Individualized Home Exercise Research Articles

The Home Stroke Rehabilitation and Monitoring System Trial: A Randomized Controlled Trial

Because many individuals poststroke lack access to the quality and intensity of rehabilitation to improve upper extremity motor function, a home-based robotic-assisted upper extremity rehabilitation device is being paired with an individualized home exercise program. The primary aim of this project is to determine the effectiveness of robotic-assisted home therapy compared with a home exercise program on upper extremity motor recovery and health-related quality of life for stroke survivors in rural and underserved locations. The secondary aim is to explore whether initial degree of motor function of the upper limb may be a factor in predicting the extent to which patients with stroke may be responsive to a home therapy approach. We hypothesize that the home exercise program intervention, when enhanced with robotic-assisted therapy, will result in significantly better outcomes in motor function and quality of life. A total of 96 participants within six-months of a single, unilateral ischemic, or hemorrhagic stroke will be recruited in this prospective, single-blind, multisite randomized clinical trial. The primary outcome is the change in upper extremity function using the Action Research Arm Test. Secondary outcomes include changes in: upper extremity function (Wolf Motor Function Test), upper extremity impairment (upper extremity portion of the Fugl-Meyer Test), self-reported quality of life (Stroke Impact Scale), and affect (Centers for Epidemiologic Studies Depression Scale). Similar or greater improvements in upper extremity function using the combined robotic home exercise program intervention compared with home exercise program alone will be interpreted as evidence that supports the introduction of in-home technology to augment the recovery of function poststroke.

Perspectives and Experiences Related to Physical Activity of Elders in Long-Term-Care Settings

This qualitative study investigated individual and situational factors influencing physical activity (PA) practices of elders in residential-care/assisted-living (RC/AL) communities. This article describes the results of focus-group interviews involving 47 residents across 6 RC/AL settings. Thematic analysis revealed 6 themes: staying active, past PA experiences, value of PA, barriers to PA, strategies to facilitate PA, and support needs to promote PA. Staying active meant walking indoors and out, attending chair-exercise programs, performing professionally prescribed home exercises, and using available exercise equipment. Past PA experiences shaped current preferences and practices. Participants agreed that exercise helped maintain physical functioning but recounted cognitive and situational barriers to PA. Lack of dedicated exercise space and short corridors hampered efforts to stay active. Participants wished for individualized home exercise programs and supervised exercise sessions. Future research should examine the extent to which the physical environment and PA programming in RC/AL communities affect elders' PA.

Effect of a Home Exercise Program on Dynamic Balance in Elderly With a History of Falls

To determine exercise efficacy in improving dynamic balance in community-dwelling elderly with a fall history. Thirty-five participants were randomly assigned to a treatment (TG; n = 19, 77 ± 7 yr) or control group (CG; n = 16, 75 ± 8 yr). The TG received an individualized home exercise program, and the CG received phone calls twice per week for 12 weeks. Participants' dynamic-balance abilities- directional control (DC), endpoint excursion (EE), maximum excursion (ME), reaction time (RT), and movement velocity (MV)-were measured using the Balance Master at 75% limits of stability. Functional reach (FR) was also measured. At 12 weeks the TG demonstrated significant improvements in DC (p < .0025), EE (p < .0005), and ME (p < .0005), but the CG did not. No significant group differences were found for MV, RT, or FR. Excursion distances and directional control improved but not reaction time, suggesting that exercises requiring quick responses may be needed.

Physiotherapy Home Exercise Program for Haemophiliacs

Regular physiotherapy can improve the stability and flexibility of joints and decrease the bleeding risk in patients with haemophilia. To reduce the appointments for the patients and to make exercising a part of daily live, an individualized home exercise program (HEP) was designed. Retrospectively the number of bleedings during the HEP was compared to number of bleedings before. 8 patients aged between 4 and 16 years with haemophilia A were evaluated. At start and after 13 month patients had a motion analysis via topographic ultrasound. According to the results and clinical findings an individualized HEP was created. Standardised scores for clinical evaluation and the patient based evaluation of exercises were designed. At every appointment exercises were individually adjusted. Patients exercised in median 1.7 times a week. No training related bleeds occurred. 7 of 8 patients showed reduced joint and/or muscle bleeds (p<0.02). Clinical scores raised slightly in every patient. However the second motion analysis of squat and gait showed a worsening in 7 of 8 patients (p>0.05). A HEP can help to advance in physical fitness and coordination and may reduce bleeding tendency, but needs to be accomplished regularly. Patients are interested but the motivation to exercise at home is low. Disorders measured by motion analysis seem not to be sufficiently influenced by our surrogate training program.

