Graded Exercise Program Research Articles

Study protocol for a single-arm pilot trial investigating the feasibility of a multimodal digital technology for managing metabolic syndrome in patients with chronic obstructive pulmonary disease

Individuals diagnosed with Chronic Obstructive Pulmonary Disease (COPD) are exposed to an increased risk of metabolic syndrome (MetS), which negatively affects their health outcomes and quality of life. Lifestyle interventions have shown promise in managing MetS. This study outlines the protocol for a web-based multimodal self-care program, Digital Metabolic Rehabilitation, for managing MetS in patients with COPD. The Digital Metabolic Rehabilitation is a single-arm pilot trial that integrates the Canadian Health Advanced by Nutrition and Graded Exercise (CHANGE) Program and a web-based wellness platform. The web-based wellness platform employed in this study is My Viva Plan (MVP)®, which integrates a holistic, multicomponent approach to promote wellness. The intervention will primarily focus on lifestyle changes for patients with COPD. Over 6 months, participants will use the web-based wellness platform and engage in weekly online support group sessions. Fifty patients diagnosed with stage I-II COPD and MetS will participate. Blood tests, anthropometrics, body composition, physical function, muscle strength, physical activity, energy metabolism, quality of life and mental health will be assessed at baseline, 3, and 6 months. The Digital Metabolic Rehabilitation program aims to explore whether a multimodal integrative intervention delivered through a web-based wellness platform can be implemented by patients with COPD with MetS. By combining the expertise of the CHANGE Program with the digital delivery format, the intervention seeks to enhance self-monitoring and foster better self-management practices. The protocol outlines a novel and potentially impactful intervention for managing MetS in patients with COPD.

Effects of a combined nutrition and graded exercise program on metabolic health and diet quality

Effects of a combined nutrition and graded exercise program on metabolic health and diet quality

Long-Term Outcome of Motor Functional Neurological Disorder After Rehabilitation.

Functional neurological disorder (FND) is defined as the presence of neurological symptoms that are inconsistent with a neurological disease. We performed a single-center retrospective study aimed at determining the long-term outcome of FND patients receiving inpatient rehabilitation and the predictors of a good outcome. A multidisciplinary graded exercise program was provided with one or two daily physiotherapy and occupational therapy sessions on 5 days each week, as well as weekly psychological support. Outcome was assessed using the motor part of the Functional Independence Measure scale (FIM; maximum score of 91) at admission, discharge, and follow-up, with the last assessment performed by phone interview. The 30 included patients were aged 43.6±14.7 years (mean±standard deviation), comprised 70% females, and received a mean of 4 weeks of rehabilitation. The admission FIM score (80.2±8.3) was significantly lower than the discharge FIM score (86.9±4.6; p<0.001, Wilcoxon signed-rank test). No notable difference was observed between discharge and follow-up FIM scores (85.5±8.5, p=0.54). The mean follow-up of the 36-month FIM scores at discharge and follow-up was dichotomized as a good outcome in cases where all items were scored ≥6 (functional independence). Binomial logistic regression showed that absence of a comorbid psychiatric disorder (p=0.039, odds ratio=10.7) was a predictive factor for a good outcome at follow-up. Other variables (e.g., sex and age) were not significant predictors of clinical outcome (all p≥0.058). These results suggest inpatient intensive rehabilitation for motor FND is effective and produces favorable long-term results. Further studies with larger groups are warranted so that the management protocols can be standardized.

Utility and usability of a wearable system and progressive-challenge cued exercise program for encouraging use of the more involved arm at-home after stroke—a feasibility study with case reports

