Resistance Training In Patients Research Articles

Effect of blood flow restriction with low-intensity resistance training in patients with osteoarthritis and rheumatoid arthritis: a systematic review and meta-analysis based on randomized controlled trials.

This study evaluated the effects of blood flow restriction with low-intensity resistance training (BFR + LIRT) on pain, adverse events, muscle strength, and function in patients with osteoarthritis (OA) and rheumatoid arthritis (RA) through a systematic review and meta-analysis. This study adhered to the guidelines of the Preferred Reporting Items for Systematic Review and Meta-Analyses 2020 (PRISMA 2020) and applied the A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR2) standards to ensure the high quality of the systematic review. A comprehensive literature search was conducted until August 2023 using four selected keywords (osteoarthritis, rheumatoid arthritis, blood flow restriction training, and resistance training) across five search engines (PubMed, Embase, Web of Science, CENTRAL, and PEDro). Ten studies were analyzed. The results showed that BFR + LIRT had similar effects on pain, risk of adverse events, muscle strength, self-reported function, and physical function compared with resistance training (RT). This systematic review and meta-analysis further support the potential of BFR + LIRT in the disease management of patients with OA or RA. According to this analysis, BFR + LIRT had a lower risk of adverse events than high-intensity resistance training (HIRT) and may be a safer training modality. BFR + LIRT offers greater advantages in improving physical function than LIRT and was able to provide similar benefits to HIRT without increasing the training load. These findings suggest that BFR + LIRT is a safe and effective strategy for treating patients with OA or RA. However, owing to the limited number of studies covered in this analysis, additional higher-quality studies are needed to strengthen this conclusion.

Impact of resistance training in patients with intellectual disabilities: a systematic review and meta-analysis

Objective: This study reviews the effects of resistance training (RT) and combined exercises on adults with intellectual disabilities (ID), focusing on muscular strength improvements. Methodology: Databases including PubMed, Cochrane Library, Scopus, and Web of Science were searched until August, selecting studies that compared RT and combined exercises against control groups. Results: A total of 24 studies with 924 participants were analyzed. RT significantly improved body weight (mean difference [MD] = -1.05, p=0.01) and leg press-RM outcomes (MD = 12.86, p<0.0001) versus controls. Combined exercises also showed notable benefits, enhancing overall training effects (MD = 21.95, p=0.0006) and sit-to-stand performance (MD = 3.10, p=0.0003). Conclusion: RT and combined exercises significantly benefit body composition, flexibility, muscular strength, and cardiorespiratory fitness in individuals with ID. Customizing exercise programs based on individual needs, considering age, ID severity, and preferences, is vital.

Resistance Training in Depression.

More than 320 million people around the world suffer from depression. Physical activity and sports are effective treatment strategies. Endurance training has already been intensively studied, but any potential antidepressant effect of resistance training is unknown at present, nor is it clear whether this could yield any relevant benefit in clinical use. The PubMed database was selectively searched for recent studies and review articles concerning the use, efficacy, and safety of resistance training in persons with depressive symptoms and diagnosed depression. Two meta-analyses revealed that resistance training alleviated depressive symptoms with a low to moderate effect size (0.39-0.66). Resistance training in patients with diagnosed depression was studied in seven randomized controlled trials, in which the duration of the intervention ranged from eight weeks to eight months. In six of these trials, the depressive symptoms were reduced. In one trial, a persistent benefit was seen in the resistance-training group at 26 months of follow-up (adherence, 33%). Moreover, resistance training improved strength, quality of life, and quality of sleep. No serious adverse events occurred; this indicates that resistance training in depression is safe. Resistance training seems to have an antidepressant effect. Open questions remain concerning its effects in different age groups, as well as the optimal training parameters. Further high-quality trials will be needed to document the effect of resistance training more conclusively and to enable the formulation of treatment recommendations.

Cardiovascular Benefits of Resistance Training in Patients With Heart Failure With Reduced Ejection Fraction: A Systematic Review.