Feasibility and parent satisfaction of a physical therapy intervention program for children with acute lymphoblastic leukemia in the first 6 months of medical treatment

Children with acute lymphoblastic leukemia (ALL) are at risk for developing musculoskeletal complications during and after their medical treatment. The objective of this study was to examine the feasibility of an in-hospital physical therapy- and home exercise program during the first four phases of medical treatment, for children with newly diagnosed ALL. Nine patients, between the ages of 2-14 years old were enrolled within 2 weeks of diagnosis in the study. Each patient was evaluated at study entry, after each of the first four phases of therapy and each time patients were re-admitted to the hospital. Following the initial physical therapy evaluation an individualized home exercise program was developed, consisting of stretching, strengthening, and aerobic exercises. The following end points were measured at each evaluation: gross motor assessment as measured by gross motor function measure (GMFM), health-related quality of life as measured by the PedsQL and parent satisfaction questionnaire. This study was feasible with 98% of the evaluation sessions completed. The GMFM and PedsQL improved steadily throughout the study; however, the PedsQL slightly decreased from interim maintenance to delayed intensification. The parents reported being satisfied with the physical therapy program. We demonstrated that an in-hospital- and home exercise physical therapy program during the first four phases of medical treatments is feasible for children with ALL. Future randomized studies are needed to confirm whether an initial physical therapy program at diagnosis in children with ALL will limit functional impairments, improve overall fitness and increase health-related quality of life.

Can pelvic floor muscle training reverse pelvic organ prolapse and reduce prolapse symptoms? An assessor-blinded, randomized, controlled trial

The aim of this study was to investigate the effectiveness of pelvic floor muscle training in reversing pelvic organ prolapse and alleviating symptoms. This assessor-blinded, parallel group, randomized, controlled trial conducted at a university hospital and a physical therapy clinic randomly assigned 109 women with prolapse stages I, II, and III to pelvic floor muscle training (n = 59) or control (n = 50). Both groups received lifestyle advices and learned "the Knack." In addition, pelvic floor muscle training comprised individual physical therapy sessions and home exercise. Student t test, Mann-Whitney U test, odds ratio, and effect size were used to compare groups. Eleven (19%) women in the pelvic floor muscle training group improved 1 Pelvic Organ Prolapse Quantification System stage vs 4 (8%) controls (P = .035). Compared with controls, the pelvic floor muscle training group elevated the bladder (difference: 3.0 mm; 95% confidence interval, 1.5-4.4; P < .001) and rectum (5.5 mm; 95% confidence interval, 1.4-7.3; P = .022) and reduced frequency and bother of symptoms compared with controls. Pelvic floor muscle training is without adverse effects and can be used as treatment for prolapse.

Feasibility and Outcomes of a Home-Based Exercise Program on Improving Balance and Gait Stability in Women With Lower-Limb Osteoarthritis or Rheumatoid Arthritis: A Pilot Study

Williams SB, Brand CA, Hill KD, Hunt SB, Moran H. Feasibility and outcomes of a home-based exercise program on improving balance and gait stability in women with lower-limb osteoarthritis or rheumatoid arthritis: a pilot study. Objective To evaluate the feasibility and gait stability and balance outcomes of a 4-month individualized home exercise program for women with arthritis. Design Pre-post interventional study. Setting General community. Participants Women (N=49) (volunteers) with lower-limb osteoarthritis or lower-limb rheumatoid arthritis were enrolled. Only 39 subjects were eligible and completed the study. Intervention After completion of the initial assessment, all participants received home balance exercises from an experienced physiotherapist based on assessment findings and exercises available from commercially available kits. All measures were repeated 4 months later. Main Outcome Measures Falls risk (Falls Risk of Older People—Community Setting) and balance measures. Results Thirty-nine women (mean age, 69.3y; 95% confidence interval, 65.7–72.9) completed the 4-month program. At baseline, 64% of participants reported falling in the preceding 12 months, and the average falls risk (Falls Risk of Older People—Community Setting) score was 14.5, with 42% rated as moderate risk (16–23). Participants achieved improved performance on most balance and related measures after the exercise program, including falls risk ( P=.01), activity levels ( P=.015), fear of falling ( P=.022), functional reach test ( P=.001), rising index for sit to stand ( P=.001), step width in walking ( P=.001), and body mass index ( P=.006). Conclusions An individualized balance training home exercise program is feasible for older women with osteoarthritis or rheumatoid arthritis and may improve stability during walking and other functional activities.

