Intensive Exercise Therapy Research Articles

Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society.

RECOMMENDATION 1: Clinicians should conduct a focused history and physical examination to help place patients with low back pain into 1 of 3 broad categories: nonspecific low back pain, back pain potentially associated with radiculopathy or spinal stenosis, or back pain potentially associated with another specific spinal cause. The history should include assessment of psychosocial risk factors, which predict risk for chronic disabling back pain (strong recommendation, moderate-quality evidence). RECOMMENDATION 2: Clinicians should not routinely obtain imaging or other diagnostic tests in patients with nonspecific low back pain (strong recommendation, moderate-quality evidence). RECOMMENDATION 3: Clinicians should perform diagnostic imaging and testing for patients with low back pain when severe or progressive neurologic deficits are present or when serious underlying conditions are suspected on the basis of history and physical examination (strong recommendation, moderate-quality evidence). RECOMMENDATION 4: Clinicians should evaluate patients with persistent low back pain and signs or symptoms of radiculopathy or spinal stenosis with magnetic resonance imaging (preferred) or computed tomography only if they are potential candidates for surgery or epidural steroid injection (for suspected radiculopathy) (strong recommendation, moderate-quality evidence). RECOMMENDATION 5: Clinicians should provide patients with evidence-based information on low back pain with regard to their expected course, advise patients to remain active, and provide information about effective self-care options (strong recommendation, moderate-quality evidence). RECOMMENDATION 6: For patients with low back pain, clinicians should consider the use of medications with proven benefits in conjunction with back care information and self-care. Clinicians should assess severity of baseline pain and functional deficits, potential benefits, risks, and relative lack of long-term efficacy and safety data before initiating therapy (strong recommendation, moderate-quality evidence). For most patients, first-line medication options are acetaminophen or nonsteroidal anti-inflammatory drugs. RECOMMENDATION 7: For patients who do not improve with self-care options, clinicians should consider the addition of nonpharmacologic therapy with proven benefits-for acute low back pain, spinal manipulation; for chronic or subacute low back pain, intensive interdisciplinary rehabilitation, exercise therapy, acupuncture, massage therapy, spinal manipulation, yoga, cognitive-behavioral therapy, or progressive relaxation (weak recommendation, moderate-quality evidence).

Functional Recovery After Stroke: A Review of Current Developments in Stroke Rehabilitation Research

This review article discusses current research developments in functional recovery after stroke. With the institutionalization of stroke services across health care facilities, a reduction in mortality rates, length of inpatient stay and improved independence in activities of daily living has been reported. Several systematic reviews show that traditional treatment approaches induce improvements that are confined to impairment level only and do not generalize to a functional improvement level. More recently developed treatment strategies that incorporate compensation strategies with a strong emphasis on functional training, may hold the key to optimal stroke rehabilitation. Intensity and task-specific exercise therapy are important components of such an approach. Guidelines may assist the clinician in this responsibility. However, due to marked heterogeneity of the stroke population and poor methodological quality of many studies, results are uncertain. Several options are discussed to overcome the problem of stroke heterogeneity in research designs. Longitudinal repeated measurements designs are required to study the effects of non-linearity and time dependency of functional recovery in stroke. Furthermore, prognostic research based on sound clinimetric data generates relevant information that may guide the clinician in clinical decision making and in determining optimal treatment strategies.