Cardiovascular diseases pose a serious problem for health globally. Among these, congestive heart failure is the leading cause of mortality and morbidity worldwide. According to the recent census, heart failure contributes to a huge financial burden annually. Exercise therapy is an integral part of the non-pharmacological management of heart failure. Due to the availability of various types of exercise therapies and rapid advancements in the existing evidence, it is often challenging to prescribe an appropriate exercise program. Although there is unequivocal evidence supporting the cardiovascular benefits of aerobic therapy, the incorporation of resistance training into exercise regimens should also be encouraged due to its effects on muscular endurance and ameliorating skeletal myopathy in heart failure. In this study, we used a systematic literature review (SLR) approach to give an overview of the current literature and highlight the cardiovascular benefits of resistance training, alone or in combination with aerobic training. We reviewed articles from well-recognized journals published between 2013 and 2023, finally narrowing down to nine selected papers for a thorough analysis. The inclusion criteria comprise studies dealing with heart failure with reduced ejection fraction (HFrEF), resistance training alone or in combination with aerobic therapy, and studies available for free in either the PubMed or Google Scholar databases. The systematic review revealed that resistance training in combination with aerobic therapy has greater cardiovascular benefits than either resistance or aerobic therapy alone. A few unique approaches, like periodic intermittent muscular exercise (PRIME) and super circuit training (SCT), have demonstrated an improvement in cardiac and non-cardiac clinical outcomes compared to conventional exercise therapies. Moreover, various factors, like lack of motivation and lack of time, contribute to poor adherence to exercise therapy. Approaches like telerehabilitation and designing exercise regimens with activities that patients enjoy have led to improvements in long-term adherence rates. Nevertheless, further exploration and research by conducting randomized controlled trials on a larger scale is essential to explore the potential of resistance training in the rehabilitation of patients with heart failure with reduced ejection fraction and to develop the most effective exercise therapy.

Comparing the effect of intermittent blood flow restriction training and high-load resistance training in patients with patellofemoral pain: study protocol for a randomised trial

BackgroundPatellofemoral pain (PFP) syndrome is a common knee joint functional disorder. Blood flow restriction (BFR) training has shown promise in improving PFP; however, the effectiveness of intermittent BFR (iBFR) training...

Critically appraised paper: High-intensity resistance training is not superior to low-intensity resistance training in patients with knee osteoarthritis [commentary

Critically appraised paper: High-intensity resistance training is not superior to low-intensity resistance training in patients with knee osteoarthritis [commentary

Critically appraised paper: High-intensity resistance training is not superior to low-intensity resistance training in patients with knee osteoarthritis.

Critically appraised paper: High-intensity resistance training is not superior to low-intensity resistance training in patients with knee osteoarthritis.

Does resistance training in patients with metabolic syndrome reduce cardiovascular risk factors?

Does resistance training in patients with metabolic syndrome reduce cardiovascular risk factors?

Effect of resistance training on HbA1c and other cardiovascular risk factors in patients with type 2 diabetes: a systematic review and meta-analysis of randomized controlled trials

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Obesity, hypertension, hyperlipidemia, and other cardiovascular risk factors are commonly clustered in patients with diabetes type II (T2DM). As a result, patients with T2DM are at increased cardiovascular (CV) risk. Exercise therapy is recommended in the prevention and management of patients with T2DM. In the last decade, dynamic resistance training has attracted more interest as an exercise therapy in the management of patients with diabetes. Though, the primary outcome in these intervention trials has mostly been glycated hemoglobin (HbA1c). Given the high prevalence of other CV risk factors in patients with T2DM, knowledge on the impact of dynamic resistance training on the overall CV risk profile of these patients is important. Purpose To perform a systematic review with meta-analysis to investigate the effects of resistance training on HbA1c and other traditional cardiovascular risk factors in patients with T2DM. Methods and analyses A systematic search was conducted in the electronic databases MEDLINE, Embase, SPORTdiscus and PEDro from the earliest date available until the first of September 2021 to identify peer reviewed randomized controlled trials investigating the effect of resistance training on HbA1C in adults with T2DM. Primary outcome was HbA1C. Secondary outcomes included traditional CV risk factors (i.e. blood pressure, blood lipids, body composition) and physical fitness (muscle strength, exercise capacity). Effect sizes were calculated using random effect models. Data are reported as weighted mean and 95% confidence limits. Results Fourteen trials could be included in the meta-analysis. Resistance training was found to significantly reduce HbA1c [-0.35 % (95% CL -0.61 to -0.11)], systolic blood pressure [-4.6 mmHg (95%CL -8.7 to -0.39)], diastolic blood pressure -2.25 (95%CL -4.45 to -0.048)) and body fat (-0 0.038). Muscle strength was significantly improved in the three studies reporting this outcome. Other cardiovascular risk factors including fasting plasma glucose, high-density-lipoprotein, low-density-lipoprotein, triglycerides and peak oxygen uptake capacity (VO2 peak) remained unchanged after resistance training in patients with T2DM. Conclusion The available data suggests that resistance training can exert favorable effects on HbA1C but also on blood pressure, body composition and muscle strength of patients with type 2 diabetes. Further research is needed to determine the impact of different resistance training characteristics such as volume, frequency and type of training on the overall CV risk profile of patients with type 2 diabetes.

