ATR, QoL, and PF study’s evidence and strength were also included. A total of 12 studies with 714 patients with AIS were included. Five studies used a control group with exercises and 7 with braces. The results showed that exercise-brace can decrease CA and ATR and increase QoL and PF with AIS; however, the strength of conclusion for all outcomes was moderate. In this review, 4 studies were categorized as low RoB, 3 as moderate RoB, and 5 as high RoB. Level of evidence analysis revealed that 12 studies were classified as level of evidence B. The current studies do not sufficiently support the effects of exercise and brace therapy on CA, ATR, QoL, and PF in patients with AIS.

Can kinesiotaping optimise the results of an exercise-based treatment for rotator cuff-related shoulder pain? (PhD Academy Award)

Can kinesiotaping optimise the results of an exercise-based treatment for rotator cuff-related shoulder pain? (PhD Academy Award)

Efficacy and implementation of exercise-based smoking cessation treatment for adults with high anxiety sensitivity (STEP): Study protocol for a randomized controlled trial

Anxiety sensitivity (AS), reflecting the fear of bodily sensations, is a transdiagnostic vulnerability factor that underpins both affective psychopathology and smoking. Phase II research supports the efficacy of a 15-week community-based intervention (STEP) that combines high-intensity exercise offered by the YMCA with standard smoking cessation treatment (tobacco quitline and nicotine replacement therapy) for sedentary smokers with elevated AS. This Phase III study aims to enroll 360 adults to evaluate whether STEP efficacy for achieving smoking abstinence generalizes to Black and Hispanic smokers with elevated AS.

Identifying the Cerebral Physiologic Response to Aerobic Exercise Following Concussion: A Scoping Review.

The purpose of this study was to identify the cerebral physiologic response to aerobic exercise in individuals with a symptomatic concussion, highlighting available knowledge and knowledge gaps in the literature. A systematic scoping review was conducted and reported in keeping with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews. A search of EMBASE, MEDLINE, SCOPUS, BIOSIS, and Cochrane libraries was conducted on June 15, 2023 (from database inception). An online systematic/scoping review management system was used to remove duplicates, and the remaining articles were screened for inclusion by 2 researchers. Inclusion criteria required articles to be original research published in peer-reviewed journals. Additionally, studies were required to have an aerobic exercise component, include a measure of cerebral physiology during a bout of aerobic exercise, exclude moderate and/or severe traumatic brain injury (TBI) populations, and be in the English language. Both human and animal studies were included, with participants of any age who were diagnosed with a mild TBI/concussion only (ie, Glasgow Coma Scale score ≥ 13). Studies could be of any design as long as a measure of cerebral physiologic response to a bout of aerobic exercise was included. The search resulted in 1773 articles to be screened and data from 3 eligible studies were extracted. There are currently too few studies investigating the cerebral physiologic response to aerobic exercise following concussion or mild TBI to draw definitive conclusions. Further research on this topic is necessary since understanding the cerebral physiologic response to aerobic exercise in the concussion and mild TBI populations could assist in optimizing exercise-based treatment prescription and identifying other targeted therapies.

Device-Assisted Therapy for Lingual Function Rehabilitation: A “How To” Guide for Clinicians

Purpose: Lingual function rehabilitation is a frequently targeted area of exercise-based dysphagia treatment. This tutorial aims to provide a detailed guideline for clinicians on how to apply currently available evidence for implementation of lingual rehabilitation exercises both with and without device-assisted modalities. Method: We provide a detailed review of existing definitions of lingual function parameters (e.g., strength and endurance) with currently available normative values for clinical reference. Guidelines are also provided on how to use available lingual manometry (Iowa Oral Performance Instrument and Tongueometer) to aid in both assessment and treatment. With respect to determining exercise targets based on the lingual function assessment, we review the importance of leveraging principles of exercise physiology into the rehabilitation planning. Strategies for incorporating exercise physiology principles into strength and endurance training are provided along with a case example illustrating these concepts. Conclusions: This tutorial serves as a framework for clinical implementation of comprehensive lingual function assessment and rehabilitation. Considerations regarding barriers in access to equipment and clinical advocacy are also discussed.

