Home-based Group Research Articles

Comparison of Obesity Related Index and Exercise Capacity Between Center-Based and Home-Based Cardiac Rehabilitation Programs.

ObjectiveTo compare a center-based cardiac rehabilitation (CR) program with a home-based CR program in terms of improving obesity related index and cardiopulmonary exercise capacity after the completing a phase II CR program.MethodsIn this study, there were seventy-four patients with acute myocardial infarction after percutaneous coronary intervention who were analyzed. Patients with mild to moderate risk (ejection fraction >40%) were included in the group. The patients underwent an exercise tolerance test by measurement of the modified Bruce protocol at three assessment points. Those in the center-based CR group participated in a 4-week training program with electrocardiography monitoring of the patient’s progress and results, while those patients who were in the home-based CR group underwent self-exercise training. We measured the obesity related indices such as body mass index, fat free mass index (FFMI), and cardiopulmonary exercise capacity including peak oxygen consumption (VO2max), metabolic equivalents (METs), heart rate, resting systolic blood pressure and the diastolic blood pressure of the participants and noted the results.ResultsOf the 74 patients, 25 and 49 participated in the center-based and home-based CR programs, respectively. Both groups showed significant improvement in VO2max and METs at 1-month and 6-month follow-up. However, FFMI was significantly improved only in the center-based CR group after 1 month of the phase II CR.ConclusionBoth groups identified in the study showed significant improvement of VO2max and METs at 1-month and 6-month follow-up. However, there was no significant difference in the intergroup analysis. A significant improvement of FFMI was seen only in the center-based CR group after phase II CR.

Parents' acceptance and regret about end of life care for children who died due to malignancy.

PurposeTo analyse the preference of end of life care place in paediatric oncology patients, and to understand the end of life care needs and regrets among the care givers.MethodThis was an observational qualitative study. Parents of in-curable paediatric malignancy patients who died during the years 2016–2018 were interviewed using a pre-formed open-ended questionnaire. Fears during the last phase of child’s life, most disturbing symptoms, choice of end of life care plan, regret of care givers and reasons for such choices were noted and analysed.ResultTwenty six families were interviewed. A median of 3 months of discordance was noted between declaration of in-curability and acceptance of the same by the family. During terminal months, pain (84.62%) was described as the most bothersome symptom followed by respiratory distress (73.08%). Eighteen families (69%) opted for home-based terminal care, 8 (31%) for hospital-based terminal care. Regret of choice was noted in 62.5% families of the hospital-based care group (separation from home environment being the main reason) and 38.89% of the home-based care group (lack of access to health care personnel and pain medication being the main reasons).ConclusionHome-based care is the preferred option for end of life care by the care givers. Lack of community-based terminal care support system and availability of analgesics are the main areas to work on in India.

Loss of relationship: a qualitative study of families and healthcare providers after patient death and home-based palliative care ends.

Home-based palliative care is care of the patient in their home, while doctors and other healthcare providers (HCPs) make visits as required. Family involvement naturally cultivates a relationship between HCPs and the family. Once the patient dies and home-based palliative care ends, this relationship is abruptly terminated, which may be challenging to both the family and the HCPs. The objective of this study was to understand the thoughts and opinions of HCPs and families on their encountered loss of relationship at the end of home-based palliative care. Perceptions of 63 participants (32 HCPs and 31 family members) were explored using semi-structured interviews and the qualitative research methodologies of grounded theory. HCPs were interviewed at the Temmy Latner Centre for Palliative Care (TLCPC), a home-based palliative care group of physicians, and 2 hospitals in Toronto, while family members were recruited from TLCPC's records of deceased patients. Six overarching themes, relating to HCP-family relationship dynamics, the experience of loss of relationship, and potential solutions, were derived from the data: (I) home palliative care is intimate; (II) dissatisfaction is experienced with abrupt relationship ending; (III) families benefit from open communication, especially after patient death; (IV) HCPs recognize the insufficiency in bereavement resources; (V) benefits are recognized for a system to ease loss of relationship, and lastly; (VI) challenges with introducing such a system concern HCP. Overall, families and HCPs do not like the loss of relationship post-patient death, and recognize the potential benefits of an approach that would allow for communication going forward.

