Exercise Program For Patients Research Articles

At home e-based physical exercise programs in patients with multiple sclerosis: a scoping review

IntroductionPhysical exercise (PE) improves symptoms and quality of life in people with multiple sclerosis (pwMS). However, incorporating PE into daily lives of pwMS pose difficulties. As an alternative to in-person PE, e-based PE has been proposed because of its advantages in terms of accessibility and convenience.ObjectiveTo synthesize existing evidence on e-based PE at home in adults MS and discuss study designs, rehabilitation programs, intervention effects and possible knowledge gaps.MethodsIn this scoping review, a systematic search in electronic databases including Embase, Medline, CINAHL and Cochrane Library was conducted following the PRISMA guidelines. Peer-reviewed articles in English on e-based PE interventional studies at home involving adult pwMS, published from 2008 until April 2023, were identified and exported to Covidence. Data from the included studies were extracted and synthesized. This scoping review identified different types of e-based PE interventions used in pwMS across different study designs, but when evaluating intervention effects, this review focused solely on randomized controlled trials (RCTs).ResultsA total of 3,006 studies were retrieved and 179 studies were screened in full text, resulting in the inclusion of 54 studies with a total of 2,359 pwMS. Of those, 33 were RCTs and three were qualitative studies. The studies reported on various e-based interventions including video-based programs, telerehabilitation, and web-based programs. The interventions evaluated muscle strength, cardiorespiratory fitness, walking speed, endurance, balance, and fatigue, as well as symptoms of depression and cognitive dysfunction. E-based PE interventions at home in RCTs demonstrated improvement of depressive symptoms and anxiety, while inconsistent results were reported for fatigue, walking speed and balance. No significant benefits were observed regarding dexterity. Results were generally heterogeneous and were limited by small sample sizes. Several limitations were identified, such as lack of physical activity assessment prior to the intervention and poor reporting of duration, intensity, frequency and adherence to e-based PE interventions.ConclusionE-based PE interventions in pwMS may improve MS-related symptoms, but the study quality is generally low, and findings are often inconsistent. Several important limitations of the existing literature have been identified in the present review, which can guide future research.

Evaluation Of A State-wide, Community-based Exercise Program In Patients Undergoing Cancer Treatment: A Subgroup Analysis Of The Life Now Exercise Program

Evaluation Of A State-wide, Community-based Exercise Program In Patients Undergoing Cancer Treatment: A Subgroup Analysis Of The Life Now Exercise Program

Abstract P126: Exercise-Induced Changes in Skeletal Muscle of Patients with Chronic Kidney Disease on Maintenance Hemodialysis

Background: Chronic kidney disease (CKD) patients on maintenance hemodialysis (MHD) often experience sarcopenia and functional decline. The impact of exercise and inactivity on sarcopenia in CKD is poorly understood. We aimed to identify exercise-responsive genes that are differentially expressed between controls and patients on MHD. We also aim to investigate the changes in gene expression in skeletal muscle following a resistance exercise program in patients on MHD. Methods: In a cross-sectional study, we performed RNA sequencing analysis in skeletal muscle biopsies from two groups (matched for age, gender, body mass index, and history of diabetes): controls (n=13) and patients on maintenance hemodialysis (MHD, n=10). In a separate cohort, we conducted a 12-week intradialytic resistance training in seven patients on MHD. Skeletal muscle biopsies were collected pre- and post-intervention to assess the acute (before and after a single bout of exercise) and chronic (after 12 weeks) effects of exercise. Total RNA was extracted and used to construct libraries for RNA sequencing using the Illumina NovaSeq 6000 system. Differentially expressed genes (DEGs) were identified based on a false discovery rate (FDR) of less than 0.05 and a fold change greater than 1.5. Exercise and inactivity-responsive genes in non-CKD populations identified in the MetaMEx (www.metamex.eu) were used as reference. Results: We found significant DEGs between the control and MHD that were affected by exercise or inactivity according to MetaMEx. These genes and fold changes between control and MHD groups are depicted in Table 1. In the exercise intervention cohort, we observed no significant differences in the expression of these genes either acutely (Figure 1A) or 12 weeks after the exercise intervention (Figure 1B). Conclusion: We found many DEGs related to exercise and inactivity between patients on MHD and controls; however, resistance training does not significantly alter skeletal muscle gene expression. Future studies should explore alternative exercise interventions, such as HIIT exercise, aerobic training, combined aerobic and resistance training, or longer duration programs, to determine if these approaches can effectively modulate gene expression and improve sarcopenia and frailty in this population.

Effect of a Nurse-Led Exercise Program on Depression in Elderly Patients with Diabetes: A Retrospective Study.