BackgroundUnderstanding the role of adherence to home exercise programs for survivors of stroke is critical to ensure patients perform prescribed exercises and maximize effectiveness of recovery.MethodsSurvivors of hemiparetic stroke with impaired motor function were recruited into a 7-day study designed to test the utility and usability of a low-cost wearable system and progressive-challenge cued exercise program for encouraging graded-challenge exercise at-home. The wearable system comprised two wrist-worn MetaMotionR+ activity monitors and a custom smartphone app. The progressive-challenge cued exercise program included high-intensity activities (one repetition every 30 s) dosed at 1.5 h per day, embedded within 8 h of passive activity monitoring per day. Utility was assessed using measures of system uptime and cue response rate. Usability and user experience were assessed using well-validated quantitative surveys of system usability and user experience. Self-efficacy was assessed at the end of each day on a visual analog scale that ranged from 0 to 100.ResultsThe system and exercise program had objective utility: system uptime was 92 ± 6.9% of intended hours and the rate of successful cue delivery was 99 ± 2.7%. The system and program also were effective in motivating cued exercise: activity was detected within 5-s of the cue 98 ± 3.1% of the time. As shown via two case studies, accelerometry data can accurately reflect graded-challenge exercise instructions and reveal differentiable activity levels across exercise stages. User experience surveys indicated positive overall usability in the home settings, strong levels of personal motivation to use the system, and high degrees of satisfaction with the devices and provided training. Self-efficacy assessments indicated a strong perception of proficiency across participants (95 ± 5.0).ConclusionsThis study demonstrates that a low-cost wearable system providing frequent haptic cues to encourage graded-challenge exercise after stroke can have utility and can provide an overall positive user experience in home settings. The study also demonstrates how combining a graded exercise program with all-day activity monitoring can provide insight into the potential for wearable systems to assess adherence to—and effectiveness of—home-based exercise programs on an individualized basis.

Impact of Lifestyle Modification on Quality of Life in Patients with Metabolic Syndrome: Findings from the CHANGE Program Intervention Study in Prince Edward Island, Canada.

Purpose: To assess the modification in quality of life (QoL) of patients with metabolic syndrome (MetS) after participating in Canadian Health Advanced by Nutrition and Graded Exercise (CHANGE) program and identify predictors of this modification in QoL among participants. Methods: A convenience sample of 100 patients with MetS completed the 12-month CHANGE program (diet and exercise regular counseling). 36-Item Short Form Health Survey (SF-36), International Physical Activity Questionnaire (IPAC), Physician Assessment and Clinical Education (PACE), and the Mediterranean Diet Score (MDS) questionnaires were employed to assess participants' QoL, physical activity (PA), sedentary behaviors, and quality of diet, respectively. In addition, physical fitness tests (6-Minute Walk Test, One-Leg Stance Test, and Grip Strength Test) were used. Medical history, blood tests, and anthropometric [height, weight, and waist circumference (WC)] and blood pressure measurements were performed by a nurse. Linear regression analysis was performed to identify predictors of QoL. Results: Participants' mean age was 58.3 ± 11.0, and 75.4% were females. After the CHANGE program, participants demonstrated significant reduction in the number of MetS criteria and significant improvement of physical and mental components of QoL. Moreover, there was significant increase in participants' PA, MDS, and physical fitness mean scores with corresponding significant reduction in sedentary behavior time, blood pressure, and WC measures. Linear regression analysis revealed that age, WC, screen time, PA, and physical fitness were significant predictors of QoL. Conclusion: The 12-month group-based diet and exercise counseling led to clinically significant improvement in MetS criteria and in important measures of health and fitness among participants, which improved their QoL. Age, fitness measures, and daily screen time were associated with QoL.

Effects of Paraplegia Fitness Integrated Training on Physical Function and Exercise Self-Efficacy and Adherence Among Individuals With Spinal Cord Injury.

ObjectiveTo determine the effects of the Paraplegia Fitness Integrated Training (PARAFiT) program, which is an integrated graded physical exercise and health education program for individuals with spinal cord injury (SCI).MethodsThis nonrandomized single-blind study included 44 participants, who were assigned to either an intervention (PARAFiT) group or an active control (conventional physiotherapy) group. The intervention group underwent the PARAFiT program (8 weeks), which consisted of circuit-based interval training, progressive upper limb resistance training, and health education sessions. During the unsupervised period, the intervention group continuously underwent health education program once a month for 2 months (8 weeks). Repeated-measures analysis of variance was used for the analysis.ResultsThe intervention group presented with a higher level of physical activity than did the control group; however, the difference was not significant (p=0.36). Additionally, the intervention group presented with better exercise self-efficacy and cardiorespiratory fitness and stronger bilateral shoulder muscle and handgrip than did the control group (all p<0.05). Exercise adherence was higher in the intervention group than in the control group during both the supervised (80% vs. 75%) and unsupervised (40% vs. 20%) periods.ConclusionThe PARAFiT program enhanced the level of physical activity, exercise self-efficacy, physical fitness, and exercise adherence among the patients with SCI. Future studies should incorporate guidelines for home-based exercises and regular monitoring to promote long-term adherence to exercise and physical activity among individuals with SCI.

