Exercise-based Treatment Research Articles

Chiropractic management of a 47-year–old firefighter with lumbar disk extrusion

Objective This case report describes the effect of exercise-based chiropractic treatment on chronic and intractable low back pain complicated by lumbar disk extrusion. Clinical Features A 47-year–old male firefighter experienced chronic, unresponsive low back pain. Pre- and posttreatment outcome analysis was performed on numeric (0-10) pain scale, functional rating index, and the low back pain Oswestry data. Secondary outcome assessments included a 1-rep maximum leg press, balancing times, push-ups and sit-ups the patient performed in 60 seconds, and radiographic analysis. Intervention and Outcome The patient was treated with Pettibon manipulative and rehabilitative techniques. At 4 weeks, spinal decompression therapy was incorporated. After 12 weeks of treatment, the patient's self-reported numeric pain scale had reduced from 6 to 1. There was also overall improvement in muscular strength, balance times, self-rated functional status, low back Oswestry scores, and lumbar lordosis using pre- and posttreatment radiographic information. Conclusion Comprehensive, exercise-based chiropractic management may contribute to an improvement of physical fitness and to restoration of function, and may be a protective factor for low back injury. This case suggests promising interventions with otherwise intractable low back pain using a multimodal chiropractic approach that includes isometric strengthening, neuromuscular reeducation, and lumbar spinal decompression therapy.

Curing dyslexia and attention‐deficit hyperactivity disorder by training motor co‐ordination: Miracle or myth?

Dore Achievement Centres are springing up world-wide with a mission to cure cerebellar developmental delay, thought to be the cause of dyslexia, attention-deficit hyperactivity disorder, dyspraxia and Asperger's syndrome. Remarkable success is claimed for an exercise-based treatment that is designed to accelerate cerebellar development. Unfortunately, the published studies are seriously flawed. On measures where control data are available, there is no credible evidence of significant gains in literacy associated with this intervention. There are no published studies on efficacy with the clinical groups for whom the programme is advocated. It is important that family practitioners and paediatricians are aware that the claims made for this expensive treatment are misleading.

No evidence that an exercise‐based treatment programme (DDAT) has specific benefits for children with reading difficulties

Reynolds and Nicolson (Dyslexia: An International Journal of Research & Practice, 2007) report follow-up data 12 and 18 months after a period of intervention consisting of an exercise-based treatment programme (Dyslexia Dyspraxia Attention Treatment Programme, DDAT). The findings suggested the treatment had effects on bead threading, balance, rapid naming, semantic fluency and working memory but not on reading or spelling. We argue that the design of the study is flawed, the statistics used to analyse the data are inappropriate, and reiterate other issues raised by ourselves and others in this journal in 2003. Current evidence provides no support for the claim that DDAT is effective in improving children's literacy skills.

Rehabilitation of Achilles and patellar tendinopathies

Achilles and patellar tendinopathies affect a broad range of the population and are difficult conditions to manage clinically. The pathology is persistent in the chronic tendon and can be considered to be failed healing. The exact cause of tendinopathy pain is unclear but may be related to changes in neurovascular structures. Rehabilitation for Achilles and patellar tendinopathies is based on an exercise programme that aims to improve muscle-tendon function and normalise the pelvic/lower limb kinetic chain. This incorporates a programme for restoring and improving muscle strength, endurance and power and retraining sport-specific function. Rehabilitation may take a prolonged period of time, both the athlete and clinician must be patient and persistent to maximise results from an exercise-based treatment.

How relevant are exercise capacity measures for evaluating treatment effects in chronic fatigue syndrome? Results from a prospective, multidisciplinary outcome study

Objective: To evaluate the outcome of a multidisciplinary treatment programme for patients with chronic fatigue syndrome, including health-related quality of life (HRQoL) and psychosocial variables, and exercise capacity measures. Design: A six-month prospective outcome study. Setting: University outpatient rehabilitation clinic; group setting. Subjects: One hundred and sixteen women fulfilling chronic fatigue syndrome criteria. Interventions: Cognitive behaviourally and graded exercise-based strategies; emphasis on adaptive lifestyle changes. Measures: Short Form General Health Survey (SF-36); Symptom Checklist (SCL-90); Causal Attribution List (CAL); Self-Efficacy Scale (SE); maximum progressive bicycle ergometer test with respiratory gas analysis; and isokinetic leg strength test, before and after treatment. Results: The total group significantly improved on nearly all reported HRQoL/ psychosocial variables. Changes in exercise capacity measures were rather modest and did not correlate or only weakly correlated with HRQoL/psychosocial variables. Subgroup analyses indicated that less fit patients improved significantly more on exercise capacity measures than their more fit counterparts. Patients who were fitter at baseline scored better on pretreatment HRQoL/psychosocial variables, but both subgroups improved similarly on these variables. Conclusions: Health-related quality of life and psychosocial functioning in patients with chronic fatigue syndrome improves after a six-month cognitive behaviourally and graded exercise-based multidisciplinary treatment programme. Increase in exercise capacity measures is not a necessary condition for reported improvements, except for less fit patients.

