Exercise Program Research Articles

Metabolic syndrome is associated with poorer outcomes in people with osteoarthritis participating in a rehabilitation program: an observational study

Purpose To determine the prevalence of metabolic syndrome and explore its association with clinical outcomes (pain, quality of life, and physical function) in adults participating in an education and exercise program (GLA:D®). Methods An observational study of adults with hip and/or knee osteoarthritis who participated in GLA:D® between 2019 and 2022. Metabolic syndrome status was determined through self-report. Differences in clinical outcomes among people with, at risk of (1–2 risk factors), or without metabolic syndrome were compared at baseline, 3-, and 12-months using linear mixed models (age, sex, and baseline outcomes as covariates). Results Of 6846 participants (aged 65(SD 9) years), 20% (n = 1337) had, and 68% (n = 4632) were at risk of metabolic syndrome. Adults with metabolic syndrome reported higher pain (0–100 VAS: 7.3, 95% CI 5.4–9.1), lower health-related quality of life (EQ5D 0–100, VAS: −8.6, 95% CI −10.2 to −7.0), and slower gait speed (−0.26 m/s, 95%CI -0.3 to −0.23) at baseline compared to those with no metabolic risk factors. Differences remained at 3- and 12-months for pain and quality of life. Conclusions Metabolic syndrome risk factors were common in adults with osteoarthritis. Clinical outcomes remain impaired in people with metabolic syndrome compared to those without after education and exercise, suggesting further intervention may be required.

Goal-Directed Rehabilitation Versus Standard Care for Individuals with Hereditary Cerebellar Ataxia: A Multicenter, Single-Blind, Randomized Controlled Superiority Trial.

Rehabilitation is thought to reduce ataxia severity in individuals with hereditary cerebellar ataxia (HCA). This multicenter, randomized controlled superiority trial aimed to examine the efficacy of a 30-week goal-directed rehabilitation program compared with 30 weeks of standard care on function, ataxia, health-related quality of life, and balance in individuals with an HCA. Individuals with an autosomal dominant or recessive ataxia (aged ≥15 years) were enrolled at 5 sites in Australia. Participants were randomized (1:1) to receive rehabilitation (6 weeks of outpatient physiotherapy followed by a 24-week home exercise program) (n = 39) or continued their usual activity (n = 37). The primary outcome measure was the motor domain of the Functional Independence Measure (mFIM) at 7 weeks. Secondary outcomes included the Scale for the Assessment and Rating of Ataxia (SARA) and the SF-36v2, assessed at 7, 18, and 30 weeks. Outcome assessors were blinded to treatment allocation. Seventy-one participants (rehabilitation, 37; standard-care, 34) were included in the intention-to-treat analysis. At 7 weeks, mFIM (mean difference 2.26, 95% confidence interval [CI]: 0.26 to 4.26, p = 0.028) and SARA (-1.21, 95% CI: -2.32 to -0.11, p = 0.032) scores improved after rehabilitation compared with standard care. Compared with standard care, rehabilitation improved SARA scores at 30 weeks (mean difference -1.51, 95% CI: -2.76 to -0.27, p = 0.017), but not mFIM scores (1.74, 95% CI: -0.32 to 3.81, p = 0.098). Frequent adverse events in both groups were fatigue, pain, and falls. Goal-directed rehabilitation improved function at 7 weeks, with improvement in ataxia and health-related quality of life maintained at 30 weeks in individuals with HCA, beyond that of standard care. ANN NEUROL 2024.

PROMOÇÃO DA SAÚDE E BEM-ESTAR EM IDOSOS ATRAVÉS DE PROGRAMAS DE EXERCICIOS FUNCIONAL: UMA REVISÃO INTEGRATIVA

This study presents an integrative review on the benefits of functional exercises for elderly health and well-being. With the global aging population and associated public health challenges, it is crucial to explore practices that enhance quality of life (SILVA; SANTOS, 2019). The research analyzed studies that highlight how functional training aids in maintaining physical fitness, autonomy, and disease prevention. Observed benefits include improvements in physical abilities, such as strength and balance, and cognitive function (ALMEIDA; CARDOSO, 2022), as well as a positive impact on social interaction and psychological well-being among the elderly (FREITAS; ALMEIDA, 2021). The study also discusses adapting exercise programs to meet individual needs, considering factors like health conditions and reduced mobility (RODRIGUES; LIMA, 2023)

The impact of different forms of exercise on intraocular pressure, blood flow, and the risk for primary open angle glaucoma.

