Group-based Exercise Program Research Articles

Effects of group-based versus individual physical exercise programs for knee osteoarthritis: A systematic review and meta-analysis

Background: Knee osteoarthritis (OA) is the most common joint disease worldwide and is associated with a high rate of disability and poor quality of life. However, little is known about the therapeutic effects of group-based versus individual-based physical exercise protocols. Objective: To investigate the effects of individual versus group-based physical exercises on pain intensity and functional outcomes in people with knee OA. Methods: MEDLINE/PubMed, Cochrane, EMBASE, and PEDro databases were searched from the earliest date available to July 2023. Study quality was evaluated using the PEDro scale. Mean difference (MD), standardized mean difference (SMD), and 95% confidence interval (CI) were calculated using a random effect model. Results: Six studies, with 763 patients, met the study criteria. Group-based physical exercises improved pain intensity (VAS 0-100) MD -17.2 (95% CI: -22.2 to -12.3), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale MD -0.54 (95% CI: -1.0 to -0.08), WOMAC function subscale MD -2.1 (95% CI: -4.1 to -0.08) compared to individual modality. No significant difference regarding muscle strength and exercise tolerance was found for participants in the group-based physical exercises compared with individual physical ones. Conclusion: Group-based physical exercise was more successful in reducing pain intensity and functional impairment in patients with knee OA than individual exercise programs. Both group-based and individual physical exercise programs enhanced muscle strength and 6-minute walk distance.

‘Making a connection’: a qualitative study of experiences from a cancer telerehabilitation program

PurposeSpecialised group-based exercise rehabilitation is beneficial for cancer survivors but access to these services is limited. Telerehabilitation provides an opportunity to expand reach, but we do not know about the experiences of those who participate in this way. This study explored participant experiences of an exercise-based telerehabilitation program for people with cancer.MethodA qualitative study using semi-structured interviews was completed. Twenty-two cancer survivors were purposively sampled from the experimental group of a randomised controlled trial evaluating exercise-based cancer telerehabilitation delivered in groups using synchronous videoconferencing. Interviews were audio-recorded and transcribed verbatim. Data were coded independently by two reviewers and analysed inductively by thematic analysis.Results‘A feeling of connection’ was the overarching theme. Participants perceived they connected with the health service, expert health professionals, and peers through participating in the telerehabilitation program. These connections provided a personalised rehabilitation experience and improved perceptions of physical and emotional well-being. Two subthemes suggested connection was facilitated by (1) the acceptability of telerehabilitation and (2) enhanced accountability to exercise. Participants felt disconnected when they were unable to participate in the program due to cancer treatment and side effects (e.g. fatigue), feeling unwell, and co-morbidities.ConclusionWe identified that telerehabilitation facilitated connections that enhanced the reach of exercise to cancer survivors. Our findings support using telerehabilitation to deliver specialised group-based exercise programs alongside more traditional models of care to increase participation in exercise among people with cancer.

Relevance of therapist feedback in the context of group‑based exercise programs in medical rehabilitation – Results from a qualitative study with patients and exercise therapists

Background Although group-based exercise programs account for nearly half of exercise therapy services provided in German medical rehabilitation facilities, information regarding the application and effects of therapist feedback in this setting is sparse. Therefore, the aim of this qualitative study was to develop an understanding of the relevance of therapist feedback in the context of group-based exercise programs from the patients’ and therapists’ perspective. Methods Semi-structured interviews were conducted with five rehabilitation patients as well as five exercise therapists with work experience in group-based exercise therapy. Data were analysed using structuring content analysis. Results Three types of therapist feedback with respective modalities and characteristics were identified. Besides corrective feedback to support the patients’ exercise instruction, motivational feedback and performance feedback were used to aid the strengthening of psychological resources. Although therapist feedback constituted an important component of patient-therapist-interaction, evidence suggesting a facilitation of coping strategies, participation or long-term physical activity adherence was sparse. Conclusions While therapist feedback in group-based exercise programs likely aids the recovery of physical and psychological functions, its potential to promote the long-term goals of exercise therapy in medical rehabilitation appears to be underutilised.

