Exercise Rehabilitation Program Research Articles

The effect of participating in MedEx Wellness, a community-based chronic disease exercise rehabilitation programme, on physical, clinical and psychological health: A study protocol for a cohort trial

BackgroundCommunity-based exercise rehabilitation programmes for chronic disease are an effective alternative to traditional hospital-based programmes. MedEx Wellness is a novel community-based exercise rehabilitation programme that integrates a range of chronic diseases. The aim of this trial was to investigate the effect of participating in MedEx Wellness on physical, clinical and psychological health. MethodsA prospective cohort study was conducted. Participants were recruited at induction to the MedEx Wellness programme following referral from healthcare professionals. Participants underwent a baseline assessment before commencing the exercise programme and repeat assessments at 3, 6 and 12 months. The primary outcome was cardiorespiratory fitness (6 minute- time trial) at 12 months. Secondary outcomes included health-related quality of life (EuroQoL-5D, Satisfaction with Life Scale, Warwick Edinburgh Mental Wellbeing Scale, Patient Health Questionnaire8, Functional Assessment of Cancer Therapy Questionnaire), free living activity behavior (accelerometer) and healthcare utilization (recall questionnaire). Tertiary outcomes included blood pressure (24 h), biomarkers (lipids, glucose and C-reactive protein), other components of physical fitness, including strength (handgrip test, sit-to-stand test), flexibility (sit-and-reach test), body composition (body mass index and waist-to-hip ratio), and falls risk (timed up and go test), and claudication time (incremental treadmill walking test), cognitive function, including attention (Attention Network Task), memory (Luck & Vogel Visual Working Memory Task) and cognitive reserve. Exploratory outcomes included psychosocial determinants of physical activity (self-efficacy, social support, intentions). DiscussionThis trial will evaluate whether participation in the MedEx Wellness programme has positive effects on physical, clinical and psychological health in individuals with a range of chronic diseases. Trial registrationISRCTN Registry ISRCTN10351412.

Effect of home-based rehabilitation exercise program for elderly patients with femoral neck fracture after bipolar hemiarthroplasty

Effect of home-based rehabilitation exercise program for elderly patients with femoral neck fracture after bipolar hemiarthroplasty

Editor's Perspective: The Clinical Exercise Physiologist in the Time of Covid-19

At the time of this writing, the world is amid a pandemic due to the SARS-CoV-2 virus (a new coronavirus) which causes COVID-19 disease. More than 3.5 million are known to have been infected, and it can cause a range in severity of symptoms from asymptomatic (believed to occur in most individuals) to those with mild to severe flulike symptoms to those who end up in intensive care units (ICUs) with severe acute respiratory syndrome requiring artificial respiration support from a ventilator. Those with more severe effects often have chronic comorbid diseases including diabetes, chronic lung disease, cardiovascular disease, hypertension, and obesity. Up to 19% and 29% of those with 1 or >2 of these comorbidities, respectively, end up in ICUs or dying (1).So what are the current and future roles of the clinical exercise physiologist (EP) during the age of COVID-19? Let us begin with current roles. Many clinical EPs in the United States work in exercise rehabilitation programs, primarily cardiac rehabilitation, but some others in diabetes, pulmonary, weight management, or oncology programs. During the COVID-19 pandemic, most programs discontinued “nonessential” services to reduce or eliminate direct patient contact. Because of this, clinical EPs in these programs are currently (April 2020) not seeing patients in the traditional face-to-face encounter. However, many have either begun or extended the use of remote connection with patients. Connections range from as simple as a phone call to texting/messaging regularly to video visits using commercially available products. Other activities include reassessing and updating patient education materials, but in many situations, this has not been enough to keep all staff working full time. Unfortunately, in the United States, some clinical EPs have been furloughed and have resorted to enrolling in their states' unemployment benefits programs.Others have fulfilled supplementary duties within their work environments. Some of the duties might remain within the clinical EP's scope of practice (e.g., asking COVID-19-related symptom questions as door screeners in clinics and hospitals or taking vital signs such as temperature, blood pressure, heart rate, and assessing for dyspnea). Others have learned new skills, including face mask fitting. Additionally, at Henry Ford Hospital in Detroit, some clinical EPs have been deployed to work as research staff in an ongoing study assessing the effect of hydroxychloroquine to prevent SARS-CoV-2 infection in hospitals, first responders, public transportation, and nursing home staff who are at high risk of virus exposure due to their essential vocations.This pandemic has seen clinical EPs in various countries rise to the occasion. They have been, in some cases, recognized for their skill and abilities and used in ways they have never been used previously, but there are some opportunities for clinical EP professional growth as the current pandemic ends. Those working in rehabilitation settings should continue to advocate for the development, use of, and reimbursement for virtual visits, particularly those using telehealth or video visits. Unfortunately, the US Medicare program denied a request for reimbursement for video visits associated with cardiac rehabilitation. Alternatively, in Michigan, Blue Cross is very interested in expanding this technology for their members. Despite the Medicare decision, this might be an unprecedented opportunity, and likely a necessary one, to demonstrate alternative methods to provide supervised exercise programming. This is especially necessary if supervised exercise needs grow to desired levels set forth by the Million Heart Initiative for cardiac rehabilitation (2) and the American Heart Association for those with symptomatic peripheral artery disease (PAD; 3). It has been estimated that current programs in the United States only have capacity for ∼47% of all patients referred to cardiac rehabilitation. If one adds PAD, and especially if other chronic diseases are approved by the US Medicare system for supervised exercise (e.g., cancer and renal rehabilitation), the current system will become quickly overwhelmed. Adding to this is the emerging information that a poor lifestyle leading to comorbidities, such as hypertension, obesity, and diabetes, also leads to an increased risk of severe COVID-19, so supervised exercise programs may become in very high demand.I believe this is a time in history for clinical EPs across the world to rise to the occasion and show the broader allied health community, patients, and lawmakers that we are ready to provide the necessary care to all patients who might benefit from supervised exercise training.