Cost-effectiveness of a home-based group educational programme on renal replacement therapies: a study protocol

IntroductionLiving donor kidney transplantation (LDKT) is the optimal treatment for most patients with end-stage renal disease (ESRD). However, there are numerous patients who cannot find a living kidney donor. Randomised...

Endocrine Therapy-Related Symptoms and Quality of Life in Female Cancer Survivors in the Yale Fitness Intervention Trial.

The aim of the current study was to describe and compare endocrine therapy-related symptoms and quality of life in female cancer survivors taking aromatase inhibitors, tamoxifen, and no endocrine therapy, and to evaluate the effect of an exercise intervention on these symptoms and quality of life. Randomized controlled trial. An aerobic resistance exercise intervention group was compared with a home-based exercise control group over 1 year. The exercise intervention was supervised for the first 6 months, followed by 6 unsupervised months. Perimenopausal and early postmenopausal female cancer survivors within 3 years of completing primary or adjuvant chemotherapy were selected. A total of 154 women were enrolled in the study. Type of endocrine or hormonal therapy was documented. Symptoms were measured by the Breast Cancer Prevention Trial Symptom Checklist and the Functional Assessment of Cancer Therapy-Endocrine Subscale. Quality of life was measured by the Functional Assessment of Cancer Therapy-General. Data were collected at baseline, and at 6 and 12 months. Participants generally had mild symptom distress. There was no difference in symptoms by endocrine therapy group or by exercise group. Participants taking aromatase inhibitors in the aerobic resistance exercise intervention group reported significant improvement in social, family, and functional well-being and better quality of life compared to those in the control group at 6 months but not at 12 months. Findings were similar to those of previous large clinical trials in that no significant differences were found for endocrine therapy-related symptoms and quality of life by type of endocrine therapy taken. However, exercise may improve quality of life outcomes for women taking aromatase inhibitors. Exercise has established efficacy for patient outcomes such as cardiovascular fitness, fatigue, weight management, and quality of life and may provide better quality of life for women who take aromatase inhibitors as adjuvant therapy.

Participation in Physical Activity During Center and Home-Based Pulmonary Rehabilitation for People With COPD: A SECONDARY ANALYSIS OF A RANDOMIZED CONTROLLED TRIAL.

To compare levels of physical activity during center and home-based pulmonary rehabilitation (PR) in people with chronic obstructive pulmonary disease. Forty-five consecutive participants (23 male, n = 20, in the home-based group) with mean age of 68 ± 8 yr and forced expiratory volume in the first second of expiration (FEV1) 53 ± 18% predicted undertook physical activity monitoring using the SenseWear Armband during the final week of the interventions of center or home-based PR. Differences in time spent in total physical activity (≥1.5 METs), time spent in moderate to vigorous intensity physical activity (≥3 METs), and steps were compared. Home participants spent a median and interquartile range of 310 (199-328) min/d engaged in total physical activity (29% moderate to vigorous intensity physical activity) compared with 300 (204-370) min/d for the center group (28% moderate to vigorous intensity physical activity, P = .98). Daily step count did not differ between groups (home-based median 5232 [2067-7718] versus center-based median 4049 [1983-6040], P = .66). Of note, center-based participants took 38% more steps on days of program attendance compared with nonattendance days (mean difference: 761 steps/d; 95% CI, -56 to 1579, P = .06). For people with chronic obstructive pulmonary disease undertaking PR, no differences in physical activity levels between center and home-based programs were demonstrated. Understanding the impact of the indirect supervision and motivational interviewing technique utilized during home-based PR on levels of physical activity in people with chronic obstructive pulmonary disease may support clinical implementation of the model as an alternative option to traditional care.

Implementing a Home-Based Telehealth Group Adherence Intervention with Adolescent Transplant Recipients.