Primary open angle glaucoma (POAG) is a chronic disease characterized by progressive optic nerve damage and irreversible loss of vision, often diagnosed at late stages. Elevated intraocular pressure (IOP) is the major risk factor for its onset and progression while older age, myopia, genetic factors, blood pressure (BP), and reduced ocular blood flow (OBF) have also been linked to the disease. Different forms of exercise are known to have significant, but variable, effects on IOP, BP, ocular perfusion pressure (OPP), OBF and oxygen metabolism, and ultimately the risk for development and progression of POAG. While population-based studies lack agreement regarding the relationship between exercise and POAG status, data suggests that resistance training causes a short-term increase in IOP, BP, and OPP. Conversely, aerobic exercise has been shown to cause a short-term decrease in IOP and increase in BP and OPP. Research also suggests that following an exercise program over an extended period may lead to a long-term decrease in IOP, however its cessation results in a prompt return to baseline levels. Data suggests normal vascular autoregulation ensures minimal change in OBF following extended exercise unless OPP rises ∼70% above baseline. Although exercise may alter IOP, BP, and OBF, both acutely and chronically, it is currently uncertain if physical activity significantly alters risk for the onset and progression of POAG.

Effectiveness of a web-based foot-ankle exercise program for treating ulcer risk factors in diabetic neuropathy in a randomized controlled trial

The need for strategies to prevent complications from diabetic neuropathy (DPN) is well recognized. However, foot-ankle exercise programs show weak to moderate evidence, and barriers to their implementation persist, including broad and facilitated access to exercise programs, which guarantee for equity. In this paper, we report for the first time the effectiveness of a web-based foot-ankle exercise program aiming to improve DPN-related outcomes, gait biomechanics and functional outcomes. Sixty-two participants with DPN were randomly allocated into the control group (CG; n = 31), which received the usual care, or the intervention group (IG; n = 31), which received the usual care plus a 12-week foot-ankle exercise program using a web-based software (the SOPeD software). The primary outcomes, DPN symptoms and severity, were assessed using the Brazilian version of the Michigan Neuropathy Screening Instrument and the Decision Support System for Classification of Diabetic Polyneuropathy, respectively. Secondary outcomes included tactile sensitivity (monofilaments) and vibration perception (tuning fork), functional outcomes, such as foot pain and function (Foot Health Status Questionnaire), foot muscle strength and plantar pressure during gait (emed plate), and foot-ankle kinematics and kinetics during gait. Outcomes were assessed at baseline, 12 and 24 weeks by an assessor blinded to group allocation. DPN symptoms and severity remained unchanged after the web-based foot-ankle program. However, IG showed improvements compared to CG, with greater functional reach at 12 weeks, better foot function, reduced foot pain and greater plantarflexion degree during push-off at 24 weeks. Regarding plantar loading during gait, the forefoot pressure reduced in the IG at 12 weeks compared to baseline, but at 24 weeks, forefoot load increased in the IG compared to CG. The 12-week web-based foot-ankle exercise program was feasible, acceptable, demonstrating safety with minimal adverse events, such as delayed onset muscle soreness and foot muscle cramping. While DPN-related outcomes were unaffected by the 12-week SOPeD program, modest improvements in foot pain and function, functional reach, and changes in plantar pressure and plantarflexion degree during gait were noted, mostly at 24 weeks.Trial registration: ClinicalTrials.gov, NCT04011267. Registered on 8 July 2019.