Potential benefits of environmental volunteering programs of the health of older adults: a pilot study

PurposeTo study the effects of participating in a 12-week environmental volunteering program on the physical performance of older adults across different age groups Materials and MethodsWe conducted a pretest–posttest pilot study with a single group. The intervention consisted of twice-weekly recycling activities and once-weekly rehabilitation exercise at community-based care centers. The recycling activities of the environmental volunteering program included sorting and handling paper products, plastics, and metals; disposing electronic products; and sorting clothes. The rehabilitation exercise program comprised a 90-min course for special needs and 30 min of health education. The evaluation tools were the handgrip strength, five-times-sit-to-stand test, sit-and-reach test, Timed Up and Go (TUG) test and usual and fast gait speeds. ResultsIn total, 45 participants completed the program. After the program, the participants showed significantly great improvements compared to baseline in all outcome measures. We further divided these participants into two age subgroups [65–75 years (n = 31) and >75 years (n = 14)]. The 65–75-year subgroup only showed significant improvements in handgrip strength, TUG and usual gait speed. However, the >75-year subgroup showed significant improvements in all outcome measures. ConclusionsThis innovative environmental volunteering program conducted in a local Taiwanese community can be a sustainable and feasible model to improve physical performance in the participants, the subgroup aged >75 years in particular. It also provides a potential avenue for researchers and policymakers to address environmental and aging-related issues.

The Beneficial Role of Exercise Training for Myocardial Infarction Treatment in Elderly.

Worldwide, elderly people have a higher prevalence of myocardial infarction (MI), which is associated with body function aging and a sedentary lifestyle. In addition to medication, exercise training is a well-established supplementary method to prevent and treat cardiovascular diseases (CVDs). Substantial evidence has shown the value of different intensity exercise programs in the prevention and treatment of MI, and exercise rehabilitation programs are also applicable to elderly patients with MI. Although exercise rehabilitation programs could significantly improve function, quality of life (QoL), and lower mortality and morbidity for people with MI, such programs are underused because their mechanisms are not accurately elucidated. To promote the application of exercise therapy for MI, this review summarizes the benefits and mechanisms of exercise rehabilitation for post-MI patients and provides rationalized proposals for outpatient cardiac rehabilitation.

Rationale and design of a smartphone-enabled, home-based exercise program in patients with symptomatic peripheral arterial disease: The smart step randomized trial.

BackgroundSupervised exercise therapy (SET) is recommended in patients with symptomatic peripheral arterial disease (PAD) as first‐line therapy, although patient adoption remains low. Home‐based exercise therapy (HBET) delivered through smartphones may expand access. The feasibility of such programs, especially in low‐resource settings, remains unknown.MethodsSmart Step is a pilot randomized trial of smartphone‐enabled HBET vs walking advice in patients with symptomatic PAD in an inner‐city hospital. Participants receive a smartphone app with daily exercise reminders and educational content. A trained coach performs weekly phone‐based coaching sessions. All participants receive a Fitbit Charge HR 2 to measure physical activity. The primary outcome changes in 6‐minute walking test (6MWT) distance at 12 weeks over baseline. Secondary outcomes are the degree of engagement with the smartphone app and changes in health behaviors and quality of life scores after 12 weeks and 1 year.ResultsA total of 15 patients are randomized as of December 15, 2019 with a mean (SD) age of 66.1 (5.8) years. The majority are female (60%) and black (87%). At baseline, the mean (SD) ABI and 6MWT were 0.86 (0.29) and 363.5 m, respectively. Enrollment is expected to continue until December 2020 to achieve a target size of 50 participants.ConclusionsThe potential significance of this trial will be to provide preliminary evidence of a home‐based, “mobile‐first” approach for delivering a structured exercise rehabilitation program. Smartphone‐enabled HBET can be potentially more accessible than center‐based programs, and if proven effective, may have a potential widespread public health benefit.