Introduction: To improve access to care and engage adolescent transplant recipients for adherence-promoting interventions, innovative solutions utilizing technology are needed. Materials and Methods: This study describes the implementation of a five-session group intervention targeting medication adherence in adolescent transplant recipients through home-based telemedicine. Results: Seven videoconferencing groups were conducted with a total of 33 participants living a median of 57 miles away from their transplant medical center. The median coefficient of variation (CV) of tacrolimus (immunosuppression medication) decreased from 32.2% to 23.5% from the pregroup to postgroup phase. Analyses indicated that the group was acceptable and engaging for participants, as highlighted by one participant reporting, "I liked how me and the group members came together… it felt like a little family." Overall satisfaction with the group and with the technology was endorsed by 86%. The group intervention was generally feasible; however, there were technological difficulties reported by participants and the facilitator, particularly given the diversity of the home-based connections and equipment. Other adaptations helped improve recruitment, attendance, and participation. Discussion: Implementing a telehealth group can pose unique challenges, especially with a group of adolescent participants. Although nonsignificant, we observed a decrease in the median CV of tacrolimus, indicating that medication adherence generally improved after group intervention. Our experience facilitating these groups provides insights into strategies to optimize feasibility and the participant experience. Distance of participants from the hospital is an important consideration and provides a strong rationale for the need for telemedicine-enabled approaches. We explore and discuss the challenges to implementing a home-based group, suggest practical strategies and developmentally sensitive adjustments when working with adolescents, and propose strategies to prepare clinicians for obstacles that may present when implementing a telehealth group with youth.

Effects of a 12-week home-based exercise program on quality of life, psychological health, and the level of physical activity in colorectal cancer survivors: a randomized controlled trial.

To examine the effects of a home-based exercise program on quality of life (QOL), psychological health, and the level of physical activity (PA) in colorectal cancer survivors. Seventy-one colorectal cancer survivors were randomized into either a home-based exercise group (N = 37) or control group (N = 34). The home-based exercise program included unsupervised walking, stationary bike, or swimming for aerobic exercise, as well as resistance exercise DVDs, a pedometer, and an exercise log. The Functional Assessment of Cancer Therapy-Colorectal, Functional Assessment of Chronic Illness Therapy-Fatigue Scale, patient health questionnaire, and Godin Leisure-Time Exercise Questionnaire were used to assess QOL, fatigue, depression, and PA levels. Among the 71 participants, 30 in the exercise group and 28 in the control group completed the study. The change in the QOL between the intervention and control groups was insignificant. However, QOL was significantly improved in the exercise group (QOL, p = 0.024). Sub-domain of QOL, emotional well-being, and trial outcome index-physical/functional/colorectal (p = 0.015 and p = 0.035, respectively) were improved in the exercise group. The level of PA was significantly increased after 12weeks in the exercise group (97.0 ± 188.5 vs. 332.6 ± 306.1, p < 0.001), and the change significantly differed compared with the control group (mean change 235.6 vs. 16.3, p < 0.001). The home-based exercise program may improve the QOL and psychological health in colorectal cancer survivors. We have demonstrated that the home-based exercise program was effective in increasing the level of PA in colorectal cancer survivors.

A four-week, home-based exercise program is effective in treating subacute low back

Background: Low back pain (LBP) is a prevalent condition affecting a large portion of the population world-wide and it is one of the leading causes of morbidity and work absenteeism. Objective: To investigate the effectiveness of a four-week, home-based exercise program in treating subacute LBP in adults.&#x0D; Methods: A quantitative, experimental research design was employed. Twenty male and female adults aged between 18 and 65 years with subacute LBP were recruited by means of advertisements and word of mouth and allocated into either a control group (CG) or a home-based exercise group (HG). Both groups underwent a pre-test that consisted of answering two questionnaires, the Visual Analogue Scale for Pain (VASP) and the Oswestry LBP and Disability Questionnaire. The (CG) received no intervention over the four-week intervention period, while the intervention group (HG) was given an exercise program and instructed to perform the exercises at home, three times a week for four weeks. After four weeks (post-test), the two questionnaires were repeated. After eight weeks (follow-up test) both groups again completed the two questionnaires. Descriptive statistics, non-parametric inferential statistics and Cohen’s effect size (d) were used to analyse the data and statistical significance was set at a confidence level of 95% (p?0.05).&#x0D; Results: Following the home-based exercise intervention there were significant improvements observed in lower back pain and function for the HG. The HG’s Oswestry scores improved significantly (p=0.005) and their VASP also showed a significant improvement (p=0.011). Significant improvements also occurred between the pre-test and four-week follow-up for the HG’s Oswestry score (p=0.021) and for the HG’s VASP (p=0.005). No significant improvement was found for the CG between pre-test and post-test or between pre-test and the four-week follow-up. Large effect sizes (d&gt;0.8) were also observed for the HG between the pre- and the post-test (d=1.59) as well as between the HG and the CG at post-test (d=1.52) and at the four-week follow-up (d=1.6).&#x0D; Conclusion: The exercise intervention resulted in statistically significant and clinically significant improvements in both function and pain in adults with subacute LBP.