Patients with diabetes often face psychological challenges, particularly depression. The coexistence of these two conditions can significantly impact both the mental and physical health of individuals. This study aims to investigate the effects of nurse-led exercise training on elderly patients diagnosed with type 2 diabetes mellitus and comorbid depression through experimental research. By selecting appropriate exercise programs for patients, the study seeks to identify effective strategies for improving both their physical health and depressive symptoms. Additionally, it aims to offer tailored exercise recommendations to enhance the overall well-being of these patients. The observation group (n = 53) and the control group (n = 53) were selected based on the interventions documented in the patients' medical records, with eligible patients identified as research participants. The control group received standard medication, while the observation group engaged in intensive exercise training in addition to their standard treatment, dedicating 60-90 min per day to exercise. Prior to and following the intervention, blood glucose indices, levels of 5-hydroxytryptamine (5-HT) and norepinephrine (NE), self-rating depression scale (SDS), Self-Rating Anxiety Scale (SAS), Pittsburgh Sleep Quality Index (PSQI), and Generic Quality of Life Inventory (GQOLI-74) scores were assessed to evaluate the impact of the exercise training intervention. Following the intervention, levels of fasting blood glucose (FBG), 2-h postprandial blood glucose (PBG), and Hemoglobin A1c (HbA1c) were reduced compared to pre-intervention levels, with the exercise group exhibiting lower levels than the control group (p < 0.05). Additionally, post-intervention, patients' levels of 5-HT and NE increased, with the exercise group demonstrating higher levels than the control group (p < 0.05). Moreover, post-intervention, SDS and SAS scores decreased, with more significant improvements observed in the observation group (p < 0.05). Furthermore, the intervention improved sleep quality and quality of life among patients in the exercise group compared to those in the control group (p < 0.05). Nurse-guided exercise training demonstrates a significant capacity to ameliorate glycemic indexes among patients with diabetes mellitus comorbid with depression. It not only diminishes depression and anxiety levels but also enhances the expression of 5-HT and NE. Furthermore, it effectively elevates patients' sleep quality and quality of life. These findings underscore the potential of nurse-led exercise interventions for clinical promotion and widespread application.

Effects of a Resistance Exercise Program in Patients with Colorectal Cancer Undergoing Chemotherapy Treatment: A Randomized Controlled Trial Study Protocol.

Background: Colorectal cancer is a leading cause of morbidity and mortality worldwide, with chemotherapy being a crucial treatment despite its significant side effects, such as chemotherapy-induced peripheral neuropathy (CIPN). Physical exercise has shown potential benefits in mitigating these side effects and improving patients' overall well-being. Objective: This study aims to evaluate the efficacy of a strength exercise program in reducing CIPN in patients with colorectal cancer undergoing chemotherapy, along with secondary objectives including impacts on quality of life, body mass index, oxygen consumption, anxiety and depression, fatigue, sleep quality, and various analytical parameters. Methods: A double-blind randomized controlled trial was conducted with 44 participants, divided into an intervention group (supervised resistance training twice a week and home exercises) and a control group (home exercises only). The primary outcome measure was CIPN, assessed using the EORTC QLQ-CIPN20 questionnaire. Secondary outcomes included assessments using the EORTC QLQ-C30, the 6-minute walk test, HADS, FACT-F, and MISS, along with various blood parameters. Results and Conclusions: The study will provide insights into the effectiveness of physical exercise in managing CIPN and improving various health parameters in colorectal cancer patients. By developing tailored exercise protocols, this research aims to enhance patient quality of life, optimize treatment outcomes, and reduce the incidence of debilitating side effects, thereby supporting the integration of physical exercise into standard oncological care.

Comparison of Outcomes of Physical Therapy Exercises Combined with Either a Video-Based Smartphone Application System or a Written Exercise Program Handout in 34 Patients with Non-Specific Neck Pain.

BACKGROUND An exercise program was developed using risk factors for non-specific neck pain. This study aimed to compare the effects video-based versus image- and text-based remote home training performed using this exercise program in patients with non-specific neck pain. MATERIAL AND METHODS Among the 37 patients with non-specific neck pain recruited, 34 patients who satisfied the inclusion criteria were enrolled in this study. The participants were randomized into the experimental (n=17) and control (n=17) groups. The patients in the experimental group performed exercises using a video-based application system, whereas those in the control group performed exercises using an image- and text-based printout. In-home training was implemented for 6 weeks in both groups. The neck pain intensity, disability index, active range of motion (aROM), forward head posture (FHP), and compensatory neck flexion were measured before and after the intervention. The within-group and between-group differences were analyzed at the end of the interventions. RESULTS Improvements in pain intensity, cervical ROM, disability index, FHP, and compensatory neck flexion were observed after in-home training in the experimental group (P.05). Between-group comparison revealed that the experimental group exhibited greater improvement in pain intensity, cervical ROM, and FHP than the control group (P<.05). CONCLUSIONS The findings of this study suggest that the video-based home exercise program improved pain intensity, aROM, neck disability index, FHP, and compensatory neck flexion in patients with non-specific neck pain.