Knee Joint Biomechanics in Physiological Conditions and How Pathologies Can Affect It: A Systematic Review.

The knee joint, as the main lower limb motor joint, is the most vulnerable and susceptible joint. The knee injuries considerably impact the normal living ability and mental health of patients. Understanding the biomechanics of a normal and diseased knee joint is in urgent need for designing knee assistive devices and optimizing a rehabilitation exercise program. In this paper, we systematically searched electronic databases (from 2000 to November 2019) including ScienceDirect, Web of Science, PubMed, Google Scholar, and IEEE/IET Electronic Library for potentially relevant articles. After duplicates were removed and inclusion criteria applied to the titles, abstracts, and full text, 138 articles remained for review. The selected articles were divided into two groups to be analyzed. Firstly, the real movement of a normal knee joint and the normal knee biomechanics of four kinds of daily motions in the sagittal and coronal planes, which include normal walking, running, stair climbing, and sit-to-stand, were discussed and analyzed. Secondly, an overview of the current knowledge on the movement biomechanical effects of common knee musculoskeletal disorders and knee neurological disorders were provided. Finally, a discussion of the existing problems in the current studies and some recommendation for future research were presented. In general, this review reveals that there is no clear assessment about the biomechanics of normal and diseased knee joints at the current state of the art. The biomechanics properties could be significantly affected by knee musculoskeletal or neurological disorders. Deeper understanding of the biomechanics of the normal and diseased knee joint will still be an urgent need in the future.

Cardiorespiratory fitness and cancer in men with cardiovascular disease: Analysis from the Veterans Exercise Testing Study.

Cardiovascular disease and cancer share similar risk factors and are the leading causes of death worldwide. This study aimed to assess the association between cardiorespiratory fitness, cancer incidence and cancer mortality in men with cardiovascular disease. Baseline cardiorespiratory fitness (treadmill exercise test) was assessed in 565 men aged 58.9 ± 17 with documented cardiovascular disease and free from any malignancy. Cox multivariable hazard models, population attributable fraction and exposure impact number were analyzed in model accounting for competing events for cancer outcomes. Mean cardiorespiratory fitness was 7.6 ± 3.4 metabolic equivalents. During a 12.0 ± 7.5 year follow-up, 147 participants developed any type of cancer, 70 died from cancer, and five died from causes other than cancer as competing events. Compared to low cardiorespiratory fitness (<5 metabolic equivalents), moderate (5-10 metabolic equivalents) and high cardiorespiratory fitness (>10 metabolic equivalents) were associated with 50% (0.50, 95% confidence interval (0.27-0.91)) and 68% (0.32 (0.11-0.88)) reduced risks for cancer mortality (p trend = 0.026), respectively. Survival time was longer among individuals with moderate (20.8 (19.7-22) years) and high (24.9 (23-26.7) years) compared to low cardiorespiratory fitness (17.2 (15.1-19.3) years), p < 0.001. Population attributable fraction and exposure impact number for cancer mortality were 13% (4.1-17.7) and 10.8 (5.1-56.4), p = 0.01, respectively. Cardiorespiratory fitness was not associated with cancer incidence. Higher cardiorespiratory fitness was independently associated with lower risk of cancer mortality and extended survival time in men with cardiovascular disease, although it was not associated with cancer incidence. Improving cardiorespiratory fitness through supervised exercise rehabilitation programs could potentially serve as a cost-effective public-health strategy for secondary prevention and survivorship in men with cardiovascular disease.

P105 Therapists acceptability of delivering a psychologically informed gait rehabilitation intervention in early rheumatoid arthritis (GREAT): a qualitative interview study