A four-week home-based exercise programme is effective in treating subacute low back pain in adults

Background: Low back pain (LBP) is a prevalent condition affecting a large portion of the population world-wide and it is one of the leading causes of morbidity and work absenteeism. Objective: To investigate the effectiveness of a four-week, home-based exercise program in treating subacute LBP in adults.&#x0D; Methods: A quantitative, experimental research design was employed. Twenty male and female adults aged between 18 and 65 years with subacute LBP were recruited by means of advertisements and word of mouth and allocated into either a control group (CG) or a home-based exercise group (HG). Both groups underwent a pre-test that consisted of answering two questionnaires, the Visual Analogue Scale for Pain (VASP) and the Oswestry LBP and Disability Questionnaire. The (CG) received no intervention over the four-week intervention period, while the intervention group (HG) was given an exercise program and instructed to perform the exercises at home, three times a week for four weeks. After four weeks (post-test), the two questionnaires were repeated. After eight weeks (follow-up test) both groups again completed the two questionnaires. Descriptive statistics, non-parametric inferential statistics and Cohen’s effect size (d) were used to analyse the data and statistical significance was set at a confidence level of 95% (p?0.05).&#x0D; Results: Following the home-based exercise intervention there were significant improvements observed in lower back pain and function for the HG. The HG’s Oswestry scores improved significantly (p=0.005) and their VASP also showed a significant improvement (p=0.011). Significant improvements also occurred between the pre-test and four-week follow-up for the HG’s Oswestry score (p=0.021) and for the HG’s VASP (p=0.005). No significant improvement was found for the CG between pre-test and post-test or between pre-test and the four-week follow-up. Large effect sizes (d&gt;0.8) were also observed for the HG between the pre- and the post-test (d=1.59) as well as between the HG and the CG at post-test (d=1.52) and at the four-week follow-up (d=1.6).&#x0D; Conclusion: The exercise intervention resulted in statistically significant and clinically significant improvements in both function and pain in adults with subacute LBP.

Relationship of Neuropsychiatric Symptoms with Falls in Alzheimer's Disease - Does Exercise Modify the Risk?

To explore how neuropsychiatric symptoms (NPS) are associated with number of falls and how exercise modifies the risk of falling in community-dwelling people with Alzheimer's disease (AD) and NPS. Secondary analysis of a randomized controlled trial. Community. Community-dwelling individuals with AD (N=210) who completed the Neuropsychiatric Inventory (NPI) (N = 179). Participants were randomized into 3 groups: group-based exercise (4-hour sessions with approximately 1 hour of training) and tailored home-based exercise (1 hour of training) twice a week for 1 year and a control group receiving usual community care. In this secondary analysis, we merged the home-based and group-based exercise groups and compared this group with the control group. NPS were measured using the NPI at baseline, and spousal caregivers recorded falls in daily fall diaries during 1 year of follow-up. The number of falls increased linearly with NPI score in the control group. Fall rates were 1.48 (95% confidence interval (CI)=1.26-1.73) per person-year in the intervention group and 2.87 (95% CI=2.43-3.35) in the control group. Adjusted for age, sex, Mini-Mental State Examination (MMSE) score, and Short Physical Performance Battery (SPPB) score, incidence rate ratio (IRR) was 0.48 (95% Cl=0.39-0.60, p < .001). Main effects for fall rate were significant for group (p < .001) and NPI total (p < .02); the interaction effect was also significant (p = .009) (adjusted for sex, age, MMSE score, SPPB score, and psychotropic medication use). Exercise may decrease the risk of falling in community-dwelling individuals with AD and NPS. Future exercise trials should confirm this finding in participants with significant NPS. ACTRN12608000037303. J Am Geriatr Soc 66:2377-2381, 2018.

