Exercise Therapy Group Research Articles

Clinical Effects of Additional Platelet-Rich Plasma Application to Exercise Therapy in Patients with Subacromial Impingement Syndrome: A Double-Blind Randomized Controlled Trial.

Exercise therapy (ET) is the main and initial treatment modality for treating subacromial impingement syndrome (SIS). The isolated or combined use of platelet-rich plasma (PRP) applications in treating SIS is increasing and promising. A comparison was made on the effectiveness of ET alone and in combination with PRP on pain, functionality, and quality of life (QoL) in patients with SIS. The purposes of this study were to (1) investigate the possible positive effects of PRP injections combined with ET in treating SIS on pain, functionality, and QoL and (2) propose an alternative treatment protocol. It was hypothesized that the group receiving PRP applications in addition to ET would have a better QoL due to less pain and higher functionality 6 months after treatment. Randomized controlled trial; Level of evidence, 2. Volunteer patients diagnosed with SIS were included based on history and physical examination findings. All participants underwent magnetic resonance imaging to confirm the diagnosis and exclude possible accompanying pathologies. The patients were randomly divided into 2 groups. The first group underwent ET at home for 8 weeks (ET group), and the second group received the same ET program and an additional 2 PRP injections, at the beginning of the study and the end of the fourth week (PRP group). Patients were evaluated initially and 6 months after the treatment using the visual analog scale (VAS) for pain score, Constant-Murley Score (CMS), and the 36-Item Short Form Health Survey (SF-36). The Kolmogorov-Smirnov test determined the conformity of the data to a normal distribution, chi-square analysis was used to compare categorical variables between groups, and the Mann-Whitney U test was used to compare continuous and intergroup variables. Intragroup changes before and after treatment were evaluated with the Wilcoxon signed-rank test. P < .05 was considered statistically significant. A total of 67 patients were initially enrolled; 5 were excluded and 6 were lost to follow-up (1 because of a COVID diagnosis). Thus, 56 patients (56 shoulders) were included for analysis. There were 28 patients in the ET group and 28 patients in the PRP group. There were no statistical differences between groups regarding participant characteristics and clinical evaluations before treatment. A statistically significant improvement was observed in pain (VAS subgroups), functionality (CMS subgroups), and QoL (SF-36 subgroups) evaluations of patients in both the ET and the PRP groups compared with before the treatment and 6 months after treatment (P < .05). At the 6-month posttreatment evaluation, the PRP group was statistically significantly superior to isolated ET in terms of VAS rest (P = .001) and night (P = .004) scores. This superiority was also in favor of the PRP group in flexion strength (P = .001), abduction strength (P = .046), and abduction degree (P = .041) measurements. There was no significant difference between ET and PRP groups regarding VAS activity, CMS, and SF-36 scores (P > .05) at 6 months. Our study showed that both isolated ET and additional PRP application to ET are effective methods in SIS treatment regarding pain, function, and QoL. Combining ET with PRP was superior in reducing pain and improving abduction degree and strength.

Manual therapy plus sexual advice compared with manual therapy or exercise therapy alone for lumbar radiculopathy: a randomized controlled trial.

The biopsychosocial approach to managing low back pain (LBP) has the potential to improve the quality of care for patients. However, LBP trials that have utilized the biopsychosocial approach to treatment have largely neglected sexual activity, which is an important social component of individuals with LBP. The objectives of the study are to determine the effects of manual therapy plus sexual advice (MT+SA) compared with manual therapy (MT) or exercise therapy (ET) alone in the management of individuals with lumbar disc herniation with radiculopathy (DHR) and to determine the best sexual positions for these individuals. This was a single-blind randomized controlled trial. Fifty-four participants diagnosed as having chronic DHR (>3 months) were randomly allocated into three groups with 18 participants each in the MT+SA, MT and ET groups. The participants in the MT+SA group received manual therapy (including Dowling's progressive inhibition of neuromuscular structures and Mulligan's spinal mobilization with leg movement) plus sexual advice, those in the MT group received manual therapy only and those in the ET group received exercise therapy only. Each group received treatment for 12 weeks and then followed up for additional 40 weeks. The primary outcomes were pain, activity limitation, sexual disability and kinesiophobia at 12 weeks post-randomization. The MT+SA group improved significantly better than the MT or ET group in all outcomes (except for nerve function), and at all timelines (6, 12, 26, and 52 weeks post-randomization). These improvements were also clinically meaningful for back pain, leg pain, medication intake, and functional mobility at 6 and 12 weeks post-randomization and for sexual disability, activity limitation, pain catastrophizing, and kinesiophobia at 6, 12, 26, and 52 weeks post-randomization (p<0.05). On the other hand, many preferred sexual positions for individuals with DHR emerged, with "side-lying" being the most practiced sexual position and "standing" being the least practiced sexual position by females. While "lying supine" was the most practiced sexual position and "sitting on a chair" was the least practiced sexual position by males. This study found that individuals with DHR demonstrated better improvements in all outcomes when treated with MT+SA than when treated with MT or ET alone. These improvements were also clinically meaningful for sexual disability, activity limitation, pain catastrophizing, and kinesiophobia at long-term follow-up. There is also no one-size-fits-all to sexual positioning for individuals with DHR.