Abstract Background Great Strides is a brief psychologically informed gait rehabilitation intervention (two compulsory face-to-face sessions and up to four optional sessions delivered over 3 months) aimed at improving lower limb function for adults with early rheumatoid arthritis (RA). As part of the Gait Rehabilitation in Early Arthritis Trial (GREAT) feasibility study, physiotherapists and podiatrists received two days of bespoke training delivered by psychologists, physiotherapists and podiatrists on i) the gait rehabilitation exercise programme (six walking exercises) ii) aspects of motivational interviewing (MI) and iii) delivery of key behaviour change techniques (BCTs) to facilitate motivation and adherence to the Great Strides intervention. The training was supported by a bespoke therapist manual and session checklists. The aim of this study was to explore therapists’ acceptability of: (1) the bespoke training received and (2) delivering the intervention within the GREAT feasibility study. Methods All 10 therapists who received training were invited to complete semi-structured interviews. The topic guide was informed by the Theoretical Framework of Acceptability (TFA). Interviews were audio recorded, professionally transcribed and a deductive thematic analysis was applied. Data were coded into six TFA constructs (Affective Attitude; Burden; Intervention Coherence; Opportunity Costs; Perceived Effectiveness; Self-efficacy). Results Nine out of ten therapists (four physiotherapists, five podiatrists) participated in the semi-structured interviews. Five therapists (four physiotherapists, one podiatrist) delivered the Great Strides intervention. Key barriers and enablers with regards to the acceptability of the bespoke training and intervention delivery were identified. Training: Therapists liked the supportive training environment (affective attitude), understood the purpose of the training sessions (intervention coherence), reported that the role play exercises aided their confidence in applying MI and BCTs (self-efficacy) and found that the training sessions were vital preparation for delivering the intervention (perceived effectiveness). Aspects of training which were considered unacceptable included the lack of time to attend the training sessions (opportunity costs). Delivery: All therapists enjoyed applying MI and BCTs to encourage participants to complete the gait exercises (affective attitude) and valued the opportunity to provide individualised care (intervention coherence). Barriers associated with acceptability included the use of trial-related materials (e.g. checklist) during intervention delivery (burden), interference of intervention delivery with routine clinical workload (opportunity costs) and the time delay between receiving training and initial intervention delivery (perceived effectiveness). Conclusion Both GREAT intervention training and delivery were considered acceptable to most therapists. The results have guided key refinements for training and intervention delivery for the GREAT internal pilot and full trial (e.g. remote access to training, timing of training in relation to intervention delivery). These refinements have the potential to improve the bespoke training and enhance the delivery of the Great Strides intervention maximising efficiency and potential for effectiveness. Disclosures M. Sekhon None. E. Godfrey None. G. Hendry None. N.E. Foster None. S. Hider None. M. van der Leeden None. H. Mason None. A. McConnachie None. I. McInnes None. A. Patience None. C. Sackley None. M. Steultjens None. A. Williams None. J. Woodburn None. L. Bearne None.

Neural Health, Depression, and Fatigue in Cancer Survivors Enrolled in a Structured Exercise Rehabilitation Program

ObjectiveThe purpose of this cross‐sectional study was to explore relationships between biomarkers of neural health, including brain‐derived neurotrophic factor (BDNF) and nerve growth factor (NGF), cardiorespiratory fitness and muscular strength, and depression, fatigue, and quality of life (QOL) in cancer survivors who are currently receiving either chemotherapy and/or radiation treatments (TM), or not receiving treatment (NT), while enrolled in a structured exercise program.MethodsPhysically active cancer survivors were recruited from the University of Northern Colorado Cancer Rehabilitation Institute. Age, height, weight, and body fat percentage (BF%) were obtained, and cardiorespiratory fitness and muscular strength were evaluated using peak oxygen uptake (VO2 peak) and estimated one‐repetition maximum, respectively. Depression, fatigue, and QOL were evaluated with the Beck Depression Inventory, Revised Piper Fatigue Scale, and Ferrans and Powers QOL Index Version III Questionnaire. Rested and fasted plasma BDNF and NGF concentrations were obtained using enzyme‐linked immunosorbent assays. Differences between groups were evaluated using an unpaired t‐test, and Pearson’s correlation was used to determine the relationship between BDNF and NGF, and cardiorespiratory fitness, muscular strength, and questionnaire scores. Data are presented as mean ± standard deviation and significance was defined as P &lt; 0.05.ResultsTwenty‐four cancer survivors participated in the study and were divided into TM (n=12) and NT (n=12) groups. Time since treatment for NT was 10.2±8.6 months. No significant differences were observed between groups in physical characteristics, fitness measures, or survey scores. When all participants were grouped together, characteristics were age: 65.2±12.9 y, height: 167.1±8.0 cm, weight: 79.8±16.6 kg, BF%: 36.7±9.6%, VO2 peak: 25.8±6.9 mL/min/kg, chest press: 37.0±15.9 kg, leg press: 103.7±38.1 kg, depression score: 5.7±3.8, fatigue score: 3.2±2.2, and QOL score: 23.8±2.9. Concentrations of BDNF were significantly lower in TM (85.1±27.9 pg/mL) compared to NT (141.3±68.2 pg/mL; P=0.01); however, when TM and NT were combined, mean NGF concentrations were 5.0±0.7 pg/mL and there were no significant differences between TM and NT groups. Concentrations of BDNF and NGF were not associated with measures of cardiorespiratory fitness or muscular strength, or with depression, fatigue, or QOL.ConclusionsConcentrations of BDNF were significantly lower in physically active cancer survivors currently undergoing cancer‐related treatment. Although these cancer survivors were participating in structured exercise, which is known to increase circulating BDNF concentrations, these rehabilitation programs may not completely protect individuals against cancer‐related treatment reductions in BDNF.Support or Funding InformationUniversity of Northern Colorado Faculty Research and Development Program