A proposed self-guide to return to exercise in COVID-19 survivors: A public perspective

To return to being physically active, COVID-19 survivors need a guide to safely return to exercise. The most common symptoms reported in COVID-19 survivors were fatigue and breathlessness. It is crucial to rule out severe complications post-acute COVID-19 such as myocarditis, pulmonary embolism, pulmonary fibrosis and deep vein thrombosis before exercise. In this study, we proposed a self-guide assessment to safely return to exercise using post-COVID-19 Physical Activity Readiness Questionnaire and discussed on COVID-19 survivor-graded exercise programme. The key points highlighted during graded exercise programme are (1) individualisation, (2) monitoring for red flag symptoms (chest pain, breathlessness at rest or minimal exertion, palpitation, chest tightness and severe calf pain), (3) step down 1 stage if feels extreme fatigue on exercise, (4) start slow and progress slow with the exercise and (5) if in doubt, to refer yourself out to health professionals. These steps will encourage COVID-19 survivors to continue being active. It will also ease the healthcare burden by reducing the number of referrals of pre-participation health evaluation for mild symptoms or asymptomatic COVID-19 survivor patients to return to exercise.

Exercise therapy following traumatic anterior shoulder dislocation injuries – Protocol of a systematic review and meta-analysis

Background: Anterior shoulder dislocation (ASD) is a common injury which leads to reduced functional capacity and impairs athletic participation. Relevant guidelines recommend a phased, criteria driven, and graded exercise program to help manage the associated symptoms of ASD. The most recent evidence synthesis on its treatment was done in 2019, however, this review did not fully focus on active exercise-based interventions. There is a need for a best evidence synthesis focussing on active exercise-based interventions for traumatic ASD.

Prediction modelling of 1-year outcomes to a personalized lifestyle intervention for Canadians with metabolic syndrome.

Metabolic syndrome (MetS) comprises a cluster of risk factors that includes central obesity, hypertension, dyslipidemia, and impaired glucose homeostasis. Although lifestyle interventions reduce MetS risk, not everyone responds to the same extent. The primary objective of this study was to identify variables that could predict 1-year changes in MetS risk in individuals participating in the Canadian Health Advanced by Nutrition and Graded Exercise (CHANGE) program. Participants were allocated into training (n = 157) and test (n = 29) datasets by availability of genetic data. A linear mixed-effect model revealed that age, medication, fasting glucose, triglycerides, high-density lipoprotein cholesterol, waist circumference, systolic blood pressure, and fibre intake were associated with continuous MetS (cMetS) score across all time points. Multiple linear regressions were then used to build 2 prediction models using 1-year cMetS score as the outcome variable. Model 1 included only baseline variables and was 38% accurate for predicting cMetS score. Model 2 included both baseline variables and the 3-month change in cMetS score and was 86% accurate. As a secondary objective, we also examined if we could build a model to predict a person's categorical response bin (i.e., positive responder, nonresponder, or adverse responder) at 1 year using the same variables. We found 72% concordance between predicted and observed outcomes. These various prediction models need to be further tested in independent cohorts but provide a potentially promising new tool to project patient outcomes during lifestyle interventions for MetS. Novelty Short-term changes in cMetS score improve prediction model performance compared with only baseline variables. Predictive models could potentially facilitate clinical decision-making for personalized treatment plans.

Identifying psychosocial characteristics that predict outcome to the UPLIFT programme for people with persistent back pain: protocol for a prospective cohort study

IntroductionPrognostic screening of people with low back pain (LBP) improves utilisation of primary healthcare resources. Whether this also applies to secondary healthcare remains unclear. Therefore, this study aims to develop...