Correction to: Effects of a Group-Based Aerobic Exercise Program on the Cognitive Functions and Emotions of Substance Use Disorder Patients: a Randomized Controlled Trial

Correction to: Effects of a Group-Based Aerobic Exercise Program on the Cognitive Functions and Emotions of Substance Use Disorder Patients: a Randomized Controlled Trial

Effects of a 12-week intrinsic foot muscle strengthening training (STIFF) on gait in older adults: a parallel randomized controlled trial protocol

BackgroundFalling is highly prevalent among older adults and has serious impact. Age-induced mobility impairments, such as gait modifications, are strongly associated with increased fall risk. Among fall prevention interventions, those including exercises are most effective. However, there is an urgent need to further improve these kinds of interventions. Strengthening the plantar intrinsic foot muscles might benefit mobility in older adults, which may contribute to the reduction of fall risk. The aim of this paper is to provide a protocol to investigate the effect of a plantar intrinsic foot muscle strengthening training versus no training on gait and intrinsic foot muscle function in older adults who are involved in a functional exercise program.MethodsFor this assessor-blinded RCT, older adults (> 65 years) are recruited who are involved in a group-based functional exercise program. Eligibility criteria include: being able to ambulate 10 m barefoot without using a walking aid and reporting to have either fear of falling or experienced a fall in the previous 12 months or have difficulties with mobility, gait, or balance in daily life. Participants are randomly assigned to an intervention and a control group. The intervention group follows a 12-week plantar intrinsic foot muscle strengthening training. The training consists of isolated and functional foot exercises to be performed 5 times a week, each session lasting approximately 20 min. The training is supervised once a week and the intensity gradually increases based on the participant’s progression. Both groups keep a diary to report physical activities, fall incidents and movement related discomfort. The control condition is limited to keeping this diary. Data are collected at baseline and post-intervention. The trial outcomes are the between group differences in the mean change from baseline in maximum gait speed (primary outcome measure), capacity and strength of the plantar intrinsic foot muscles, foot and ankle biomechanics during gait, and various other fall risk-related variables. ANCOVA’s are used to analyze the trial outcomes.DiscussionThe results of this RCT will offer recommendations, related to plantar intrinsic foot muscle strengthening, to existing fall preventive exercise programs.Trial registrationThe trial is registered in the United States National Library of Medicine through ClinicalTrials.gov (NCT05531136, 07/26/2022).

Acceptability, feasibility, and effectiveness of WE-SURF™: a virtual supervised group-based fall prevention exercise program among older adults

Conducted physically, supervised group-based falls prevention exercise programs have demonstrated effectiveness in reducing the risk of falls among older adults. In this study, we aimed to assess the acceptability, feasibility, and effectiveness of a virtual supervised group-based falls prevention exercise program (WE-SURF™) for community-dwelling older adults at risk of falls.MethodA preliminary study utilizing virtual discussions was conducted to assess the acceptability of the program among six older adults. Effectiveness was evaluated in a randomized controlled feasibility study design, comprising 52 participants (mean age: 66.54; SD: 5.16), divided into experimental (n = 26) and control (n = 26) groups. The experimental group engaged in a 6-month WE-SURF™ program, while the control group received standard care along with a fall’s prevention education session. Feasibility of the intervention was measured using attendance records, engagement rates from recorded videos, dropouts, attrition reasons, and adverse events.ResultsPreliminary findings suggested that WE-SURF™ was acceptable, with further refinements. The study revealed significant intervention effects on timed up and go (TUG) (η2p:0.08; p < 0.05), single leg stance (SLS) (η2p:0.10; p < 0.05), and lower limb muscle strength (η2p:0.09; p < 0.05) tests. No adverse events occurred during the program sessions, and both attendance and engagement rates were high (> 80% and 8/10, respectively) with minimal dropouts (4%). The WE-SURF™ program demonstrated effectiveness in reducing the risk of falls while enhancing muscle strength and balance.ConclusionIn conclusion, WE-SURF™ was demonstrated to be an acceptable, feasible, and effective virtual supervised group-based exercise program for fall prevention in community-dwelling older adults at risk of falls. With positive outcomes and favourable participant engagement, WE-SURF™ holds the potential for wider implementation. Further research and scaling-up efforts are recommended to explore its broader applicability.(Registration number: ACTRN 12621001620819).