지적 장애인들의 재활운동프로그램 개발 및 효과

본 연구의 목적은 신체적 장애를 동반한 지적 장애인들의 재활운동프로그램 처치에 따른 물체조작기술과 이동기술능력의 향상에 있다. 연구방법은 지적 장애인 14명을 대상으로 개별화 프로그램을 운동시킨 그룹 운동군(MRE, n=6)과 일반 주간보호센터에서 운동시킨 그룹 통제군(MRC, n=8)으로 구분하였다. 주 2회 60분씩 8주간 적용한 개별화 운동 프로그램 후 TGMD-2의 대근운동능력인 이동운동능력(달리기, 갤롭, 홉, 립, 제자리멀리뛰기, 슬라이드)과 물체조작능력(치기, 제자리튀기기, 받기, 차기, 오버헤드던지기, 굴리기)을 측정하였다. 모든 자료는 SPSS 23.0 통계 프로그램을 이용하여 각 그룹별 평균과 표준편차를 산출하였고, 측정변인들을 검정하기 위하여 2-way ANOVA를 적용하였으며, 사후검정은 Tukey 방법을 적용하였다. 통계적 유의수준은 p< .05를 기준으로 설정하였다. 연구결과 MRE 그룹은 이동기술 및 물체조작기술의 하위영역에서 개별화 운동 프로그램 수행 후 증가한 경향을 보였다. 특히 물체조작기술의 하위영역인 오버헤드 던지기에서 MRE 그룹이 운동전보다 운동 후 유의하게(p< .05) 증가하였고, MRC 그룹보다 유의하게(p< .05) 높은 점수가 나타났다. 그러므로 지적 장애인의 폼롤러, 메디신볼, 탄성밴드, 뉴 스포츠를 이용하여 장애 유형과 수준에 맞는 개별화 재활운동프로그램을 통해 하체를 안정화시키고 필요한 근육을 긴장 및 이완시켜 대근운동능력 발달에 긍정적인 영향을 미쳤다. 이와 같이 지적 장애인들을 위한 개별화 운동 프로그램은 운동수행능력 및 체력 발달에 긍정적인 영향을 미쳤으며 차후 지적 장애인의 인지능력과 신체 장애정도를 고려한 개별화 재활운동프로그램이 필요할 것이다.

Urinary Incontinence - Incidence, Associations and Effect of Lung Transplant

Compared to healthy peers, the prevalence of urinary incontinence (UI) is greater in males and females with respiratory disease, but the trajectory of UI and relationship with respiratory symptoms is unknown following lung transplantation (LTx). Prospective questionnaire study aimed to investigate the prevalence and association with coughing of urinary incontinence before and after LTx. The Leicester Cough Questionnaire (LCQ) and International Consultation on Incontinence Questionnaires Modules (ICIQ) were completed by consenting adult LTx candidates and repeated 3 months after their LTx. These validated modules identify the prevalence and impact of UI. All participants completed a 10 -12 week, thrice weekly exercise rehabilitation program RESULTS: Of 93 participants, 76% were transplanted (43% male, age males mean 62 [SD 9] years, females 52 [SD 14] years). Prostate problems were reported by 12% of males; 30% of females were nulliparous and 41% postmenopausal. There was a significant difference between the report of any UI (stress or urgency) from pre (n=56, p<0.0001) to post LTx (n=33, p=0.182). There was a difference between males and females for report of UI pre LTx (42/53 females, 14/40 males, p<0.0001) which was not demonstrated post LTx (20/37 females, 13/34 males, p=0.182). In females, scores for UI symptoms (pre: median 3 [IQR 0.3 to 6], post: 1 [0 to 4], p<0.0001) and quality of life (mean difference 5.8 [95%CI 1.3 to 10.2]) significantly improved post LTx. Pre LTx UI symptom scores were lower in males (pre: median 1 [IQR 0 to 2]) and no difference was demonstrated post LTx (1 [0 to 3], p=0.650). No difference in scores for quality of life was demonstrated in males (mean difference -0.7 [95%CI -7.1 to 5.7]). For participants with UI pre LTx, no relationship was observed post LTx with improvement in UI and improvement consistent with the minimal important difference for LCQ (females p=0.621, males p=0.757). Improvement in UI symptom and quality of life scores were observed in females following LTx. Resolution of UI symptoms did not appear to be related to change in cough in males or females post LTx. However, the lack of improvement in UI in some participants following LTx indicates the need for further work in order to identify vulnerable participants, and routine screening should be considered pre and post LTx.