Barriers and facilitators to the delivery of a biopsychosocial education and exercise programme for patients with chronic low back pain in Ghana. A qualitative study

Purpose Low back pain management has evolved with researchers advocating for a biopsychosocial management model. The biopsychosocial management model has been predominantly applied in high-income countries and underexplored in low- and middle-income countries including Ghana. This study aimed to explore the potential barriers and facilitators to patients with chronic low back pain (CLBP) and physiotherapists engagement with a biopsychosocial intervention (exercise and patient education) as part of a feasibility study. Material and methods This was a qualitative study embedded within a mixed-methods, sequential, feasibility study, in Ghana, applying semi-structured interviews. Two categories of participants involved in this study were, two trained physiotherapists, and six patients with CLBP, sampled within the feasibility study. Results Regarding the barriers and facilitators to the delivery of the BPS intervention, five interlinked themes emerged from the thematic analysis. These were: structure and process of delivery; patients’ expectations; patients’ health beliefs, autonomy, and engagement; external influences and personal and professional characteristics of physiotherapists. Conclusion The themes that emerged from this study demonstrated many positive facilitators based on participants’ improved understanding of LBP and the clarity and purpose of the biopsychosocial intervention. The results therefore demonstrate a potential to deliver the biopsychosocial intervention in a Ghanaian context.

Effectiveness of Ultrasound Therapy, TheraBiteDevice, Masticatory Muscle Exercises, and Stabilization Splint for the Treatment of Masticatory Myofascial Pain: A Randomized Controlled Trial.

Myofascial pain syndrome (MPS) is a particular type of temporomandibular joint disorder. Research findings comparing various treatment approaches are scarce and controversial. Therefore, this study aimed to compare the effectiveness of ultrasound therapy, stabilization splint, TheraBitedevice, and masticatory muscle exercises in reducing pain intensity and improving mandibular mobility in patients with MPS. It was a single-blind, randomized, parallel-group, active-controlled trial that took place between April 2023 and October 2023 at the Department of Fixed Prosthodontics, Damascus University. Patients older than 18 years old with myofascial pain accompanied by limited jaw opening and pain lasting for at least 6 months were included. Eighty patients were randomly assigned into four groups using online randomization software: ultrasound therapy, stabilization splint, TheraBitedevice, and masticatory muscle exercises. Only outcome assessors were masked totreatment allocation. The exercise regimen was the exercise program for patients with TMD. The following primary outcome measures were considered at the baseline (t0), at the first (t1), second (t2), and fourth (t3) week of treatment, and at the second (t4) and fifth (t5) month of follow-up: pain intensity using the visual analogue scale, maximum interincisal opening, right lateral movement, and left lateral movementmeasured in millimeters. The pain level changed from severe to mild at t3 in ultrasound therapy, stabilization splint, and TheraBitedevice groups. In the masticatory muscle exercises group, it changed to moderate, with a significant difference between ultrasound therapy (p = 0.012) and stabilization splint (p = 0.013) groups. In addition, the mandibular mobility continued to improve at the subsequent follow-up periods (t4 and t5). All therapies are equally effective after 5-month follow-up. However, ultrasound therapy and stabilization splints have the benefit of achieving rapid improvement. ISRCTN20833186.

Adherence to physical exercise program in patients with hypertension

The study aims to assess adherence to a physical exercise program in patients with hyper-tension. 120 hypertensive patients were included in a 3-month physical exercise program (first 2 weeks, 10 daily sessions, under the supervision of a physical therapist in a rehabili-tation center, continued at home, 5 sessions per week). After the 3-month exercise program 108 patients completed an adherence questionnaire. All patients considered the physical exercise program important for their physical health; 82% of them also considered the program important for their mental health. 94% of patients admitted as necessary to con-tinue the physical exercise program after the end of the study. The lowest percentages of patients (47%) admitted the fitting of the physical exercise sessions performed in a rehabil-itation center with their daily program. Adherence to a 3-month physical exercise was beneficial for physical and mental health status of patients with hypertension. The pro-moting factors for a good adherence to rehabilitation were involvement and availability of patients, living in the city or nearby villages, free of charge exercise sessions and quality of physical therapy. The assessment of adherence by an easy-to-use tool can provide im-portant data for adapting the rehabilitation program to patients’ need and expectations. Keywords: hypertension; physical exercise; adherence.