Examining the clinical role and educational preparation of heart failure nurses across Europe. A survey of the Heart Failure Association (HFA) of the European Society of Cardiology (ESC) and the Association of Cardiovascular Nursing and Allied Professions (ACNAP) of the ESC.

To describe the clinical practice and educational preparation of heart failure (HF) nurses across Europe and determine the key differences between countries. A survey tool was developed, in English, by the Heart Failure Association Patient Care committee of the European Society of Cardiology (ESC). It was translated into eight languages, before electronically disseminated by nurse ambassadors, presidents of HF national societies and through social media. A total of 837 nurses involved in the daily care of patients with HF from 15 countries completed the survey. Most nurses, 78% (n = 395) worked within a hospital outpatient setting, and 51% (n = 431) had access to a specialized HF multidisciplinary team. Nurses performed a range of activities including patient education to promote self-care, virtual and in-person symptom monitoring. A third had more than 5-year experience in cardiac care and 22% (n = 182) prescribed HF medications. There was a significant correlation between HF nurses that prescribed HF medications and access to a specialist multidisciplinary team (p = 0.04). A small number of nurses, mainly from Belgium, supported invasive monitoring (n = 68, 8%) with 14% (n = 120) of mostly Danish nurses supporting exercise programmes. The majority of nurses surveyed were committed to further academic professional development, with 41% (n = 343) having completed a HF course. The role of the HF nurse varies across Europe, however involvement in patient education, symptom monitoring and follow-up remain core to their practice. In specific activities including the prescribing of HF medications and involvement in invasive monitoring, practice has advanced with collaboration in the multidisciplinary team. Consequently, harmonization of education, training and career pathways are required to standardize HF care aligned with expert guidelines across Europe.

The effect of home exercises with kinesiotaping on pain, functionality, and work performance in bus drivers with non-specific neck pain.

Clinical research on the management and rehabilitation of work-related upper spinal pain in bus drivers is sparse, indicating a gap in knowledge and treatment strategies. This highlights the growing need for innovative approaches to rehabilitation programs in this area. To examine the effects of kinesio taping (KT) on pain, functionality, and work performance in bus drivers experiencing neck pain. The study involved 44 participants who were randomised into two different groups: the exercise group (n= 22) and the kinesio tape group (n= 22), with participants in both groups undertaking exercise interventions. Evaluations were made before and after 6 weeks of treatment. At the end of the 6-week, the participants' ROM, pain evaluations and functional scales were evaluated with disability, and work functionality. Neck pain severity decreased in both groups (p< 0.001 for each value), but there was no difference between the groups (p: 0.071). When disability scores were evaluated, improvement was noted in both groups (p: 0.001 for each value), but no statistically significant difference was found (p: 0.754). When the improvements in ROM values before and after the treatment were examined, the difference between the groups was recorded only in the neck extension ROM value (p: 0.011). Significant improvement was noted in all sub-steps of job performance in both groups (p< 0.05). KT added to ergonomic training and home exercise programmes is effective in controlling work-related musculoskeletal pain in drivers with neck pain. However, the addition of KT to exercise therapy was found to be no more effective than exercise therapy alone in improving pain control, functionality and work performance.

ANALYZING THE EFFECTIVENESS OF PROGRAMS ON SHOULDER FUNCTION IN PATIENTS WITH KINESIOPHOBIA.

Background: Involvement of overhead activities is present in many of the games. In volleyball it’s very important. In a competitive atmosphere the collegiate players tend to get injuries, because of that they are developing apprehension. They are becoming kinesiophobia, there are very less studies are available related to this domain, Objective: This study analyzed the effectiveness of SINEX (Shoulder instability neuromuscular exercises) program on shoulder function in patients with kinesiophobia compared to HOMEX (Home based standard care exercise) program. Methods: This is an experimental study; participants were volleyball players who is kinesiophobic. Study setting was KG Campus, study duration is 6 months, and Treatment duration is 12 weeks. Total sample size was 22. By using random sampling method, the population divided into two groups. SINEX was given for Group A and HOMEX for Group B. The outcome measures were SPADI (shoulder pain and disability index) and Spiking velocity. Results: The study assessed the Shoulder function, after the training program, the player improved as well as the player was able to perform the game as well. Both SPADI and spiking velocity show positive improvement. T values of SPADI and Spiking velocity is 11.731 and 2.765 at p&lt;0.05. Conclusion: SINEX (Shoulder instability neuromuscular exercises) program shows better improvement on shoulder function in patients with kinesiophobia compared to HOMEX (Home based standard care exercise) program.