Effectiveness of a balance training home exercise programme for adults with haemophilia: a pilot study

Adults with haemophilia and other bleeding disorders often develop lower limb musculoskeletal problems associated with bleeds into joints and muscles, which may affect balance performance and increase likelihood of falling. The aim of this study was to evaluate the effectiveness of an individualized balance and strength home exercise programme on improving balance and related outcomes for adults with haemophilia and other bleeding disorders. Twenty male adults with haemophilia and other bleeding disorders (mean age 39.4 years, 95% CI = 33.7-45.1) were recruited to participate. They underwent a comprehensive clinical and force platform assessment of balance and related measures. Based on assessment findings, the assessing physiotherapist provided an individualized home exercise programme of balance, strengthening and walking exercises. Re-assessment occurred after the 4-month exercise programme. Twelve participants (60%) completed the programme and were re-assessed. There were no safety problems or dropouts associated with the exercise programme aggravating joint status. Although there were no statistically significant changes in any of the measures (adjusted for multiple comparisons), there were improvements of between 5% and 22% on 10 of the 16 measures, with the Neurocom modified Clinical Test of Sensory Interaction on Balance (P = 0.036) and Timed Sit to Stand (P = 0.064) approaching significance. A tailored home exercise programme targeting balance, strengthening and walking is feasible for adults with haemophilia and other bleeding disorders. These results suggest that positive physical outcomes including improved balance and mobility may be achieved with this type of programme.

Minimising disability and falls in older people through a post-hospital exercise program: a protocol for a randomised controlled trial and economic evaluation.

BackgroundDisability and falls are particularly common among older people who have recently been hospitalised. There is evidence that disability severity and fall rates can be reduced by well-designed exercise interventions. However, the potential for exercise to have these benefits in older people who have spent time in hospital has not been established.This randomised controlled trial will investigate the effects of a home-based exercise program on disability and falls among people who have had recent hospital stays. The cost-effectiveness of the exercise program from the health and community service provider's perspective will be established. In addition, predictors for adherence with the exercise program will be determined.Methods and designThree hundred and fifty older people who have recently had hospital stays will participate in the study. Participants will have no medical contraindications to exercise and will be cognitively and physically able to complete the assessments and exercise program.The primary outcome measures will be mobility-related disability (measured with 12 monthly questionnaires and the Short Physical Performance Battery) and falls (measured with 12 monthly calendars). Secondary measures will be tests of risk of falling, additional measures of mobility, strength and flexibility, quality of life, fall-related self efficacy, health-system and community-service contact, assistance from others, difficulty with daily tasks, physical activity levels and adverse events.After discharge from hospital and completion of all hospital-related treatments, participants will be randomly allocated to an intervention group or usual-care control group. For the intervention group, an individualised home exercise program will be established and progressed during ten home visits from a physiotherapist. Participants will be asked to exercise at home up to 6 times per week for the 12-month study period.DiscussionThe study will determine the impact of this exercise intervention on mobility-related disability and falls in older people who have been in hospital as well as cost-effectiveness and predictors of adherence to the program. Thus, the results will have direct implications for the design and implementation of interventions for this high-risk group of older people.Trial RegistrationThe protocol for this study is registered with the Australian New Zealand Clinical Trials Registry ACTRN12607000563460.

Effects of an Exercise Program to Increase Hip Abductor Muscle Strength and Improve Lateral Stability Following Stroke: A Single Subject Design

Persons with lower extremity weakness following stroke often demonstrate difficulty with weight transfer and paretic lower extremity loading. These deficits, in turn, can lead to problems with lateral stability, or the ability to control movement of the center of mass in the frontal plane. The primary aim of this study was to examine the efficacy of an individualized home exercise program in improving hip abductor muscle strength and lateral stability in a subject with chronic stroke. An A-B-A treatment-withdrawal single-subject design was used. The subject was a 70-year-old male who had experienced a left hemispheric stroke 36 months prior to initiation of the study. Bilateral hip abductor muscle strength, single limb stance (SLS), timed 360 degrees turn, Step Test, and 10-m walk at self-selected and fast speeds were recorded at regular intervals during the baseline (A-I), treatment (B), and treatment-withdrawal (A-2) phases. The home exercise program in the B phase consisted of lower extremity weight bearing and weight transfer activities and exercise on a lateral training device 3 to 5 times a week for 6 weeks. The Berg Balance Scale (BBS) and Stroke Impact Scale (SIS) were administered at the completion of each phase and at 6-week follow-up. Data were analyzed using visual analysis and the split-middle method of trend estimation. Mean levels of all measures improved from A-1 to B phases, with significant increases in trend for hip abductor muscle strength and SLS bilaterally. Most improvements were maintained during the treatment-withdrawal (A-2) phase and at follow-up. A home exercise program that includes exercise on a lateral training device shows promise for producing increases in hip abductor muscle strength and accompanying improvements in some measures of physical performance and disability in persons with chronic stroke.