Chest Injury-football

HISTORY: 17 year old high school football wide receiver presented with left back and rib pain. He sustained a hit in that region during a football game the night before. He was taken out of the game due to pain and difficulty breathing which ultimately kept him from finishing the game. After the game he continued to have pain for which he took a muscle relaxant that he had from a previous injury and over the counter pain medication with minimal pain relief. The pain persisted through the night and into the following morning. His pain was worse with deep breathing and any pressure on his chest. He denied any shortness of breath, dyspnea with exertion, cough, wheezing or hemoptysis. PHYSICAL EXAMINATION: Appeared in no acute distress, Ecchymosis over the posterior lateral aspect of left lower ribs with tenderness to palpation, No crepitus, No palpable deformity, Symmetric chest expansion, posterior rib/back pain reproduced with deep inspiration, Equal bilateral breath sounds, No hyper-resonance to percussion, Normal respiratory rate, Negative anterior posterior compression test, Positive lateral compression test, Full AROM of the back DIFFERENTIAL DIAGNOSIS: Rib fracture, Pneumothorax, Pulmonary contusion, Pulmonary embolism TEST AND RESULTS: X-ray Rib series: Small left apical pneumothorax involving approximately 20% of the hemi thorax. Suspected nondisplaced fractures involving the posterolateral left eighth and ninth ribs with small linear lucencies within these regions. Chest CT scan: Small left-sided pneumothorax approximately 20%. No acute osseous injury. FINAL WORKING DIAGNOSIS: Pneumothorax TREATMENT AND OUTCOMES: The patient was sent to ER after being seen in clinic to expedite getting a CT scan done after the X-rays. After the CT scan was obtained it was decided by the ED to admit the patient for observation. He obtained a subsequent x-ray that evening 12 hours after is initial which showed a slightly smaller left apical pneumothorax. He was discharged the next day. Repeat chest x-ray done three days after discharge showed improving pneumothorax. Patient was seen in clinic 2 weeks after his discharge from the hospital and was started on a graded exercise program with repeat x-ray at 1 week after clinic visit showed resolution of pneumothorax. He returned to full game play at 4 weeks after his initial injury.

Development of ProFibro — a mobile application to promote self-care in patients with fibromyalgia

Fibromyalgia is a rheumatic syndrome characterised by chronic widespread pain, often associated with fatigue, unrefreshed sleep and cognitive problems. Effective management of fibromyalgia requires a proactive approach in which the patient takes responsibility for self-care. The purpose of this research was to develop an application (app) for promoting self-care as a complementary Mobile Health resource to physical therapy in the management of fibromyalgia. The app was developed in five stages, according to the prototyping paradigm. In Stage 1, an expert panel of five physical therapists, five patients with fibromyalgia, a digital interface designer and a programmer analysed the requirements and content, and set the software objectives. In Stage 2, the designer created the screen layouts. In Stage 3, the programmer developed the prototype for the Android operating system (Google Inc., Mountain View, CA, USA). In Stage 4, the prototype was pilot tested regarding its quality of use by 10 patients with fibromyalgia. Finally, in Stage 5, the designer improved the interface and the programmer built the final product.This article describes the development of ProFibro, the first free mobile app in Brazilian Portuguese for fibromyalgia. Its functions are patient education through animation, self-monitoring, sleep strategies, scheduling, graded exercise programme, practice of gratitude, family adjustments and hints through notifications.

Knee Joint Loading in Healthy Adults During Functional Exercises: Implications for Rehabilitation Guidelines.

Study Design Controlled laboratory study. Background The inclusion of specific exercises in rehabilitation after knee injury is currently expert based, as a thorough description of the knee contact forces during different exercises is lacking. Objective To quantify knee loading during frequently used activities such as squats, lunges, single-leg hops, walking stairs, standing up, and gait, and to grade knee joint loading during these activities. Methods Three-dimensional motion-analysis data of 15 healthy adults were acquired during 9 standardized activities used in rehabilitation. Experimental motion data were processed using musculoskeletal modeling to calculate contact and shear forces on the different knee compartments (tibiofemoral and patellofemoral). Using repeated-measures analyses of variance, contact and shear forces were compared between compartments and exercises, whereas muscle and average maximum femoral forces were compared only between exercises. Results With the exception of squats, all therapeutic exercises imposed higher forces to the tibiofemoral joint compared to gait. Likewise, patellofemoral forces were greater during all exercises when compared to gait. Greater compartmental contact forces were accompanied by greater compartmental shear forces. Furthermore, force distribution over the medial and lateral compartments varied between exercises. With increased knee flexion, more force was imposed on the posterior portion of the condyles. Conclusion These results suggest that with careful selection of exercises, forces on an injured zone of the joint can be reduced, as the force distribution differs strongly between exercises. Based on the results, a graded exercise program for progressive knee joint loading during rehabilitation can be conceptualized. J Orthop Sports Phys Ther 2018;48(3):162-173. Epub 6 Jan 2018. doi:10.2519/jospt.2018.7459.