Effect of interdisciplinary obesity care on metabolic markers and body weight in people with type 2 diabetes in a rural setting: A randomised controlled trial.

Management of type 2 diabetes includes medications that can unintentionally increase obesity and insulin resistance. This unblinded, single-centre, randomised controlled trial focused on rural Australian adults with type 2 diabetes (aged 18-75 and body mass index [BMI] >30 kg/m2), measuring the effectiveness of a tailored interdisciplinary obesity care approach compared with usual diabetes care. Led by a nurse practitioner with allied health support (dietitian ± psychologist and physiotherapist), the bariatric treatment involved reducing weight-gaining medications, a 500-calories/day deficit, an unsupervised exercise program emphasising movement/strength and psychotherapy, 3-monthly to 24-months with support phone calls at weeks 2, 4, 8 and 10. Outcomes from the 224 (113 intervention/111 control) participants were differences in biomedical and physical markers within- and between-groups estimated using multivariate mixed-effects linear regression between recruitment and 6-monthly follow-ups. Greater change occurred in intervention compared with control groups at 12 and 24 months in mean: body weight (-5.9 kg [95% confidence interval, CI: -8.53, -3.23] and -9.0 kg [95% CI: -13.2, -4.77]); BMI (-2.03 kg/m2 [95% CI: -2.92, -1.15] and -3.51 kg/m2 [95% CI: -4.93, -2.08]); and glycated haemoglobin (-0.26% [95% CI: -0.69%, 0.18%] and -0.63% [95% CI: -1.17%, 0.08%]). The control group showed a significant increase in mean leptin level, resulting in a between-group difference (-27.1 [95% CI: -42.7, -11.5]). Lipids and blood pressure differences were inconclusive, while exploratory analysis showed greater decline in estimated glomerular filtration rate in the control group. The interdisciplinary obesity approach, compared with usual diabetes care, resulted in sustained weight loss and improved diabetes control over 2 years. Trial registration number: ACTRN12622000240741.

A PRELIMINARY ANALYSIS ON HOME EXERCISE PROGRAM ADHERENCE IN MIDDLE-AGED ADULTS USING THE EXERCISE ADHERENCE RATING SCALE (EARS) – A RETROSPECTIVE STUDY.

Background: Adherence to Home Exercise Program (HEP) is crucial for achieving an effective rehabilitation outcome, particularly among middle-aged adults (40-60 years) who have to face many challenges maintaining regular physical activities. Understanding the current adherence levels can inform strategies to enhance participation in HEP regimens. Objective: The study aims to find the level of adherence in middle-aged adults to HEP using the Exercise Adherence Rating Scale (EARS) through a patient report. Methods: The study was conducted with middle-aged adults who follow HEP for musculoskeletal conditions. Participants were asked to fill the EARS; to know the level of adherence they have towards home exercise program. Data were collected from patients who approached OPD following a musculoskeletal condition. Descriptive statistics are done with the data collected to analyze the adherence of subjects towards exercise. Result: From the EARS questionnaire it was analyzed that from a total of 94 subjects present in this study, 76 subjects showed a non-adherent value, and 18 subjects showed adherent value. The average mean value and standard deviation value of the non-adherent group is 11.8 ± 0.607 and 2.701, while for the adherent group it is 19.16 ± 0.385 and 0.833 respectively. Conclusion: From this study it is known that middle-aged adults are non-adherent to home exercise programs because of which the improvement in the rehabilitation program is not fulfilled.

