Exercise In Prevention Research Articles

The PANDEM-2 Simulation Exercise: Training the Coordinated Response to a Large-Scale Pandemic in 2 European Public Health Emergency Operations Centers.

In the course of the EU funded Pandemic Preparedness and Response (PANDEM-2) project, a functional exercise (FX) was conducted to train the coordinated response to a large-scale pandemic event in Europe by using new IT solutions developed by the project. This report provides an overview of the steps involved in planning, conducting, and evaluating the FX. The FX design was based on the European Centre for Disease Prevention and Control (ECDC) simulation exercise cycle for public health settings and was carried out over 2 days in the German and Dutch national public health institutes (PHI), with support from other consortium PHIs. The planning team devised an inject list based on a scenario script describing the emergence of an influenza pandemic from a novel H5N1 pathogen. The multi-disciplinary participant teams included 11 Dutch and 6 German participants. The FX was supported by 9 international project partners from 8 countries. Overall, participants and observers agreed that the FX goals were achieved. The FX was a suitable format to test the PANDEM-2 solutions in 2 different country set-ups. It demonstrated the benefit of regular simulation exercises at member state level to test and practice public health emergency responses to be better prepared for real-life events.

TRANSLATABLE EXERCISE INTERVENTIONS TO REACH OLDER ADULTS WITH PHYSICAL AND COGNITIVE FRAILTY

Abstract Mobility limitations, falls and dementia are leading causes of disability, institutionalization, and mortality among U.S older adults. Considering that the population of adults aged ≥ 65 years is projected to surpass 80 million by 2040, more effective and scalable intervention strategies to maintain mobility, reduce falls or offset cognitive decline are necessary to help older Americans to continue to live independently. This presentation will discuss the rationale, design and implementation of several innovative exercise intervention strategies for older adults with mobility limitations, elevated fall risk, and for older adults at high risk for developing dementia. The session will specifically describe how large-scale clinical trial evidence for the benefits of exercise can be translated to reach more vulnerable older adults in real-world community-based settings. The session will also describe how a digitally delivered multicomponent fall prevention exercise program can be tailored to reach at-risk older adults in their own homes. Overall, it is posited that these innovative interventions hold significant potential as highly scalable approaches for maintaining mobility, preventing falls, and mitigating cognitive decline among rapidly expanding populations of older adults.

IMPLEMENTATION OF A VIRTUAL FALL PREVENTION PROGRAM IN OLDER VETERANS

Abstract Though virtual platforms have increased in popularity few studies have explored the implementation and benefit of a virtually-based fall prevention program. MOVing FREEly (Multicomponent Otago Virtual Falls Reduction Exercise and Education program) is a VA-based fall prevention program delivered entirely over a virtual care platform. The MOVing FREEly program is six-weeks long and includes both education in fall-risk reduction and evidence-based fall prevention exercises. Process measures captured implementation considerations, feasibility and effectiveness of the program. 27 participants who were older (mean 75 years), mostly male (89.0%), white (85.2%) and moderate or high risk of falling completed the program. 70% were new to the virtual platform. Attendance for education and exercise classes was > 80% with little attrition. There was improvement in the Falls Efficacy Scale-International short form and statistically significant improvement in 30 second sit-to-stand and single leg balance tests. Process measures indicated that 40% of participants needed extra help at the start of each class to sign-on to the virtual visit, which was provided by program facilitators. By the fourth class, all participants were self-sufficient in their ability to navigate the virtual platform. Additional considerations such as electronic health record documentation and coding; clinic setup, referral management and virtual appointment scheduling; patient privacy and health emergency planning were necessary for the start-up and sustainability of the program. Virtual fall prevention programs are feasible and effective but require careful logistical planning and considerations. Implementation considerations from this program can guide future telerehabilitation research and clinical efforts.

Evidence-based ankle pump exercise in prevention of postoperative deep-vein thrombosis in patients with lower extremity fracture

Evidence-based ankle pump exercise in prevention of postoperative deep-vein thrombosis in patients with lower extremity fracture

Exercise in primary, secondary and tertiary prevention of aortic stenosis.

Exercise in primary, secondary and tertiary prevention of aortic stenosis.

The Effects of Swallowing Exercises in Healthy Older Adults: A Systematic Review.