Moderately intensive exercise in a temperate pool for patients with rheumatoid arthritis: a randomized controlled study

The aim of this study was to evaluate the effects of moderately intensive pool exercise therapy on patients with rheumatoid arthritis (RA). Forty-six patients with chronic RA were randomly assigned to a treatment group and a control group. The treatment group (n = 20) exercised in a temperate pool twice a week for 12 weeks. The control group (n = 23) continued with their previous activities. Aerobic capacity, measured by means of a submaximum bicycle test, and the physical component of the SF-36 were chosen as the primary outcome measures. Two tests of muscle endurance were chosen as the secondary outcome measure. Additional functional tests and instruments were included. No significant differences between the groups were found for the primary outcome measures. Significant improvements in the following aspects of muscular function (P < 0.05) were found in the treatment group when their performance was compared with that of the control group: isometric shoulder endurance, grip force, dynamic endurance of lower extremities (chair test) and muscle function of lower extremities. Significant improvements were also found for vitality (SF-36) compared with the control group. The improvements in the training group were maintained for 3 months. Pool exercise therapy of moderate intensity significantly improved muscle endurance in the upper and lower extremities in patients with RA, while no impact on aerobic capacity was found. However, the study population was small and there is a need for further studies with larger populations.

Ambulatory long-term rehabilitation of heart patients

In Germany cardiac rehabilitation contains a comprehensive 3 to 4 week inpatient program. The aim of our study was to perform an outpatient long-term rehabilitation including intense exercise and behavior therapy. In this setting the health benefits could be increased over the first 6 months. Hundred and twelve patients (94 men and 18 women, age 55 +/- 11 years) after myocardial infarction (52%), bypass-surgery (37%), PTCA (23%), and others (15%) were included in the ongoing study. Cholesterol and LDL-cholesterol diminished significantly. HDL-cholesterol was increased significantly after 6 months. The endurance exercise capacity per rate-pressure-product was increased by 46% during the 6 months period. The intake of cholesterol could significantly be diminished from 307 +/- 25 to 258 +/- 19 mg per day. Five of 16 patients became free from smoking. The first results from the long-term outpatient program show that the time of intervention and also the intensity of the medical, exercise and the behavior therapy are important factors for a successful rehabilitation.

Reduced oxidative susceptibility of LDL from patients participating in an intensive atherosclerosis treatment program

The goal of this investigation was to determine whether participation in an atherosclerosis treatment program would reduce the oxidative susceptibility of LDL from patients with coronary artery disease. The treatment program included intensive exercise therapy, stress management, and consumption of a diet containing 10% fat. The size and antioxidant and lipid contents of LDL particles from 25 patients were analyzed at baseline and after 3 mo of therapy. The susceptibility of LDL to copper-mediated oxidation was measured by a conjugated diene assay and headspace gas chromatography (HSGC). Atherosclerosis treatment significantly reduced plasma total cholesterol and apolipoprotein B concentrations and the molar ratio of LDL cholesterol ester to apolipoprotein B (P < 0.01). The LDL content of a-tocopherol and β-carotene was increased (27% and 17%, respectively, P < 0.04) and the molar ratio of LDL cholesterol ester the sum of LDL a-tocopherol and LDL b-carotene decreased from 159 at baseline to 122 at 3 mo (P < 0.01). The lag phase of LDL conjugated diene formation increased 24%, whereas the maximum rate of oxidation slowed 29% (P < 0.01). As assessed by HSGC, copper-catalyzed formation of volatile lipid oxidation products was reduced 15% (P < 0.007); the reduction in volatiles was correlated with an increase in the α-tocopherol content of LDL (r = 20.48, P < 0.01). The principal determinants of reduced LDL oxidative susceptibility were the particle contents of α-tocopherol and β-carotene. To our knowledge, this is the first report to document a reduction in LDL oxidation in coronary artery disease patients undergoing atherosclerosis-reversal therapy.