Effects of Adding Four Sessions of Ultrasound-Guided Percutaneous Electrical Nerve Stimulation to an Exercise Program in Patients with Shoulder Pain: A Randomized Controlled Trial.

Objective: Percutaneous electrical nerve stimulation (PENS) appears to be effective for the treatment of musculoskeletal pain. The aim of this trial was to investigate the effects on disability and pain, as well as on the psychological aspects of adding PENS into an exercise program in patients with subacromial pain syndrome. Methods: A randomized, parallel-group clinical trial was conducted. Sixty patients with subacromial pain were allocated into exercise alone (n = 20), exercise plus PENS (n = 20), or exercise plus placebo PENS (n = 20) groups. Patients in all groups performed an exercise program twice daily for 3 weeks. Patients allocated to the PENS group also received four sessions of ultrasound-guided PENS targeting the axillar and suprascapular nerves. Patients allocated to the exercise plus placebo PENS received a sham PENS application. The primary outcome was related disability (Disabilities of the Arm, Shoulder, and Hand, DASH). Secondary outcomes included mean pain, anxiety levels, depressive symptoms, and sleep quality. They were assessed at baseline, one week after, and one and three months after. An analysis was performed using intention-to-treat with mixed-models ANCOVAs. Results: The results revealed no between-group differences for most outcomes (related disability: F = 0.292, p = 0.748, n2p = 0.011; anxiety: F = 0.780, p = 0.463, n2p = 0.027; depressive symptoms: F = 0.559, p = 0.575, n2p = 0.02; or sleep quality: F = 0.294, p = 0.747, n2p = 0.01); both groups experienced similar changes throughout the course of this study. Patients receiving exercise plus PENS exhibited greater improvement in shoulder pain at one month than those in the exercise (Δ -1.2, 95%CI -2.3 to -0.1) or the placebo (Δ -1.3, 95%CI -2.5 to -0.1) groups. Conclusions: The inclusion of four sessions of ultrasound-guided PENS targeting the axillar and suprascapular nerves into an exercise program did not result in better outcomes in our sample of patients with subacromial pain syndrome at one and three months after treatment.

Abstract GS02-10: Effects of a structured and individualized exercise program on fatigue and health-related quality of life in patients with metastatic breast cancer: the multinational randomized controlled PREFERABLE-EFFECT study