Dysphagia, common among older adults, leads to significant morbidity and potential mortality. The role of preventative exercises in healthy, community-dwelling elderly people remains to be understood. In this systematic review, we aimed to understand whether preemptive exercise programs can improve swallowing in healthy older adults. Articles published from 1990 to 2023 were included and identified through searches of MEDLINE, EMBASE and Cochrane databases by a medical librarian using the keywords "presbyphagia" and" aging" and "dysphagia" and "management", as well as "therapy" and "treatment", "swallowing therapy", and the combinations of these keywords. Of 2269 abstracts initially screened, 15 full-text articles were included in this review, consisting of 454 patients. Of the 15 studies included, ten were randomized controlled, three non-randomized clinical trial, one a prospective cohort study, and one an interventional study. The reported age range of the participants was between 60 and 91years-old. Sixty-two percent of the participants were elderly females. In terms of interventions, nine studies employed tongue strengthening exercises, five utilized swallowing resistance techniques, two involved pronunciation and karaoke practice, two focused on recline and head lift exercises, one utilized high-speed jaw opening exercises, and one employed electrical stimulation of swallowing muscles. Swallowing exercises strengthen targeted muscle groups in healthy older adults and can be utilized to prevent swallowing problems that occur with aging. Further longitudinal studies are needed to understand the benefits of preventative therapy models. Level of Evidence: Level 4.

Effects of prevention programmes on injury risk in military personnel: a systematic review with meta-analysis

IntroductionExercise programmes have been used to prevent injuries in military personnel, as they can reduce modifiable risk factors for injuries. Our aim was to review the literature to evaluate the...

Jaw exercise in head and neck cancer patients for prevention of temporomandibular disorders: a randomized controlled trial.

To prospectively evaluate the effect of a preventive jaw-training intervention program on the development of temporomandibular disorders (TMD) in patients treated for head and neck cancer (HNC). We randomized 58 consecutive patients with squamous cell carcinoma in the head and neck area into two groups before initiation of a curatively intended oncologic treatment: training with a jaw mobilizer once a day or a control group without active exercise. A comprehensive examination according to diagnostic criteria for temporomandibular disorders (DC/TMD) was conducted at baseline (before oncologic treatment) 6 and 12months after completed radiation therapy (RT). The patients recorded training frequency in a diary. There were significant differences in the changes of maximal incisal opening (MIO) between the intervention and control groups at 6 and 12months compared to baseline (p = 0.010 and p = 0.012, respectively) with more deterioration in the control group. The control group had a higher prevalence of TMD diagnosis at the 6-month follow-up (p = 0.010) and a close to significant level at the 12-month follow-up (p = 0.055). This unique study, which evaluates the effect of a preventive jaw-training program for prevention of TMD in patients with HNC undergoing high dose RT, found that the preventive jaw-training program could prevent the deterioration of MIO and development of TMD. This preventive exercise program could prevent the deterioration in MIO and the development of TMD in HNC patients, leading to less pain and better jaw function.

Influence of Baduanjin on cardiopulmonary function in long-term practitioners and beginners.

Baduanjin, a traditional Chinese exercise for health enhancement and chronic disease prevention, has been practiced for millennia. However, studies on the exercise intensity of Baduanjin are limited. Most existing studies focus on its general health benefits rather than quantifying its specific intensity levels. This study aims to measure and compare the exercise intensity indices of long-term Baduanjin practitioners and beginners, providing insights into its mechanisms for disease prevention and treatment and supporting the scientific formulation of clinical exercise prescriptions. Twenty healthy adults aged 35-45 years old and the mean BMI was 24.45 were recruited and divided into a beginner group (A group, no prior practice, 10 participants) and a skilled group (B group, practice duration ≥3 years, 10 participants). The Italian Cosmed/K5 wireless portable cardiopulmonary testing system was used to measure indicators during the practice. Within-group analysis revealed statistically significant differences in oxygen consumption (VO2), oxygen consumption per kilogram of body weight (VO2/kg), metabolic equivalent (METs), heart rate (HR), oxygen pulse (VO2/HR), respiratory rate (RR), and minute ventilation (VE) between exercise and resting states in both the B and A groups (P < 0.001). In between-group comparisons, resting HR was significantly lower in the B group compared to the A group (P < 0.01). During Baduanjin practice, significant between-group differences were found in METs, HR (P < 0.01), and RR (P < 0.05), with the A group exhibiting higher values for METs, HR, and RR than the B group. Baduanjin positively impacts cardiovascular function and exercise performance, with long-term practitioners showing significantly better cardiovascular recovery and overall function.