Guided graded exercise self-help plus specialist medical care versus specialist medical care alone for chronic fatigue syndrome (GETSET): a pragmatic randomised controlled trial

SummaryBackgroundGraded exercise therapy is an effective and safe treatment for chronic fatigue syndrome, but it is therapist intensive and availability is limited. We aimed to test the efficacy and safety of graded exercise delivered as guided self-help.MethodsIn this pragmatic randomised controlled trial, we recruited adult patients (18 years and older) who met the UK National Institute for Health and Care Excellence criteria for chronic fatigue syndrome from two secondary-care clinics in the UK. Patients were randomly assigned to receive specialist medical care (SMC) alone (control group) or SMC with additional guided graded exercise self-help (GES). Block randomisation (randomly varying block sizes) was done at the level of the individual with a computer-generated sequence and was stratified by centre, depression score, and severity of physical disability. Patients and physiotherapists were necessarily unmasked from intervention assignment; the statistician was masked from intervention assignment. SMC was delivered by specialist doctors but was not standardised; GES consisted of a self-help booklet describing a six-step graded exercise programme that would take roughly 12 weeks to complete, and up to four guidance sessions with a physiotherapist over 8 weeks (maximum 90 min in total). Primary outcomes were fatigue (measured by the Chalder Fatigue Questionnaire) and physical function (assessed by the Short Form-36 physical function subscale); both were self-rated by patients at 12 weeks after randomisation and analysed in all randomised patients with outcome data at follow-up (ie, by modified intention to treat). We recorded adverse events, including serious adverse reactions to trial interventions. We used multiple linear regression analysis to compare SMC with GES, adjusting for baseline and stratification factors. This trial is registered at ISRCTN, number ISRCTN22975026.FindingsBetween May 15, 2012, and Dec 24, 2014, we recruited 211 eligible patients, of whom 107 were assigned to the GES group and 104 to the control group. At 12 weeks, compared with the control group, mean fatigue score was 19·1 (SD 7·6) in the GES group and 22·9 (6·9) in the control group (adjusted difference −4·2 points, 95% CI −6·1 to −2·3, p<0·0001; effect size 0·53) and mean physical function score was 55·7 (23·3) in the GES group and 50·8 (25·3) in the control group (adjusted difference 6·3 points, 1·8 to 10·8, p=0·006; 0·20). No serious adverse reactions were recorded and other safety measures did not differ between the groups, after allowing for missing data.InterpretationGES is a safe intervention that might reduce fatigue and, to a lesser extent, physical disability for patients with chronic fatigue syndrome. These findings need confirmation and extension to other health-care settings.FundingUK National Institute for Health Research Research for Patient Benefit Programme and the Sue Estermann Fund.

Family physician-led, team-based, lifestyle intervention in patients with metabolic syndrome: results of a multicentre feasibility project.

Metabolic syndrome (MetS) is a medical condition with major complications and health care costs. Previous research has shown that diet and exercise can improve and reverse this condition. The goal of this study was to test the feasibility and effectiveness of implementing the Canadian Health Advanced by Nutrition and Graded Exercise (CHANGE) program into diverse family medicine practices to improve MetS. In this longitudinal before-after study, 305 adult patients with MetS were recruited from 3 diverse family medicine team-based organizations to the CHANGE personalized diet and exercise program. Participants were followed for 12 months. Primary outcomes included feasibility and reversal of MetS. Secondary outcomes included improvement in MetS components, changes in diet quality, aerobic fitness and cardiovascular risk. Participants attended 76% and 90% of the kinesiologist and dietitian visits, respectively. At 12 months, 19% of patients (95% confidence interval [CI] 14%-24%) showed reversal of MetS, VO2max increased by 16% (95% CI 13%-18%), and Healthy Eating Index and Mediterranean Diet Scores improved by 9.6% (95% CI 7.6%-11.6%) and 1.4% (1.1%-1.6%), respectively. In addition, the Prospective Cardiovascular Munster (PROCAM) 10-year risk of acute coronary event decreased by 1.4%, from a baseline of 8.6%. A team-based program led by the family physician that educates patients about the risks of MetS, and with a dietitian and kinesiologist, empowers them to undertake an individualized supervised program of diet modification and exercise, is feasible, improves aerobic capacity and diet quality, reverses MetS and improves MetS components at 12 months.