Predictors of improvement following early exercises rehabilitation program for patients undergoing open lumbar discectomy

Background and aims: Low back pain is mostly due to disc herniation and has a burden upon economy and social aspects of life. Failure to improve after open lumbar discectomy is frustrating. Therefore, identifying predictors of improvement is of great clinical benefit. Aims: This research was conducted to evaluate whether an early exercises rehabilitation program using educational booklet would provide benefit to patients following open lumbar discectomy and determine potential factors of improvement.Patients and methods: Design: Single blind randomized controlled trial. Eighty-eight patients scheduled for open lumbar discectomy from January 2017 to January 2019 at Assiut and Ain Shams Universities hospitals in Egypt were randomly assigned to two groups. Control group (n = 44) received routine postoperative instructions while intervention group (n = 44) received routine instructions in addition to early exercises rehabilitation program and were also provided with a specifically designed educational booklet. Patients were followed up after six months using Oswestry disability index.Results: There was significant improvement among intervention group as compared to control group in several domains of Oswestry disability index (walking, sitting, standing, sleeping, travelling and sexual and social life). Better pre-operative Oswestry disability index score and early application of exercises rehabilitation program using an educational booklet predicted better postoperative Oswestry disability index score after six months.Conclusion: Application of an early exercise rehabilitation program and providing patients with a specifically designed educational booklet would be helpful for patients following open lumbar discectomy. Clinical Relevance: Early exercises rehabilitation program can be used by nursing staff as a reference in management of patients following open lumbar discectomy.

Efficacy and Safety of an mHealth App and Wearable Device in Physical Performance for Patients With Hepatocellular Carcinoma: Development and Usability Study.

BackgroundExercise is predicted to have a positive effect among hepatocellular carcinoma (HCC) patients. However, these patients are hesitant to start and build up an exercise program for one major reason: the vague fear of developing hepatic decompensation, a potentially fatal condition that can lead to death. Integrating mobile health (mHealth) with individualized exercise programs could be a possible option for promoting physical capacity among HCC patients.ObjectiveThe aim of this study was to evaluate the efficacy and safety of rehabilitation exercises, which have been individually prescribed via an mHealth app, on physical fitness, body composition, biochemical profile, and quality of life among HCC patients.MethodsA total of 37 HCC patients were enrolled in a 12-week course with an mHealth app program targeted to HCC patients. The wearable wristband device Neofit (Partron Co) was provided to participants, and recorded daily physical data, such as the number of steps, calorie expenditure, exercise time, and heart rate. Each participant was given an individualized rehabilitation exercise program that was prescribed and adjusted at the 6-week midintervention period based on the assessment results. At baseline, 6-week, and 12-week sessions, participants’ physical fitness levels (ie, 6-minute walk test, grip strength test, and 30-second chair stand test) were measured. Physical activity levels, as measured by the International Physical Activity Questionnaire-Short Form (IPAQ-SF); body composition (ie, body mass index, body fat percentage, and muscle mass); biochemical profiles; and quality of life, as measured by the European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire C30, were assessed at baseline and at the end point. At the 6-week midpoint, exercise intensity was individually adjusted.ResultsOf the 37 patients, 31 (84%) completed the 12-week intervention. Grip strength improved significantly after 12 weeks of the intervention. The 30-second chair stand test and the 6-minute walk test showed significant improvement from 0 to 6 weeks, from 0 to 12 weeks, and from 6 to 12 weeks. Muscle mass and the IPAQ-SF score increased significantly after 12 weeks of the intervention without biochemical deterioration.ConclusionsFollowing 12 weeks of mHealth care, including an individually prescribed rehabilitation exercise program, we saw significant improvements in physical fitness, body composition, and physical activity without any complication or biochemical deterioration among compensated HCC patients who had completed therapy.

Effectiveness of the Out-Patient Rehabilitation and Home Exercise Program to the Patients with Lumbar Disc Herniation

