Self-directed Exercise Research Articles

Self-directed Exercise and Quality of Life in Breast Cancer Survivors Using Aromatase Inhibitors

Self-directed Exercise and Quality of Life in Breast Cancer Survivors Using Aromatase Inhibitors

Teaching Evidence-Based Imaging in the Radiology Clerkship Using the ACR Appropriateness Criteria

Given escalating health care costs and limited resources, the effective utilization of imaging is essential to permit optimal patient care. Because only 21.4% of medical schools require radiology clerkships, most students do not understand the indications for and clinical effectiveness of most imaging tests. Therefore, the authors introduced two focused sessions on evidence-based imaging during the required radiology core clerkship at their institution. From June 2008 to September 2009, 259 students in the radiology core clerkship participated in a didactic session on principles of evidence-based imaging and/or a small-group session and self-directed learning exercise using the American College of Radiology (ACR) Appropriateness Criteria. Students evaluated the exercise on a five-point scale for its effectiveness in teaching imaging strategies and its impact on their future careers. Two hundred twenty-eight of 259 students (88%; 93 third year, 135 fourth year) participated in the two sessions. Two hundred thirteen of 223 (96%) were not aware of the ACR's Web site as a resource prior to this exercise. Two hundred fourteen of 228 (94%) found the ACR Appropriateness Criteria a useful resource. Two hundred two of 228 (89%) stated that they would likely use this resource in other clinical rotations and future practice. Two hundred three of 228 (89%) reported having a solid understanding of the indications for imaging tests following the sessions. Students praised the ACR's Web site for its comprehensive coverage of different modalities and their relative radiation risks. They valued working collaboratively on common clinical scenarios. The ACR Appropriateness Criteria are a valuable resource for teaching evidence-based imaging to medical students. A majority of students indicated that they plan to use this resource in the future.

Evaluation of a paediatric asthma education package for health professionals

To evaluate an evidence-based paediatric asthma management education package designed for health professionals with particular emphasis on formulation of written asthma action plans (AAPs) and inhalation device technique. A prospective cohort study was conducted involving graduate medical programme medical students and tertiary paediatric hospital junior house staff. Three case-based Microsoft Powerpoint presentations were used to highlight important aspects of asthma management including the formulation of an AAP and inhalation device technique. This was delivered in small-group sessions to medical students and as a self-directed learning exercise to junior house staff. Outcome measures were ability to write an accurate AAP, confidence and competence in using and teaching asthma devices, and knowledge of asthma. Forty medical students and 14 junior house staff were recruited. Mean scores for the written AAP improved from 4.2 (out of 19) to 16.2 for medical students (mean change 12.0; 95% confidence interval (CI) 11.0-13.0; P < 0.001) and from 11.5 to 16.8 for junior doctors (mean change 5.3; 95% CI 3.5-7.2; P < 0.001). Confidence in using and teaching asthma inhalation devices also improved (P < 0.001 for students and P < 0.05 for house staff), as did asthma knowledge and skills in using the devices in the students (P < 0.001). The education package was effective in teaching participants how to write an accurate AAP and improved their confidence and ability in demonstrating proper inhalation device technique. We believe that the package has the potential to be used more widely for either small-group or self-directed learning.

Exercise and Peripheral Arterial Disease

Letters2 May 2006Exercise and Peripheral Arterial DiseaseDae Hyun Kim, MD, MPHDae Hyun Kim, MD, MPHFrom the Jefferson Medical College, Philadelphia, PA 19107.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-144-9-200605020-00017 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:Dr. McDermott and colleagues (1) found that self-directed walking exercise at least 3 times weekly was associated with a slower rate of functional decline in patients with peripheral arterial disease (PAD) after adjusting for sociodemographic and clinical characteristics, including aspirin, statin, and angiotensin-converting enzyme inhibitor use. They also took into consideration that a proportion of patients benefited from participating in supervised exercise programs. They did not, however, adjust for the use of pharmacologic interventions for claudication, such as pentoxifylline and cilostazol, which might have more significant and direct effects on functional performance than those seen with aspirin, ...

Physical Performance in Peripheral Arterial Disease: A Slower Rate of Decline in Patients Who Walk More

