Exercise Rehabilitation Program Research Articles

A Study of the Reliability, Validity, and Physiological Changes of Sit-to-Stand Tests in People With Heart Failure.

The objective of this study was to describe the psychometric properties and physiological response of the five times sit-to-stand (STST-5) and 60-sec sit-to-stand test (STST-60) in adults with heart failure (HF). People with HF enrolled in a 12-wk exercise rehabilitation program completed two STST-5 and two STST-60 as part of their usual baseline and follow-up assessments. Test-retest reliability, validity, and responsiveness of the two STSTs were described. Results were correlated with the 6-min walk test (6MWT) and timed up and go test (TUGT), and rating of perceived exertion and physiological responses were compared between all tests. Feasibility was also reported according to the presence of adverse events and adherence to the protocol. Forty-nine adults with HF participated in this study. Intraclass correlation coefficients of the STST-5 and STST-60 were 0.91 (95% CI, 0.78-0.96) and 0.96 (95% CI, 0.93-0.98), respectively. The STST-60 was strongly associated with both the 6MWT ( r = 0.76) and the TUGT ( rs =-0.77). The STST-5 was strongly associated with the TUGT ( rs = 0.79) and moderately associated with the 6MWT ( rs =-0.70). Rating of perceived exertion and lower limb fatigue were greater in the STST-60 than in the 6MWT ( P < .001) or STST-5 ( P < .001). Adverse events occurred in five participants undertaking the STST-60 and one participant undertaking the STST-5. The STST-5 and STST-60 are reliable and valid measures of functional exercise capacity in people with HF.

Feasibility and Safety of a Powered Exoskeleton for Balance Training for People Living with Multiple Sclerosis: A Single-Group Preliminary Study (Rapper III)

To evaluate the feasibility, usability, safety, and potential health benefits of using an exoskeleton device for rehabilitation of people living with multiple sclerosis. Single-group preliminary study. Eleven adults living with multiple sclerosis, with Expanded Disability Status Scores that ranged from 6 to 7.5 (mean age (standard deviation; SD) 54.2 (11.8) years), were recruited. Individual participants undertook a balance rehabilitation exercise programme using the Rex Rehab robotic exoskeleton device. Each participant undertook 4 × 45-60 min supervised, balance exercise sessions. Primary outcomes were: (i) the number of participants who completed the trial protocol safely, and (ii) the number and nature of adverse events reported. Secondary outcomes were: mobility; balance; spasticity; sleep; functional independence; quality of life; and device satisfaction. Ten out of 11 participants completed the trial protocol safely. Four adverse events were recorded (1 serious), all of which were deemed unrelated to the trial. Secondary outcomes showed allied improvements in balance, joint mobility, spasticity and quality of life. All participants found the device acceptable to use. These results suggest that it is feasible and safe to use the Rex Rehab exoskeleton device to assist with balance rehabilitation for people living with multiple sclerosis.

The effect of a rehabilitation exercise program using neuromuscular facilitators of sensory receptors on muscle spasm in the cervical region of women

The effect of a rehabilitation exercise program using neuromuscular facilitators of sensory receptors on muscle spasm in the cervical region of women

Using Smartphone TechnolOGy to Support an EffecTive Home ExeRcise Intervention to Prevent Falls amongst Community-Dwelling Older Adults: The TOGETHER Feasibility RCT