Percutaneous bone marrow concentrate and platelet products versus exercise therapy for the treatment of rotator cuff tears: a randomized controlled, crossover trial with 2-year follow-up

BackgroundSurgical repair is recommended for the treatment of high-grade partial and full thickness rotator cuff tears, although evidence shows surgery is not necessarily superior to non-surgical therapy. The purpose of this study was to compare percutaneous orthobiologic treatment to a home exercise therapy program for supraspinatus tears.MethodsIn this randomized-controlled, crossover design, participants with a torn supraspinatus tendon received either ‘BMC treatment’, consisting of a combination of autologous bone marrow concentrate (BMC) and platelet products, or underwent a home exercise therapy program. After three months, patients randomized to exercise therapy could crossover to receive BMC treatment if not satisfied with shoulder progression. Patient-reported outcomes of Numeric Pain Scale (NPS), Disabilities of the Arm, Shoulder, and Hand, (DASH), and a modified Single Assessment Numeric Evaluation (SANE) were collected at 1, 3, 6, 12, and 24 months. Pre- and post-treatment MRI were assessed using the Snyder Classification system.ResultsFifty-one patients were enrolled and randomized to the BMC treatment group (n = 34) or the exercise therapy group (n = 17). Significantly greater improvement in median ΔDASH, ΔNPS, and SANE scores were reported by the BMC treatment group compared to the exercise therapy group (-11.7 vs -3.8, P = 0.01; -2.0 vs 0.5, P = 0.004; and 50.0 vs 0.0, P < 0.001; respectively) after three months. Patient-reported outcomes continued to progress through the study’s two-year follow-up period without a serious adverse event. Of patients with both pre- and post-treatment MRIs, a majority (73%) showed evidence of healing post-BMC treatment.ConclusionsPatients reported significantly greater changes in function, pain, and overall improvement following BMC treatment compared to exercise therapy for high grade partial and full thickness supraspinatus tears.Trial registrationThis protocol was registered with www.clinicaltrials.gov (NCT01788683; 11/02/2013).

Dry needling combined with exercise therapy: Effects on wrist flexors spasticity in post-stroke patients - A randomized controlled trial.

The positive contribution of dry needling (DN) in conjunction with exercise therapy for patients with stroke and spasticity remains uncertain. To examine the effects of DN combined with exercise therapy on wrist flexor spasticity and motor function in patients with stroke. Twenty-four participants with stroke were randomly assigned to either the DN and exercise therapy group or the DN alone group. Assessments were conducted at baseline, after the 4th treatment session, and 3 weeks post-treatment. A significant Group×Time interaction was observed for wrist active range of motion (ROM) (P = 0.046), favoring the DN with exercise therapy group (∼10° at baseline, ∼15° immediately after the 4th session, and 15.4° at follow-up). The improvements in spasticity, passive ROM, and H-reflex latency were sustained during follow-up. However, there were no significant between-group differences in any outcome at any measurement time point. The combined DN and exercise therapy did not exhibit superiority over DN alone concerning spasticity severity and motor function. However, it demonstrated additional advantages, particularly in improving motor neuron excitability and wrist passive extension.

Early Surgery Versus Exercise Therapy and Patient Education for Traumatic and Nontraumatic Meniscal Tears in Young Adults-An Exploratory Analysis From the DREAM Trial.