Gaps in Physical Medicine and Rehabilitation for Blindness and Low Vision: The Imperative of Rehabilitation for Visual Disability.

Persons with blindness and low vision experience increased fall and injury risk beyond atypical biomechanics and balance impairments. Falling risk doubles with blindness, and more than triples with depth perception losses. Despite this, physical therapy focuses on musculoskeletal injuries postevent rather than taking a proactive and preventative approach for persons with blindness and low vision. We posit that physical therapy implemented preinjury, alongside orientation and mobility training of adapted movement protocols could positively affect injury avoidance and severity for persons with blindness and low vision. The global VISION 2020 initiative seeks increased access to rehabilitation services and treatments to enhance quality-of-life for persons with blindness and low vision. In support, this article reviews research studies in rehabilitation science that promote physical health and well-being, and stresses preventative skilled mobility and therapeutic exercise to mitigate injury. To reduce the personal, financial, and societal costs associated with blindness and low vision, as well as position patients for better outcomes, we review an evidence base that may generate immediate impact in this area. While these recommendations provide an initial framework, the role of physical therapy in prehabilitative care remains a critical gap that must be addressed. It is imperative that interventions, guidelines, impairment/severity-specific practices, and overall health promotion are re-evaluated and redesigned for persons with blindness and low vision, affording equity for health and mobility.

Meta-analysis of the effects of different exercise modes on cardiac function and peak oxygen uptake in patients with type 2 diabetes mellitus.

The benefits of exercise for primary and secondary prevention of cardiovascular events have been reported in patients with type 2 diabetes mellitus (T2DM). However, the effects of exercise on cardiac structure and function require clarification. A literature search for clinical studies reporting on the effects of exercise on cardiac structure, cardiac function, and VO2peak in T2DM patients was conducted. PubMed, Embase, EBSCO, Web of Science, and China National Knowledge Infrastructure were systematically searched for original articles published from January 2000 to July 2023. The effect size was expressed as the mean difference (MD) or standardized mean difference (SMD) and its 95% confidence interval (CI). Subgroup analyses were performed by exercise mode (high-intensity interval training [HIIT] or moderate-intensity continuous training [MICT]) and intervention duration (>6 or ≤6 months). Compared to usual care, both HIIT and MICT significantly affected left ventricular end-diastolic volume (MD: 19.44, 95% CI: 13.72 to 25.17, p < 0.00001; I2 = 42%; MD: 13.90, 95% CI: 7.64 to 20.16, p < 0.0001; I2 = 0%), but only HIIT significantly affected left ventricular mass (MD: 17.04 g, 95% CI: 5.45 to 28.62, p = 0.004; I2 = 0%). HIIT significantly improved left ventricular ejection fraction (MD: 5.52, 95% CI: 2.31 to 8.73, p = 0.0008; I2 = 0%), as did MICT in the ≤6 months subgroup (MD: 1.36, 95% CI: 0.61 to 2.10, p = 0.0004; I2 = 0%). Neither significantly affected systolic tissue velocity. HIIT significantly improved VO2peak (MD: 8.04, 95% CI: 6.26 to 9.83, p < 0.00001; I2 = 0%), as did MICT in the ≤6 months subgroup (MD: 3.33, 95% CI: 2.39 to 4.27, p < 0.00001; I2 = 0%). Exercise significantly improved cardiac structure, systolic function, and VO2peak, but did not significantly affect diastolic function in T2DM patients. HIIT seemed to be superior to MICT at improving VO2peak and left ventricular ejection fraction in T2DM patients. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/, PROSPERO registration no.: CRD4242018087376.

Prophylactic Swallowing Exercises in Patients with Laryngeal Cancer Who Underwent Total Laryngectomy-A Randomized Trial.