Introduction: Falls have major implications for quality of life, independence, and cost of health services. Strength and balance training has been found to be effective in reducing the rate/risk of falls, as long as there is adequate fidelity to the evidence-based programme. The aims of this study were to (1) assess the feasibility of using the “Motivate Me” and “My Activity Programme” interventions to support falls rehabilitation when delivered in practice and (2) assess study design and trial procedures for the evaluation of the intervention. Methods: A two-arm pragmatic feasibility randomized controlled trial was conducted with five health service providers in the UK. Patients aged 50+ years eligible for a falls rehabilitation exercise programme from community services were recruited and received either (1) standard service with a smartphone for outcome measurement only or (2) standard service plus the “Motivate Me” and “My Activity Programme” apps. The primary outcome was feasibility of the intervention, study design, and procedures (including recruitment rate, adherence, and dropout). Outcome measures include balance, function, falls, strength, fear of falling, health-related quality of life, resource use, and adherence, measured at baseline, three-month, and six-month post-randomization. Blinded assessors collected the outcome measures. Results: Twenty four patients were randomized to control group and 26 to intervention group, with a mean age of 77.6 (range 62–92) years. We recruited 37.5% of eligible participants across the five clinical sites. 77% in the intervention group completed their full exercise programme (including the use of the app). Response rates for outcome measures at 6 months were 77–80% across outcome measures, but this was affected by the COVID-19 pandemic. There was a mean 2.6 ± 1.9 point difference between groups in change in Berg balance score from baseline to 3 months and mean 4.4 ± 2.7 point difference from baseline to 6 months in favour of the intervention group. Less falls (1.8 ± 2.8 vs. 9.1 ± 32.6) and less injurious falls (0.1 ± 0.5 vs. 0.4 ± 0.6) in the intervention group and higher adherence scores at three (17.7 ± 6.8 vs. 13.1 ± 6.5) and 6 months (15.2 ± 7.8 vs. 14.9 ± 6.1). There were no related adverse events. Health professionals and patients had few technical issues with the apps. Conclusions: The motivational apps and trial procedures were feasible for health professionals and patients. There are positive indications from outcome measures in the feasibility trial, and key criteria for progression to full trial were met.

Parents’ Perspectives of Partnering With Therapists to Administer Intensive Rehabilitation for Children With Perinatal Stroke

<h3>Research Objectives</h3> Parental participation in their young children's rehabilitation has been promoted to increase intervention intensity. Yet, parents' perspectives on increased involvement, including the barriers and facilitators, remain unclear. The objective of this study was to explore parent perspectives of partnering with therapists to administer early, intensive rehabilitation to their children with perinatal stroke. <h3>Design</h3> Parents participated in semi-structured interviews before and after partnering with a physical therapist (PT) to deliver a 12-week intervention for their child. Interviews were audio recorded and transcribed verbatim. Interpretive description methodology was used to generate knowledge that is relevant for clinical practice. <h3>Setting</h3> Rehabilitation occurred in the child's home and in pediatric physical therapy clinical sites in three cities in Canada. <h3>Participants</h3> Twelve Parents (11 mothers, 1 father) of children between 8 months and 3 years old with spastic unilateral cerebral palsy (CP) as a result of perinatal stroke. A diverse group was sampled including single parents, parents of one or multiple children, parents working in and outside the home, families who had immigrated to Canada and families with a wide range of previous experience with rehabilitation. <h3>Interventions</h3> The intervention was ELEVATE (Engaging the Lower Extremity Via Active Therapy Early), a play-based PT intervention targeting the lower extremity of children with CP. The intervention was 1 hour/day, 4 days/week for 12 weeks and was administered by a PT in partnership with parents (2 sessions delivered by each/week). <h3>Main Outcome Measures</h3> N/A. <h3>Results</h3> The three themes were 1) the importance of taking a positive approach to therapy, 2) the focus on maximizing their child's potential, and 3) participating in intensive rehabilitation is "worth it", despite the challenges. Families discussed the importance of making therapy fun, the value of intervening when their child is young, and a number of barriers to participating in intensive rehabilitation including long commutes and requiring child care for siblings. <h3>Conclusions</h3> These results will help facilitate meaningful engagement of parents in their children's rehabilitation, especially early, intensive rehabilitation and home exercise programs. <h3>Author(s) Disclosures</h3> None.

The comparative effects of exercise type on motor function of patients with Parkinson's disease: A three-arm randomized trial.