In scientific literature there are few studies dealing with the effectiveness of home exercise program in patients with low back pain. These issues are very important since the out-patient institutions provide just temporal and short-term physical therapy. Patients having gone through it are left without the supervision of physical therapist and depend only on the effectiveness of home exercise program. There is also lack of studies in which the effectiveness of out-patient treatment and home exercise program is compared. The aim of the study was to assess the effectiveness of the out-patient rehabilitation and home exercise program for patients with lumbar disc herniation. Contingent: there were 60 patients from 20 to 60 years of age (average age 40.7 ± 2.2) investigated, 27 women and 33 men. The patients with strong low back pain had been treated in the Department of Vertebroneurology and in the Department of Physical Medicine and Rehabilitation of Kaunas Clinical Hospital. All the patients were diagnosed with the intervertebral disc herniation, no surgical treatment was applied before. After in-patient rehabilitation one group was pointed to the out-patient rehabilitation (30 patients), the second group participated in home treatment (30 patients, too). This group was called home exercise program group. These patients were motivated to do exercises 14 days, once a day at home and agreed to participate in home rehabilitation program. Home exercise program for these patients was composed. Methods of the investigation: low back pain (using numerical analogue pain scale), the level of functional disability (using RolandMorris questionnaire) and the quality of life (EQ-5D questionnaire) before and after treatment were evaluated.Results: after out-patient rehabilitation, low back pain and functional disability decreased and the quality of life increased more than after home exercise program. Conclusion: 1. After out-patient rehabilitation, low back pain and the level of functional disability decreased and the quality of live increased more than after home exercise program. 2. Home exercise program reduced low back pain and the level of functional disability, but it did not change the quality of life (p &gt; 0.05). Practical recommendation: low back pain, the level of functional disability decreased and quality of life after out-patient rehabilitation improved more in comparison to those patients, who applied home exercise program and it is recommended to continue out-patient rehabilitation after in-patient treatment.Keywords: low back pain, intervertebral disc herniation, out-patient rehabilitation, home exercise program.

Autonomic nervous activity of patient with schizophrenia during Pepper CPGE-led upper limb range of motion exercises

Healthcare for the increasing senior population is a significant challenge. To address this problem, the use of healthcare robot is increasingly being recognized to have strong potential in addressing older adult and psychiatric patients' healthcare and welfare needs. The purpose of this preliminary study is to evaluate the changes in the autonomic nervous activity of an elderly patient with schizophrenia during upper limb range of motion (ROM) exercises led by Pepper (SoftBank Robotics) with the application program of Care Prevention Gymnastics Exercises (Pepper-CPGE) made by Xing Company in Japan. A Pepper-CPGE-led three-minute radio gymnastics program (Radio Exercises #1, consisted of three types of exercises) and instructions were developed. The normal aging 69-year old schizophrenic subject followed instructions from Pepper throughout the intervention. Electrocardiography (ECG) records, heart rate, acceleration score, and ROM exercises of upper limb were collected and analyzed using the GSM's Bonaly Light instrument and Image-J analysis. (1) The high-frequency (HF) (indicative of parasympathetic nervous activity), and low-frequency (LF)/HF ratio (indicative of sympathetic nerve activity) were increased in reference from the baseline data before the exercise stretching the chest. (2) The momentum decreased as the ROM of shoulder joint flexion declined. Declines in both parasympathetic and sympathetic nervous activity were observed. Also, (3) when the exercise "bend the body forward" was performed, the HF and LF/HF also decreased. Evaluation of robot-based rehabilitation exercise program effectiveness by the ROM exercises image analysis and autonomic nervous activity is essential for the futurist programming of ROM exercise among patients with schizophrenia.

The feasibility of implementing an exercise programme for deconditioned cancer survivors in a national cancer centre: FIXCAS Study

Introduction: As both the number of cancer survivors and the length of survival time are increasing, long-term health issues related to cancer and its treatment are becoming more prevalent. Research suggests that exercise can mitigate several negative health consequences in cancer survivors and improve physical function and quality of life. Multi-modal exercise interventions have been proposed as a cornerstone for survivorship care. However, studies evaluating exercise programmes within the Irish population are lacking. Purpose: To evaluate the introduction, implementation and acceptability of a multi-modal exercise rehabilitation programme for deconditioned cancer survivors in a real-world, standard practice setting. Methods and analysis: In this single-arm prospective feasibility study, cancer survivors (n=40) will undergo a 10-week multi-modal exercise programme. The study population will comprise of cancer survivors attending outpatient services in an Irish national cancer centre. Participants will be aged 18 or older and have completed treatment with curative intent. Feasibility will be evaluated in terms of recruitment, adherence and compliance to the programme. Secondary outcomes will examine physical function and quality of life measures. In addition, the acceptability of the programme will be assessed through stakeholder feedback. Ethics and dissemination: Ethical approval through the St. James’s Hospital and Tallaght University Hospital Research and Ethics Committee is currently pending. The study results will be used to optimise the intervention content and may serve as the foundation for a larger definitive trial. Results will be disseminated through peer-review journals, congresses and relevant clinical groups. Trial registration: ClinicalTrials.gov NCT04026659 (19/07/19)

Effect of visual feedback aerobic exercise training on lung hyperinflation in chronic obstructive pulmonary disease patients – A randomized control trial