The Role of Physical Activity in Cancer Survivorship: A Comprehensive Review

Cancer survivorship is an increasingly important focus in oncology, with physical activity (PA) emerging as a key intervention to enhance health outcomes post-treatment. This review explored the role of PA in improving quality of life (QoL), reducing recurrence risk, and managing treatment-related side effects among cancer survivors. The biological mechanisms of PA, including the reduction of systemic inflammation and improvement of immune function, are discussed. Additionally, the psychological and social benefits, such as reduced anxiety and social support from group-based exercise, are highlighted. Despite these benefits, numerous barriers to PA exist, including physical limitations, psychological challenges, and socioeconomic factors. Facilitators, such as tailored exercise programs and healthcare provider recommendations, can enhance participation. Special considerations, such as cancer type and age, necessitate personalized approaches to PA to maximize benefits for diverse survivor populations. The methodology involved synthesizing data from recent clinical trials, epidemiological studies, and qualitative research. In conclusion, physical activity is a vital component of survivorship care, with the potential to significantly improve both longevity and QoL. Future research should focus on refining exercise prescriptions and developing scalable interventions for widespread implementation in cancer care. Keywords: Cancer survivorship, Physical activity, Quality of life (QoL), Exercise interventions, Cancer recurrence prevention.

Biomechanics intervention promotes college students’ English vocabulary acquisition and mental health

The ability to access and use vocabulary effectively is critical to academic performance. Strong English vocabulary is important for college students because they will not only understand course material but also engage in discussion and writing activities, and interact with colleagues and teachers. However, the word order learning can be difficult, often leading to dissatisfaction and decreased desire students. The effectiveness of biomechanical intervention college students improves their mental health and develop vocabulary in English. A total of 145 college students participated in this study. Participants were randomly assigned to group A, which received a biomechanics-based exercise program, and group B, which received a traditional physical activity (PA) program. Participants completed validated questionnaires to measure mental health indicators, including anxiety, stress, and overall well-being. The questionnaires used included the Perceived Stress Scale (PSS), a well-established tool in psychological research. This research conducted tests that assessed various aspects of vocabulary knowledge, including word recognition, meaning, and usage in context. The data was analyzed using statistical methods, including descriptive statistics, t-tests, and regression analysis. ANOVA was to analyze connections between two groups. The data was analyzed using SPSS version 29 software. The results showed that it significantly improved English vocabulary acquisition and cognition health in Group A. These students also reported well, if low, mental health levels of stress and anxiety increased well-being in general. This study emphasizes biomechanics, which can be incorporated into language learning, showing increased PA. Vocabulary acquisition and positively influence mental health. The results showed that significantly improved English vocabulary acquisition and cognition health in Group A. These students also reported good, if low, mental health levels of stress and anxiety and increased well-being in general.

A cultural adaptation of acceptance and commitment therapy with exercise for older Chinese with chronic pain and depressive symptoms: A mixed-methods study.

Chronic pain and depression are highly prevalent and correlated in older adults. Acceptance and commitment therapy (ACT) and exercise have been shown to be effective for both conditions, mostly in Western literature. Little is known about integrating two approaches, particularly in Asian cultures and among less well-educated people. This article describes the iterative process of developing a culturally adapted ACT with exercise intervention for older Chinese with chronic pain and depressive symptoms. A multidisciplinary expert panel codesigned a culturally adapted ACT with exercise intervention, comprising a weekly 2-hr ACT and a 1½-hr exercise program for 8 weeks, focusing on six ACT core components and low-to-moderate intensity circuit-based resistance exercise. Its feasibility was tested through a mixed-methods, pretest-posttest design with 22 older Chinese experiencing chronic pain and depressive symptoms (Mage = 71.5 years, SD = 7.5, 86% female). Participants showed significant improvements in pain intensity, pain interference, pain self-efficacy, physical performance, pain acceptance, and committed action (all p < .05). We identified five themes to inform protocol revision: (1) contextualizing values, (2) utilizing experiential learning, (3) using culturally appropriate metaphors, (4) establishing linkage between ACT concepts and pain, and (5) promoting application through repetition and prompts. Incorporating these findings, the final protocol emphasized three core ACT components and one set of physical exercises. This is the first study demonstrating the feasibility of a culturally adapted, person-centered tailoring ACT with exercise intervention for improving pain-related outcomes and mental wellness among older Chinese. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

EFFECT OF EXERCISE ON BURST FREQUENCY A MARKER OF SYMPATHETIC ACTIVITY IN HYPERTENSIVE INDIVIDUALS: A SYSTEMATIC REVIEW.