Physiotherapy interventions for ankylosing spondylitis

Ankylosing spondylitis (AS) is a chronic, inflammatory rheumatic disease. Physiotherapy is considered an important part of the overall management of AS. To summarise the available scientific evidence on the effectiveness of physiotherapy interventions in the management of AS. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, AMED, CINAHL and PEDro up to January 2007 for all relevant publications, without any language restrictions. We checked the reference lists of relevant articles and contacted the authors of included articles. We included randomised and quasi-randomised studies with AS patients and where at least one of the comparison groups received physiotherapy. The main outcomes of interest were pain, stiffness, spinal mobility, physical function and patient global assessment. Two reviewers independently selected trials for inclusion, extracted data and assessed trial quality. Investigators were contacted to obtain missing information. Eleven trials with a total of 763 participants were included in this updated review. Four trials compared individualised home exercise programs or a supervised exercise program with no intervention and reported low quality evidence for effects in spinal mobility (Relative percentage differences (RPDs) from 5-50%) and physical function (four points on a 33-point scale). Three trials compared supervised group physiotherapy with an individualised home-exercise program and reported moderate quality evidence for small differences in spinal mobility (RPDs 7.5-18%) and patient global assessment (1.46 cm) in favour of supervised group exercises. In one study, a three-week inpatient spa-exercise therapy followed by 37 weeks of weekly outpatient group physiotherapy (without spa) was compared with weekly outpatient group physiotherapy alone; there was moderate quality evidence for effects in pain (18%), physical function (24%) and patient global assessment (27%) in favour of the combined spa-exercise therapy. One study compared daily outpatient balneotherapy and an exercise program with only exercise program, and another study compared balneotherapy with fresh water therapy. None of these studies showed significant between-group differences. One study compared an experimental exercise program with a conventional program; statistically significant change scores were reported on nearly all spinal mobility measures and physical function in favour of the experimental program. The results of this review suggest that an individual home-based or supervised exercise program is better than no intervention; that supervised group physiotherapy is better than home exercises; and that combined inpatient spa-exercise therapy followed by group physiotherapy is better than group physiotherapy alone.

Rehabilitation exercise for treatment of vestibular disorder: A case study

Vertigo and dizziness are common symptoms in the general population. While the clinical picture is well known and widely described, there are different interpretations of Benign Paroxysmal Positional Vertigo. The purpose of this case report was to describe the treatment of a 56 year old woman with complains of positional vertigo for 35 consecutive years. She suffered from a sudden onset of rotatory, unilateral horizontal canal type benign paroxysmal positional vertigo (BPPV). The symtoms started a day after falling from a bus, where she injured her head. Otherwise her medical history was unremarkable. She was treated with an individualized home exercise program of eye movement exercises, Brandt/Daroff exercises, and general conditioning exercises (i.e., laying on the left side from sitting on the bed, while the head rotated 45 degrees to the right, waiting for about one minue; twice a day on gradual basis, not laying on the side all the way, but to use enough pillows to lay about at 60 degrees). Four weeks from the start of physical therapy, the patient was free of symptoms, even when her neck was in the extended position.

ASSESSMENT OF FALL RISK FACTORS IN ELDERLY WOMEN BEFORE AND AFTER A PHYSICAL THERAPY INTERVEN-TION PROGRAM.