Study protocol for a nationwide implementation of internet-based vestibular rehabilitation for patients with chronic vestibular symptoms (I-RECOVER)

BackgroundVestibular rehabilitation is a safe and effective exercise-based treatment for patients with chronic vestibular symptoms. However, it is underused in general practice. Internet-based vestibular rehabilitation (Vertigo Training), which has proven to be effective as well, was developed to increase uptake. We now aim to improve the quality of care for patients with vestibular symptoms by carrying out a nationwide implementation of Vertigo Training. We will evaluate the effect of this implementation on primary care.MethodsOur implementation study consists of three successive phases:1) We will perform a retrospective observational cohort study and a qualitative interview study to evaluate the current management of patients with vestibular symptoms in primary care, in particular anti-vertigo drug prescriptions, and identify areas for improvement. We will use the results of this phase to tailor our implementation strategy to the needs of general practitioners (GPs) and patients.2) This phase entails the implementation of Vertigo Training using a multicomponent implementation strategy, containing: guideline adaptations; marketing strategy; pharmacotherapeutic audit and feedback meetings; education; clinical decision support; and local champions.3) In this phase, we will evaluate the effect of the implementation in three ways.a. Interrupted time series. We will use routine primary care data from adult patients with vestibular symptoms to compare the number of GP consultations for vestibular symptoms, referrals for vestibular rehabilitation, prescriptions for anti-vertigo drugs, and referrals to physiotherapy and secondary care before and after implementation.b. Prospective observational cohort study. We will extract data from Vertigo Training to investigate the usage and the characteristics of participants. We will also determine whether these characteristics are associated with successful treatment.c. Qualitative interview study. We will conduct interviews with GPs to explore their experiences with the implementation.DiscussionThis is one of the first studies to evaluate the effect of a nationwide implementation of an innovative treatment on Dutch primary care. Implementation strategies have been researched before, but it remains unclear which ones are the most effective and under what conditions. We therefore expect to gain relevant insights for future projects that aim to implement innovations in primary care.

An invigorating journey towards better function and well-being: A qualitative study of knee osteoarthritis patients’ experiences with an online exercise and education intervention

ObjectiveTo explore what it means for patients with knee osteoarthritis (OA) to engage in online delivered exercise and education. MethodWe combined participant observations and focus group interviews with knee OA patients who engaged in an 8-week program (12 exercise sessions and 2 education sessions) delivered online. Data underwent a three-level phenomenological-hermeneutic interpretation inspired by Ricoeur's narrative and interpretation theory. ResultsWe performed 17 participant observations during online group-based exercise sessions with twenty individuals with knee OA (12 females), median age 71 years (range: 48 to 81), and five focus group interviews with fifteen of the individuals. The following three themes emerged from the data analysis: 1. Exercise engagement portrays an experience of ownership of the exercise-based treatment, leading to better function and well-being and raising hope for the future 2. A good start but only halfway supported portrays perceived well-guided in performing knee OA exercise, however also some unmet support needs in the online format, and 3. Beneficial peer companionship with online constraints portrays a socially engaging peer forum that, at times, was limited by the online format. ConclusionsThis phenomenological-hermeneutic study reflects that supervised online exercise and education facilitate identity mobility, potentially increasing self-efficacy to adopt weekly exercise habits in patients with knee OA. However, the program may benefit from enabling a more interactive approach between peer participants and combining the online format with physical group classes. Moreover, further individualization and focus on a gradual approach toward self-management are encouraged.