OBJECTIVE: To compare the effect of early meniscal surgery versus exercise and education with the option of later surgery on pain, function, and quality of life in young patients with a meniscal tear, taking symptom onset into account. DESIGN: Randomized controlled trial. METHODS: In a randomized controlled trial (the "Danish RCT on Exercise versus Arthroscopic Meniscal surgery for young adults" [DREAM] trial), 121 patients aged 18-40 years with a magnetic resonance imaging-verified meniscal tear were randomized to surgery or 12 weeks of supervised exercise and patient education. For this exploratory study, the analyses were stratified by symptom onset (traumatic/nontraumatic). The main outcome was the difference in change after 12 months in the mean score of 4 Knee injury and Osteoarthritis Outcome Score subscales (KOOS4) covering pain, symptoms, function in sport and recreation, and quality of life. RESULTS: Forty-two patients (69%) in the exercise therapy group and 47 (78%) in the surgery group were categorized as having a traumatic tear. We observed no difference in change in the KOOS4 after 12 months between the 2 treatment groups for either traumatic tears (18.8 versus 16.0 in the surgery versus exercise therapy groups; adjusted mean difference, 4.8 [95% confidence interval, -1.7 to 11.2]) or nontraumatic tears (20.6 versus 17.3 in the surgery versus exercise therapy groups; adjusted mean difference, 7.0 [95% confidence interval, -3.7 to 17.7]). CONCLUSION: In patients with traumatic and nontraumatic meniscus tears, early meniscal surgery did not appear superior to exercise and education in improving pain, function, and quality of life after 12 months. Further research is needed to confirm the clinical applicability of these findings. J Orthop Sports Phys Ther 2024;54(5):1-10. Epub 22 February 2024. doi:10.2519/jospt.2024.12245.

Effects of Home Exercise and Manual Therapy or Supervised Exercise on Nonspecific Chronic Low Back Pain and Disability

In this study, we aimed to evaluate the effects of two therapeutic methods: home-based exercise and manual therapy (MT) or supervised exercise on pain and functional status in individuals with chronic nonspecific low back pain. In total, 60 individuals with LBP were included in this randomized study. All participants were treated for 6 weeks in one of two groups: the manual therapy group or the exercise therapy group. In addition, all participants were asked to perform an exercise program at home independently. Levels of pain, spinal mobility, disability, and abdominal and back muscle endurance were measured before and after 6 weeks of intervention. Results: After MT, disability was reduced by 70% (F = 42.2; p &lt; 0.00; ηp2 = 0.99) and pain was reduced by 78% (F = 4.9; p &lt; 0.00; ηp2 = 0.51). After exercise therapy, disability and pain were reduced by 78% (F = 11.5; p &lt; 0.00; ηp2 = 0.78) and 68% (F = 9.4; p &lt; 0.00; ηp2 = 0.41), respectively. Muscle endurance and lumbar spine mobility values were significantly higher in both groups after 6 weeks of intervention (p &lt; 0.00). After 12 MT interventions, lumbar spine mobility increased by 40% (F = 1.9; p &lt; 0.00; ηp2 = 0.24) and after exercise therapy by 38% (F = 28.4; p &lt; 0.00; ηp2 = 0.82). Abdominal muscle endurance improved by 29% (F = 24.2; p &lt; 0.00; ηp2 = 0.79) after MT and by 34% (F = 57.6; p &lt; 0.00; ηp2 = 0.67) after exercise therapy; back muscle endurance improved by 18% (F = 48.6; p &lt; 0.00; ηp2 = 0.78) after MT and by 20% (F = 14.2; p &lt; 0.00; ηp2 = 0.76) after exercise therapy. After 6 weeks of intervention, there was no statistically significant difference between the pain, disability, and spinal mobility groups (p &gt; 0.05). However, differences between groups in kinesiophobia (p = 0.02), back (p &lt; 0.02) and abdominal (p &lt; 0.03) muscle endurance values were statistically significant. Following the home exercise program and manual therapy, or the home exercise program and supervised exercise, LBP and disability had clinically significant reductions and functional status showed improvement.

Effectiveness of non-surgical management in rotator cuff calcific tendinopathy (the effect trial): protocol for a randomised clinical trial

IntroductionRotator cuff calcific tendinopathy (RCCT) involves calcific deposits in the rotator cuff. Non-surgical interventions such as extracorporeal shockwave therapy (ESWT) and ultrasound-guided percutaneous irrigation of calcific tendinopathy (US-PICT) are recommended...

