Self-managed Exercise Research Articles

Live experience of people with diabetes mellitus on selfmanagement during COVID-19 in remote area of Indonesia

Introduction: People with Diabetes Mellitus (DM) are vulnerable to COVID-19. Therefore, it’s important to maintain good self-management (diet, exercise, medicine, and health care visitations) during pandemics. Unfortunately, during the COVID-19 pandemic, it’s difficult for them to maintain adequate self-management. Therefore, this study aimed to explore the self-management of people with DM during the pandemic, especially in a remote area of Indonesia.

Effect of a Self-directed and Supervised Pulmonary Rehabilitation Approach on Cough and Sputum Expectoration in Chronic Obstructive Pulmonary Disease

Background. Chronic obstructive pulmonary disease (COPD) is a multifactorial, progressive chronic lung disease. COPD was rated as the third largest cause of death by the World Health Organization (WHO) in 2016. Cough and sputum are present in about 60% of COPD patients. For persons with COPD who are unable to attend the standard centre-based program, home-based pulmonary rehabilitation offers a cost-effective option. The aim. To compare the effects of supervised and self-directed pulmonary rehabilitation on cough and sputum expectoration in patients with chronic obstructive pulmonary disease. Methods. Forty COPD-diagnosed subjects with ages between 40 to 60 years were recruited for this randomized clinical trial. The participants were randomly distributed into self-managed (n=18) and supervised (n=19) groups. Data was collected using a 6-minute walk test, the Leicester Cough Questionnaire and a cough and sputum assessment questionnaire at baseline after 6 weeks post treatment. Results. There was a significant difference found between self-managed and supervised groups for six-minute walk test with P value to be P > 0.005. While analysing LCQ, overall no significant difference was observed demonstrating between two groups with P > 0.05; besides, physical factors showed a significant difference during the pre-session which showed P = 0.004. No significant difference was found while analysing values from Cough and sputum assessment questionnaire with P > 0.05 Conclusion. Supervised exercise program and self-managed group show equal improvement in COPD patients. Self-management exercise should be encouraged for active involvement of patient during the treatment and to promote self-preventive behavior. Keywords: sputum, cough, self-management, pulmonary rehabilitation.

Impact of COVID-19 lockdown on physical activity behaviours of older adults who participated in a community-based exercise program prior to the lockdown.

This study investigated the impact of the 2020 COVID-19 lockdown on community-dwelling older adults attending a community-based exercise program to seek strategies to keep them active during self-isolated situations. A two-phase mixed methods approach included a survey followed by in-person focus groups. Forty-eight participants, with 32 starting a community-based exercise program before the lockdown and 16 joining the program after the lockdown, completed a questionnaire survey about physical activities before and during the lockdown. This was followed by three focus groups (26 participants in total) to identify factors influencing physical activity behaviours found in the survey. The survey found that the COVID-19 lockdown had varied impact on exercise adherence of the older adults: 43% of the participants exercised less during the lockdown than pre-lockdown, but 26% exercised more. Interestingly, among the participants approximately 80% still achieved the recommended physical activity level by the WHO during the lockdown. The focus groups revealed that exercise behaviours before the lockdown directly affected the behaviours during the lockdown. Participants' recognition of the support from trustworthy people also influenced their motivation to perform exercises in an isolated environment. Remote exercise programs, such as digital and printed exercise materials, were found beneficial for the participants only when they came from the people the older adults trusted through their previous experience (i.e., the program). A sense of belonging to the exercise group was also essential for the participants to achieve self-managed exercise. It was concluded that older adults need connections to an exercise group and a trustworthy exercise instructor who could continuously support them to be physically active in isolated situations such as lockdowns, in addition to exercise knowledge and a better understanding of the benefits of exercise.