Purpose/Hypothesis: Physical mobility is important for promoting good health and maintaining the well-being of all persons. Physical fitness determines the degree of independence and health care needs among the elderly. Functional independence is necessary to lead a normal life and hence it is a mean of assessing quality of life. The purpose of this study was to evaluate the effects of exercises on impairment and physical performance measures in elderly women residing in an assisted living facility with different functional levels. Number of Subjects: Participants were 20 elderly females (87.1 ± 3.8 years) in two groups according to their functional levels (a high and a low-functional level groups) Materials/Methods: Both high and low-functional level groups participated in a combined program of group and individualized home exercise programs for eight weeks. The outcome measures were: two impairment measures: average strength and habitual gait velocity; four timed tasks: 5-repetition sit-to-stand from a standard chair, 5-repetition step-up forward and step-down backward on a single 4-inch step, 50-foot walk, and up and go. A two-factor repeated measures Multivariate Analysis Of Variance (MANOVA) and a follow-up analysis of variance (ANOVA) were used. Results: There was an overall significant main effect of treatment (F6, 13 = 15.88, p < .001), significant main effect of group (F6, 13 = 3.24, p = .03) but no interaction of treatment by functional level (F6, 13 = 0.64, p = .7) for all the dependent variables used in the MANOVA with the Wilk's Lambda criterion. Results from the follow-up ANOVA showed significant improvement in standardized average strength (F1, 18 = 37.9, p < .001), habitual gait velocity (F1, 18 = 15.9 p = .001), 50-foot walk task (F1, 18 = 28.2, p < .001). Participants were able to perform 5-repetition sit-to-stand (F1, 18 = 39.3, p < .001) and 5-repetition step-up task (F1, 18 = 25.67 p < .001) significantly faster after the intervention compared to before the intervention. They also increased significantly the timed up and go task velocity (F1, 18 = 22.3, p < .001). Additionally, both groups (high and low functional levels) gained similar benefits from this combined group and individualized exercise programs. Conclusions: There was no serious adverse effects was reported in this 80 to 95 years old group which may indicate the ability of elderly females to tolerate moderate exercise programs if intensity increases gradually. The increase of habitual and fast gait velocities and the other timed tasks after the intervention may enable subjects to negotiate the environment more effectively and safely. Improvements in physical performance might partially explain a reduction in the risk for falling. Clinical Relevance: A moderate intensity eight-week combined exercise program may be effective in improving strength; habitual gait velocity; and performance on the timed measures in elderly females and hence reduce their risk for falls. The gained improvement may occur in individuals who have high or low functional levels.

Physiotherapy interventions for ankylosing spondylitis.

Ankylosing spondylitis (AS) is a chronic rheumatic disease. Due to the consequences of the disease, physiotherapy is regarded to be an important part of the treatment. The objective is to summarise the available scientific evidence on the effectiveness of physiotherapy interventions in the management of AS. We searched the Cochrane Musculoskeletal Group Trial register, Cochrane Controlled Trials Register, MEDLINE, EMBASE, CINAHL and Pedro up to February 2000 for all relevant publications, limited to English and Scandinavian languages. The reference lists of relevant articles were checked and the authors of included articles were contacted. We included randomised and quasi randomised studies where the participants were patients with AS, classified by the New York criteria, and where at least one of the comparison groups received some kind of physiotherapy. The main outcomes of interest were spinal mobility, pain, stiffness, physical function and global assessment of change. Both reviewers independently selected trials for inclusion, extracted data and assessed trial quality. Investigators were contacted to obtain missing information. Three trials were included with 241 participants, and all were assessed to have moderate to high risk of bias. Two trials compared the effect of supervised group physical therapy with an individualised home exercise program, and reported differences in favour of the supervised group. For pain and stiffness, the relative difference in change from baseline for the supervised group compared to the home exercise group was 50% after treatment. One trial compared an individual program of exercises and disease education with no intervention, and found differences in favour of the exercise group. The tendency toward positive effects of physiotherapy, in the management of AS, call for further research in this field in order to reach sufficient evidence on which physiotherapy modalities and applications are to be recommended. New trials should address other physiotherapy interventions commonly used in practice. There is not sufficient evidence yet available to base recommendations for or against the use of physiotherapy interventions for ankylosing spondylitis.

Current status of cardiac rehabilitation

Cardiac rehabilitation is an important management strategy in patients with coronary artery disease. Substantial data from both mortality and morbidity studies support the benefits. Recent studies of patients with coronary artery disease have shown that exercise confers greater benefit in those who are also on a fat-controlled diet than in those who are not. In addition, high-intensity exercise has been found to improve left ventricular function in men with coronary artery disease. Individual home exercise programs, both with and without telephone monitoring, are prescribed by physicians and health care professionals for an increasing number of patients. Aggressive modification of coronary risk factors is also incorporated in the overall cardiac rehabilitation program, and the concept of greater total kilocalorie expenditure per week is emphasized.