Implementation of Group-Based Exercise Programs in Physiotherapy: A Rapid Scoping Review.

This review synthesized implementation literature on group-based exercise programs in physiotherapy. MEDLINE and Embase databases were searched for English and French articles published between 2000 and 2022. Through a two-step process (titles/abstracts and full text), two independent reviewers selected studies. The independent reviewers then extracted data and assessed study quality using the Mixed Methods Appraisal Tool. A total of 31 studies involving 4555 participants were included. Data on the group-based programs were extracted using the Consensus on Exercise Reporting Template and reported narratively. Implementation outcomes were reported narratively. The most frequently reported constructs pertained to feasibility and acceptability. Overall, the implementation of group-based programs appeared to be feasible, yielding high rates of adherence and attendance (between 36% and 91%), moderate-to-high completion rates (between 46% and 100%), low-to-moderate dropout rates (between 4.5% and 35.9%), and high satisfaction (satisfaction scores generally ranging above 7/10). The present findings also indicate a high acceptability for group-based physiotherapy exercise programs among patients. This review provided an overview of the literature on the implementation of group-based exercise programs in physiotherapy. In addition, it identified the need for more evidence on fidelity and costs. Future research should address these gaps to better inform healthcare stakeholders.

Capturing Exercise Psychological Need Satisfaction Among Older Adults: The BPNES

ABSTRACT Regular exercise participation which is a component of promoting health and healthy aging among older adults necessitates the creation of environments that fulfill participants’ needs for autonomy, competence, and relatedness, thus, providing opportunities to promote authentic interest in the activities and meaningful social engagement. Appropriate tools to capture satisfaction of these needs may prove invaluable to gain an understanding of the effectiveness of exercise programs from participants’ perspective. The aim of the study was to examine psychometric aspects of the Basic Psychological Needs in Exercise Scale (BPNES) scores based on responses of 675 older adult Greek exercise participants, men and women, aged 65 to 80 years, attending indoor group-based exercise programs. The data supported the factorial validity, internal reliability, nomological validity, and equivalent item interpretation of BPNES scores between groups differing in demographic characteristics. Older adults with exercise experience greater than three years reported higher exercise needs satisfaction for all three needs compared to those exercising less than three years. The favorable psychometric characteristics of the BPNES in this population make it a valuable tool for the assessment of the extent to which older adults’ needs for autonomy, competence, and relatedness are fulfilled in group-based exercise settings.

Effects of Multicomponent Exercise on Community-Dwelling Older Adults With Mild Cognitive Impairment.

To explore the effects of a group-based multicomponent exercise program on general cognitive functioning, depression, and social functioning in community-dwelling older adults with mild cognitive impairment (MCI) and whether the effects can be maintained. Fifty older adults with MCI were conveniently recruited from two communities in the study area and randomly assigned to the intervention group or control group. The intervention group received three sessions of 60-minute, multicomponent exercise per week for 3 months, plus MCI-related health education. The control group only received MCI-related health education. Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment Beijing Version (MoCA-BJ) were used to assess general cognitive function. The Functional Activities Questionnaire (FAQ) and Geriatric Depression Scale (GDS-30) were used to evaluate participants' social function and depression, respectively. Participants' exercise intensity was assessed using the Category Ratio Scale. After the 3-month intervention, there were significant improvements in general cognitive function (p = 0.046), attention (p = 0.009), delayed recall (p = 0.015), and social function (p = 0.011) in the intervention group compared with the control group. However, after 3-month postintervention follow up, no significant differences in MMSE, MoCA-BJ, GDS-30, and FAQ scores were noted between groups. The 3-month multicomponent exercise program improved general cognitive function and social functioning in community-dwelling older adults with MCI. However, there was no evidence that these benefits lasted for another 3 months after stopping the exercise program. [Research in Gerontological Nursing, 17(2), 65-79.].