Psychological factors and symptom duration are associated with exercise-based treatment effect in people with hypermobile shoulders: A secondary analysis of a randomised controlled trial

BackgroundShoulder symptoms are common in patients with hypermobility spectrum disorders (HSD), but few studies focus on identifying factors associated with treatment effects. AimTo identify baseline and clinical characteristics associated with a better outcome 16 weeks after starting an exercise-based treatment in patients with HSD and shoulder symptoms. DesignExploratory secondary analysis of data from a randomised controlled trial. MethodSelf-reported treatment outcome was reported as change between baseline and follow-up after 16 weeks of high-load or low-load shoulder strengthening. Multiple linear and logistic regressions were used to investigate associations of patient expectations of treatment effect, self-efficacy, fear of movement, and symptom duration with change in shoulder function, shoulder pain, quality of life, and patient reported health change. All regression models were performed firstly with adjustments for covariates (age, sex, body mass index, hand dominance, treatment group, and baseline score of the outcome variable) and secondly with additional adjustments for exposure variables. ResultsExpectations of complete recovery were associated with an increased odds of perceiving an important improvement in physical symptoms after a 16-week exercise-based treatment program. Higher self-efficacy at baseline seemed to be associated with improved shoulder function, shoulder pain and quality of life. A higher fear of movement seemed to be associated with increased shoulder pain and decreased quality of life. A longer symptom duration was associated with decreased quality of life. ConclusionExpectations of complete recovery, higher self-efficacy, lower fear of movement and shorter symptom duration seem to be important for better treatment outcomes.

Effectiveness of vestibular rehabilitation therapy (VRT) after persistent dizziness following sport-related concussion: a systematic review of the literature

Background: Vestibular Rehabilitation therapy (VRT) is an exercise-based treatment program designed to promote vestibular habituation, adaptation, and substitution. The goals of VRT are to enhance gaze stability, postural stability, and to improve activities of daily living. Dizziness and balance impairments are common following sport-related concussions; however, it is unclear how much impact VRT may have in the treatment for this population. Purpose: To conduct a systematic review to verify the application and outcomes of VRT after sport-related concussion with persistent dizziness and to determine the effectiveness of the treatment for sport-related concussion. Method: A systematic review of the following electronic databases was conducted: CINAHL Complete, PsycINFO, SPORTDiscus, Academic Search Complete, PUBMED, COCHRANE, and MEDLINE. The search ranged from January 2011 to April 2023. Results: 248 articles were found based on the specific search criteria. From them, 105 were selected and 54 records screened. After applying the criteria of inclusion and exclusion, four articles remained for examination. Conclusion: Vestibular rehabilitation therapy shows promise to improve dizziness and imbalance symptoms in those who have suffered sport-related concussions. As current return-to-play protocols do not account for adequate compensation of the vestibular system and may result in reinjury, vestibular rehabilitation may be able to assist the player’s recovery time, and in turn prevent reinjury; however, due to limited evidence, further studies are necessary to confirm these findings.

THE EFFECT OF ACTIGRAPHY MEASURED PHYSICAL ACTIVITY ON EXECUTIVE FUNCTION IN OLDER ADULTS

Abstract Executive function (i.e., decision making, self-control, planning) is important for facilitating independent living in older adults. Physical activity may preserve executive function, but previous research has demonstrated sex differences in both physical activity and executive function among older adults. Few studies have investigated sex differences in the association between the two. We examined associations between objectively measured physical activity and executive function with attention to sex differences. We recruited N = 204 participants (Mage =71, SD=6.36; 57% women) with (n=47) and without (n=157) Alzheimer’s disease from the University of Kansas Alzheimer’s Disease Research Center. We used wrist-worn accelerometers (Actigraph GT9X) to measure physical activity 24 hours a day for 7 days in a free-living environment. We categorized physical activity as moderate to vigorous (MVPA) based on the Montoye (2020) Adult Vector Magnitude cut-points. We evaluated sex differences in the association between executive function and MVPA using multiple regression with an interaction term, adjusting for age, education, and dementia status. We used a composite score to combine tests of executive function (Digit Symbol Substitution, Stroop Interference, Trail making Part B, and Verbal Fluency). Results indicated, older age and lower education were associated with lower executive function scores (β=-2.12, p &amp;lt; 0.001; B=2.13, p &amp;lt; .05). In contrast to previous research, we did not find evidence for sex differences in the MVPA, executive function, nor the association between the two in our sample. Future research should investigate whether individualized exercise-based interventions and treatment between men and women may differentially benefit cognitive function.