Effectiveness of shoulder mobilization combined with muscle energy technique in the management of adhesive capsulitis: A randomized control trial

Background: Adhesive capsulitis is a debilitating condition characterized by a gradual, painful loss of shoulder motion. As a part of physical therapy programs, mobilization techniques are an important part of the intervention. However, the potential utility of mobilization along with other interventions under supervision is not explored, especially compared to home program exercises. Aim: The objective of the study was to compare the effects of the combination of Maitland’s mobilization protocol and muscle energy techniques (METs) with self-directed nonsupervised general home exercise program (HEP) in frozen shoulder patients. Methods: A total of 24 subjects (14 females and 10 males) were randomized into mobilization with supervised exercise therapy (MSE) group (n = 12) and HEP group (n = 12). Subjects in the MSE group were given Maitland’s mobilization technique and MET for 3 sets (10 glides per set), 3 times/week for 6 weeks, and nonsupervised general HEP for the HEP group. Pain intensity and range of motions (ROMs) of the shoulder were measured for both the groups at the completion of the study duration. Results: Both the groups showed alleviation in pain, but a significant improvement was found in the MSE group than the HEP group. The within-group study showed that ROM was improved in flexion, abduction, external rotation (ER), and internal rotation in the two groups; however, the percentage change was higher in the MSE group than in the HEP group. Significant group effect (P = 0.041 and P = 0.009), time effect (P &lt; 0.001 and P &lt; 0.001), and group × time effects (P &lt; 0.001 and P &lt; 0.001) were found for flexion and ER ROM. Conclusions: A supervised protocol that includes mobilization and other exercises can be an alternative protocol used for the treatment of frozen shoulder without profound adverse effects.

Effectiveness of Kinesio Video and Pelvik Roxing Exercise Video on Reducing Back Pain of Third Trimester Pregnant Women

Background: Back pain in pregnant women is a common problem that is often experienced during pregnancy, especially in the third trimester. Back pain in pregnant women not only interferes with the mother's quality of life, but can also affect fetal well-being and the delivery process. In an effort to address the problem of back pain in pregnant women, various physical therapy methods have been developed. Two methods that have gained attention are Kinesio techniques and Pelvic Roxing Exercises.&#x0D; Method: This research is a quantitative research with a pre-experimental study that uses a one group pretest-posttest design with no control group. The sample of this study was third trimester pregnant women at PMB Latifah and PMB Zainab Jambi City as many as 60 pregnant women. The sampling technique used purposive sampling technique. This research instrument is a questionnaire. Data were analyzed using the mann whitney test.&#x0D; Results: The results showed that in the Kinesia Taping therapy group it was known that before being given Kinesio Taping treatment, the scale of back pain felt by respondents was 67% feeling moderate pain and 33% feeling severe pain controlled. After being given Kinesio Taping, the pain scale felt by respondents was 57% feeling mild pain and 43% feeling moderate pain. In the Pelvic Roxing Exercise therapy group, it is known that before being given Pelvic Roxing Exercise therapy, the scale of back pain felt by respondents is 9% feeling mild pain, 70% moderate pain and 21% severe pain controlled. After being given Pelvic Roxing Exercise therapy, the scale of back pain felt by respondents was 77% mild pain and 235 moderate pain. The results of the mann whitney test obtained p-value = 0.041, p-value &lt;0.05 so that there is a significant difference between the results after kinesio taping and pelvic roxing exercise interventions&#x0D; Conclusion: Based on the results of the study, it can be concluded that there are differences in the scale of back pain in third trimester pregnant women before being given kinesio taping therapy and pelvic roxing exercise with after being given kinesio taping therapy and pelvic roxing exercise.

Effectiveness of Circuit Class Training for Gait Parameters in Subactute Stroke Patients

Introduction: Mostly the CVA patient’s exhibit hemi paretic gait distinguished by unhurried and uneven gait pattern accompanied by faulty selective muscles power, retarded as well as changed balance reaction along with decreased weight bearing on the hemiplegic limb. Many studies have shown that use of walking aids, muscle strengthening, over ground walking, treadmill training and FES, are some of the available physiotherapy treatments to ameliorate gait in patients with stroke. Objective of our research program is to find out the difference between the efficacies of circuit class training versus conventional exercise program on gait parameters in sub- acute stroke subjects. Methodology: In this study using pre-post-test experimental design, 30 subjects with sub- acute stroke were assigned to 2 (groups A and group B) based on inclusion and exclusion criteria. Each group shall contain 15 subjects. Group A receives circuit class training 1 hour per session on alternative days for 4 weeks and Group B received conventional training program for 30 minutes a day, for all days in a week, for 4 weeks, total sessions were 22-24. The outcomes are 6 MWT, DGI and SSQOL. The pre- and post- test values are taken on the first day and then after 4 weeks of treatment. Results: After the treatment there was an improvement within both groups. In the circuit class training group, there was an improvement after the intervention (P&lt;0.04) and conventional exercise therapy group (P&lt;0.03). There was no remarkable differentiation between these both protocols. The significance level between both the group was kept as P&gt;0.5. Conclusion: After the 4 weeks of the study the results reveals that the two groups (group A and group B) show marked changes in the gait parameters as well as the quality of life. However, when comparing circuit class interventions and conventional interventions there was no difference in the level of significance. So, our study concluding that both exercise protocols are effective and there is no significant difference between these both protocols on gait parameters and quality of life in subjects with sub- acute stroke.