Exercise and behaviour change support for individuals living with and beyond cancer: Interim results and program satisfaction of the EXCEL study

PurposeExamine the impact of the EXercise for Cancer to Enhance Living Well's (EXCEL) 10–12-week exercise and behaviour change support intervention on secondary effectiveness outcomes, including patient-reported outcomes, physical function, and program satisfaction. MethodsIndividuals with cancer up to 3 years post treatment with any tumour type were eligible. Outcomes were measured at baseline and immediately following the 10–12-week intervention. Patient-reported outcomes included participant characteristics, overall well-being, cognition, fatigue, symptom severity, exercise barrier self-efficacy, and program satisfaction. Physical function included shoulder flexion, 30-s sit to stand, sit and reach, 2-min step test or 6-min walk test (in-person only), and single leg balance. Wilcoxon signed-rank tests were used to assess changes in patient-reported outcomes and physical function assessments from baseline to 12-weeks. ResultsA total of 804 participants enrolled in the study in the first 2.5-years, with 699 completing the intervention. Wilcoxon signed rank tests and Rosenthal coefficients (r) showed significant (p ​< ​0.05) small improvements in well-being (r ​= ​0.10), fatigue (r ​= ​0.25), symptom severity (r ​= ​0.17), and self-efficacy (r ​= ​0.11). Significant (p ​< ​0.01) moderate to large improvements were observed for the 30-s sit to stand (r ​= ​0.54), sit and reach (left: r ​= ​0.46; right: r ​= ​0.41), 2-min step test (r ​= ​0.66), 6-min walk test (r ​= ​0.52), and single leg balance (left: r ​= ​0.32; right: r ​= ​0.34) assessments. Participants reported high satisfaction with program staff (average ​= ​4.5/5) and that the program was beneficial and enjoyable (average ​= ​4.6/5). ConclusionEXCEL's group-based exercise program with behaviour change support, delivered in an online supervised setting to individuals living with cancer, may improve patient-reported outcomes and physical function and is associated with high participant satisfaction.

Experiences and perspectives of integrating nutrition education into an exercise program for people with chronic medical conditions.

Community-based healthy eating and exercise programs are effective interventions to support some people with chronic conditions. This research aimed to explore the experiences and perceptions of participants regarding the integration of nutrition education into a successful group based exercise program for people with chronic medical conditions. Semi-structured interviews were conducted with past participants of a community based group exercise program (Health Moves) with embedded nutrition advice based in a regional area of New South Wales. A total of 60 individuals who had participated in the Health Moves program between 2017 and 2019 were invited to participate and 19 (32%) randomly selected participants consented to be interviewed. Interviews explored participants' experiences, program impacts, and barriers to sustaining changes post program. Similar concepts and patterns were grouped into themes. Four themes were identified that described the experiences with a community-based group exercise intervention with a nutrition component. The major themes evident were that Health Moves facilitated motivation (via access to health professionals, peer support, accountability, affordability); and there were challenges identified to sustaining change (including cost, comorbidities, end of program support, environmental factors); Nutrition advice was valuable for some but not for all (difficulty recalling nutrition components, superficial coverage) Practical and interactive nutrition advice is desired. Participants expressed a high degree of satisfaction with the program but require ongoing support to sustain changes post program. The position and integration of nutrition education within this exercise program was perceived by participants to be suboptimal. Increased access to practical, interactive nutrition education components may improve participant satisfaction and engagement. SO WHAT?: Key findings from this research include a desire for removal of didactic nutrition education sessions and request for increased peer support. Modifications to the program include the integration of interactive self-paced nutrition modules. Peer support partnerships are now encouraged by trainers to support ongoing motivation of participants to keep training together outside the structured exercise program and transition to managing their own exercise routine. Discussions between organisations involved about ongoing pathway/program support or reduced cost 'off peak' gym membership is underway to help with costs incurred by participants.