REDUCTION OF SYMPATHETIC DRIVE DURING REST AND ACTIVITY AFTER INTENSE EXERCISE THERAPY IN CARDIAC REHABILITATION 953

An increased sympathetic drive may trigger myocardial hyperstimulation and arthythmias. Intense exercise training improves function and perfusion of the myocard and the skeletal muscles. It also reduces neurohormonal output. The goal of our study was to examine the effects of a 6 months intense exercise therapy integrated in an ambulatory cardiac rehabilitation program on carecholamine output at rest, during and after exercise. 13 patients with coronary artery disease (after bypass surgery. PTCA or myocardial infarction; 58±5 years, 172±8 cm, 72±10 kg) performed intense exercise therapy 4.2±0.4 times per week, 30 min each. Before and after 6 months of rehabilitation two successive incremental tests on a cycle ergometer were performed. Epinephrine (E), norepinephrine (NE), blood lactate(Lac), and heart rate (HR) were measured at rest, during and 5 min after both tests. NE and E elimination from the blood were calculated from the difference at the end of the test and 5 min after the test. Exercise therapy increased endurance training capacity by 48±15% (before 75±28 W: after 6 months 103±32 W, mean HR were nearly identical). In the incremental tests before and after rehabilitation maximal workload was significantly increased from 1.89±0.5 to 2.32±0.51 W per kg body weight. At a submaximal, comparable intensity (80 W) Lac and HR were significantly reduced from 2.3±1.0 to 1.7±0.6 mmol/l and from 113±18 to 106±17 b min. The results of NE and E are listed in thetable. Intense exercise therapy in patients with CAD, which increases endurance capacity by 40-50%, diminishes significantly the sympathetic drive during test and also during exercise. The possibility of a faster elimination of increased catecholamines from the blood could result in a higher tolerance against neurohormonal induced myocardial ischemia or arrhythmia.

Effects of a three-year exercise therapy program on cognitive functioning of elderly personal care home residents

The purpose of this study was to examine the effects of the Intense Exercise Therapy (IET) on the cognitive levels offunctioning of elderly persons monitored for three years. The study was based on the premise that daily group exercise enhances physiological as well as psychological processes and consequently may improve cognitive abilities for elderly persons. The study hypothesized that the cognitive functioning level of elderly persons participating in the IET would be significantly higher than the level of those persons in the no treatment control group. A previous study by Lindenmuth and Moose' indicated a positive effect of exercise therapy on cognitive functioning for Alzheimer patients. The sample consisted of 82 elderly (64-98 years old) residents of eight separate personal care facilities in Pennsylvania. Residents who volunteered attended by choice either group exercise therapy or a no treatment control group. A pretest, posttest experimental design was utilized in an attempt to control extraneous variables. Pretreatment, during treatment, and posttreatment measures were collected on the Cognitive Abilities Screening Test (CAST). After participating in the IET, elderly persons were found to have significantly higher (2 &lt; .001) cognitivefunctioning levels. Thesefindings lead to the conclusion that effects of the IETincluded an improvement in cognitive levels offunctioningfor the elderly participants in the treatment group. In addition, elderly persons in the control group showed Alzheimer-like symptoms and demonstrated CAST scores indicative of moderate impairment and organic brain disease. The implication is that a strategy such as the IET used by personal care homes and other institutions caring for the elderly would be of benefit in assisting elderly residents to maintain and improve cognitive levels. The IET is especially practical due to ease of use, low cost, and brevity of actual exercise sessions.

Improving cognitive abilities of elderly Alzheimer's patients with intense exercise therapy

This study focused on changes in the cognitive abilities of Alzheimer's patients residing in two separate long term care facilities as they were part of a group exercise therapy program. The research problem of this study was how to measure possible improvement in cognitive abilities in this population. The sample consisted of43 elderly (65-98 years old) Alzheimer's patients who resided in either of two convalescent homes in Pennsylvania. Patients who had been diagnosed as having Alzheimer's disease by their physician were assigned to either group exercise therapy, or to a no treatment control group. A pre-test, post-test experimental design was utilized in an attempt to control extraneous variables. The study was based on the premise that daily group exercise enhances physiological as well as psychological processes and consequently may im-prove cognitive abilities of patients with Alzheimer's disease. A student's t-test was utilized to test significance. The difference in the before and after scores of the experimental group (exercise) were significant (p .001) while the control group change was not significant. It can therefore be concluded that the hypotheses of this study was supported by the data obtained.