This study aims to determine the efficacy of prophylactic swallowing exercises on swallowing function in patients undergoing total laryngectomy for laryngeal cancer. The design was a randomized controlled trial set in one tertiary care academic medical center. A total of 92 patients undergoing total laryngectomy for stages III and IV laryngeal cancer performed five targeted swallowing exercises for a period of three months after their surgery, starting two weeks after the surgery. Weekly swallowing therapy sessions were held with the patients in order to encourage adherence and proper technique. The controls received no preventive exercise and were referred for swallowing treatment following the surgery, as well as radiation therapy if necessary. The Functional Oral Intake Scale (FOIS) and the Performance Status Scale for Head and Neck Cancer Patients (PSS-H&N) were used to measure swallowing function at the baseline, one week following the surgery, and three, six, nine, and twelve months following the surgery. Right after the surgery, there were no statistically significant variations between the intervention and control groups in the FOIS scores (p value = 0.64), the Eating in Public subscale scores (p value = 1) and Normalcy of Diet subscale scores (p = 0.33) of the PSS-H&N. The scores were significantly better among the intervention patients at months 3, 6, 9, and 12 for all the scores, with p values smaller than 0.000. Although not immediately following the surgery, the patients who engaged in prophylactic swallowing exercises showed improvements in their ability to swallow at 3, 6, 9, and 12 months following their procedure.

Surviving to thriving: Virtual nutrition education in patients with breast cancer

IntroductionImproved outcomes in the treatment of breast cancer has increased the importance of formal survivorship. National guidelines and accreditation standards require institutional survivorship programs; however, implementation presents operational challenges. While existing literature affirms the need for clinician involvement in survivorship, applicability to virtual formats is unknown. Here we report our 3-year experience with design and implementation of virtual nutrition workshops in breast cancer survivorship. Materials and methodsFree virtual workshops were developed by an interdisciplinary team and offered to eligible participants on a quarterly basis. Workshop content focused on diet, nutrition, and exercise in cancer prevention, development, and recurrence. A question-and-answer session addressed misconceptions about nutrition and cancer. Participants were invited to participate in an evaluation survey after each workshop. Post-workshop assessment of course effectiveness was performed with a four-point Likert scale and qualitative comments. Results116 women participated in the workshops. Quarterly attendance consistently grew and averaged sixteen participants per session. Post workshop surveys demonstrated significant improvements in participants’ knowledge, and likelihood of behavioral modification. 93 % of participants had the highest rating for likelihood of making a change to their diet, and 83 % for likelihood of making changes to physical activity. Qualitative feedback supported both the effectiveness of the education as well as the virtual group setting. ConclusionsVirtual group workshops are effective for survivorship education. They present a feasible way to improve access to oncologic-trained dieticians for low-acuity concerns. The realistic design affords itself to easy reproducibility in other institutions seeking to implement disease-specific survivorship programs.

Cost-effectiveness analysis of the digital fall preventive intervention Safe Step among community-dwelling older people aged 70 and older

Falls are the most common cause of injury in older people, with consequences for the individual and society. With an increasing population of older people, falls and related costs are expected to increase. It is crucial to identify scalable and cost-effective interventions and subsequently reduce fall-related costs. The aim was to evaluate the cost-effectiveness of the Safe Step digital fall preventive exercise intervention over a period of 12 years and, in addition, to evaluate the impact of increased recruitment cost and decreased intervention effect. The intervention was evaluated in an observational study in a municipality context targeting community-dwelling older people of age 70 + . A Markov model with five states was used to model the cost-effectiveness of the Safe Step intervention and evaluate quality-adjusted life years (QALYs) and fall-related costs from a societal perspective. By using data from a meta-analysis as basis for the estimated intervention effect, the Safe Step intervention was compared with a no-intervention alternative. The results showed that the Safe Step intervention dominated no intervention. In the sensitivity analysis with the most conservative estimate of intervention effect, the ICER was €7 616 per QALY gained. Hence, Safe Step showed to be a cost-saving fall preventive intervention in older people at risk of falling and potentially cost-effective even with a low estimated intervention effect. Future studies on efficacy of fall preventive digital interventions will contribute in precising effect estimates and enhance the validity of these cost-effectiveness results.

Biomechanic Differences Between Anticipated and Unanticipated Volleyball Block Jump: Implications for Lower Limb Injury Risk.