Synchronous Group-Based Online Exercise Programs for Older Adults Living in the Community: A Scoping Review.

Older adults are the least physically active group with specific barriers to regular exercise, and online exercise programs could overcome some of those barriers. This scoping review aimed to describe the characteristics of supervised group-based synchronous online exercise programs for older adults living in the community, their feasibility, acceptability, and potential benefits. MEDLINE (Ovid), Embase, SPORTDiscus, and the Cumulative Index to Nursing and Allied Health Literature were searched until November 2022. The included studies met the following criteria: participants aged 50years and above, a minimum of a 6-week group-based supervised and synchronous intervention, and original articles available in English. Eighteen articles were included, with 1,178 participants (67% female, average age of 71 [57-93]years), most (83%) published in the past 3years. From the limited reported studies, delivering supervised, synchronous online exercise programs (one to three times/week, between 8 and 32weeks) for older adults living in the community seems feasible, accepted, and can improve physical function.

Role of Social Support and Technology Interventions in Exercise Adherence among Older Adults with Stroke: A Narrative Review

Stroke is a major cause of disability among older adults, and exercise is a critical component of poststroke rehabilitation. However, exercise adherence among stroke survivors is often low, leading to reduced quality of life and functional outcomes. This narrative review aims to explore the types and effectiveness of social support and technology interventions in promoting exercise adherence and improving health outcomes among older adults with stroke. The studies included in this review were relevant (original articles, systematic reviews, and meta-analyses) and reported on exercise adherence, social support, and technology within the context of older adults with stroke. The studies extracted for this narrative review were research articles published from 2010 till date. Electronic databases were searched to identify relevant studies. Our findings report that group-based exercise programs are more effective social support interventions for long-term exercise adherence than home-based individual programs for older adults. Technology, particularly remote monitoring devices and platforms, is also been effective in improving engagement and adherence to exercise programs, leading to better functional outcomes and enhanced quality of life for older adults with stroke. In conclusion, social support and technology are effective strategies for promoting exercise adherence in post-stroke older adults. However, further research is needed to identify how best to complement social support approaches with technology tools in clinical practice for optimal outcomes. Through these strategies healthcare professionals can improve functional outcomes and enhance the quality of life for stroke survivors.

The ESCAPE Trial for Older People With Chronic Low Back Pain: A Feasibility Study of a Clinical Trial of Group-Based Exercise in Primary Health Care.

Low back pain is a highly disabling health condition that generates high costs for patients and healthcare systems. For this reason, it is considered a serious public health problem worldwide. This pilot study aimed to assess the feasibility of a future randomized controlled trial (RCT) by evaluating adherence to treatment, contamination between groups, satisfaction with treatment, and understanding of the exercise instructions provided by the physiotherapist. Additionally, we sought to identify and implement necessary modifications to the exercise protocol for better suitability in older people. We conducted a prospective, registered pilot RCT comparing an 8-week group-based exercise program with a waiting list in older people (≥60years old) with chronic low back pain. Sixty participants were recruited through social media, pamphlets, and invitations at community referral centers. The study demonstrated the feasibility of a full RCT. Participants reported high satisfaction with the treatment (i.e.,100% indicated willingness to return for future services) and a high understanding of the exercise instructions (i.e.,81.8% reported "very easy" comprehension). Adherence to the exercise program exceeded the average reported for group exercise interventions in older adults (i.e.,82.58%). Dropout was associated solely with preexisting physical activity levels. The exercise protocol was successfully adapted to better suit the needs of the older adult population. This pilot RCT demonstrates the feasibility of a full-scale RCT to evaluate the effectiveness of group exercise in improving pain intensity and disability in older adults with chronic low back pain. The implemented adjustments to the exercise protocol and overall study approach strengthen the methodological foundation and expected accuracy of the future RCT.