Yang-ge dancing is a culturally specific exercise in which people are required to perform motor skills in coordination with rhythmic music. As an integrated exercise with both physical (decelerating the progression of aged-related motor function degeneration) and mental benefits, it has gained great popularity in China, especially among middle-aged and older adults. It remains largely unknown whether Yang-ge dancing (YG) can effectively improve main symptoms of Parkinson's disease (PD), while conventional exercise rehabilitation program has been recommended in the hospital setting. To this end, this study aimed to investigate the comparative effects of exercise therapy on motor function of PD patients. A sample of 51 PD patients were randomly assigned to Yang-ge dancing, conventional exercise, or conventional exercise with music. Participants in each group performed 60 min per session, five sessions per week of interventions for 4 weeks. All the participants were assessed using the Unified Parkinson's Disease Rating Scale-motor examination, Berg balance test, timed up and go test, and Purdue pegboard test. Motor performances were examined before and after intervention. All the three groups were benefited from exercise. Compared to conventional exercise, the Yang-ge dancing and conventional exercise with music had additional positive effects in mobility with reference to baseline.In addition, compared to the two conventional exercise groups (either with/without music), the Yang-ge dancing further enhanced manual dexterity. Exercise with rhythmic auditory stimulation optimized mobility in PD, while YG dance specifically contributed to improvement in manual dexterity. [https://clinicaltrials.gov/], identifier [ChiCTR2200061252].

Effect of Rehabilitation Exercise Program with Motion Taping on Pain, Muscle Strength, and WOMAC Index in 50s Middle Aged Women with Osteoarthritis of the Knee Joint

Effect of Rehabilitation Exercise Program with Motion Taping on Pain, Muscle Strength, and WOMAC Index in 50s Middle Aged Women with Osteoarthritis of the Knee Joint

Effects of Rehabilitation Exercise with Blood Flow Restriction after Anterior Cruciate Ligament Reconstruction

The present study examined the effects of a rehabilitation exercise program with blood flow restriction (BFR) vs. a general rehabilitation exercise program in patients who have undergone anterior cruciate ligament (ACL) reconstruction. Among a total of 24 patients, the general rehabilitation exercise group (GRE, n = 12) and blood flow restriction group (BFR, n = 12) were assigned the same. The GRE group conducted a general rehabilitation exercise, and the BFR group conducted a BFR exercise along with the general rehabilitation exercise. All participants performed the rehabilitation exercise program session for 60 min three times a week for 12 weeks under supervision. All dependent parameters (Lysholm score and International Knee Documentation Committee (IKDC) subjective score, muscle activity, isokinetic muscular function, Y-balance test) were evaluated before and after the rehabilitation exercise program. GRE improved the Lysholm score, IKDC subjective score and Y balance test (posterior-medial, posterior-lateral) (p &lt; 0.05). Moreover, BFR was effective in improving the Lysholm score and IKDC subjective score and muscle activity (e.g., vastus medialis oblique during isokinetic contraction and rectus femoris during isometric contraction), isokinetic function (e.g., peak torque and total work) and Y-balance test (e.g., anterior, posterior medial, posterior lateral) (p &lt; 0.05). Our study confirmed that a rehabilitation exercise program with BFR after ACL reconstruction is a more effective rehabilitation modality for improving muscle activity during muscle contraction and muscle function compared with GRE. Therefore, it is recommended to use BFR as an effective rehabilitation program for rapid recovery after ACL reconstruction.

Effects of Neuromuscular Electrical Stimulation and Blood Flow Restriction in Rehabilitation after Anterior Cruciate Ligament Reconstruction.