Commentary: Zebrafish as a Model for Osteoporosis—An Approach to Accelerating Progress in Drug and Exercise-Based Treatment

Osteoporosis (OP) is a degenerative disease characterized by reduced bone strength and increased fracture risk. As the global population continues to age, the prevalence and economic burden of osteoporosis can be expected to rise substantially, but there remain various gaps in the field of OP care. For instance, there is a lack of anti-fracture drugs with proven long-term efficacy. Likewise, though exercise remains widely recommended in OP prevention and management, data regarding the safety and efficacy for patients after vertebral fracture remain limited. This lack of evidence may be due to the cost and inherent difficulties associated with exercise-based OP research. Thus, the current research landscape highlights the need for novel research strategies that accelerate OP drug discovery and allow for the low-cost study of exercise interventions. Here, we outline an example of one strategy, the use of zebrafish, which has emerged as a potential model for the discovery of anti-osteoporosis therapeutics and study of exercise interventions. The strengths, limitations, and potential applications of zebrafish in OP research will be outlined.

Telerehabilitation: A Practical Remote Alternative for Coaching and Monitoring Physical Kinetic Therapy in Patients with Mild and Moderate Disabling Parkinson's Disease during the COVID-19 Pandemic.

Background The COVID-19 pandemic imposed social/physical distancing, lockdown measures, and forced reorientation of the rehabilitation programs for people with Parkinson's disease (PD). Epidemiologic safety measures boosted remote exercise-based treatment. Objectives Remote delivery of rehabilitation care services is not typically used in our department. Therefore, this study aimed to assess and implement a telehealth physical rehabilitation program tailored for outpatients with idiopathic PD and slight or medium functional limitations. Methods A prospective study was performed on a group of outpatients with idiopathic PD, selected from the database of the neurorehabilitation clinic of the Emergency Teaching Hospital “Bagdasar-Arseni.” We studied 17 patients (5 women and 12 men), aged between 54-70 years (average 65.9 ± 4.87), with a disease history of 7.3 ± 3.6 (years), with mild or moderate disabling clinical forms, quantified by an average Hoehn and Yahr score of 2.3 ± 0.35 (limits 1.5-3). All patients underwent pharmacologic treatment with unchanged doses throughout the study. No patients had disabling osteoarticular problems (all could walk independently) and had no significant psycho-cognitive dysfunction. Patients were supervised and coached online in tandem by the therapist and physician. In addition, a family member assisted and supervised the patient's performance and coordinated the technical electronic procedures. Walking biodynamics was assessed by timing “6-meters walking” and “Get up and walk 3 meters” (TUG) tests. Each person attended ten sessions of motor telerehabilitation procedures (2 per week) lasting 50 minutes each during social distancing (October-December 2021). Results None of the patients was at increased risk of falling. They all improved their locomotor performance, reflected in a significant decrease in TUG duration (the initial average time improved from 13.50 seconds to 10.57). The telerehabilitation program also significantly improved the average walking speed (initially, 44.5 cm/sec and finally, it raised to 56.8 cm/sec). Discussion. The TUG and “6-meters walking” tests are helpful tools for a global biodynamic remote assessment of PD patients. Limitations of the study: a small group of selected patients, restrictive working conditions (due to epidemiological social/physical restrictions and no direct physiotherapist-patient contact), and need for supervision by an attendant to assist the subject and perform the audio-video transmission. Further studies are necessary to identify the optimal web-based model of care and boost the implementation of this modern neurorehabilitation concept. Conclusions Telemedicine turned the virtual space into a new reality and may compensate for the restrictions imposed on face-to-face meetings in pandemic conditions. Moreover, with modern telecommunication techniques, a regular and individualized physical kinetic rehabilitation program can be performed even in pandemic conditions. Remote delivery of kinetic motor programs was appropriate for selected groups of PD patients.