The efficacy of high- and low-load resistance training in patients with coronary artery disease: a follow-up of a randomised controlled trial

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Slovenian Research Agency. Background Perseverance of beneficial effects of exercise training in cardiac rehabilitation remains understudied. Maximal aerobic capacity (VO2 max) and quality life were mostly maintained at 1 year follow-up after aerobic training (AT) or after a combination of AT and mostly low-load (LL) resistance training (RT), while the effects of high-load (HL) RT remain unknown in patients with coronary artery disease (CAD). Purpose This study investigated the effects of combination of AT with HL-RT or LL-RT in comparison to AT alone on maximal aerobic capacity, physical activity, and quality of life in patients with CAD at 1-year follow-up after cardiac rehabilitation. Methods We initially enrolled 79 patients with CAD to combined AT and HL-RT, combined AT and LL-RT or AT alone, and 59 patients completed the study. The assessments at 1-year follow-up were completed by 53 patients, with [mean (SD) or median (interquartile range)] age = 61 (8) years, height = 172.1 (8.4) cm, weight = 83.93 (14.03) kg and left ventricular ejection fraction = 50 (45,60) %. During the study, all patients performed the same interval aerobic cycling (40 min/session, intervals of 3-5 min of work-load cycling separated by 2 min of unloaded cycling, intensity progressed from 50% to 80% of maximal workload achieved at baseline cardiopulmonary exercise test). In HL-RT-group, the training load progressively increased from 70% of 1-RM (6–11 reps/set) to 80% of 1-RM (6–8 reps/set), while in LL-RT group the training load progressively increased from 35% of 1-RM (12–22 reps/set) to 40% of 1-RM (12–16 reps/set) in the first seven weeks of the intervention. Similar progression of RT was used after 1-RM re-evaluation following 7 weeks of training. After cardiac rehabilitation, patients were given written brochure with included advice on home-based physical activity with emphasis on aerobic and resistance exercises. Maximal aerobic performance, objectively measured physical activity and quality of life were measured after 1-year. Results At 1-year follow-up majority of the patients increased VO2max (62%). Patients increased VO2max (+0.08 l/min, p = 0.022) and had higher respiratory exchange ratio (+0.06, p < 0.001), regardless of the randomisation. There was no significant effect of time x group interaction on the outcomes. VO2max was increased in AT (+0.13 l/min, p = 0.026) and LL-RT (+0.12 l/min, p = 0.031) groups, while respiratory exchange ratio was greater in LL-RT (+0.6, p = 0.004) and HL-RT (+0.7, p = 0.003) groups at follow-up. Post-training physical activity and quality of life were high but remained unchanged after 1 year. Conclusions The combination of AT and HL-RT or LL-RT was not superior to AT alone in changes of maximal aerobic performance, physical activity and quality of life in patients with coronary artery disease at 1-year follow-up.

Management of Glycemia during Acute Aerobic and Resistance Training in Patients with Diabetes Type 1: A Croatian Pilot Study