The present study aimed to examine and compare the effects of a rehabilitation exercise (RE) using neuromuscular electrical stimulation (NMES) and blood flow restriction (BFR) on muscle function and knee functional abilities in patients who underwent anterior cruciate ligament reconstruction (ACLR). A total of 45 patients who underwent ACLR (28.76 ± 0.8 years; 34 males and 11 females) were retrospectively divided into three groups: control (CON, n = 15), NMES (n = 15), and BFR (n = 15). All participants carried out the RE program for 60 min, thrice a week for 12 weeks. The Lysholm score, International Knee Documentation Committee (IKDC) subjective score, thigh circumference at 5 cm from the knee joint, Y-balance posterior medial, and lateral significantly increased in all groups via intervention (p &lt; 0.05). However, NMES showed a higher thigh circumference at 15 cm from the knee joint than CON via intervention (p &lt; 0.05), and the strength and endurance of quadriceps femoris and hamstrings and Y-balance anterior showed a significant increase via intervention in NMES and BFR compared with CON (p &lt; 0.05). In conclusion, we confirmed that RE using NMES and BFR effectively enhances muscle function and balance in ACLR patients.

Hamstring Injuries: Critical Analysis Review of Current Nonoperative Treatments

Hamstring injuries are common among active and athletic individuals, especially those involved in high-speed running, distance running, or sports requiring sudden directional changes. Acute hamstring strains often occur as an eccentric strain during running or a stretch-type injury caused by simultaneous hip flexion and knee extension. Proximal hamstring tendinopathy is an overuse injury of the hamstring tendon as a result of chronic cicatrization of the musculotendinous unit. Repeated stress to the hamstring tendon leads to increased cellularity of tendon fibers, disruption of collagen, and subsequent microinjury of the tissue that attaches the tendon to bone. Management of hamstring injuries generally begins with nonoperative modalities consisting of eccentric rehabilitative exercise programs. Although various other treatment modalities are available, the comparative efficacy of these supportive measures is not well differentiated at this time. In this article, we review the current literature with regard to the nonoperative treatment of hamstring injuries, specifically focusing on acute hamstring muscle strains and proximal hamstring tendinopathy in order to provide supplementary insight on the effectiveness of current modalities.

What elements of the exercise prescription process should clinicians consider when prescribing exercise for musculoskeletal rehabilitation in a one on one setting? A review of the literature and primer for exercise prescription

Background Despite exercise being a fundamental component of musculoskeletal rehabilitation, there is a lack concise, evidence-based recommendations to inform the clinician’s development of rehabilitative exercise programs for patients in a one-on-one rehabilitation setting. Current evidence is widely dispersed throughout the literature, with each paper addressing one element of the exercise prescription process in isolation. Objectives The aim of this review is to draw together current and available literature to summarise the elements of the exercise prescription process that a clinician should consider when prescribing exercises programs for musculoskeletal rehabilitation in a one-on-one setting. Methods Literature was first obtained by database searches, then hand searches were performed based on the reference lists from papers from the original search. Literature was then summarised and synthesised to create a collation of the elements of the exercise prescription process a clinician should consider for musculoskeletal rehabilitation in a one-on-one setting. Major Findings The reviewed literature was categorised into two main themes: the clinical considerations and decision making underpinning the exercise prescription and the physical implementation of the exercise prescription to the patient. Each theme contained key elements and sub-elements that may systematically guide a clinician through the exercise prescription process. Conclusion Whilst much evidence on exercise prescription in musculoskeletal rehabilitation is present in the literature, there is a lack of concise collated evidence that explores the elements of the exercise prescription process that could inform a clinicians clinical practice. The summary of these elements provides clinicians with a succinct summary that could aid in improving their exercise prescription process and potentially improve patient outcomes. Further research into the efficacy and importance of each element in clinical practice is needed.

Effectiveness of Rehabilitation Exercise in Improving Physical Function of Stroke Patients: A Systematic Review.