CARDIOPULMONARY TEST PARAMETERS USEFUL FOR ADDRESSING PATIENTS WITH PECTUS EXCAVATUM TO PROMOTION OF PHYSICAL ACTIVITY

Objective: Exercise training increases muscle VO2 by increasing O2 transport and O2 uptake positively affecting cardiac output. In subjects with pectus excavatum cardiac output increase during exercise might be limited by the conformation of the chest. In this condition, the psychological impact of the deformity can further reduce the propensity to physical activity, leading to a sedentary lifestyle. Surgery is the preferred choice in severe cases. However, many patients with milder deformities can benefit from exercise-based treatment. The choice of the therapeutic strategy is fundamental, but the functional parameters on which to base this choice are not yet well defined. Therefore, we investigated the relationships between habitual physical activity and functional physiological parameters obtained from the cardiopulmonary exercise test (exercise performance and stroke volume at peak exercise) in pectus excavatum. Design and method: A cohort of adolescents (15 with pectus excavatum and 15 age- and sex-matched healthy controls) underwent Cardiopulmonary Exercise Test to estimate exercise performance (VO2 max) and stroke volume at peak exercise (VO2/HR, O2 pulse). Habitual weekly physical activity, estimated with International Physical Activity Questionnaire – Short Form (IPAQ-SF), was expressed as METs h-1·week-1. Determinants of exercise performance and stroke volume at peak exercise were investigated in the whole group with multivariable linear regression analysis adjusted for sex, body mass index, forced expiratory volume in the first second, and presence of pectus excavatum. Results: When compared to healthy controls, subjects with pectus excavatum had lower VO2 max (37.2 ± 6.6 vs 45.4 ± 6.4 mL·kg-1·min-1, p &lt; 0.05), and O2 pulse (12.1 ± 2.4 vs 16.2 ± 3.6 mL·min-1·bpm-1, p &lt; 0.05). Importantly, physical activity level was a predictor of VO2 max (B = 0.085; 95% Cl 0.010 to 0.160) while it did not affect O2 pulse (B = 0.035; 95% Cl -0.004 to 0.074). Conclusions: Training programs should be encouraged to increase cardiopulmonary performance in subjects with pectus excavatum. A marked reduction in O2 pulse at peak exercise might be considered as a criteria to address a subject towards surgery.

Survey of confidence and knowledge to manage patellofemoral pain in readers versus nonreaders of the physical therapy clinical practice guideline

ObjectivesTo compare beliefs of physical therapists (PTs) who read the clinical practice guideline (CPG) for the management of individuals with patellofemoral pain (PFP) to those who have not read the CPG. DesignCross-sectional study. SettingOnline survey. Participants494 currently licensed/registered PTs or physiotherapists. Main outcome measuresRespondents answered Likert-based or open-ended questions regarding the diagnosis, prognosis, risk factors, and management of individuals with PFP, as well as confidence for managing individuals with PFP, especially the ability to identify beneficial and non-beneficial interventions. We dichotomized responses into participants who read (READERS) and did not read (NonREADERS) the CPG. ResultsMost respondents held inaccurate beliefs about risk factors and prognosis; however, READERS’ beliefs better aligned with the CPG than NonREADERS (P < 0.01). Most respondents correctly agreed that hip and knee exercise was the recommended treatment strategy; yet NonREADERS believed in implementing unsupported passive treatments (P < 0.01). READERS reported greater confidence in managing individuals with PFP, delivering evidence-based interventions, identifying less beneficial treatments, and locating evidence-based resources than NonREADERS (P < 0.01). ConclusionWhile READERS and NonREADERS held accurate beliefs for exercise-based treatment for PFP, greater knowledge translation is needed to counter inaccurate beliefs regarding risk factors, prognostic factors, and passive treatments.