A comparison of blood pressure reductions following 12-weeks of isometric exercise training either in the laboratory or at home

Isometric exercise training (IET)–induced reductions in resting blood pressure (RBP) have been achieved in laboratory environments, but data in support of IET outside the laboratory are scarce. The aim of this study was to compare 12 weeks of home-based (HOM) IET with laboratory-based, face-to-face (LAB) IET in hypertensive adults. Twenty-two hypertensive participants (24–60 years) were randomized to three conditions: HOM, LAB, or control (CON). IET involved isometric handgrip training (4 × 2 minutes at 30% maximum voluntary contraction, 3 days per week). RBP was measured every 6 weeks (0, 6, and 12 weeks) during training and 6 weeks after training (18 weeks). Clinically meaningful, but not statistically significant reductions in RBP were observed after 12 weeks of LAB IET (resting systolic blood pressure [SBP] −9.1 ± 4.1; resting diastolic blood pressure [DBP] −2.8 ± 2.1; P > .05), which was sustained for 6 weeks of detraining (SBP −8.2 ± 2.9; DBP −4 ± 2.9, P > .05). RBP was reduced in the HOM group after 12 weeks of training (SBP −9.7 ± 3.4; DBP −2.2 ± 2.0; P > .05), which was sustained for an additional 6 weeks of detraining (SBP −5.5 ± 3.4; DBP −4.6 ± 1.8; P > .05). Unsupervised home-based IET programs present an exciting opportunity for community-based strategies to combat hypertension, but additional work is needed if IET is to be used routinely outside the laboratory.

Home-based versus office-based biofeedback therapy for constipation with dyssynergic defecation: a randomised controlled trial

Office-based biofeedback therapy is effective for constipation with dyssynergic defecation, but must be performed by skilled staff, is only available in selected centres, and requires multiple visits. The efficacy of home-based biofeedback therapy is unknown. We compared clinical and subjective outcomes with home-based and office-based approaches. In this randomised controlled trial, eligible patients were adult outpatients (age 18-80 years) who met the Rome III criteria for functional constipation and who had been referred to a tertiary-care centre after non-response to routine management, and who had dyssynergic defecation. Patients were randomly assigned according to a schedule generated in advance by the study biostatistician, in permuted blocks of four, to receive office-based or home-based biofeedback therapy. Office-based biofeedback comprised therapist-guided pelvic floor training for six sessions over 3 months (visits every 2 weeks). Home-based biofeedback comprised 20 min self-training sessions twice per day, in which a self-inserted probe was used to provide visual feedback via a handheld monitoring device of anal sphincter pressure and push effort. Patients recorded in diaries the time of each defecation attempt, stool consistency, straining effort, feeling of incomplete evacuation, need for digital assistance with stooling, and satisfaction with bowel function, from 1 week before enrolment to the end of follow-up. Treatment responders were defined post hoc as those with normalisation of dyssynergic defecation and an increase in the number of complete spontaneous bowel movements per week by 3 months. Cost outcomes calculated from health-care costs and loss of salary were assessed from hospital billing and medical records and questionnaires. Primary outcome measures were the presence of a dyssynergic pattern during attempted defecation, balloon expulsion time, the number of complete spontaneous bowel movements per week, and satisfaction with bowel function, assessed by intention to treat (non-inferiority) and per protocol. This trial is registered with ClinicalTrials.gov, number NCT03202771. Of 300 patients screened we enrolled 100, from Jan 7, 2005, to Jan 31, 2010. 83 patients completed training (38 [76%] of 50 in the home-based biofeedback group and 45 [90%] of 50 in the office-based biofeedback group). 34 (68%) patients in the home-based group and 35 (70%) in the office-based group were classified as responders. All primary outcomes improved significantly from baseline in the two treatment groups (all p<0·0001). Home-based biofeedback therapy was non-inferior to office-based therapy for number of complete spontaneous bowel movements per week, satisfaction with bowel function, and balloon expulsion time in the intention-to-treat and per-protocol analyses, and for dyssynergia in the per-protocol analysis. No adverse events were reported. The median cost of home-based biofeedback therapy was significantly lower than that for office-based treatment (US$1081·70, IQR 794·90-1399·30 vs $1942·50, 1621·70-2369·00, p=0·009). Home-based and office-based biofeedback therapy for dyssynergic defecation improved bowel symptoms and physiology with similar efficacy. A home-based programme could substantially broaden the availability and use of this treatment. National Institutes of Health.