Rehabilitation is a crucial part of recovery for stroke survivors, and numerous studies have examined various exercises and treatments of stroke. In addition, it is very important for patients to choose the timing of rehabilitation and what kind of rehabilitation they will proceed with. The purpose of the current study is to examine research investigating the effects of rehabilitation exercise programs in recovery of physical function in patients with stroke, based on aspects of their physical function, physical strength, and daily activities, and systematically examine their effects. Therefore, through systematic review, we have investigated the effects of interventions in rehabilitation exercise programs for recovery of physical function in patients with stroke. We collected relevant publications through the databases MEDLINE/PubMed and Google scholar. Twenty-one articles were ultimately selected for the analysis. We classified the rehabilitation programs and identified the trends of treatment for stroke survivors. Our review indicated that task-oriented therapy is still dominant, but various types of combined rehabilitations have been attempted. In addition, it was identified that physical and active rehabilitation were required rather than unconditional rest, even at an early stage. Home-based treatment was used for rapid recovery and adaptation to daily life during the mid-term period.

The correlates and reference values for the 6-minute walk distance in Taiwanese adults with schizophrenia

Purpose The study aimed to identify the factors associated with the 6-min walk distance (6MWD) and to provide reference values for the 6MWD in individuals with schizophrenia (SCZ) in Taiwan. Methods A proportional stratified sampling method was utilized based on distribution of gender, age and body mass index (BMI) at the study hospital. The 6-minute walk test was conducted according to the American Thoracic Society protocol. Results A total of 237 patients with SCZ completed the 6-minute walk test. The 6MWD was significantly associated with age, height, weight, and length of the onset of SCZ. Stepwise linear regression revealed that height and age were significant determinants of 6MWD. The reference values for males and females at different age groups were determined. Notably, females over 60 walked substantially shorter than the age younger than 60. Conclusions Height and age were the main predictors for 6MWD among people with SCZ in Taiwan. The established reference values can be used to identify those at risk of poor cardiorespiratory fitness and as a target outcome during exercise programs in psychiatric rehabilitation. Our results highlight that older females with SCZ may be a priority group to target with exercise interventions to mitigate the faster decline in cardiorespiratory fitness. IMPLICATIONS FOR REHABILITATION Height and age were predictors of 6-min walk distance (6MWD) in schizophrenia (SCZ). The established age- and gender reference values for the 6MWD can be used to identify those at risk of poor cardiorespiratory fitness. Females with SCZ over age 60 may be a priority group to target with exercise interventions to mitigate the faster decline in cardiorespiratory fitness.

Physical fitness and its association with fatigue in patients with low-grade glioma

Purpose To evaluate physical fitness and its association with fatigue in patients with low grade glioma (LGG). Methods Cross-sectional study. Muscle strength was measured with a digital dynamometer, cardiorespiratory fitness (peak oxygen uptake (VO2peak), maximal workload (MWL)) by cardiopulmonary-exercise-testing, and fatigue by using the Multidimensional Fatigue Inventory. Results Thirty patients were included, mean age of 44.1 (SD11.2) years, and 67% were men, 31.2 (SD18) months post-diagnosis. Muscle strength (p < 0.01), and cardiorespiratory fitness (VO2peak, MWL) (p < 0.01) were significantly decreased compared to predicted values based on age and gender. Thirty percent of the patients experienced severe physical fatigue, and severe mental fatigue was reported in 57% of the patients. Cardiorespiratory fitness showed weak to moderate (r − 0.46 to r − 0.52) but significant (p < 0.01) correlations with physical fatigue, not with mental and general fatigue. Muscle strength was not associated with fatigue. A lower VO2peak was independently associated with a higher level of physical fatigue, adjusted for Karnofsky Performance Status (R2 0.40). Conclusions Physical fitness (muscle strength, cardiorespiratory fitness) is reduced in patients with LLG, and a lower level of cardiorespiratory fitness (VO2peak) is independently associated with a higher level of experienced physical fatigue. Trials to explore the benefit of exercise programs to improve cardiorespiratory fitness and, consequently, fatigue are warranted. Implications for rehabilitation Physical fitness (muscle strength and cardiorespiratory fitness) is reduced in patients with low-grade glioma. Patients with low-grade glioma should be screened for fatigue with the multidimensional fatigue inventory, to differentiate between mental and physical fatigue. Patients with low-grade glioma with severe physical fatigue should be screened for reduced physical fitness, especially cardiorespiratory fitness by objective cardiopulmonary-exercise-testing. Rehabilitation exercise programs to improve cardiorespiratory fitness and, consequently, (physical) fatigue could be warranted in patients with low-grade glioma.