Abstract INTRODUCTION: Patients with metastatic breast cancer (mBC) often experience cancer- and treatment-related side effects that can impair daily life activities and health-related quality of life (HRQoL). Interventions are needed that improve HRQoL by alleviating fatigue and other side effects during palliative BC cancer treatment. Recent evidence-based international guidelines (ASCO, ACSM) recommend exercise for patients with BC during adjuvant treatment for reducing side effects. However, evidence of the effectiveness of exercise in patients with mBC is scarce. The PREFERABLE-EFFECT study (NCT04120298) was designed to assess the effects of a 9-month supervised exercise program in patients with mBC on fatigue, HRQoL, and other cancer- and treatment-related side effects. METHODS: PREFERABLE-EFFECT is a multinational, randomized controlled trial including patients with mBC from five European countries (Germany, Poland, Spain, Sweden, The Netherlands) and Australia. Participants were randomly assigned to usual care or an individualized, structured exercise program consisting of aerobic, resistance, and balance training. The first six months included twice weekly supervised exercise sessions of one hour. In the last three months, one supervised session was replaced by an unsupervised session, supplemented by an exercise App. All participants received general exercise advice (physical activity ≥ 30 min/day) and an activity tracker. Our primary outcomes, physical fatigue (subscale of the EORTC QLQ-FA12) and HRQoL (summary score of the EORTC QLQ-C30), were assessed at baseline, 3, 6, and 9 months. Among other physical fitness outcomes, maximal short exercise capacity was assessed with the Steep Ramp Test. The intervention effects (intention-to-treat) were determined by comparing the change from baseline to 3, 6 (i.e., primary endpoint) and 9 months between groups using separate mixed models for repeated measures, adjusted for baseline values of the outcome variable and stratification factors (mBC line of treatment (1st/2nd vs. 3rd or higher) and study center). A significant improvement of either or both primary outcomes (applying the Bonferroni-Holm method) was considered as successful. RESULTS: Between 2019-2022, we included 357 patients with mBC, with 178 patients randomized to the exercise intervention and 179 to usual care. Patients were, on average, 55.4 years of age (SD=11.1), most patients received 1st or 2nd line of treatment at study enrollment (74.8%) and had bone metastases (73.9%). At 6 months (primary endpoint), participation in the exercise intervention resulted in statistically significant positive effects on both primary outcomes, compared to usual care: physical fatigue was lower (mean difference: -5.3, 95% CI -10.0; -0.6, p=0.027, effect size (ES)=0.22) and HRQoL was better (+4.8, 95% CI 2.2; 7.4, p=0.0003, ES=0.33). Beneficial effects were also found at 3 months (physical fatigue: -3.4, -7.8; 1.0, ES=0.14 and QoL: 3.9, 1.5; 6.3, ES=0.27) and 9 months (physical fatigue: -5.6, -10.9; -0.4, ES=0.24 and QoL: +4.3, 1.4; 7.3, ES=0.31). Further, at the primary endpoint, we found positive exercise effects on physical fitness (+24.3 Watts, 15.5; 33.1, ES=0.42) and numerous QLQ-C30 scales, including social functioning (+5.5, 0.2; 10.8, ES=0.20), pain (-7.1, -12.1; -1.9, ES=0.28) and dyspnea (-7.6, -12.2; -3.0, ES=0.28). Two SAEs occurred (one wrist fracture and one sacral stress fracture), neither related to bone metastases. CONCLUSION: This large multinational study demonstrated significant beneficial effects of a supervised exercise intervention offered during palliative treatment on mBC patients’ fatigue, HRQoL, and other clinically relevant outcomes. Based on these findings, we recommend supervised resistance and aerobic exercise as part of supportive care regimens during palliative treatment of mBC. Citation Format: Anne May, Anouk Hiensch, Johanna Depenbusch, Martina Schmidt, Evelyn Monninkhof, Mireia Pelaez, Dorothea Clauss, Philipp Zimmer, Jon Belloso, Mark Trevaskis, Helene Rundqvist, Joachim Wiskemann, Jana Muller, Carlo Fremd, Renske Altena, Joanna Kufel-Grabowska, Rhode Bijlsma, Lobke van Leeuwen-Snoeks, Daan ten Bokkel-Huinink, Gabe Sonke, Bruce Mann, Prudence Francis, Gary Richardson, Isabel Álvarez, Wolfram Malter, Elsken Van der Wall, Neil Aaronson, Elżbieta Senkus, Ander Urriticoechea, Eva Zopf, Wilhelm Bloch, Martijn Stuiver, Yvonne Wengström, Karen Steindorf. Effects of a structured and individualized exercise program on fatigue and health-related quality of life in patients with metastatic breast cancer: the multinational randomized controlled PREFERABLE-EFFECT study [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr GS02-10.

Effectiveness of supervised physiotherapy versus a home exercise program in patients with distal radius fracture: a randomized controlled trial with a 2-year follow-up

ObjectiveTo determine in the long term whether supervised physiotherapy is more effective than a home exercise program for functional improvement and pain relief in patients with distal radius fracture (DRF). DesignRandomized controlled trial. SettingRehabilitation hospital. ParticipantsA total of 74 patients older than 60 years with extra-articular DRF were randomly allocated into two groups. InterventionsThe experimental group received 6 weeks of supervised physiotherapy (n = 37) and the control group received 6 weeks of home exercise program (n = 37). Main outcome measuresThe primary outcome was wrist/hand function assessed using the Patient-Rated Wrist Evaluation (PRWE) questionnaire; secondary outcomes were the pain visual analogue scale (VAS), grip strength and wrist flexion–extension active range of motion. ResultsAll patients completed the trial. For the primary outcome, at 6-weeks and 1-year follow-up, the PRWE questionnaire showed a mean difference between groups of 18.6 (95% CI 12.8 to 24.3) and 18.5 points (95% CI 12.7 to 24.2) respectively, these differences are clinically important. Conversely, at 2-year follow-up this effect decreases to 3.3 points (95% CI −2.4 to 9.0). For secondary outcomes, at 6-weeks and 1-year follow-up, in all measurements the effect size range from medium to large. Conversely, at 2-year follow-up only grip strength showed large effect size in favor of supervised physiotherapy, the rest of outcomes did not show difference between groups. ConclusionAt the 6-week and 1-year follow-up, supervised physiotherapy was more effective for functional improvement and pain relief compared with a home exercise program in patients older than 60 years with extra-articular DRF. However, this effect decreases over time, at the 2-year follow-up, only grip strength showed a difference in favor of supervised physiotherapy. Trial registrationBrazilian registry of clinical trials UTN no. U1111- 1249-2492. Registered 17 March 2020. Contribution of the Paper•Current evidence has shown controversial results regarding the effectiveness of supervised physiotherapy versus a home exercise program in elderly patients with DRFs.•At the 6-week and 1-year follow-up, supervised physiotherapy is more effective for functional improvement and pain relief.•However, at the 2-year follow-up, only grip strength showed a difference in favor of supervised physiotherapy in these patients.