Chlorine Gas Poisoning in an Aquatic Exercise Pool: A Case Report

Background and Purpose: This case report describes an incident of chlorine gas poisoning in an aquatic exercise class of senior adults in which 24 participants, facility employees, and first responders required emergency medical attention with some requiring hospitalization. The cause of the chlorine gas release, the health effects on participants, and the facility's subsequent response are described. The purpose of this case is to inform physical therapists and exercise professionals working in aquatic exercise pools about chlorine gas poisoning prevention and mitigation efforts. Case Description: The cause of this incident was a series of breakdowns in safety procedures leading to the release of chlorine gas while a class was in session. Because of limited exit points, physical debilitation of some participants, and a lack of proper safety equipment, the evacuation effort was delayed, overwhelming participants, facility employees, and first responders with toxic gas. Twenty-four people were transported to the emergency department with 7 hospitalized. At least 3 are known to suffer long-term health effects. Outcomes: The facility concluded that normal operating procedures and safety protocols were not followed. Following the review, the facility took measures to ensure adherence to proper procedures, revised its emergency action plan, and acquired the appropriate safety equipment. Discussion: The accidental release of chlorine gas in an exercise pool is a rare but potentially catastrophic event. Facilities operating exercise and aquatic therapy pools must follow strict protocols for the safe handling of pool chemicals and be prepared to respond immediately if a chlorine gas accident occurs. This case report serves as an example of risk management for the prevention of and response to a catastrophic release of chlorine gas during a group exercise or aquatic therapy session.

Effect of pulsed magnetic therapy and moderate exercise on the course of postmenopausal osteoporosis

BACKGROUND: Osteoporosis is a common musculoskeletal disease with significant complications that can become a global public health problem and a major cause of death and morbidity.&#x0D; AIM: The present study aimed to determine the effect of pulsed magnetotherapy, aerobic exercise, and a combination of both methods on postmenopausal women with osteoporosis.&#x0D; MATERIALS AND METHODS: The randomized clinical trial included 45 patients with osteoporosis aged 60 to 65 years who had menopause at least 6 months ago and had been sedentary for at least 6 months. Patients were randomly divided into 3 equal groups. Group A (magnetic therapy group): received standard treatment (bisphosphonates, calcium and vitamin D) in addition to pulsed magnetic therapy in the hip area for 12 weeks (3 sessions per week). Group B (exercise group): received conventional treatment plus moderate-intensity aerobic exercise for 12 weeks (3 sessions per week). Group C (combined magnetic therapy and exercise therapy group): received standard medical treatment plus pulsed magnetic therapy and moderate-intensity aerobic exercise for 12 weeks (3 sessions per week). Bone mineral density was assessed in three groups at baseline by dual-energy X-ray absorptiometry and after 12 weeks of treatment.&#x0D; RESULTS: The results showed that intragroup analysis revealed a statistically significant increase (p 0.05) in bone mineral density in the 3 study groups. Comparison of the results among the 3 tested groups revealed a significant increase (p 0.05) in mean post-test bone mineral density values in group C compared to group A and group B. There was no significant statistical difference in mean bone mineral density between the two groups A and B after testing.&#x0D; CONCLUSION: The combination of pulsed magnetotherapy and moderate-intensity aerobic exercise showed a significant improvement in hip bone mineral density compared with either method alone.

Hospitalized older adults' experiences of virtual reality-based group exercise therapy with cycle ergometers: An early feasibility study

Sedentary behavior among hospitalized older adults is a well-described challenge that can increase the risk of loss of function and mortality. Therefore, it is important to encourage physical activity (PA) during hospitalization. Exertion Games (exergames) have repeatedly been suggested as a tool to encourage and sustain motivation in rehabilitation programs. This article presents early findings from a convergent parallel mixed methods study that explored whether social presence and PA could be combined through the novel use of immersive virtual reality technology in a feasible group exercise constellation. Inpatients (n=10, 50% female, 80.3±8.2 years) were invited to participate in a bi-weekly VR group session. Most participants (62%) responded that it was a good experience to a large/great extent, which they would like to use repeatedly (76%). The technology was easy for untrained healthcare professionals and had minimal adverse events for the participants. However, a major finding illustrates that the enclosing immersiveness of the headset hindered conversation during exercise sessions. The exclusion of sight likely had a negative effect on forming relations between the participants, which conversely caused the participants to experience a lack of cohesion and relatedness with the other participants. VR-mediated group therapy may be a promising solution to existing physiotherapy practices since it may incorporate basic psychological needs. However, to optimize for social interaction, future systems will need to afford a higher degree of social presence, e.g., through avatar embodiment in a shared virtual environment, to support older adults' autonomous motivation for PA through social interaction and novel technologies.