Outcomes of Genetic Testing-Based Cardiac Rehabilitation Program in Patients with Acute Myocardial Infarction after Percutaneous Coronary Intervention.

Objective There can be extreme variability between individual responses to exercise training, and the identification of genetic variants associated with individual variabilities in exercise-related traits could guide individualized exercise programs. We aimed to screen the exercise-related gene sensitivity of patients with acute myocardial infarction after PCI by establishing the gene spectrum of aerobic exercise and cardiopulmonary function sensitivity, test the effect of individualized precision exercise therapy, and provide evidence for the establishment of a precision medicine program for clinical research. Methods Aerobic exercise- and cardiopulmonary function-related genes and single-nucleotide polymorphisms (SNPs) were obtained by data mining utilizing a major publicly available biomedical repository, the NCBI PubMed database. Biological samples from all participants underwent DNA testing. We performed SNP detection using Samtools. A total of 122 patients who underwent PCI were enrolled in the study. We screened the first 24 cases with a high mutation frequency for aerobic exercise- and cardiopulmonary function-related genes and the last 24 cases with a low mutation frequency and separated them into two groups for the exercise intervention experiment. Results In both the low mutation frequency group and the high mutation frequency group, after 8 weeks of exercise intervention, 6 MWT distance, 6 MWT%, VO2/kg at peak, and VO2/kg at AT were significantly improved, and the effect in the high mutation frequency group was significantly higher than that in the low mutation frequency group (6 MWT distance: 468 vs. 439, P=0.003; 6 MWT%: 85 vs. 77, P=0.002, VO2/kg at peak: 14.7 vs. 13.3, P=0.002; VO2/kg at AT: 11.9 vs. 13.3, P=0.003). Conclusions There is extreme variability between individual responses to exercise training. The identification of genetic variants associated with individual variabilities in exercise-related traits could guide individualized exercise programs. We found that the subjects with a high mutation frequency in aerobic exercise and cardiopulmonary function-related genes achieved more cardiorespiratory fitness benefits in the aerobic exercise rehabilitation program and provided evidence for the establishment of a precision medicine program for clinical research.

The Effects of a Combined Pre- and Post-Operative Anterior Cruciate Ligament Reconstruction Rehabilitation Program on Lower Extremity Muscle Imbalance

This study examined whether the 5-week pre-operative progressive exercise rehabilitation program with weekly monitoring contributed to a significantly lower muscle activity imbalance in the treatment group, both before and immediately after anterior cruciate ligament reconstruction (ACLR), as well as during the next 5 weeks in comparison to the control group. Twelve professional soccer players took part in the study (from among the top three Polish levels of competition) (age: 26 ± 5 years, body mass: 73 ± 7 kg, stature: 180 ± 6 cm, training experience: 15 ± 4 years). The participants were randomly assigned to the treatment group (n = 6) or to the control group (n = 6). Both groups performed the same pre- and post-operative progressive exercise rehabilitation program, while the rehabilitation of the treatment group was extended by supplementary body-weight functional stabilization training. The three-way repeated-measures ANOVA revealed a statistically significant interaction for muscle × group × time (p &lt; 0.0001; F = 24.897; η2 = 0.806). The post-hoc analysis for the interaction effect of muscle × group × time indicated a significantly higher muscle activity imbalance for every measured muscle in the control group at any time point than in the treatment group (from p = 0.036 to p &lt; 0.0001). The muscle activity imbalance was significantly higher from the 1st to 4th weeks than in the last week before surgery for quadriceps (p &lt; 0.016 for all) and hamstrings (p &lt; 0.001). However, in the case of gluteal muscles’ activity imbalance, it was significantly higher at every time point of the post-operative phase than in the last week before surgery (p &lt; 0.001). The results of this study showed that the 5-week pre-operative rehabilitation program with weekly monitoring influenced outcomes of the post-operative phase. Nevertheless, performing both pre- and post-ACLR rehabilitation significantly reduced the muscle activity imbalance of lower limbs, but in the case of the quadriceps muscles, not to a sufficient level.