Exercise rehabilitation programs increase treadmill walking performance in patients with peripheral arterial disease (PAD) and intermittent claudication. However, it is unknown whether patients with PAD who walk for exercise regularly have less functional decline than those with less walking activity. To determine whether patients with PAD who report that they walk for exercise 3 or more times per week have less annual functional decline than those who walk for exercise less frequently. Prospective cohort study with a median follow-up of 36 months (interquartile range, 24 to 36 months). Academic medical center. 417 men and women with PAD. Participants were classified at baseline and annually according to the number of times they reportedly walked for exercise each week. Functional assessments (6-minute walk distance, 4-meter walking speed, summary performance score) were measured at baseline and annually. Results were adjusted for age, sex, ethnicity, comorbid conditions, body mass index, ankle-brachial index, education, leg symptoms, cigarette use, geriatric depression score, previous year's level of functioning, and patterns of missing data. Compared with those who exercised less frequently, patients who walked for exercise 3 or more times per week had a significantly smaller average annual decline in 6-minute walking distance (-48.0 feet per year compared with -56.6 feet per year for those who walked 1 to 2 times per week and -79.4 feet per year for nonexercisers; P for trend = 0.037). Patients who walked for exercise at least 3 times per week experienced a smaller average annual decline in the usual-paced 4-meter walking velocity (-0.014 m/s per year compared with -0.022 m/s per year for those who walked 1 to 2 times per week and -0.045 m/s per year for nonexercisers; P = 0.005). Similar findings were observed for the fast-paced 4-meter walk. The subset of asymptomatic patients who walked for exercise 3 or more times per week had annual declines in 6-minute walking performance (P = 0.107), normal-paced walking velocity (P = 0.065), and the summary performance score (P = 0.115); however, these declines were smaller than those observed in asymptomatic participants who walked fewer than 3 times per week. Because this was an observational study, associations reported here cannot be construed as causal relationships. Sample sizes for subgroup analyses were small, which limited statistical power. Among patients with PAD, self-directed walking exercise performed at least 3 times weekly is associated with significantly less functional decline during the subsequent year. Similar trends were observed in the subset of asymptomatic patients with PAD. These findings may be particularly important for the numerous patients with PAD who do not have access to supervised walking exercise programs.

Determinants of cardiac function: simulation of a dynamic cardiac pump for physiology instruction.

A computer model is described that simulates the cardiac cycle of a mammalian heart. The model emphasizes the pressure-volume plot as a teaching tool to explain the behavior of the heart as a pump. It exhibits realistic responses to changes in preload, afterload, contractility, and heart rate while displaying time-dependent changes in pressure and volume in addition to the pressure versus volume plot. It differs from previous models by graphing these parameters on a beat-to-beat basis, allowing visualization of the dynamic adaptation of the pumping heart to various stimuli. A system diagram is also included to further promote student understanding of the physiology of cardiac function. The model is useful for teaching this topic to medical, graduate, or undergraduate students. It may also be used as a self-directed computer laboratory exercise.

Basic principles of synaptic physiology illustrated by a computer model.

A computer model is described that simulates many basic aspects of chemical synapse physiology. The model consists of two displays, the first being a pictorial diagram of the anatomical connections between two presynaptic neurons and one postsynaptic neuron. Either or both of the presynaptic cells can be stimulated from a control panel with variable control of the number of pulses and firing rate; the resulting presynaptic action potentials are animated. The second display plots the membrane potential of the postsynaptic cell versus time following presynaptic stimulation. The model accurately simulates temporal and spatial summation when the presynaptic cells are arranged and stimulated in parallel and simulates presynaptic inhibition when they are arranged and stimulated in series. Excitatory and inhibitory postsynaptic potentials can be demonstrated by altering the nature of the ionic conductance change occurring on the postsynaptic cell. The effects on summation of changing length constant or time constant of the postsynaptic cell can also be illustrated. The model is useful for teaching these concepts to medical, graduate, or undergraduate students and can also be used as a self-directed computer laboratory exercise. It is available for free download from the internet.

Development and validation of an exercise performance support system for people with lower extremity impairment.

To identify innovative strategies to support appropriate, self-directed exercise that increase physical activity levels of people with arthritis. This article reports on one interactive, multimedia exercise performance support system (PSS) for people with lower extremity impairments in strength or flexibility. An interdisciplinary team developed the PSS using self-report of lower extremity musculoskeletal impairments (flexibility and strength) to produce an individualized exercise program with video and print educational materials. Initial evaluation has investigated the validity and reliability of program assessments and recommendations. PSS self-report and professional assessments were similar, with more impairments indicated by self-report. PSS exercise recommendations were similar to those made by 3 expert physical therapists using the same exercise data base. Results of PSS impairment assessments were stable over a 1-week period. PSS exercise recommendations appear to be reliable and a valid reflection of current exercise knowledge in rheumatology. Furthermore, users were able to complete the computer-based program with minimal assistance and reported it to be enjoyable and informative.