Effect of instrument-assisted soft tissue mobilization combined with exercise therapy on pain and muscle endurance in patients with chronic neck pain: a randomized controlled study

ABSTRACT Objectives The use of instrument-assisted soft tissue mobilization (IASTM) has been documented to be effective for improving pain and function, but it is unclear whether it helps improve muscle performance in musculoskeletal diseases. This study investigated the effects of IASTM combined with exercise therapy on muscle endurance and pain intensity in patients with chronic neck pain. Methods Forty-eight individuals with chronic neck pain were randomly divided into exercise therapy (ET, n = 24) and combined therapy (CT, n = 24) groups. For 4 weeks, each group underwent exercise therapy 3 days a week for a total of 12 sessions. The ET group received exercise therapy only. The CT group received IASTM combined with exercise therapy twice per week for a total of 8 sessions. The muscle endurance of the participants was assessed with the Deep Neck Flexor Muscle Endurance (DNFE) test and pain intensity with Visual Analogue Scale (VAS) at baseline and post-treatment. Results While both groups showed significant improvement in pain intensity (p < 0.05), the CT group showed a greater effect size for pain (CT group: Cohen’s d = 3.28; ET group: Cohen’s d = 2.12). The CT group showed significant improvement for muscle endurance (p < 0.05), whereas the ET group did not (p > 0.05). Conclusion In the current study, the IASTM intervention combined with ET improved pain and muscular endurance in participants with chronic neck pain compared to exercise therapy alone. As an alternative method, IASTM intervention before exercise seems to increase the short-term recovery effect in chronic neck pain conditions.

Safety and efficacy of aggressive exercise therapy for patients with unilateral early-stage spondylolysis: A retrospective comparative cohort study

IntroductionBony union in patients with early-stage spondylolysis can be achieved using a rigid corset and avoiding sports activities. However, prolonged absence from sports activities may decrease physical fitness. This study aimed to investigate the safety and efficacy of aggressive exercise therapy for patients with early-stage spondylolysis (ESS). MethodsThirty-one patients (aged <19 years; 26 males) diagnosed with unilateral ESS were divided into light intensity (L group; n = 16) and aggressive (A group; n = 15) exercise groups. All patients wore a hard corset and received light intensity (L group) or aggressive (A group) exercise therapy for 2–3 months. After treatment, the bony union was assessed using magnetic resonance imaging and computed tomography. The mean interval between the initial and second computed tomography examinations, including treatment drop-out rates, was determined. Results: Second computed tomography examination results showed that bony union was either improved or achieved in both groups. The mean interval between the initial and second computed tomography examinations was 78.1 ± 19.7 and 78.1 ± 17.4 days in the L and A groups, respectively, with no significant difference. The L group had a higher drop-out rate (n = 5; 31.3%) than the A group (n = 1; 6.7%), albeit not significant. DiscussionBoth groups showed bony union after treatment, suggesting that aggressive exercise therapy was safe and effective for patients with unilateral ESS. Moreover, the lower drop-out rate in group A suggests that aggressive exercise therapy maintained the patients’ adherence to long-term treatment. ConclusionsAggressive exercise therapy was effective-to-safe and maintained good motivation in patients with ESS.

Effects and Usefulness of Inspiratory Muscle Training Load in Patients with Advanced Lung Cancer with Dyspnea.

Patients with advanced lung cancer tend to experience dyspnea. Pulmonary rehabilitation has been reported as a method for relieving dyspnea. However, exercise therapy imposes a high burden on patients, and it is difficult to sustain in many cases. Inspiratory muscle training (IMT) imposes a relatively low burden on patients with advanced lung cancer; however, its benefits have not been demonstrated. We retrospectively analyzed 71 patients who were hospitalized for medical treatment. The participants were divided into an exercise therapy group and an IMT load + exercise therapy group. Changes in maximal inspiratory pressure (MIP) and dyspnea were examined using a two-way repeated measures analysis of variance. MIP variations significantly increase in the IMT load group, with significant differences between baseline and week 1, between week 1 and week 2, and between baseline and week 2. The analysis also showed that the variations in dyspnea decreased in the IMT load + exercise therapy group with significant differences between baseline and week 1 and between baseline and week 2. The results show that IMT is useful and has a high persistence rate in patients with advanced lung cancer who present dyspnea and cannot perform high-intensity exercise therapy.