Effect of Mobilization with Movement and Kinesio Taping on Knee Function and Pain in Gonarthrosis

Background. Gonarthrosis is one of the most common diseases of the musculoskeletal system. As the disease progresses, the patient’s social and physical activities change. Reliable and effective therapies that slow the progression of gonarthrosis have not yet been found. There is a lack of evidence that a short course of physiotherapy and exercise-based treatment is effective or of how mobilization with movement and kinesio taping affects knee function and pain. We believe that in patients with knee gonarthrosis, the positive effects of physiotherapy combined with mobilization with movement and kinesio taping on knee functions and pain will be better than in those subjects who received only traditional physiotherapy.&#x0D; Aim. To determine the effect of mobilization with movement and kinesio taping on knee function parameters and pain in gonarthrosis.&#x0D; Methods. The study included 22 people diagnosed with gonarthrosis. For the experimental group (n=11), physiotherapy exercise, mobilization with movement and kinesiotape were applied, whereas the control group (n=11) used only physiotherapy exercise procedures. Subjects were evaluated for pain intensity, active knee range of motion, dynamic knee joint stability and evaluation of thigh muscle strength.&#x0D; Results. In the experimental group, there was a significant decrease in pain after 7 days and a significant difference with control group. Significant knee flexion results were recorded in the experimental group and significant knee extension results were recorded in the control group. In the experimental group, the dynamic knee joint stabilization significantly increased after 14 days. The strength of the thigh muscles was significantly increased in the experimental group after 14 days.&#x0D; Conclusion. The effect of mobilization with movement and kinesio taping of knee function, dynamic stability pain improving functional performance of dynamic stability was more significant than an exercise program lasting two weeks in subjects with knee gonarthrosis.&#x0D; Keywords: gonarthrosis, mobilization with movement, kinesio taping.

Dysphagia rehabilitation following acquired brain injury, including cerebral palsy, across the lifespan: a scoping review protocol

BackgroundSwallowing impairment (dysphagia) following brain injury can lead to life-threatening complications such as dehydration, aspiration pneumonia and acute choking episodes. In adult therapeutic practice, there is research and clinical evidence to support the use of swallowing exercises to improve swallowing physiology in dysphagia; however, the use of these exercises in treating children with dysphagia is largely unexplored. Fundamental questions remain regarding the feasibility and effectiveness of using swallowing exercises with children. This review aims to outline the published literature on exercise-based treatment methods used in the rehabilitation of dysphagia secondary to an acquired brain injury across the lifespan. This will allow the range and effects of interventions utilised to be mapped alongside differential practices between adult and child populations to be formally documented, providing the potential for discussions with clinicians about which rehabilitative interventions might be appropriate for further trial in paediatrics.MethodsThis study will use a scoping review framework to identify and systematically review the existing literature using Joanna Briggs Institute (JBI) and Preferred Reporting Items for Systematic Reviews (PRISMA) scoping review guidelines. Electronic databases (MEDLINE, PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Allied and Complementary Medicine Database (AMED)), grey literature and the reference lists of key texts including systematic reviews will be searched. Information about the rehabilitation design, dosage and intensity of exercise programmes used as well as demographic information such as the age of participants and aetiology of dysphagia will be extracted. The number of articles in each area and the type of data source will be presented in a written and visual format. Comparison between the literature in adult and child populations will be discussed.DiscussionThis review is unique as it directly compares dysphagia rehabilitation in adults with that of a paediatric population in order to formally identify and discuss the therapeutic gaps in child dysphagia rehabilitation. The results will inform the next stage of research, looking into the current UK-based speech and language therapy practices when working with children with acquired dysphagia.Systematic review registrationOpen science framework osf.io/ja4dr

Moderate-intensity exercise alleviates pyroptosis by promoting autophagy in osteoarthritis via the P2X7/AMPK/mTOR axis