(1) Background: The increased risk of developing hypoglycemia and worsening of glycemic stability during exercise is a major cause of concern for patients with type 1 diabetes mellitus (T1DM). (2) Aim: This pilot study aimed to assess glycemic stability and hypoglycemic episodes during and after aerobic versus resistance exercises using a flash glucose monitoring system in patients with T1DM. (3) Participants and Methods: We conducted a randomized crossover prospective study including 14 adult patients with T1DM. Patients were randomized according to the type of exercise (aerobic vs. resistance) with a recovery period of three days between a change of groups. Glucose stability and hypoglycemic episodes were evaluated during and 24 h after the exercise. Growth hormone (GH), cortisol, and lactate levels were determined at rest, 0, 30, and 60 min post-exercise period. (4) Results: The median age of patients was 53 years, with a median HbA1c of 7.1% and a duration of diabetes of 30 years. During both training sessions, there was a drop in glucose levels immediately after the exercise (0'), followed by an increase at 30' and 60', although the difference was not statistically significant. However, glucose levels significantly decreased from 60' to 24 h in the post-exercise period (p = 0.001) for both types of exercise. Glycemic stability was comparable prior to and after exercise for both training sessions. No differences in the number of hypoglycemic episodes, duration of hypoglycemia, and average glucose level in 24 h post-exercise period were observed between groups. Time to hypoglycemia onset was prolonged after the resistance as opposed to aerobic training (13 vs. 8 h, p = NS). There were no nocturnal hypoglycemic episodes (between 0 and 6 a.m.) after the resistance compared to aerobic exercise (4 vs. 0, p = NS). GH and cortisol responses were similar between the two sessions, while lactate levels were significantly more increased after resistance training. (5) Conclusion: Both exercise regimes induced similar blood glucose responses during and immediately following acute exercise.

Anabolic and Inflammatory Response to High- and Low-Load Resistance Training in Patients with Coronary Artery Disease: A Randomized Controlled Trial.

Kambic, Tim MKin; Božic Mijovski, Mojca PhD; Jug, Borut MD, PhD; Hadžic, Vedran MD, PhD; Lainscak, Mitja MD, PhD, FESC, FHFA Author Information

Cartilage tissue turnover increases with high- compared to low-intensity resistance training in patients with knee OA

ObjectivesTo investigate cartilage tissue turnover in response to a supervised 12-week exercise-related joint loading training program followed by a 6-month period of unsupervised training in patients with knee osteoarthritis (OA). To study the difference in cartilage tissue turnover between high- and low-resistance training.MethodPatients with knee OA were randomized into either high-intensity or low-intensity resistance supervised training (two sessions per week) for 3 months and unsupervised training for 6 months. Blood samples were collected before and after the supervised training period and after the follow-up period. Biomarkers huARGS, C2M, and PRO-C2, quantifying cartilage tissue turnover, were measured by ELISA. Changes in biomarker levels over time within and between groups were analyzed using linear mixed models with baseline values as covariates.ResultshuARGS and C2M levels increased after training and at follow-up in both low- and high-intensity exercise groups. No changes were found in PRO-C2. The huARGS level in the high-intensity resistance training group increased significantly compared to the low-intensity resistance training group after resistance training (p = 0.029) and at follow-up (p = 0.003).ConclusionCartilage tissue turnover and cartilage degradation appear to increase in response to a 3-month exercise-related joint loading training program and at 6-month follow-up, with no evident difference in type II collagen formation. Aggrecan remodeling increased more with high-intensity resistance training than with low-intensity exercise.These exploratory biomarker results, indicating more cartilage degeneration in the high-intensity group, in combination with no clinical outcome differences of the VIDEX study, may argue against high-intensity training.

Sensory-motor training versus resistance training in the treatment of knee osteoarthritis: A randomized controlled trial

Objective To compare the effectiveness of sensory-motor training and resistance training in patients with knee osteoarthritis. Design Randomized controlled trial. Setting Istanbul University, Department of Physiotherapy and Rehabilitation. Subjects Forty-eight participants with knee osteoarthritis. Interventions Following baseline assessment, participants were randomly allocated to sensory-motor training (n = 24) and resistance training (n = 24). Both groups received training three times a week for 8 weeks. Main measures The primary outcome measure was the Western Ontario and McMaster Universities Arthritis Index (WOMAC). The secondary outcome measures were pain level, muscle strength, proprioception, range of motion, quality of life, and patient satisfaction with treatment. Patients were assessed before and after four- and eight-week interventions. Results There was no significant difference between the groups’ total WOMAC scores after four- and eight-week interventions (respectively, p = 0.415, p = 0.828). There was a significant improvement in pain level during movement and in the energy subscale SF-36 for resistance training after the four-week intervention (respectively, p = 0.012, p = 0.007). After the eight-week intervention, a significant difference was noted in favor of resistance training in the secondary outcome measure quality of life (QoL). No significant difference was found in other secondary outcomes. Conclusions At the end of the treatment, it was observed that sensory-motor training had a similar effect in the treatment of knee osteoarthritis symptoms to resistance training. These findings may suggest that sensory-motor training is an effective new method to treat patients with knee osteoarthritis.