AYA-UNITE: Lessons Learned on Intervention Development Promoting Social and Physical Health of Adolescent/Young Adult Cancer Survivors.

Adolescent/young adult cancer survivors (AYACS) struggle with poor psychosocial health related to social disruptions due to cancer diagnosis, impacting long-term goal achievement and overall health. In particular, social health promotion is overlooked in AYACS' care. AYA-UNITE, a sociobehavioral exercise intervention pilot for AYACS 15-21 years of age at cancer diagnosis, was designed to foster AYACS' social and physical health. AYA-UNITE was a 12-week group-based virtual exercise program incorporating strength training and aerobic activity. In this brief report, we account AYA-UNITE's conceptual design, lessons learned through AYA-UNITE intervention development, and opportunities for improvement in implementing effective AYACS psychosocial interventions (NCT03778658).

Sex-Related Differences in Functional Fitness Outcomes in Older Adults.

Sex-related differences in changes in functional fitness over time were longitudinally assessed in older adults participating in a group-based multimodal exercise program. From a database, functional fitness scores were obtained for 89 older adults (71.6 ± 6.5years old) who had completed two assessments, 5-8years apart. Lower body strength, upper body strength, aerobic endurance, flexibility, and change of direction performances were compared over time and with normative values. Females (p = .02), but not males, had an improvement in upper body strength over time. Females were also more flexible than males at both assessments (p ≤ .02). Of those who had five consecutive assessments, females were more flexible than males (p ≤ .05) and had a faster change of direction ability (p < .001). When compared with normative values, our results indicate that typical time-related functional fitness loss can be attenuated with group exercise. Our results further support the need to tailor exercise prescription according to the individual.

“To be myself again”: Perceived benefits of group-based exercise for colorectal cancer patients

PurposeTo explore the perceived benefits of a group-based exercise program for patients with colorectal cancer (CRC) undergoing chemotherapy treatment. MethodsIn-depth semi-structured interviews were conducted with all participants (n = 27) at the end of the exercise program (patients, relatives and healthcare professionals). The exercise instructor in charge of the exercise program with CRC patients also collected observational field notes throughout a research diary. ResultsThree main themes related to exercise as a coping strategy were obtained: (a) physical recovery; (b) psychosocial well-being, and (c) reconnection with their embodied selves and normal lives. Physical recovery included a perceived increase in fitness and a reduction in physical side-effects. Psychosocial well-being included perceived benefits in self-confidence, sense of control, reduced fear, feeling of being useful, sense of achievement, positive thinking and avoiding depression. All the physical and psychosocial benefits helped patients reconnect with their embodied selves, engage in activities practised before the diagnoses, improve their body image, avoid stigma, and increase their social life beyond cancer diagnoses. In this sense, some patients held on to their past selves, trying to keep or recover normality in their lives, while others acknowledged that they might not be the same person anymore, with exercise being part of this new identity. ConclusionsThis study shows that exercise is a coping strategy that benefitted CRC patients in several ways related to their physical and psychosocial quality of life.

The online delivery of exercise oncology classes supported with health coaching: a parallel pilot randomized controlled trial