Comparison of hospital based and home based exercise on quality of life, and neck and shoulder function in patients with spinal accessary nerve injury after head and neck cancer surgery

ObjectivesThe purpose of this study was to compare the effects of hospital-based and home-based exercise programs on quality of life (QOL) and neck and shoulder function of patients who underwent head and neck cancer (HNC) surgery. MethodsThis clinical trial included 40 patients with neck and shoulder dysfunction after HNC. The exercise program included range of motion (ROM) exercises, massage, stretching, and strengthening exercises. Twenty patients who were assigned to the hospital-based exercise group performed physical therapy for 40 min three times a week for four weeks, and the remaining 20 patients were assigned to the home-based group. The European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30), the EORTC Head and Neck Questionnaire (EORTC QLQ-H&N), the Neck and Shoulder Disability Index (NDI), ROM, and numeric rating scale (NRS) were assessed before and after the exercise program. The program consisted of a 10-minute ROM to the neck and shoulder, a 10-minute massage, and 15 min of progressive resistance exercises, followed by a five-minute stretching exercise. ResultsThere were statistically significant differences in the changes of neck and shoulder disability index (p < .05). Additionally, there were significant differences in neck extension and rotation ROM and NRS in the hospital-based group compared with the home-based group (p < .05). QOL was not significantly different between the two groups. ConclusionsHome-based exercise was effective for improving QOL, shoulder function, and pain relief. Hospital-based exercise had better effects on physical function of the neck and shoulder and reduced pain.

The effect of home-based phototherapy on parental stress in mothers of infants with neonatal jaundice

BackgroundHospitalization of an infant in the first days following birth is one of the most stressful events in the life of the parents of any parent. More than half of the infants suffer from neonatal jaundice, and are referred to health centers by their parents for treatment. In wake of this, the present study aims to examine the effect of home-based phototherapy on parental stress in mothers of infants with neonatal jaundice. MethodsThis is a clinical trial carried out on 64 infants with hyperbilirubinemia referred to health centers of Isfahan in 2017. The samples were randomly divided into two experimental (home-based phototherapy) and control (hospital-based phototherapy) groups. The instruments consisted of the training checklist, demographic characteristics of the mother and the parental stress scale, which was given to the parents at two stages, and the data were recorded on a daily basis and at the end of the intervention. ResultsThe results of this study showed that the mean score of maternal stress before intervention was not significantly different between the two groups (P < 0.008), but after intervention, the mean score of maternal stress in the home-based phototherapy group (56.51) was significantly lower than that of the hospital-based phototherapy group (65.23) (P < 0.001). ConclusionAccording to the findings of this research, home-based phototherapy can be considered as a suitable strategy for treatment and prevention of infant admission by reducing parental stress.

A digitally supported home-based exercise training program and dietary protein intervention for community dwelling older adults: protocol of the cluster randomised controlled VITAMIN trial

BackgroundIncreased physical activity and dietary protein intake are promising interventions to prevent or treat the age-related decline in physical performance in older adults. There are well-controlled exercise as well as dietary intervention studies that show beneficial effects on physical performance in older adults. In practice, however, weekly group based exercise or nutritional programs may not be as effective. To optimise these exercise programs for community dwelling older adults, a digitally supported and personalised home-based exercise training program has been designed aiming to improve physical performance in older adults. In addition, a protein intervention in combination with the training program may further improve physical performance in older adults.MethodsThe VITAMIN study will be a cluster randomised controlled trial with three parallel arms. In total, 240 community dwelling older adults (≥ 55 years) participating in weekly group exercise are randomly allocated into: 1) regular weekly exercise program (Control group, n = 80), 2) digitally supported personalised home-based exercise training program group (VITA group, n = 80) and 3) digitally supported personalised home-based exercise training program group plus dietary protein counselling (VITA-Pro group, n = 80). The VITAMIN study aims to evaluate effectiveness of the digitally supported personalised home-based exercise training program as well as the additional value of dietary protein on physical performance after 6 months. In addition, a 12 month follow-up measurement will assess the retaining effect of the interventions. Primary outcome is physical performance measured by the Modified Physical Performance Test (M-PPT) and relevant secondary and observational outcomes include habitual physical activity and dietary intake, body composition, cognitive performance, quality of life, compliance and tablet usage. Data will be analysed by Linear Mixed Models.DiscussionTo our knowledge, the VITAMIN study is the first study that investigates the impact of home-based exercise, protein intake as well as use of persuasive technology in the population of community dwelling older adults.Trial registrationNL56094.029.16 / NTR (TC = 5888; registered 03–06-2016).