Volleyball is a high-intensity sport characterized by repetitive jumping, sudden directional changes, and overhead movements, all of which significantly increase the risk of injuries, particularly to the shoulders, knees, and ankles. Despite the frequency of injuries caused by actions like blocking and spiking, there has been limited research focused on the specific biomechanical risk factors unique to volleyball. This study aimed to investigate the lower limb biomechanics during block jumps in both the dominant and non-dominant directions, under both anticipated and unanticipated conditions, in fifteen elite male volleyball players. Kinematic and kinetic data from the ankle, knee, and hip joints were recorded. Our results revealed statistically significant differences between the dominant and non-dominant directions at the ankle, knee, and hip joints. The non-dominant direction exhibited a greater ankle dorsiflexion angle and velocity, as well as higher knee flexion angle, velocity, moment, power, and abduction moment, along with increased hip flexion angle and power. Additionally, unanticipated movements led to increases in vertical ground reaction force (vGRF), hip extension moment, and flexion power, while ankle dorsiflexion plantarflexion velocity and knee flexion power decreased. It appears that movements in the dominant direction were stiffer and less cushioned, potentially increasing the risk of injury. While the non-dominant direction provided better shock absorption, it also elevated the knee valgus moment, which could increase the load on the knee. Furthermore, in unanticipated situations, athletes with short reaction times, unable to quickly adjust their automated movement patterns, faced a higher risk of limb overuse, thereby increasing the likelihood of injury. In practice, coaches should consider differences in limb coordination and movement direction, incorporating unilateral preventive exercises to reduce the risk of injury.

Inference-Based Cognitive Behavioral Therapy versus Cognitive Behavioral Therapy for Obsessive-Compulsive Disorder: A Multisite Randomized Controlled Non-Inferiority Trial

Introduction: Although cognitive behavioral therapy (CBT) effectively treats obsessive-compulsive disorder (OCD), many patients refuse CBT or drop out prematurely, partly because of anxiety regarding exposure and response prevention (ERP) exercises. Inference-based cognitive behavioral therapy (I-CBT) focuses on correcting distorted inferential thinking patterns, enhancing reality-based reasoning, and addressing obsessional doubt by targeting underlying dysfunctional reasoning, without incorporating an ERP component. We hypothesized that I-CBT would be non-inferior to CBT. Additionally, we hypothesized that I-CBT would be more tolerable than CBT. Methods: 197 participants were randomly assigned to 20 sessions CBT or I-CBT and assessed at baseline, posttreatment, and 6 and 12 months’ follow-up. The primary outcome was OCD symptom severity measured using the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS; non-inferiority margin: 2 points). The secondary outcome, treatment tolerability, was assessed using the Treatment Acceptability/Adherence Scale (TAAS). A linear mixed-effects model was used to assess the non-inferiority of the primary outcome and superiority of secondary outcomes. Results: Statistically significant within-group improvements in the primary and secondary outcomes were observed in both treatments. No statistically significant between-group differences in Y-BOCS were found at any assessment point, but the confidence intervals exceeded the non-inferiority threshold, making the results inconclusive. The estimated mean posttreatment TAAS score was significantly higher in the I-CBT group than in the CBT group. Conclusion: While both CBT and I-CBT are effective for OCD, whether I-CBT is non-inferior to CBT in terms of OCD symptom severity remains inconclusive. Nevertheless, I-CBT offers better tolerability and warrants consideration as an alternative treatment for OCD.

Electromyographic activity of shoulder muscles on two preventive exercise programmes for swimmer’s shoulder: elastic band versus weight

ABSTRACT Strength programmes have shown good results in preventing swimmer’s shoulder. However, there aren’t studies based on electromyographic (EMG) analysis in these programmes. This study aims to compare an EMG activity of the middle trapezius (MT), lower trapezius (LT), infraspinatus (IS), serratus anterior (SA), and pectoralis major (PM) in two swimmer’s shoulder preventive programmes – one performed with elastic band and the other with weights. Twenty competitive swimmers performed two strength programmes consisting of five exercises each, while the analysis of EMG activity in MT, LT, IS, SA, and PM for each exercise was recorded. The superficial EMG was used to collect data at a sampling frequency of 1000 hz. The Paired Sample T-test or the Wilcoxon test was applied to compare EMG activity between programmes. The internal rotation at 90º (p < 0.001) and external rotation at 90º (p ≤ 0.01) exercises produced high myoelectric shoulder muscle activity with an elastic band. Conversely, scapular punches (p < 0.001) exercise has high shoulder EMG activity when performed with weights. Performing the same preventive exercise programme with two different instruments produces great variability in the myoelectric activity of the shoulder muscles.