Exercise Therapy for Knee Osteoarthritis: A Systematic Review and Network Meta-analysis.

Exercise is an effective nonpharmaceutical therapy for knee osteoarthritis (KOA). To identify the most effective type of exercise therapy for KOA with regard to pain, stiffness, joint function, and quality of life. Systematic review; Level of evidence, 3. The PubMed, Web of Science, Embase, and Cochrane Library databases were searched, from inception to April 4, 2022. Included were randomized controlled trials that assessed the efficacy on KOA among 5 different exercise therapy groups (aquatic exercise [AE], stationary cycling [CY], resistance training [RT], traditional exercise [TC], and yoga [YG]) and compared with the control group. Outcomes among the groups were assessed with the Western Ontario and McMaster University Osteoarthritis Index (WOMAC), 6-minute walk test (6-MWT), visual analog scale (VAS) for pain, and Knee injury and Osteoarthritis Outcome Score (KOOS); weighted mean differences (WMDs) and 95% confidence intervals were calculated. Network meta-analyses comparing outcomes between all groups and with controls were performed, and group rankings were calculated using the surface under the cumulative ranking curve (SUCRA). A total of 39 studies (N = 2646 participants) were included. Most of the studies failed to blind participants and researchers, resulting in a high risk of performance bias. Significantly worse WOMAC-Pain scores were seen in controls compared with all exercise interventions except AE (WMD [95% CI]: CY, -4.45 [-5.69 to -3.20]; RT, -4.28 [-5.48 to -3.07]; TC, -4.20 [-5.37 to -3.04]; and YG, -0.57 [-1.04 to -1.04]), and worse scores were seen in controls compared with YG regarding WOMAC-Stiffness (WMD, -1.40 [95% CI, -2.45 to -0.34]) and WOMAC-Function (WMD, -0.49 [95% CI, -0.95 to -0.02]). According to the SUCRA, CY was the most effective for improving WOMAC-Pain (80.8%) and 6-MWT (76.1%); YG was most effective for improving WOMAC-Stiffness (90.6%), WOMAC-Function (77.4%), KOOS-Activities of Daily Living (72.0%), and KOOS-Quality of Life (79.1%); AE was the most effective regarding VAS pain (77.2%) and KOOS-Pain (64.0%); and RT was the most effective regarding KOOS-Symptoms (84.5%). All 5 types of exercise were able to ameliorate KOA. AE (for pain relief) and YG (for joint stiffness, limited knee function, and quality of life) were the most effective approaches, followed by RT, CY, and TC.

Supervised Group Exercise Therapy Versus Home-based Exercise Therapy: The Effect of McGill Exercises on Pain, Disability and Trunk Stability in Middle-aged Women With Non-specific Chronic Low Back Pain

Purpose: Chronic low back pain (LBP) is one of the spine disorders and musculoskeletal problems and is one of the most common causes of people’s disability. This study aims to compare the effects of McGill trunk stability exercises performed at home or in a supervised group setting on pain, disability, and trunk stability in middle-aged women with non-specific chronic LBP. Methods: The current study is a cross-sectional comparative, quasi-experimental research with a pre-test and post-test design. The statistical sample included 30 middle-aged women aged 35 to 50 years with non-specific chronic LBP in Tehran City, Iran. Based on the inclusion and exclusion criteria, they were selected and randomly assigned into two groups, home-based exercises, and supervised group exercises. The subjects performed McGill trunk stability exercises for six weeks, three 45-minute sessions per week. Pain, disability, and endurance of spinal flexor and extensor muscles were measured using pain and Quebec questionnaires, a sit-up test, and a Biering-Sorenson test, before and after 6 weeks of training. To analyze the data, descriptive statistics, paired-samples t-test, and one-way analysis of covariance (ANCOVA) tests were used at the significant level of (P≤0.05) using SPSS software, version 26. Results: The results of the present study showed that the post-test scores compared to the pre-test in both groups have improved significantly (P≥0.05), and no significant difference was observed between the two groups with the control of the covariate variable (P&lt;0.05) in the intensity of pain and endurance of the spinal flexor muscles in the post-test scores. However, a significant difference was observed in the endurance of the spinal extensor muscles in the post-test scores of the two groups in favor of the home-based exercise group (P≥0.05). Additionally, in the post-test scores, a significant difference was observed in functional disability level between the two groups (P≥0.05) so that the degree of disability in the home-based exercise group was higher than in the supervised group. Conclusion: It seems that performing McGill exercises, either in supervised group or home-based settings, can reduce pain and disability, and improve the endurance of the spinal flexor and extensor muscles in middle-aged women with non-specific chronic LBP.