Supervised, but Not Home-Based, Isometric Training Improves Brachial and Central Blood Pressure in Medicated Hypertensive Patients: A Randomized Controlled Trial.

Meta-analyses have shown that supervised isometric handgrip training reduces blood pressure in hypertensives. However, the mechanism(s) underlying these effects in medicated hypertensive patients, as well as the effects from home-based exercise training, is uncertain. The purpose of this study was to compare the effects of supervised and home-based isometric handgrip training on cardiovascular parameters in medicated hypertensives. In this randomized controlled trial, 72 hypertensive individuals (38–79 years old, 70% female) were randomly assigned to three groups: home-based, supervised isometric handgrip training or control groups. Home-based and supervised isometric handgrip training was completed thrice weekly (4 × 2 min at 30% of maximal voluntary contraction, with 1-min rest between bouts, alternating the hands). Before and after 12 weeks brachial, central and ambulatory blood pressures (BP), arterial stiffness, heart rate variability, vascular function, oxidative stress and inflammation markers were obtained. No significant (p > 0.05) effect was observed for ambulatory BP, arterial stiffness, heart rate variability, vascular function and oxidative stress and inflammatory markers in all three groups. Brachial BP decreased in the supervised group (Systolic: 132 ± 4 vs. 120 ± 3 mmHg; Diastolic: 71 ± 2 vs. 66 ± 2 mmHg, p < 0.05), whereas no significant differences were observed in the home-based (Systolic: 130 ± 4 vs. 126 ± 3 mmHg; diastolic: 73 ± 3 vs. 71 ± 3 mmHg) and control groups (p > 0.05). Supervised handgrip exercise also reduced central BP systolic (120 ± 5 vs. 109 ± 5 mmHg), diastolic (73 ± 2 vs. 67 ± 2 mmHg); and mean BP (93 ± 3 vs. 84 ± 3 mmHg), whereas no significant effects were found in the home-based (Systolic: 119 ± 4 vs. 115 ± 3 mmHg; Diastolic: 74 ± 3 vs. 71 ± 3 mmHg) and control groups (p > 0.05). In conclusion, supervised, but not home-based, isometric training lowered brachial and central BP in hypertensives.

Comparison of home-based and therapist-supervised balance training on gait variables of freezers

Parkinson's disease (PD) often manifests as dysfunctional mobility, with freezing of gait being one of the most prominent signs. Individuals who freeze (freezers) often have a greater loss of independence compared to their non-freezing counter parts. Exercise interventions have shown some benefit in reducing freezing of gait frequency and severity. However, research still need to establish what type of exercise and exercise delivery is most effective for freezers. Therefore, this study aimed to evaluate and compare the efficacy of home-based to therapist-supervised balance training on freezing of gait and gait parameters. Based on a sample of convenience, 40 participants with mild-to-moderate Parkinson's disease (Hoehn & Yahr stages I–III) were allocated to a therapist-supervised ( n = 24, age 65.4 ± 8.3 years) or home-based group ( n = 16, age 64.9 ± 7.1 years). Within each group 50% of individuals reported experiencing freezing. Both groups followed 8 weeks of balance training; the therapist-supervised (TS) group attended classes, and the home-based (HB) group followed DVDs at home. Outcome measures included the instrumented Timed-Up-and-Go and the Activity-specific Balance confidence (ABC) scale. The freezers differed significantly from the non-freezers in both TS and HB groups at pre-test for gait variables ( P < 0.03), including stride length, stride velocity and cadence, as well as self-perceived balance confidence ( P < 0.05). The freezers in the TS group improved their gait variables over time and showed a strong tendency to improve ABC scores ( P = 0.061) over time. The improvements in gait of the TS freezers shows that balance training with a therapist could be an essential tool to improve the independence and confidence of freezers. This study reiterates the differences between freezers and non-freezers, and shows the complexities a therapist should keep in mind when working with a heterogeneous group, such as PD individuals.