CONTEXT: Lung hyperinflation is defined as an abnormal increase in the volume of air remaining in the lungs at the end of normal expiration caused by the permanently destructive changes of emphysema and expiratory flow limitation. All the rehabilitation exercise programs have some reinforcement on hyperinflation mechanism directly or indirectly without any associated feedback. AIMS: This study aims to study the effect of visual biofeedback training on lung hyperinflation in chronic obstructive pulmonary disease (COPD) patients. SUBJECTS AND METHODS: 104 mild to moderate (global initiative for chronic obstructive lung disease) COPD patient of age group 40–60 years were recruited and randomly allocated to control and experimental group using random reviewer software 3.3 versions. The baseline and postoutcomes were analyzed by an external observer who is blinded. The visual training group receives biofeedback training on expiratory flow limitation. Both experimental and control group receives aerobic exercise training of 50%–60% of maximum heart rate intensity where all received cycling as a mode for 20–40 min with a warm and cool-down period. All the patients were trained for 4 days a week for 8 weeks. STATISTICAL ANALYSIS USED: Descriptive statistics, independent sample t-test, and repeated measures of analysis of variance. RESULTS: Residual volume and total lung capacity significantly reduced statistics F = 12.23 with P CONCLUSION: Visual feedback exercise training is one of the effective training methods to relieve the hyperinflation in stable COPD patients thereby improves exercise tolerance and quality of life.

Effectiveness of proprioceptive training versus conventional exercises on postural sway in patients with early knee osteoarthritis – A randomized controlled trial protocol

IntroductionIn recent times, ‘early osteoarthritis’ (EOA) has achieved recognition as a disease entity. The importance of defining EOA is in the fact that a variety of joint preservation treatments are available. Development of the sense of proprioception is a known vital element of most exercise rehabilitation programmes. Postural sways have been found to be prevalent in arthritic patients. It follows therefore that correction of early postural aberrations should help patients with EOA. The current study aims to determine the effectiveness of such proprioceptive training versus conventional exercises in patients with EOA. MethodThis study is a randomized controlled trial. A total of 100 participants between the age of 20–45 years will be recruited. Participants will be randomly assigned to conventional or interventional group. Participants in both the groups will receive 12 session of treatment over a period of four weeks. Outcome measure considered are center of pressure excursion, joint position sense, hand held dynamometer, visual analog scale and knee injury and osteoarthritis Outcome Score for functional outcome. ResultsData collected will be analyzed by mean, SD and 2 factor ANOVA for repeated measure, followed by Bonferroni post hoc analysis. Data will be analyzed using SPSS package version 17.0, p < 0.05 will be considered as significant. ConclusionThe authors hope to determine whether proprioceptive training improves outcome better than conventional exercise therapy and hope to contribute to an improved targeted treatment for patients with Early osteoarthritis.

Chest Expander Spring a Low Cost Home Physiotherapy-Based Exercise Rehabilitation after Total Hip Arthroplasty

Background: The demand for total hip arthroplasty (THA) is rising. Postoperative exercise rehabilitation helps patients recover normal joint functions by strengthening the muscles surrounding the replaced hip joint. In the face of rapidly increasing health care costs, ensuring widespread, cost-effective rehabilitation is a priority. However, the high cost of professionally supervised exercise rehabilitation programs limits access to program participation and, thus, to optimal recover of normal joint functions. Therefore, the development of an effective home-based, self-monitored exercise rehabilitation program is critical to promote the optimal recovery of THR patients. Purpose: The aim of this study was to assess the feasibility, evaluate the effectiveness of a specific Progressive Resistance Exercise program for improving hip muscles strength, resorting hip joint mobility and address the functional needs of the patient treated with primary total hip arthroplasty. Additionally; spreading the idea of a low-cost post-operative rehabilitation program using chest expander spring. Study Design: Prospective case series study. Patients and Methods: This was a prospective single-center clinical study with a 12-week intervention program carried out in an outpatient clinic and in home based. 120 patients (84 males) had been enrolled in this study to which primary total hip arthroplasty had been done. Patients were evaluated preoperatively, at baseline, 2 weeks postoperative, one week following last visit of follow-up and at 6 months postoperatively. Clinical outcome measures involved: Harris Hip Score (HHS), Oxford Hip Score (OHS), WOMAC activity score, range of hip movements (ROM), Timed Get Up and GO Test and 6 Minutes walking test. Results: The study included 120 patients (84 males). The mean age 65.3 years (range = 53-76 years). Results of clinical functional outcomes showed a progressive improvement at follow ups regarding : Harris Hip Score, Oxford Hip Score, WOMAC activity score ( related to pain, stiffness and physical functions), range of hip motions, time effect for Get up-and-go test and 6-minute walking distance test. The improvement is more achieved in last follow up visit and after 6 months postoperative. Conclusions: The study demonstrates that this novel low-cost solution holds promise in rehabilitation after THA, ensuring better clinical outcomes than conventional rehabilitation while reducing dependence on human resources. Considering the low cost and convenience of a home-based resistance training program, health professionals should consider this and similar exercise programs when providing guidance to THR patients particularly in low-income countries.