Maximal Exercise Tolerance, Objective Trunk Strength, and Mobility Measurements in Axial Spondyloarthritis.

Although exercise therapy is safe, effective, and recommended as a nonpharmacological treatment for axial spondyloarthritis (axSpA), there is a lack of guidelines regarding type and dosage. Insufficient knowledge about physical and physiological variables makes designing effective exercise programs challenging. Therefore, the goal of this study was to simultaneously assess trunk strength, spinal mobility, and the cardiorespiratory fitness of patients with axSpA. In a cross-sectional study, 58 patients with axSpA (mean age 40.8 yrs, 50% male, mean symptom duration 10.3 yrs) performed maximal cervical and trunk mobility and isometric strength tests in all planes (using David Back Concept devices) and a maximal cardiopulmonary bicycle exercise test (n = 25). Mobility and strength data were compared to healthy reference data. Cut-off values for clinical cardiopulmonary exercise testing interpretation were used to judge normality. Patients were compared based on radiographic involvement and symptom duration. Both strength (P ≤ 0.02) and mobility (P ≤ 0.001) were significantly lower for the patients with axSpA compared to the reference. Strength deficits were comparable between the radiographic and nonradiographic groups (P > 0.05, except trunk extension [P = 0.03]), whereas mobility showed higher deficits in the radiographic group (cervical extension [P = 0.02] and rotation [P = 0.01], and trunk extension [P = 0.03] and rotation [P = 0.03]), regardless of symptom duration. Similarly, symptom duration positively affected oxygen pulse (P = 0.03), relative anaerobic threshold (P = 0.02), and aerobic capacity (P = 0.02). In patients with axSpA, strength is more affected than mobility when compared to healthy controls. Likewise, mainly the metabolic component of aerobic capacity is impaired, affecting cardiopulmonary fitness. These findings indicate that future personalized exercise programs in patients with axSpA should incorporate exercises for cardiopulmonary fitness next to strength and mobility training.

Feasibility of a novel exercise program for patients with breast cancer offering different modalities and based on patient preference

PurposeExercise improves quality of life and reduces the side effects of cancer therapies. Nevertheless, attendance to exercise programs remains a challenge for patients. This study explored the feasibility of an exercise program in which women with breast cancer may be allowed to choose among three exercise delivery modalities. MethodsForty-seven patients with breast cancer (stage I-IV) participated in a 12-week combined aerobic and resistance training program. The exercise modality was chosen by patients according to their preferences and needs among three options: the personal training program, the home-based program, or the group-based program. Exercise prescription was similar between the three modalities. Whereas the primary endpoint was feasibility, assessed through recruitment rate, attendance, adherence, dropout rate, tolerability, and safety, secondary endpoints included health-related skills and quality of life. ResultsOut of 47 recruited patients, 24 chose the home-based program, 19 the personal training program, and four the group-based program. Six dropouts (13%) were registered, and no severe adverse events were recorded. The median program attendance was 98% for personal training programs, 96% for home-based programs, and 100% for group-based programs, whereas compliance resulted in more than 90% in each modality. At postintervention, a significant increase in cardiorespiratory fitness, lower body flexibility, and body weight was observed. Different quality-of-life domains were improved following the intervention, including physical and social functioning, fatigue, and appetite loss. No significant changes in other parameters were detected. ConclusionsAn exercise prescription based on a patient-preferred delivery modality showed high feasibility in women with breast cancer.

Uitbouw van vestibulaire revalidatie in een centrum voor ambulante revalidatie: behandelmethoden en resultaten bij patiënten met een unilaterale vestibulaire hypofunctie

Development of vestibular rehabilitation in an ambulatory care centre: treatment protocol and results in a group of 12 patients with a unilateral vestibular hypofunction Vestibular rehabilitation (VR) is recommended in patients with a unilateral vestibular hypofunction (UVH) or areflexia resulting from inflammatory, traumatic or other aetiologies. In this study, the authors describe the treatment protocol and discuss the results of individually delivered VR in combination with a home exercise programme in patients initiating therapy 2 months or more post-onset of a UVH. Retrospectively, the data were analysed of patients presenting with &gt; 25% hypofunction on caloric irrigation who were referred by an ear, nose and throat (ENT) specialist in the period of January 2021 until January 2023. The patients received individualized therapy sessions of 45 minutes in combination with a home exercise programme. The following outcome measures were used: Dizziness Handicap Inventory (DHI), Functional Gait Assessment (FGA), Foam Stance Eyes Closed (FSEC), Dynamic Visual Acuity Test-Non Instrumented (DVAT-NI) and comfortable gait speed. Twelve patients (9 men and 3 women) with a mean percentual hypofunction of 81% were included (6 right- and 6 left-sided). The study found clinically relevant improvements for DHI and FGA, based on the minimally clinically important difference (MCID) of these tests. The mean DVAT-NI and FSEC scores normalized towards an age-appropriate level. VR leads to clinically relevant changes on different outcome measures in UVH patients. A centre for ambulatory rehabilitation (CAR) where multidisciplinary rehabilitation for people with hearing loss is provided, is a suitable setting to offer VR because of the longstanding cooperation between ENT specialists and physiotherapists. Nevertheless, there are challenges that need consideration when implementing VR into a CAR.