Evaluation of an exercise-based treatment for children with reading difficulties.

An evaluation is reported of an exercise-based approach to remediation of dyslexia-related disorders. Pupils in three years of a Warwickshire junior school were screened for risk of literacy difficulty using the Dyslexia Screening Test (DST). The 35 children scoring 0.4 or over on the DST were divided randomly into two groups matched for age and DST score. One quarter of the participants had an existing diagnosis of dyslexia, dyspraxia or ADHD. Both groups received the same treatment at school but the intervention group used the DDAT exercise programme daily at home. Performance on the DST and specialist cerebellar/vestibular and eye movement tests were assessed initially and after six months. Cerebellar/vestibular signs were substantially alleviated following the exercise treatment whereas there were no significant changes for the control group. Even after allowing for the passage of time, there were significant improvements for the intervention group in postural stability, dexterity, phonological skill, and (one-tailed) for naming fluency and semantic fluency. Reading fluency showed a highly significant improvement for the intervention group, and nonsense passage reading was also improved significantly. Significantly greater improvements for the intervention group than the control group occurred for dexterity, reading, verbal fluency and semantic fluency. Substantial and significant improvements (compared with those in the previous year) also occurred for the exercise group on national standardized tests of reading, writing and comprehension. It is concluded that, in addition to its direct effects on balance, dexterity and eye movement control, the benefits of the DDAT exercise treatment transferred significantly to cognitive skills underlying literacy, to the reading process, and to standardized national literacy attainment tests.

Review of Working it out: Using exercise in psychotherapy.

KATE F. HAYS Working It Out: Using Exercise in Psychotherapy Washington, DC: American Association, 1999, xxii + 281 pp. (ISBN 1-55798-592-8, US$39.95, Hardcover) In this well-organized book, Kate Hays presents exercise as a important component of a multi-modal approach to therapy. The overall content is differentiated into four major sections, in the first of which Hays establishes the value of exercise. She defines her terms and lays the foundations of her rationale within the context of empirical research demonstrating the body-mind connection. The reader is then walked through various theoretical and philosophical perspectives on both therapy and exercise, and is asked to reflect upon his or her own beliefs and views. The second section moves from theory to the use of exercise as a therapeutic tool. Describing therapists as agents for change, (p. 37) Hays provides a model outlining the stages of change and assumptions therein. It is in this section that she points out the challenges encountered in using exercise in psychotherapy and defines the myriad issues related to using this approach with non-exercising clients. These involve the issues of helping clients begin an exercise program within a therapeutic context, the type and amount of exercise, and factors affecting beliefs about the efficacy of exercise (e.g., personal, social, cultural, interpersonal). Outlined in the third section are the Psychological Benefits of Exercise with Specific Populations, overviewing many common clinical populations and specific exercise-based treatment recommendations. Populations include those individuals suffering from depression, anxiety, post-traumatic stress disorder, eating disorders, and substance abuse, as well as less commonly clinical populations, such as those dealing with lifestyle issues, lifespan issues, and issues idiosyncratic to athletes. Each chapter includes Practitioner Recommendations that direct the therapist on the appropriate use of psychological techniques for that population, specific issues that may be encountered, options for application of treatment, and anticipated effects of exercise as treatment. The fourth section, Caveats and Boundaries, is just that, an important collection of chapters that did not find a place elsewhere in the book (though chapter 18 might fit in the previous section). The construct of boundaries is stretched to include boundaries on the physical limits of exercise, boundaries on the interpersonal and ethical limits of therapists and clients, and the boundaries of the professional disciplines involved in the ongoing integration of exercise and therapy. The first chapter in this section speaks to issues of moderation versus overuse of exercise, provides an excellent overview of models of overuse, and introduces the reader to constructs such as exercise deprivation and exercise degradation. The next chapter covers ethical issues and competency, including confidentiality, dual-- role relationships, self-disclosure, non-erotic physical contact, and the different traditions' perspectives on the ethics of sexual contact with present or former clients. Issues of diagnosis and third-party payments are also addressed. Hays wraps up this section with the steps a practitioner might take in order to further explore the field of sport psychology. The final section of the book constitutes a glossary of exercise and sport psychology terms and a number of appendixes. These include an outline for the development and expansion of a therapy practice that involves exercise, the history of exercise and sport psychology, and an exercise-related intake assessment. There is no major notion in the book that is not supported by a wealth of references to the literature of sport psychology or to the general field of psychology itself. As an author, Hays is very objective in her willingness to state clearly what empirical evidence does or does not exist for her assertions, acknowledging self report for its qualitative value. …