Spinning: an arising cause of rhabdomyolysis in young females.

'Spinning' is an indoor cycling regimen. The number of case reports of spinning-induced rhabdomyolysis (SIR) has increased since 2004 in South Korea. The aim of this study is to evaluate the clinical characteristics of SIR and compare it with other causes of rhabdomyolysis. Patients who were diagnosed with rhabdomyolysis from 1 September 2011 to 30 April 2015 were included. We analysed the incidence of rhabdomyolysis, biochemical parameters and forced hospitalisation, which was defined as the days from admission to creatinine phosphokinase < 2000 IU/L. Among 70 included patients, 13 (18.6%) patients were diagnosed with SIR. The mean age of the patients with SIR was 25.69 ± 5.0 years, and most were females under 35 years old (12, 92.3%). Interestingly, the mean duration of spinning exercise before admission was only 59.23 min. Moreover, the patients with SIR showed more severe progress than the all-patients-except-SIR (AESIR) group. The serum creatinine phosphokinase, aspartate transaminase and alanine transaminase levels of the patients with SIR were statistically significantly higher than the patients with AESIR. Additionally, the duration of forced hospitalisation was longer than that of the AESIR (P < 0.01). Spinning could be an important cause of rhabdomyolysis in young, unfit females, which is typically severe. A graded exercise programme is advised at the first session.

Exercise in Eating Disorders Treatment: Systematic Review and Proposal of Guidelines.

Although exercise is an effective intervention for many psychological health issues, it has often been overlooked as a potential adjunct to eating disorder (ED) treatment. Thus, our objective was to summarize the literature by synthesizing themes identified in clinical studies and explicit guidelines or recommendations for the use or management of exercise in ED interventions into a proposed set of guidelines for the use of exercise in ED treatment. A literature search in exercise science, health psychology, and the ED literature was conducted. The focus was to obtain articles that reported on therapeutic effects and/or guidelines for the therapeutic use of exercise in individuals with ED. Our review identified 11 core themes describing techniques that have been successful in using exercise therapeutically in ED treatment. These 11 guidelines are as follows: employ a team of relevant experts, monitor medical status, screen for exercise-related psychopathology, create a written contract of how therapeutic exercise will be used, include a psychoeducational component, focus on positive reinforcement, create a graded exercise program, begin with mild-intensity exercise, tailor the mode of exercise to the needs of the individual, include a nutritional component, and debrief after exercise sessions. Our review identifies specific guidelines that may enhance ED treatment outcomes. It is the first to summarize divergent literature and synthesizes previous successes that may guide the use of therapeutic exercise in some, but not all ED patients. This review provides a practical set of guidelines for the clinical management and therapeutic use of exercise in ED treatment by focusing on empowering individuals with exercise as a tool for healthy living.

Electromyographic Changes in Trunk Muscles During Graded Lumbar Stabilization Exercises