Background: Burst frequency is a factor that is used to know the relationship between sympathetic activity and blood pressure in individuals with hypertension. Various forms of exercise reduce the burst frequency among individuals with hypertension. This systematic review provides suggestion of exercise prescription for reducing blood pressure. Objective: To determine the effects of exercise training and its regulatory mechanisms on burst frequency (BF) a marker of muscle sympathetic nerve activity (MSNA) in hypertensive individuals. Methods: A systematic literature search of electronic databases such as PubMed, Web of Science and Scopus was conducted from inception to July 2024 included randomized controlled trials (RCTs), non-randomized experimental studies (non-RCTs) or pre-post experimental trials on hypertensive patients without associated metabolic disorders, with or without pharmacological treatment, aged between 18 and 70 years, both genders. Patients underwent at least 4 weeks of aerobic, resistance, or breathing exercises with BF as an outcome measure were included. The Revised Cochrane Risk of Bias tool (RoB 2) and Risk of Bias in Non-randomized Studies of Interventions tool (ROBINS-I) was used to evaluate the risk of bias. Results: Five trials were included. Four studies demonstrated a significant reduction in BF among exercise-trained hypertensive individuals, while one study reported no change in BF. Overall, two studies had "some concerns" about performance and attrition bias, one had "high RoB" for selection bias, one had “moderate RoB” due to expected confounding, and one had “serious RoB” due to uncontrolled confounding factors. Conclusion: These findings suggests that HIIT significantly reduces BF, while aerobic and breathing exercises offers lesser benefits, further research should focus on training dosages. Implications: It provides evidence to utilize tailored exercise programme that may reduce sympathetic overactivity in hypertensive patients for better blood pressure control and reduce cardiovascular risk.

Starting a surgical prehabilitation program: results from a pragmatic nonrandomized feasibility study.

We sought to assess the feasibility and estimate the effects on outcomes of a multimodal prehabilitation service implemented as an ancillary surgical service. We conducted a pragmatic, nonrandomized feasibility study of surgical prehabilitation. Patients were eligible if they were ≥ 18yr of age, fluent in English, and referred by a health professional for prehabilitation. Participants received an individualized program of preoperative exercise, nutrition, psychological, and/or smoking cessation support. The primary outcome was operational feasibility, including referral volume, enrolment rate, prehabilitation window, engagement, completion rate, and safety. Secondary outcomes included surgical complications, length of hospital stay, readmission, quality of life, and physical and mental health. Qualitative data related to intervention feasibility and acceptability. We compared intervention participants with patients who were referred for, but declined, prehabilitation. One hundred and sixteen patients were referred for prehabilitation. The mean age of referred patients was 71yr and 55% were male. Over 90% of referrals were from surgical oncology, and the most common indication for referral was frailty (46%). Of the 116 referred patients, 83 consented to participate in the study. Patient-reported and objectively measured outcomes improved by a clinically important margin from baseline to presurgery, and returned to presurgery levels by 90days postoperatively. Qualitative findings suggest that the prehabilitation intervention was well received. Multimodal surgical prehabilitation is feasible as an integrated clinical service and may be effective for improving physical and psychological outcomes. Further evaluations of clinically integrated prehabilitation programs in Canada are needed to confirm these findings.

Physical activity and cardiorenal health - from associations to interventional studies.