Effectiveness of domiciliary rehabilitation, telerehabilitation, and home exercise program on pain, function, and quality of life in patients with total knee arthroplasty

BACKGROUND: Knee osteoarthritis (OA) is the major source of disability worldwide. OA of knee is a joint disease that affects the elderly. It is characterized by progressive articular cartilage damage which further causes pain and loss of function. Total knee replacement (TKR) is the standard treatment for severe OA knee. Telerehabilitation is one of the new treatment ways and is speedily growing as an alternative for therapies. OBJECTIVES: The objective of this study was to compare the effects of domiciliary rehabilitation, telerehabilitation, and home exercise program on pain, function, and quality of life (QOL) in patients with TKR. MATERIALS AND METHODS: A total of 108 individuals were enrolled as per eligibility criteria during the study period and then were randomly divided into three groups by computer-generated, randomized sequence numbers. The parameters were obtained preoperatively, postoperatively, and at the end of 1 month using the Visual Analog Scale (VAS), Knee Injury and Osteoarthritis Outcome Score, Quality of Well-being, methadone maintenance treatment (MMT), and knee range of motion (ROM) test. P &lt; 0.05 was considered statistically significant. RESULTS: All the three groups showed a reduction in VAS scores and improved function in patients with TKR. QOL and MMT did not prove to be significant in any of the three groups. When ROM was considered, only Groups A and C showed statistical significance whereas Groups A and B showed clinical significance according to the mean difference values. CONCLUSION: All the three modes of rehabilitation among OA patients, i.e., domiciliary rehabilitation, telerehabilitation, and home-based exercise program, have shown similar effects on study variables including pain intensity, knee function, and QOL in patients with TKR. Therefore, we recommend to include telerehabilitation as one of the treatment approaches for patients with TKR whenever needed.

The effect of exercise rehabilitation on COVID-19 outcomes: a systematic review of observational and intervention studies

PurposeDisturbance to physical and psychological characteristics among COVID-19 survivors are not uncommon complications. In the current systematic review, we aimed to investigate the role of exercise rehabilitation programs, either in acute or post-acute phase, on COVID-19 patients’ outcomes.MethodsA systematic search was conducted in November 2021 of Web of Sciences, PubMed-Medline, Google Scholar, and Scopus. Observational and intervention studies on COVID-19-infected patients undergoing a rehabilitation program including any type of exercise were included if they reported physical or psychological factors as outcomes. The Cochrane risk of bias tool for randomized controlled trials and Joanna Briggs Institute (JBI) critical appraisal checklist were used by two independent reviewers.ResultsA total number of 469, and 957 patients were included in 9 intervention studies, and 14 observational studies, respectively. Most factors reported by studies as outcomes fell in the categories of exercise capacity, respiratory function, as well as psychological aspects. The reported outcomes in almost all studies, disclosed the overall beneficial role of exercise rehabilitation in improving the outcomes.ConclusionThe current review demonstrated that exercise rehabilitation generally could have a beneficial role in improvement of both physical and psychological related outcomes. As the best onset time, and FITT components are not yet completely clear, further large, well-designed RCTs are suggested to provide details of exercise rehabilitation program.

Telehealth Delivery of a Multi-Disciplinary Rehabilitation Programme for Upper Gastro-Intestinal Cancer: ReStOre@Home Feasibility Study.