Comparison of The Effectiveness of Exercise Therapy and Electroacupuncture in Patients with Forward Head Abnormalities and Myofascial Pain Syndrome: A Randomized Clinical Trial.

Forward Head Posture (FHP), which refers to the head being more forward than the shoulder, is one of the most common postural defects of all ages. Therefore, in this study, we aimed to compare the effectiveness of exercise therapy and electroacupuncture in patients with FHP and myofascial pain syndrome (MPS). The present study was an open-label randomized clinical trial. A total of 61 patients with FHP and MPS who were referred to the physical medicine clinic of Besat Hospital between 2020 and 2021 were analyzed. Patients in one group were treated with electroacupuncture, and another one was treated with exercise therapy. The primary outcomes were FHP angles (CVA, CA, and shoulder angle), pain intensity (VAS), and quality of life (SF-12). Paired t-test was used to compare the results obtained in the pre-test and post-test. To detect differences over time, the analysis of variance models was used to repeat the observations. If the p-test result is less than the test significance level of 0.05, the null hypothesis is not confirmed. The rate of final CVA and increase in CVA in the exercise therapy group were significantly higher than in the electroacupuncture group (P < 0.001). The average shoulder angle in the exercise therapy group increased from 47.1° ± 3.0° to 51.9° ± 3.3° (P < 0.001) and in the electroacupuncture group from 47.9° ± 3.1° to 51.0° ± 2.8° (P < 0.001). A significant difference was observed between the two groups in terms of pain intensity changes during the study. Overall, the results of this study showed that both exercise therapy and electroacupuncture significantly improved patients' posture, reduced pain intensity, and increased quality of life in FHP patients with MPS; But exercise therapy was more effective in improving FHP angles and electroacupuncture was more successful in reducing patients' pain intensity.

Efficacy and acceptability of supervised group exercise for mild to moderate major depressive disorder: A feasibility study

BackgroundExercise can efficiently reduce the symptoms of major depression disorder (MDD). This study aims to examine the efficacy and acceptability of supervised group exercise intervention among patients in an acute phase of mild to moderate MDD. MethodsWe enrolled patients in the psychiatric clinic of Beijing Anding Hospital affiliated to Capital Medical University in a prospective, single-arm objective performance criteria (OPC) trial. A total of 40 adults aged 18–50 who had a diagnosis of an episode of depression and the 17-item Hamilton Rating Scale for Depression (HRSD-17) score of 7–20 were recruited. Supervised exercise group intervention was applied on participants with a new episode of mild to moderate depression 3 times a week for 8 weeks without any other treatment. Every exercise session should meet the standard of moderate intensity, defined as approximately equal to 50 %–80 % of the maximal heart rate for 150 min every week. The primary end point was the clinical response at week 8, defined as a 50 % reduction in the baseline HRSD-17 score. Meanwhile, the secondary end points included the acceptability of the supervised group exercise intervention for both patients and investigators, remission rate (defined as an HRSD-17 score of 7 or less), the change of Patient Health Questionnaire (PHQ-9) and the Quality of Life, Enjoyment and Satisfaction Questionnaire-Short Form (Q-LES-Q-SF). ResultsAmong the 46 screened patients, 40 were enrolled. Of them, 4 people dropped out, while 36 received all the planned sessions of the supervised group exercise therapy and completed the week-8 assessment. At week 8, the response rate was 89 % (95 % confidence interval [CI] 74 % to 97 %) and the remission rate was 83 % (95%CI 67 % to 94 %). The overall acceptance of the supervised group exercise based on the VAS score (range 0–10) was 9.19 ± 1.27 for patients and 9.67 ± 0.62 for investigators. The least-squares mean (±SE) change from baseline at week 8 was-9.99 in the PHQ-9 score and 25.15 in the Q-LES-Q-SF score. No serious adverse events were reported during this trial. The percentage of any adverse event was 5 %. ConclusionSupervised group exercise intervention is effective in patients with acute mild to moderate MDD and has good acceptance rate among both patients and investigators.