BackgroundLumbar stabilization exercises are effective for the treatment of patients with low back pain. However, personalized exercise programs are required to facilitate more efficient treatment, as each individual exhibits the different characteristics of the trunk muscles and pain. ObjectiveTo determine the effects of graded lumbar stabilization exercises on the trunk muscles in healthy individuals, using surface electromyography. DesignA cross-sectional prospective study. SettingOutpatient pain clinic. ParticipantsTen healthy male participants without low back pain were recruited on a volunteer basis. MethodsFour common lumbar stabilization exercises were selected, including the curl up, dead bug, Superman, and bird dog exercises. Each exercise was divided into 5 intensity levels, with participants performing all exercises at each intensity level, to a total of 20 exercises. Electromyographic changes in the trunk muscles according to intensity level were analyzed. Main Outcome MeasurementsUsing superficial electromyography, the peak amplitude and area under the curve for each of the rectus abdominis (RA), external oblique abdominis (EO), multifidus (MF), and erector spinae (ES) muscles were measured. ResultsIn general, as the level of intensity increased, the activity of the related lumbar stabilizing muscles also increased significantly (P < .05). Specifically, the peak amplitudes of the RA (P = .008) and EO (P < .001) were increased during the curl up exercise, whereas the peak amplitudes of the MF (P < .001) and ES (P = .002) were increased during the bird dog exercise. The prolonged exercise duration of the Superman exercise increased the mean area under the curve of MF, ES, and RA (P < .001). ConclusionsUsing a graded exercise program, an appropriate level of exercise intensity can be prescribed and modulated according to patient tolerance and physical ability. Therefore, a graded lumbar stabilization exercise program may represent an effective way to strengthen the lumbar stabilizing muscles in patients with low back pain.

Graded Exercise Therapy Guided Self-Help Trial for Patients with Chronic Fatigue Syndrome (GETSET): Protocol for a Randomized Controlled Trial and Interview Study.

BackgroundChronic fatigue syndrome, also known as myalgic encephalomyelitis (CFS/ME), is characterized by chronic disabling fatigue and other symptoms, which are not explained by an alternative diagnosis. Previous trials have suggested that graded exercise therapy (GET) is an effective and safe treatment. GET itself is therapist-intensive with limited availability.ObjectiveWhile guided self-help based on cognitive behavior therapy appears helpful to patients, Guided graded Exercise Self-help (GES) is yet to be tested.MethodsThis pragmatic randomized controlled trial is set within 2 specialist CFS/ME services in the South of England. Adults attending secondary care clinics with National Institute for Health and Clinical Excellence (NICE)-defined CFS/ME (N=218) will be randomly allocated to specialist medical care (SMC) or SMC plus GES while on a waiting list for therapist-delivered rehabilitation. GES will consist of a structured booklet describing a 6-step graded exercise program, supported by up to 4 face-to-face/telephone/Skype™ consultations with a GES-trained physiotherapist (no more than 90 minutes in total) over 8 weeks. The primary outcomes at 12-weeks after randomization will be physical function (SF-36 physical functioning subscale) and fatigue (Chalder Fatigue Questionnaire). Secondary outcomes will include healthcare costs, adverse outcomes, and self-rated global impression change scores. We will follow up all participants until 1 year after randomization. We will also undertake qualitative interviews of a sample of participants who received GES, looking at perceptions and experiences of those who improved and worsened.ResultsThe project was funded in 2011 and enrolment was completed in December 2014, with follow-up completed in March 2016. Data analysis is currently underway and the first results are expected to be submitted soon.ConclusionsThis study will indicate whether adding GES to SMC will benefit patients who often spend many months waiting for rehabilitative therapy with little or no improvement being made during that time. The study will indicate whether this type of guided self-management is cost-effective and safe. If this trial shows GES to be acceptable, safe, and comparatively effective, the GES booklet could be made available on the Internet as a practitioner and therapist resource for clinics to recommend, with the caveat that patients also be supported with guidance from a trained physiotherapist. The pragmatic approach in this trial means that GES findings will be generalizable to usual National Health Service (NHS) practice.Trial RegistrationInternational Standard Randomized Controlled Trial Number (ISRTCTN): 22975026; http://www.isrctn.com/ISRCTN22975026 (Archived by WebCite at http://www.webcitation.org/6gBK00CUX)

Exercise And Heart Failure: Advancing Knowledge And Improving Care.

Exercise limitation is the hallmark of heart failure, and an increasing degree of intolerance is associated with poor prognosis. Objective evaluation of functional class (e.g., cardiopulmonary exercise testing) is essential for adequate prognostication in patients with advanced heart failure and for implementing an appropriate exercise training program. A graded exercise program has been shown to be beneficial in patients with heart failure and has become an essential component of comprehensive cardiac rehabilitation in these patients. An exercise program tailored to the patient's preferences, possibilities, and physiologic reserve has the greatest chance of being successful. Despite being safe, effective, and a guideline-recommended treatment to improve quality of life, exercise training remains grossly underutilized. Patient, physician, insurance and practice barriers need to be addressed to improve this quality gap.