Simple SummaryThroughout the COVID-19 pandemic, many cancer care services have safely been delivered via telehealth. Multi-disciplinary rehabilitation programmes can help address the complex physical, nutritional and quality of life needs of upper gastrointestinal (UGI) cancer survivors, but it is unknown how well these multi-component programmes translate to a telehealth model of delivery. Therefore, we assessed the feasibility of running a 12-week exercise and nutrition rehabilitation programme for UGI cancer via telehealth. Participants found the telehealth model safe, convenient and highly satisfactory. Lower levels of technology skills were a barrier to recruitment, and some participants needed help with using the technology. Some adaptations to how the exercise programme was delivered were required. Participants recommended that future versions of the programme would have some element of in-person contact. Cancer survivors should receive all possible supports to enable their participation in telehealth programmes.Background: Telehealth has enabled access to rehabilitation throughout the pandemic. We assessed the feasibility of delivering a multi-disciplinary, multi-component rehabilitation programme (ReStOre@Home) to cancer survivors via telehealth. Methods: This single-arm mixed methods feasibility study recruited participants who had completed curative treatment for oesophago-gastric cancer for a 12-week telehealth rehabilitation programme, involving group resistance training, remotely monitored aerobic training, one-to-one dietetic counselling, one-to-one support calls and group education. The primary outcome was feasibility, measured by recruitment rates, attendance, retention, incidents, acceptability, Telehealth Usability Questionnaire (TUQ) and analysis of semi-structured interviews. Results: Characteristics of the twelve participants were: 65.42 ± 7.24 years; 11 male; 10.8 ± 3.9 months post-op; BMI 25.61 ± 4.37; received neoadjuvant chemotherapy 7/12; received adjuvant chemotherapy 4/12; hospital length of stay 16 days (median). Recruitment rate was 32.4%, and retention rate was 75%. Mean attendance was: education 90%; dietetics 90%; support calls 84%; resistance training 78%. Mean TUQ score was 4.69/5. Adaptations to the planned resistance training programme were required. Participants reported that ReStOre@Home enhanced physical and psychological wellbeing, and online delivery was convenient. Some reported a preference for in-person contact but felt that the online group sessions provided adequate peer support. Conclusion: Telehealth delivery of ReStOre@Home was most feasible in individuals with moderate to high levels of digital skills. Low level of digitals skills was a barrier to recruitment and retention. Participants reported high levels of programme adherence and participant satisfaction. Adaptations to future programmes, including introducing elements of in-person contact, are required.

Effects of Physical Exercise on the Incidence of Delirium and Cognitive Function in Acutely Hospitalized Older Adults: A Systematic Review with Meta-Analysis.

Acute care hospitalization increases the likelihood of developing cognitive impairment and delirium in older adults. To summarize evidence about the effectiveness of exercise and physical rehabilitation interventions on the incidence of delirium and cognitive impairment in acutely hospitalized older patients. Relevant articles were systematically searched (PubMed, Web of Science, and CINHAL databases) until 26 August 2021. Randomized and nonrandomized controlled trials of in-hospital physical exercise interventions and rehabilitation programs compared to usual care performed for older patients (> 65 years) hospitalized for an acute medical condition were selected. The primary endpoints were changes in the incidence of delirium and cognition during acute hospitalization. The secondary endpoints included functional independence, psychological measures, well-being status, length of hospital stay, transfer after discharge, fall occurrence, hospital readmissions, and mortality rate. The endpoints were evaluated at different time points (at admission, at discharge, and after discharge). Eleven studies from 8 trials (n = 3,646) were included. The methodological quality of the studies was mostly high. None of the studies reported any adverse events related to the intervention. Early rehabilitation improved cognitive function at 3 months postdischarge (Hedge's g = 0.33, 95% confidence interval [CI] 0.19 to 0.46, p < 0.001). No between-group differences were found for incident delirium and cognitive impairment during hospitalization (all p > 0.05). In-hospital physical exercise and early rehabilitation programs seem to be safe and effective interventions for enhancing cognitive function after discharge in older patients hospitalized for an acute medical condition. However, no potential benefits were obtained over usual hospital care for the incidence of delirium.