Clustering of traditional and kidney-specific risk factors leads to elevated cardiovascular disease (CVD) risk across the trajectory of chronic kidney disease (CKD) and transplantation. As kidney function declines, the prevalence of CVD, cardiovascular events, and mortality increases. This review considers recent evidence for the association between physical activity (PA) and exercise and cardiorenal health, and the effectiveness of interventions for the prevention and management of cardiorenal decline across the CKD spectrum. Evidence supports a beneficial dose-response effect of PA in the prevention of incident CKD, and growing evidence in prevalent CKD patients for the attenuation of kidney function decline, and a reduction in CVD risk, morbidity, and mortality. Broadly speaking, across the trajectory of CKD, the literature supports the efficacy of exercise interventions for improving cardiorespiratory fitness and aspects of cardiorenal health. The mechanisms underlying improvements indicate differential effects on traditional and non-traditional risk factors for CKD progression and CVD. To date, there is limited transfer of these findings into clinical care, although the evaluation of available evidence has led to the development of the first detailed clinical practice guideline for exercise and lifestyle in CKD. There is a lack of large-scale multi-centre randomised controlled trials, and trials exploring hard clinical outcomes and long-term effects of exercise on cardiorenal outcomes. However, research should also address the challenges of implementing programmes of exercise and PA as part of routine care in combination with addressing the shortfall in literature to improve cardiorenal outcomes in all patients with CKD.

The optimal treatment duration for inspiratory muscle strengthening exercises in stroke patients: a double-blinded randomized controlled trial

ABSTRACT Background Little is known about the ideal duration of inspiratory muscle training in stroke patients. Objective The aim of this study was to assess the effects of short-term and long-term inspiratory muscle strengthening exercises in stroke patients. Methods This study was a prospective, double-blind, randomized controlled trial involving 50 stroke patients. Based on baseline maximum inspiratory pressure (MIP) values, participants were divided into two strata: those with severely weak inspiratory muscle (stratum A) and those with moderately weak inspiratory muscle (stratum B). Within each stratum, individuals were randomly assigned to either the 4-week exercise group, the 8-week exercise group, or the sham group. The exercise groups underwent inspiratory muscle strengthening exercises. The MIP, 6-minute walk test (6MWT), and the Nottingham Extended Activities of Daily Living (NEADL) Index were assessed at baseline, 8, 12, and 24 weeks. Results Subjects in Stratum A exhibited notably greater improvement after 8 weeks of training compared to those in Stratum B. Furthermore, both Stratums displayed significantly greater improvement following 8 weeks of training compared to sham training. In Stratum B cases, a significantly higher level of improvement was noted with the 4-week training in comparison to the sham training. A significant increase in NEADL index and 6MWT score was observed during the 24-week follow-up period. Conclusion For individuals with moderately weak inspiratory muscle strength, a 4-week exercise program proves sufficient in enhancing inspiratory muscle strength, walking capacity, and daily life activities. However, individuals with severely weak inspiratory muscle strength benefit more from an 8-week treatment.

Effectiveness of dry needle therapy in patients with chronic nonspecific low back pain

Background: Low back pain is a prevalent symptom worldwide, with various underlying causes, making differential diagnosis essential. This study aims to investigate the efficacy of dry needling treatment added to exercise in patients with chronic Nonspecific Low Back Pain (NLBP). The McKenzie exercise program was applied to all participants.Materials and Method: The study comprised sixty participants, randomly allocated into two groups: the dry needling (DNG) and the exercise group (EG). The participants in DNG received a total of six sessions of dry needling treatment, two days a week, to the gluteus medius and quadratus lumborum and multifidus muscles. All participants were given a McKenzie exercise program two sets per day for three weeks.Results: A significant difference was noted in the VAS-night values of the patients within the DNG before treatment (p: 0.004), and the EG also exhibited a significant difference in the VAS-activity (p: 0.017) and VAS-resting (p: 0.024) values following the treatment. A statistically significant decrease was observed in favor of DNG in VAS-rest, VAS-night, VAS-activity values (p&gt;0.001) in the comparions of the groups.Conclusions: Dry needling treatment added to exercise therapy in chronic NLBP patients is effective on activity and rest pain severity in the shortterm results. However, no additive efficacy of dry needling treatment was found on the number of trigger points, disability, and depression.