Efficacy of hippotherapy simulator exercise program in patients with stroke: a randomized single-blind clinical trial

ABSTRACT Objectives The aim of this study was to investigate the effect of hippotherapy simulator on balance, postural control, mobility, functional capacity and independence level in people with stroke. Methods This study involved 26 people with stroke aged 18–65, who were randomly assigned to a Hippotherapy Simulator Group (HSG; n = 13) and a Conventional Exercise Group (CEG; n = 13). Patients underwent assessments using the Berg Balance Scale (BBS), Postural Assessment Scale for Stroke (PAS-S), Timed Up and Go Test (TUG), Rivermead Mobility Index (RMI), 2-Minute Walking Test (2-MWT), and Barthel Daily Living Activity Index (BI) to evaluate balance, postural control, mobility, functional capacity, and independence before and after treatment. In the HSG, participants received 30 sessions of conventional exercises and hippotherapy simulator – a mechanical and robotic equipment with a dynamic saddle simulating horse movement – exercises over 6 weeks. Meanwhile, the CEG underwent 30 sessions of conventional exercises alone for 6 weeks. Results In the post-therapy evaluation between groups, BBS (p = 0.004) and 2-MWT (p < 0.001) scores were higher in HSG compared to CEG. However, no statistically significant difference was found between the two groups in terms of PAS-S, RMI, TUG and BI scores (p > 0.05). Statistically significant differences were found between BBS, PAS-S, RMI, TUG, BI and 2-MWT scores before and after treatment in both groups (p < 0.05). Conclusions Hippotherapy simulator can be added to conventional exercises to improve balance and functional capacity in people with stroke.

BS O04 Can virtual reality exercise games improve compliance with preoperative prescriptive exercise programs in patients awaiting bariatric surgery?

Abstract Background Despite the recognised benefits of increased activity prior to any surgery, non-compliance rate with prescribed exercise regimens is perceived to be higher amongst patients with obesity. Virtual-reality is becoming more recognised as an adjunctive tool within the healthcare setting. In this setting the platform enables exercise games to be played and enjoyed in the comfort of the patient’s own home, either sitting or standing depending on physical disability. The study aims to identify whether VR exercise games could be considered part of the pre-operative exercise program in patients awaiting bariatric surgery and the effects of this technology on compliance. Methods A pilot study using block randomisation, patients with obesity planned for laparoscopic Roux-en-Y gastric bypass (LRYGB) or sleeve gastrectomy (LSG) between December 2020 and December 2023 were recruited to a 6-week pre-operative regular exercise (REG) programme of either regular walking activity (RWA) or exercise using Virtual Reality device (VRX). Patients who later decided not to follow the exercise protocol were included as control (NEG). Patients with epilepsy, uncontrolled arrhythmias, heart failure or those unable to use VR systems were excluded. Pre- and post-trial demographic and progress data and follow up survey using the New Zealand Physical Activity Questionnaire were collected. Results 43 patients were recruited, 46.4kg/m2 mean referral BMI (33.8 – 65.6, SD 6.4) and 84% female. Exercise non-compliance was comparable between RWA and VRX groups (40 vs 43% respectively). 56% of NEG had their operation during short day light season (44% of REG). NEG group reported higher rate of chronic pain, poor motivation, and higher incidents of changes to surgery date (33, 33 and 22% respectively vs. none in REG). While weight loss achieved in REG prior to the operation was higher than in NEG, there was no significant difference in weight loss between the groups at 3 months follow up. Conclusions While the role of prehabilitation exercise prior to major elective surgery is well documented, the search for the ideal approach to achieve this is still ongoing. This pilot study demonstrates the limitations certain chronic conditions in patients with obesity have on the success of a pre-operative exercise programme. While more data is needed, it is important to bear these limitations in mind when recruiting patients to any exercise programme. The compliance rate remains unfavourable despite the use of VR technology.