Developing a data-driven multimodal injury and illness prevention programme in male professional football based on a risk management model: the IP2 NetWork

BackgroundCurrent injury prevention programmes in football are limited by a one-size-fits-all approach, which predominantly focuses on preventive exercise programmes while ignoring differences in risk profiles between individuals and teams.ObjectiveTo address...

Analysis of the Effectiveness of a Fall Prevention Program Incorporating an Interprofessional Team Collaboration Model on Reducing Fall Risk in Elderly Living in Long-term Care Facilities

Concurrent with population ageing, falls have become a significantly more challenging public health issue among older adults. Three years of data collected recently from a nursing home in northern Taiwan reveals an increasing trend in fall density that is primarily associated with aging, physiological decline, chronic diseases, polypharmacy, osteoporosis, and lack of exercise. The percentage of nursing home residents at high risk of falls is currently at 12.6%, and the fall rate has been reported as reaching as high as 30% annually. A fall prevention program was implemented to reduce the fall incidence rate to 18%, with secondary goals of improving fall prevention awareness, behavior, self-efficacy, lower limb muscle strength, balance, and gait by 10% on average, respectively, between pre-test and post-test. From September 30, 2023 to February 29, 2024, a health promotion activity and fall prevention exercise course were implemented using an interdisciplinary team collaboration model over a six-week period, providing individualized exercise for the participants. The study included 20 older adults with an average age of 88 years. Most (90%; n = 18) had chronic diseases, 25% (n = 5) were on more than nine medications, 70% (n = 14) had reduced bone mass, and 40% (n = 8) were at high risk of falls, with a fall incidence rate of 30% during the immediately preceding year. Post-intervention, the fall incidence rate dropped to 5%, fall prevention awareness, behavior, and self-efficacy increased by 18.3%, and lower limb muscle strength, balance, and gait improved by 11.7%. The post-test results in fall prevention awareness, behavioral changes, self-efficacy, and lower limb strength, balance, and gait were all significantly better than pre-test results, with all results achieving statistical significance. The project results support the positive effects of the developed intervention effectively on elderly physical fitness and fall risk, providing valuable insights for the implementation of fall prevention strategies in nursing homes.

Understanding “Fear Of Falling” And How It Impacts Older Persons Motivation To Engage In Fall Prevention Exercise Interventions

Abstract Background Fear of falling can cause older persons to restrict their activities, which drives reduced strength and balance and increases their falls risk. Falls can have a significant effect on older persons in terms of loss of confidence, ongoing falls risk and ultimately, a poorer quality of life (Oliver et al, 2010). Fall prevention exercise interventions can help reduce the risk of falling in older adults by up to 34% (Sherrington et al, 2020). This study aims to explore the prevalence of fear of falling in older adults both before and after attending a community-based fall prevention exercise programme. The programme consisted of an evidence-based Physiotherapy led 10-week strength and balance class, followed by a 16-week exercise instructor led strength and balance class. Methods A 2-part qualitative study. Part 1: Prior to commencing the class each participant completed a rating of their fear of falling measured by ConfBal (a validated 10 item Balance Confidence scale). Part 2: Questionnaire assessing their experience of the classes and corresponding change in balance scores. Results 17 older adults completed the programme. Surveys were returned by 8/17 to date (47%). Mean pre-intervention ConfBal score of 20, mean post intervention score of 15 (8/17 participants to date), average 4-point improvement after intervention was statistically significant (p=0.008). Reported benefits of falls prevention exercise classes include peer-peer discussion of functional ability, gaining confidence by exercising in a group environment, practising functional exercises relating to day-to-day tasks, and building social relationships. Conclusion Fear of falling amongst community dwelling older adults is common but group exercise improves confidence as well as boosting social interactions. Participation in fall prevention exercise programmes can help to better support older people as they age which may influence better health outcomes in our communities.