Hands Up Program: Results of a feasibility study of a randomized controlled trial of a bone health exercise and education program for adults aged 50-65 post distal radius fracture.

Distal radius fractures (DRF) that occur from a fall from level ground are considered fragility fractures and may be the first indication that someone has compromised bone mineral density and is at risk of having osteoporosis. Women at about 50 years of age experience a dramatic increase risk of these fractures. Rehabilitation after DRF focuses on restoring range of motion and strength in the wrist, but rarely address future bone health concerns. We developed a 6-week therapist-developed remote full body exercise and osteoporosis/bone-health education program (called The Hands Up Program). This study was designed to evaluate the feasibility of a larger trial examining the effects of a whole-body exercise and education program for people 50-65 after a DRF. Community dwelling individuals between the age of 50-65 with a radiographically confirmed DRF were recruited from the Roth| McFarlane Hand and Upper Limb Center in London, Ontario. Participants were randomized in a 1:1 ratio into either the Hands Up Program which was a twice weekly exercise and education program for 6 weeks, or the control group where they proceeded with usual care. The intervention was delivered online through a website where participants created a unique username and password to access. The primary feasibility outcomes of the study were recruitment rate (74 participants in 1 year), retention rate (75% completion), and intervention adherence rate (60% of completion of the exercise program). Secondary outcomes included strength, range of motion, self-reported outcomes, and bone density. Overall, 74 participants were recruited in 14 months. Retention did not meet the criteria for success, as only 53% of the participants attended their 12-month visit. Adherence was also not met albeit close with 55% completing the exercise program. Twelve participants withdrew from the study, five due to the time commitment, four without explanation, one due to group allocation, one due to COVID and one participant moved. One participant was deemed ineligible after consent. Four of the participants that withdrew were in the intervention group, and four in the control group, five participants withdrew before they were allocated to a group. Feedback from patients indicated potential improvements to the program: lower assessment burden, spacing out the intervention so that the education portion could be delivered during the immobilization phase of recovery, and creating a more individualized program. Adherence and retention were both a challenge, although adherence was close to target. While achieving adherence to exercise in bone health is a known challenge, given the importance of prevention in the at-risk DRF population and the challenges in co-design and delivery during the pandemic, we believe evaluation of a revitalized program is warranted.

Development of a Leg And Walking Self-exercise (LAWS) program for older adults during cancer treatment.

We developed a self-directed Leg And Walking Self-exercise (LAWS) program informed by the Exercise is Medicine initiative and evaluated the feasibility and acceptability of this program in older adults with cancer. Over a 1-year period, we prospectively enrolled 40 older adults who received a comprehensive geriatric assessment (CGA) at a geriatric oncology service and initiated a new line of systemic therapy for advanced cancer as inpatients. LAWS is a tailored, self-directed exercise program consisting of leg resistance training and walking. Exercise adherence was recorded using an exercise diary to assess feasibility. Patient perspectives on this program were evaluated using the Feasibility of Intervention Measure (FIM) and Acceptability of Intervention Measure (AIM), with a score range of 1-5, higher being better. Overall, 28% of patients were fit, 53% pre-frail, and 20% frail based on the CGA. During hospitalization (average 12days), 63% of the patients adhered to exercises at lowest intensity during more than 50% of their inpatient stay: on average, 2.8 leg exercises, 23 repetitions a day, 5.6days/week, and 19min of walking a day, 4.9days/week. Patients rated their perceived exertion at 3.0 for leg exercise and 3.0 for walking on a 1-10 Likert scale. During the period between discharge and their first outpatient appointment (average 11days), 71% of patients adhered to the LAWS program. Mean scores of FIM and AIM were 4.2 (SD = 0.5) and 4.2 (SD = 0.7), respectively. For older adults undergoing cancer treatment, LAWS is a feasible and acceptable self-directed exercise program.