The Future of Chemotherapy: The Mechanisms and Benefits of Exercise in Taxane-Induced Peripheral Neuropathy

Chemotherapy-induced peripheral neuropathy (CIPN) is a dose-limiting side-effect resulting from numerous neurotoxic chemotherapies that damages the peripheral nerves, alters sensations in the hands and feet, causes burning and shooting pains, and impairs a patient’s quality of life (QoL). There are limited established interventions to help improve CIPN symptoms. There is only one pharmacological agent (Duloxetine) for treatment of CIPN; however, it only has mild benefit, signaling a critical need for alternative management options to manage patient symptoms. Multiple studies suggest therapeutic benefits of exercise in cancer care to improve physical and psychological functioning; however, the benefits regarding CIPN symptoms and physical function are less clear. This narrative review synthesizes research articles investigating the effect and mechanisms induced by different exercise programs for patients with taxane-induced peripheral neuropathy (TIPN) symptoms and function. The overall incidence, manifestations, characteristics, and mechanisms of CIPN are also discussed. While some studies in this narrative review demonstrated that exercise programs may have benefits on sensory and motor TIPN symptoms in some but not all patients, there are consistent benefits of improved QoL and physical function across most patients. This narrative review highlights the need for future research to confirm the effects of exercise for TIPN, with a focus on other important components, including the effect of exercise adherence, type, and supervision level.

Long-term effects of a home exercise program in patients with acute myocardial infarction and percutaneous coronary intervention: prospective observational study

OBJECTIVE: Our aim was to evaluate the effects of home physical training (HPT) in patients with acute myocardial infarction (AMI) and percutaneous coronary intervention (PCI) in 1 year and the long-term period.&#x0D; MATERIALS AND METHODS: A prospective observational study was conducted. Ninety-seven patients after AMI and PCI were included: Group 1 (n=51) patients exercising at home for the next year after PCI (HPT+), and Group 2 (n=46) no exercises (HPT). The evaluation was performed at baseline, in 1 year, and 8.90.9 years. The long-term response rate was 42 patients (82.4%) in the HPT+ group and 36 (78.3%) in the HPT- group.&#x0D; RESULTS: Patients in the HPT+ group had significantly higher physical performance at the cycle ergometer exercise test in 1 and 8.90.9 years: exercise time increased by 31.4% (p 0.001) and 40% (p 0.001), respectively, and the load increased by 15.6% (p 0.001) and 32.2% (p 0.001), whereas these indicators did not change significantly in HPT- group. Daily physical activity (PA) increased by 21.9% (p 0.01) in 1 year and 19.6% (p 0.01) in 8.90.9 years in the HPT+ group. PA did not change in the HPT- group in 1 year and decreased by 23.1% (p 0.001) in 8.90.9 years to a low level. The left ventricle ejection fraction in the HPT+ group increased by 2.4% (p 0.05) in 1 year and 6.8% (p 0.05) in 8.90.9 years with no changes in HPT- group. Quality of life increased more significantly in the HPT+ group by 50.6% (p 0.05) in 1 year and 71.6% (p 0.01) in 8.90.9 years versus 25.4% (p 0.05) and 46.9% (p 0.05), respectively, in the HPT- group. In the long-term period, the HPT+ group had fewer adverse clinical outcomes, with 22 patients compared with 28 (52.4 vs 77.8%, p 0.05).&#x0D; CONCLUSION: Patients with AMI and PCI who participated in a one-year HPT program had positively affected exercise tolerance, myocardial contractility, QoL, and adverse events in the long-term follow-up period.

The effect of combined balance and strength exercise program in patients with different grades of primary knee osteoarthritis

BackgroundKnee osteoarthritis (KOA) is a degenerative disease that affects all parts of the joint including the surrounding ligaments, tendons, and muscles. Biomechanical changes that occur in KOA cause aggravation of symptoms with further joint damage. Thus, modifying the biomechanics of the knee joint may help in the prevention and treatment of KOA. For that reason, our aim was to assess the effect of combined balance and strengthening exercise programs in patients with different grades of primary KOA.ResultsAll studied groups showed comparable significant improvement in quadricep muscle strength, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score (< 0.001), time-up and go score (< 0.001), 6-m walk time (< 0.001), and dynamic balance (< 0.001) at the end of exercise program. Furthermore, patients with mild-moderate KOA showed a significant improvement in pain, physical function, total WOMAC scores, and dynamic balance compared to those with more severe KOA.ConclusionCombined balance and strengthening exercise programs may help improve pain, physical function, and dynamic balance in patients with KOA regardless of its severity. However, following exercise patients with milder forms of KOA may show greater improvement compared to patients with severe KOA.