PurposeThe primary objective was to investigate the feasibility of a synchronous, online-delivered, group-based, supervised, exercise oncology maintenance program supported with health coaching.MethodsParticipants had previously completed a 12-week group-based exercise program. All participants received synchronous online delivered exercise maintenance classes, and half were block randomized to receive additional weekly health coaching calls. A class attendance rate of ≥ 70%, a health coaching completion rate of ≥ 80%, and an assessment completion rate of ≥ 70% were set as markers of feasibility. Additionally, recruitment rate, safety, and fidelity of the classes and health coaching calls were reported. Post-intervention interviews were performed to further understand the quantitative feasibility data. Two waves were conducted — as a result of initial COVID-19 delays, the first wave was 8 weeks long, and the second wave was 12 weeks long, as intended.ResultsForty participants (n8WK = 25; n12WK = 15) enrolled in the study with 19 randomized to the health coaching group and 21 to the exercise only group. The recruitment rate (42.6%), attrition (2.5%), safety (no adverse events), and feasibility were confirmed for health coaching attendance (97%), health coaching fidelity (96.7%), class attendance (91.2%), class fidelity (92.6%), and assessment completion (questionnaire = 98.8%; physical functioning = 97.5%; Garmin wear-time = 83.4%). Interviews highlighted that convenience contributed to participant attendance, while the diminished ability to connect with other participants was voiced as a drawback compared to in-person delivery.ConclusionThe synchronous online delivery and assessment of an exercise oncology maintenance class with health coaching support was feasible for individuals living with and beyond cancer. Providing feasible, safe, and effective exercise online to individuals living with cancer may support increased accessibility. For example, online may provide an accessible alternative for those living in rural/remote locations as well as for those who may be immunocompromised and cannot attend in-person classes. Health coaching may additionally support individuals’ behavior change to a healthier lifestyle.Trial registrationThe trial was retrospectively registered (NCT04751305) due to the rapidly evolving COVID-19 situation that precipitated the rapid switch to online programming.

Effects of foot-ankle exercises on foot-ankle kinematics, plantar pressure, and gait kinetics in people with diabetic neuropathy: Secondary outcomes from a randomized controlled trial

BackgroundFollow-up report of secondary outcomes of a randomized, single-blinded, parallel controlled trial that investigated the benefits of a foot-ankle therapeutic exercise program on foot-ankle kinematics, plantar pressure, and lower limb kinetics during gait in individuals with diabetic neuropathy (DPN). MethodsSixty-six participants with DPN were randomly allocated into a control group (CG; n = 31), which received usual care, and an intervention group (IG; n = 35), which received usual care plus a 12-week group-based foot-ankle exercise program. Outcomes were assessed at baseline and 12 weeks by an assessor blinded to group allocation. ResultsThe generalized linear mixed model and intention-to-treat analysis revealed a greater hip extensor moment at push-off and greater hallux contact area in the IG than CG after 12 weeks. A within-group analysis revealed a larger arch height during stance and higher peak pressure and pressure-time integral at the central forefoot region in the IG after 12 weeks compared to baseline. There were no other significant group difference or changes over time in foot-ankle kinematics or in any other joint moment related to overall lower limb biomechanics. ConclusionThe increases in hip moment at push-off and hallux surface contact area suggest an improvement in the propulsion phase with greater participation of the toes in foot rollover after 12 weeks of a group-based foot-ankle exercises program for people with DPN. Individual face-to-face, longer-term, and more intensive interventions may be needed to positively influence foot-ankle biomechanics and pressure parameters in other plantar areas.

Therapist competencies in the context of group-based exercise programs in medical rehabilitation: a qualitative study with patients and exercise therapists from Germany

BackgroundGroup-based exercise programs account for nearly half of exercise therapy services provided in German medical rehabilitation facilities. However, information about necessary therapist competencies for the successful execution of these programs is sparse. Thus, the aim of this qualitative study was to explore relevant therapist competencies in the context of group-based exercise programs from the patients’ and therapists’ perspective.MethodsSemi-structured interviews were conducted with five rehabilitation patients following a 3-week inpatient orthopedic rehabilitation program as well as five exercise therapists with work experience in group-based exercise therapy. Data were analyzed using structuring content analysis according to Kuckartz.ResultsFrom 155 topic-related text passages, collected over 10 interviews, four competency categories with 16 subcategories and respective characteristics were identified. In addition to professional expertise like biomedical knowledge, exercise therapists were expected to possess a multitude of didactic-methodological, personal, and social-communicative abilities.ConclusionOur results suggest that the psychosocial, behavioral and educational goals of group-based exercise programs necessitate a wide range of therapist competencies. These conform to the multidimensional nature of exercise therapy and should therefore be covered in vocational and continuing education.