Treatment efficacy of a hybrid home-based rehabilitation intervention for patients with stroke: A randomized crossover trial

This study aimed to investigate the treatment effects of a hybrid home-based rehabilitation program combining mirror therapy and task-specific training compared with clinic-based rehabilitation in stroke patients. This was a single-blinded, 2-sequence, 2-period, crossover-designed study. The participants were randomly allocated to 1 of 2 order conditions: home-based rehabilitation first or clinic-based rehabilitation first. During each period, each participant received 12 treatment sessions, with a 4-week washout phase between the 2 periods. Both the home-based and clinic-based rehabilitation groups received 30 to 45 minutes of mirror therapy, followed by 45 to 60 minutes of functional task training, at each 90-min session. Before the interventions began, the client-centered Canadian Occupational Performance Measure was administered to help identify individual tasks and goals of patients. Outcome measures were selected based on the ICF. Outcomes of impairment level were the Fugl–Meyer Assessment, Box and Block Test, and Revised Nottingham Sensory Assessment. Outcomes of activity and participation levels included the Motor Activity Log, Canadian Occupational Performance Measure, and EuroQoL-5D Questionnaire. A total of 24 and 18 patients with stroke completed the study during the intervention period 1 and 2, respectively. Pretest analyses showed that there was no significant evidence of carryover effect. Home-based rehabilitation resulted in significantly greater improvements on the amount of use subscale of Motor Activity Log ( P = 0.01) than clinic-based rehabilitation. Clinic-based rehabilitation group had better benefits on the health index measured by the EuroQoL-5D Questionnaire ( P = 0.02) than home-based rehabilitation. There were no statistically significant differences between the 2 groups on the other outcomes. This study is unique in developing a hybrid home-based stroke rehabilitation intervention with patient-oriented goals. The home-based and clinic-based rehabilitation groups had comparable benefits in the outcomes of impairment level but showed differential effects in the outcomes of activity and participation levels.

//Therapist-supervised compared to home-based balance training encourages a ‘posture first’ strategy during turn-to-sit transitions in individuals with Parkinson's disease

Individuals with Parkinson's disease (IwPD) tend to turn slower and with more steps than age-match healthy individuals. This poor postural control during complex transitional movements, like turning or turn-to-sit, results in increased fall risk, as well as diminished quality of life and independence. Fall risk is furthermore aggravated when IwPD attempt to perform multiple tasks at the same time (i.e. termed dual-tasking). Previous research has shown that balance training effectively improves postural control in IwPD; however, whether a therapist-supervised or home-based balance-training program is more effective remains unclear. Consequently, this study endeavoured to compare the effect a therapist-supervised and home-based eight-week balance training program has on turning in IwPD. Twenty-nine men (65.7 ± 7.1years) diagnosed with PD (Hoehn&Yahr: II–III) were randomized into a therapist-supervised ( n = 15) or home-based ( n = 14) group. Both groups followed an eight-week balance-training program (3 × week for 45–50 minutes) under the supervision of a therapist or on their own with a DVD. Turn-to-Sit, Turning Velocity (TV) and Duration (TD) were assessed with a 7 m Timed-Up-and-Go test and the APDM mobility Lab ® , during single- and dual-task conditions, over the interventions. Percentage dual-task cost (% DTC) was also determined. No differences were found between the groups for TV and TD over time ( P > 0.05). Therapist-supervised group completed the Turn-to-Sit faster over the intervention and compare to the home-based group during single- and dual-task conditions ( P < 0.05). The % DTC was poorer in the home-based compared to therapist-supervised group post-intervention ( P = 0.04). Findings suggest that when IwPD are supervised by a therapist that they learn to prioritize postural control during the turn-to-sit transitions (i.e. ‘posture first’ strategy) as well as switch more effectively from one motor program to another. While an unsupervised home-based balance program resulted in a ‘posture second’ strategy, in which participants’ attention was divided, which may contribute to an increase fall risk.