Neuromuscular and acute symptoms responses to progressive elastic resistance exercise in patients with chronic obstructive pulmonary disease: Cross-sectional study.

Quadriceps muscle training is a key part in the rehabilitation of chronic obstructive pulmonary disease (COPD) patients. However, exercise intensity prescription and progression with the typically used elastic bands is challenging. We aimed to evaluate neuromuscular, acute symptoms and cardiorespiratory responses (heart rate and dyspnea) during progressive elastic resistance exercise in patients with COPD. Fourteen patients diagnosed with moderate-very severe COPD performed knee extensions at different elastic resistance levels (i.e., colors). The neuromuscular activity was recorded using surface electromyography for the rectus femoris, vastus lateralis and vastus medialis, together with rate of perceived exertion, perceived quadriceps fatigue, dyspnea, oxygen saturation and heart rate. For the vastus lateralis and rectus femoris, increase of muscle activity was evident from a two-level increment when using the red color. For the vastus medialis, there were no muscle activity progressions. Dyspnea, quadriceps fatigue and especially rate of perceived exertion increased in a dose-response fashion and were correlated with the resistance level and muscle activity at the three muscles. Heavy elastic resistance exercise is feasible in COPD patients without excessive dyspnea and a stable cardiorespiratory response. In general, at least two elastic resistance increments are needed to enhance muscle activity for the vastus lateralis and rectus femoris, while there is no increase for the vastus medialis. These results may help to individualize exercise dosing during elastic resistance training in patients with COPD.

Dokumentationsqualität heimbasierter Krafttrainingsstudien mit Menschen mit nicht übertragbarer Erkrankung

Billany RE, Vadaszy N, Lightfoot CJ et al. Characteristics of effective home-based resistance training in patients with noncommunicable chronic diseases: a systematic scoping review of randomised controlled trials. Journal of sports sciences 2021; 39: 1174–1185

Resistance Training for Patients with Cancer: A Conceptual Framework for Maximizing Strength, Power, Functional Mobility, and Body Composition to Optimize Health and Outcomes.

There are many benefits to the addition of exercise to cancer treatment and survivorship, particularly with resistance training regimens that target hypertrophy, bone mineral density, strength, functional mobility, and body composition. These goals are best achieved through a series of individualized high-intensity compound movements that mirror functional mobility patterns and sufficiently stress the musculoskeletal system. As a result of adequate stress, the body will engage compensatory cellular mechanisms that improve the structural integrity of bones and muscles, stimulate metabolism and the immune system, optimize functional performance, and minimize mechanical injury risk. The current evidence suggests that application of the above exercise principles, practiced in a safe environment under expert observation, may offer patients with cancer an effective means of improving overall health and cancer-specific outcomes. The following article poses several important questions certified exercise specialists and physicians should consider when prescribing resistance exercise for patients with cancer.

Resistance Training in Patients With Coronary Artery Disease, Heart Failure, and Valvular Heart Disease: A REVIEW WITH SPECIAL EMPHASIS ON OLD AGE, FRAILTY, AND PHYSICAL LIMITATIONS.

Current guidelines recommend individually adapted resistance training (RT) as a part of the exercise regime in patients with cardiovascular diseases. The aim of this review was to provide insights into current knowledge and understanding of how useful, feasible, safe, and effective RT is in patients with coronary artery disease (CAD), heart failure (HF), and valvular heart disease (VHD), with particular emphasis on the role of RT in elderly and/or frail patients. A review based on an intensive literature search: systematic reviews and meta-analyses published in 2010 or later; recent studies not integrated into meta-analyses or systematic reviews; additional manual searches. The results highlight the evaluation of effects and safety of RT in patients with CAD and HF with reduced ejection fraction (HFrEF) in numerous meta-analyses. In contrast, few studies have focused on RT in patients with HF with preserved ejection fraction (HFpEF) or VHD. Furthermore, few studies have addressed the feasibility and impact of RT in elderly cardiac patients, and data on the efficacy and safety of RT in frail elderly patients are limited. The review results underscore the high prevalence of age-related sarcopenia, disease-related skeletal muscle deconditioning, physical limitations, and frailty in older patients with cardiovascular diseases (CVD). They underline the need for individually tailored exercise concepts, including RT, aimed at improving functional status, mobility, physical performance and muscle strength in older patients. Furthermore, the importance of the use of assessment tools to diagnose frailty, mobility/functional capacity, and physical performance in the elderly admitted to cardiac rehabilitation is emphasized.