Instability and excessive use of the knee joint can cause osteoarthritis (OA). Reasonable exercise can enhance the stability of the knee joint and prevent and relieve the occurrence and development of OA. As a key switch for inflammation, P2X purinoceptor 7 (P2X7) has attracted much attention in studies of OA. Exercise can regulate P2X7 expression and activation. However, the role of P2X7 in exercise-based prevention and treatment of OA is unknown. We previously showed that moderate-intensity exercise can significantly alleviate OA symptoms. Accordingly, in this study, we evaluated the effects of exercise on P2X7 expression and activation in chondrocytes. Micro-computed tomography, hematoxylin, and eosin staining, Toluidine Blue O staining, immunohistochemistry, and terminal deoxynucleotidyl transferase dUTP nick-end labeling experiments showed that P2X7 expression was lower in the moderate-intensity exercise group than in the inflammation and low- and high-intensity exercise groups. Additionally, chondrocyte death, cartilage destruction, and the degree and severity of pyroptosis were significantly reduced, whereas autophagy levels were significantly increased in the moderate-intensity exercise group. Cell Counting Kit-8 assay, lactate dehydrogenase release, flow cytometry, enzyme-linked immunosorbent assay, cell fluorescence, western blot, reverse transcription-quantitative polymerase chain reaction, and transmission electron microscopy experiments showed that moderate activation of P2X7 promoted autophagy through the AMP-activated protein kinase (AMPK)/mammalian target of rapamycin (mTOR) signaling pathway and promoted autolysosome targeting for degradation of the inflammasome component NLRP3, thereby inhibiting pyroptosis. Additionally, the use of AMPK and mTOR activators and inhibitors indicated that the AMPK-mTOR signaling pathway, as the downstream of P2X7, played a key role in delaying the occurrence and development of OA. We propose that moderate-intensity exercise promoted chondrocyte autophagy through the P2X7/AMPK/mTOR signal axis to alleviate pyroptosis. Our findings provide novel insights into the positive and preventative effects of exercise on OA.

Is an individually tailored programme of intense leg resistance and dynamic exercise acceptable to adults with an acute lateral patellar dislocation? A feasibility study

BackgroundLateral patellar dislocations mainly affect active teenagers and young adults. To help people recover, non-surgical exercise-based treatment is often recommended but the optimal exercise-based treatment is unknown. Currently, treatment outcomes after this injury are variable. Common problems include recurrent dislocation, reduced activity levels, and later surgery. A programme of intense leg resistance exercises, and dynamic exercises related to participants’ activity-related goals, has rationale, but has not been previously reported. In line with the Medical Research Council guidance, this study aimed to assess the acceptability of a novel evidence-based exercise programme for adults after acute lateral patellar dislocation and the feasibility of future research evaluating this treatment.MethodsA single-group prospective study was conducted at the John Radcliffe Hospital, Oxford, UK. Participants were 16 years or older with an acute first-time or recurrent lateral patellar dislocation. Participants received up to six face-to-face, one-to-one, physiotherapy sessions, over a maximum of 3 months, and performed intensive home exercises independently at least three times per week. Strategies to increase exercise adherence were used. Primary objectives were to determine the number of eligible patients, the recruitment rate (proportion of eligible patients that provided written informed consent), participant adherence to scheduled physiotherapy sessions and self-reported adherence to prescribed exercise, and intervention acceptability to participants measured by attrition and a study-specific questionnaire. Data were analysed using descriptive statistics.ResultsFifteen of 22 (68%) patients with a lateral patellar dislocation were eligible. All eligible (100%) were recruited. Two of 15 (13%) participants provided no outcome data, 2/15 (13%) provided partial outcome data, and 11/15 (73%) provided all outcome data. Questionnaire responses demonstrated high intervention acceptability to participants. Participants attended 56/66 (85%) physiotherapy sessions and 10/11 (91%) participants reported they ‘always’ or ‘often’ completed the prescribed exercise. One participant redislocated their patella; another experienced knee pain or swelling lasting more than one week after home exercise on three occasions.ConclusionThe intervention appeared acceptable to adults after acute lateral patellar dislocation, and a future randomised pilot trial is feasible. This future pilot trial should estimate attrition with increased precision over a longer duration and assess participants’ willingness to be randomised to different treatments across multiple centres.Trial registrationClinicalTrials.govNCT03798483, registered on January 10, 2019