A comparison of the effects of three types of endurance training on balance and other fall risk factors in older adults

We hypothesized that short-term endurance training improves balance in older adults, if training involves movements that "stress" balance. We tested the hypothesis by looking for a dose-response relationship between movement during exercise and balance improvement. The study was a single-blinded, randomized controlled trial. Subjects were sedentary adults (N = 106) aged 68-85 with at least mild deficits in balance. Exercise groups were: stationary cycle (low movement), walking (medium movement), and aerobic movement (high movement). Subjects attended supervised exercise classes three times a week for three months, followed by self-directed exercise of any type for three months. The primary test of the hypothesis compared changes in balance after three months of supervised exercise. One balance measure (distance walked on a six-meter narrow balance beam) improved in the hypothesized dose-response manner (cycle, 3% improvement; walking, 7% improvement; aerobic movement, 18% improvement: p < 0.02, test of trend). Other balance measures did not improve with exercise. Only walking exercise improved gait speed (by 5%, p < 0.02) and SF-36 role-physical score (by 24%, p < 0.05). VO2max improved with walking (18%, p < 0.004) and aerobic movement (10%, p < 0.01), but improved less with cycling (8%, p > 0.1). Leg strength improved significantly in all exercise groups. The study hypothesis was supported only for one balance measure. Only walking improved at least one measure of all major outcomes (endurance, strength, gait, balance, and health status), suggesting that walking is most useful for all prevention. Cycle exercise appeared least useful.

Responses of 49- to 59-Year-Old Sedentary, Overweight Women to Four Months of Exercise Conditioning and/or Fitness Education

This paper reports fimess and serum lipid outcomes of healthy, sedentary, overweight (M BMI = 32.1 kg/M2), 49-to-59-year-old women following 4 months of exercise-based intervention. One hundred fifty-seven women were randomly assigned to the following groups: health and fitness education combined with aerobic training (EX) (n = 68), health and fitness education only (ED) (n = 63), and control (CO) (n = 26). The following pre- and post-intervention assessments were performed: aerobic power, body composition, resting blood pressure and heart rate, muscular strength and endurance, flexibility, and serum lipids. We found significant improvement in abdominal muscular endurance in EX, compared to ED and CO. We also found significant improvement in total serum cholesterol (TSC) and TSC/ HDL-C ratio in ED compared to EX and CO suggesting that health and fitness education alone may improve the health of this population and contribute to self-directed exercise. Additionally, small fitness improvements observed in C...

Advances in human reproductive ecology.

Human reproductive ecology pertains to reproduction biology and changes due to environmental influences. The research literature relies on clinical, epidemiological, and demographic analysis. The emphasis is on normal, nonpathological states and a broad range of ecological conditions. This review focused on the importance of age and energetic stress from ecological conditions rather than dieting or self-directed exercise in changing female fecundity. The literature on male reproductive ecology is still small but growing. J.W. Wood provided a comprehensive overview of the field. Natural fertility, as defined by Henry, is the lack of parity-specific fertility limitation. There is evidence that fertility can vary widely in natural fertility populations. There are consistent age patterns among different natural fertility populations. Doring found that there was higher frequency of anovulatory and luteal insufficiency in cycles during perimenarche and perimenopausal periods. Infertility studies have shown declines in pregnancy rates in women over the age of 30 years. Ovum donation evaluations have found both uterine age and ovarian and oocyte age to be related to the probability of a successful pregnancy. Basal follicle stimulating hormone and the endometrial thickness are important predictors of ovarian capacity and related to age and declining fecundity. Much of the literature on fecundity is derived from women with impaired reproductive physiology. In Lipson and Ellison's study of healthy women, average follicular and average luteal estradiol values declined with increasing subject age. Low follicular levels were correlated with smaller follicular size, low oocyte fertilizability, reduced endometrial thickness, and low pregnancy rates. Comparisons across populations have shown that populations experience declines in luteal function with age, but levels of luteal functions varied widely. Chronic conditions which slow growth and delay reproductive maturation may impact on lower ovarian function throughout adult life. There is a range of ovarian function along a continuum due to energetic stress. Evidence from the Lese in Zaire, the Tamang of Nepal, and Polish farm women outside Crakow suggest that workload affects ovarian function. Luteal function and ovulatory frequency is lower when women are losing weight. Among the Tamang losing weight between seasons there was evidence of lower ovarian function during the monsoon season. Polish farm women who work very hard in summer had lower ovarian function. The effect of lactation on amenorrhea appears to be due to the energetic stress on the mother in the intensity and duration of suckling. Women in poorer nutritional status may require more intense suckling. Seasonality of energy balance may be related to seasonality of female fecundity and conceptions.

How stroke patients spend their days. An observational study of the treatment regime offered to patients in hospital with movement disorders following stroke.

A number of studies have suggested that early intensive rehabilitation will promote recovery after stroke. If this is so then how far does current National Health Service provision succeed in delivering this? This observational study looks at how 15 stroke patients in a general hospital spent their days. Only 12.9% of the working day, or 62 minutes, were spent in therapy. Patients spent most of their working day, 38.6%, in 'recreation', and most of this time was spent on the ward. For much of this time they could have been available for therapy sessions or involved in self-directed exercise. The impact of a new regime aimed at increasing intensity of therapy for the hemiplegic arm is examined.