High-intensity versus low-intensity resistance training in patients with knee osteoarthritis: A randomized controlled trial

Objectives To assess whether (i) high-intensity resistance training (RT) leads to increased muscle strength compared to low-intensity RT in patients with knee osteoarthritis (OA); and (ii) RT with vitamin D supplementation leads to increased muscle strength compared to placebo in a subgroup with vitamin D deficiency. Design Randomized controlled trial Setting Outpatient rehabilitation centre Subjects Patients with knee OA Interventions 12 weeks of RT at high-intensity RT (70–80% of 1-repetition maximum (1-RM)) or low-intensity RT (40–50% of 1-RM) and 24 weeks of vitamin D (1200 International units vitamin D3 per day) or placebo supplementation. Main measures Primary outcome measure was isokinetic muscle strength. Other outcome measure for muscle strength was the estimated 1-RM. Secondary outcome measures were knee pain and physical functioning. Results 177 participants with a mean age of 67.6 ± 5.8 years were included, of whom 50 had vitamin D deficiency. Isokinetic muscle strength (in Newton metre per kilogram bodyweight) at start, end and 24 weeks after the RT was 0.98 ± 0.40, 1.11 ± 0.40, 1.09 ± 0.42 in the high-intensity group and 1.02 ± 0.41, 1.15 ± 0.42, 1.12 ± 0.40 in the low-intensity group, respectively. No differences were found between the groups, except for the estimated 1-RM in favour of the high-intensity group. In the subgroup with vitamin D deficiency, no difference on isokinetic muscle strength was found between the vitamin D and placebo group. Conclusions High-intensity RT did not result in greater improvements in isokinetic muscle strength, pain and physical functioning compared to low-intensity RT in knee OA, but was well tolerated. Therefore these results suggest that either intensity of resistance training could be utilised in exercise programmes for patients with knee osteoarthritis. No synergistic effect of vitamin D supplementation and RT was found, but this finding was based on underpowered data.

Safety and effectiveness of resistance training in patients with late onset Pompe disease - a pilot study

Pompe disease is a progressive myopathy resulting from deficiency in lysosomal enzyme acid α-glucosidase (GAA), which leads to glycogen accumulation in lysosomes primarily in skeletal and cardiac muscle. Enzyme replacement therapy (ERT) with recombinant human (rh) GAA works well in alleviating the cardiomyopathy; however, many patients continue to have progressive muscle weakness. The purpose of this study was to evaluate the effectiveness of a respiratory training combined with 24-week supervised resistance training program on muscle strength (measured by Biodex)), and respiratory function including maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP) in subjects with late onset Pompe disease receiving ERT. Ten subjects participated in a 24-week resistance exercise program, three times per week, in addition to respiratory muscle exercise training six days per week. Overall, at the end of the resistance training program, as measured by Biodex dynamometry, the leg extensor strength improved by 10.5 ± 3.2Nm. (<p 0.01), leg flexors improved by 12.1 ± 4.1Nm (p < 0.01), the elbow flexors improved by 5.1 ± 2.3Nm (p = 0.03), and the elbow extensor strength improved by a mean of 4.5 ± 1.9Nm. (p = 0.02). MIP improved by 8.5 ± 3.7 cm H2O (p = 0.03) and the MEP by 6.4 ± 4.4 (p = 0.16). The exercise training significantly improved the trajectories of MIP and 6 MWT outcomes but not FVC when compared with the natural history data available in 6 individuals. These pilot results indicate that resistance training combined with respiratory training and ERT had a positive effect on muscular strength, functional capacity, and respiratory function in patients with late-onset Pompe disease and might be considered as a potential adjunct therapy in this population.