Effects of self-management exercise group participation in community-dwelling older adults

BackgroundThe effects of physical fitness and age on motor function in older adults who continue to exercise remain unclear. This study aimed to examine the effects of participation in self-management exercise groups in adults aged ≥65 years.MethodsThe motor functions of 372 citizens who participated in a self-management exercise group for 1 year were examined. The motor functions were assessed by measuring grip strength, five-repetition sit-to-stand test, 5-m fastest walking time (walking time) and timed up and go test. The participants were grouped according to their baseline grip strength (low or high grip strength groups). The baseline parameters were compared to those assessed 1 year after group participation. In addition, the rates of long-term care/support need certification were examined at 2-year follow-up.ResultsIn the low grip strength group aged ≥75 years, the grip strength of men, and grip strength and five-repetition sit-to-stand test results of women improved after 1 year. In the high grip strength group, the five-repetition sit-to-stand and timed up and go test results of men aged 65–74 years and five-repetition sit-to-stand test results of men aged ≥75 years improved. Among women in the high grip strength group, grip strength, five-repetition sit-to-stand test, walking time, and timed up and go test results improved in the participants aged 65–74 and ≥ 75 years. The number of new long-term care/support need certifications was comparable in both groups.ConclusionsParticipation in self-management exercise groups led to maintaining or improving physical fitness among community-dwelling-older adults. Furthermore, higher baseline grip strength was associated with improvements in many motor functions; therefore, participation in self-management exercise groups before the onset of functional decline is desirable.

Enablement and empowerment among patients participating in a supported osteoarthritis self-management programme - a prospective observational study.

BackgroundIn Sweden, core treatment for osteoarthritis is offered through a Supported Osteoarthritis Self-Management Programme (SOASP), combining education and exercise to provide patients with coping strategies in self-managing the disease. The aim was to study enablement and empowerment among patients with osteoarthritis in the hip and/or knee participating in a SOASP. An additional aim was to study the relation between the Swedish version of the Patient Enablement Instrument (PEI) and the Swedish Rheumatic Disease Empowerment Scale (SWE-RES-23).MethodsPatients with osteoarthritis participating in a SOASP in primary health care were recruited consecutively from 2016 to 2018. The PEI (score range 0–12) was used to measure enablement and the SWE-RES-23 (score range 1–5) to measure empowerment. The instruments were answered before (SWE-RES-23) and after the SOASP (PEI, SWE-RES-23). A patient partner was incorporated in the study. Descriptive statistics, the Wilcoxon’s signed rank test, effect size (r), and the Spearman’s rho (rs) were used in the analysis.ResultsIn total, 143 patients were included in the study, 111 (78%) were women (mean age 66, SD 9.3 years). At baseline the reported median value for the SWE-RES-23 (n = 142) was 3.6 (IQR 3.3–4.0). After the educational part of the SOASP, the reported median value was 6 (IQR 3–6.5) for the PEI (n = 109) and 3.8 (IQR 3.6–4.1) for the SWE-RES-23 (n = 108). At three months follow-up (n = 116), the reported median value was 6 (IQR 4–7) for the PEI and 3.9 (IQR 3.6–4.2) for the SWE-RES-23. The SWE-RES-23 score increased between baseline and three months (p ≤ 0.000). The analysis showed a positive correlation between PEI and SWE-RES-23 after the educational part of the SOASP (rs = 0.493, p < 0.00, n = 108) and at follow-up at three months (rs = 0.507, p < 0.00, n = 116).ConclusionsPatients reported moderate to high enablement and empowerment and an increase in empowerment after participating in a SOASP, which might indicate that the SOASP is useful to enable and empower patients at least in the short term. Since our results showed that the PEI and the SWE-RES-23 are only partly related both instruments can be of use in evaluating interventions such as the SOASP.Trial registrationClinicalTrials.gov. NCT02974036. First registration 28/11/2016, retrospectively registered.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12891-022-05457-9.

An interprofessional community-based program for diabetes education and exercise self-management

An interprofessional group of students were brought together to develop and implement an effective interprofessional, educational and exercise program for older adults with diabetes living in an independent senior living community. Students were from a doctor of physical therapy (DPT), undergraduate nursing (BSN), and masters of public health program (MPH) at the same university. The primary objective of this offering was to develop the Community Partners in a Diabetes Education Program in an interprofessional context to lead to improved student values and beliefs about interprofessional collaboration. The program included weekly activities focused on the self-management of diabetes, including exercise, prevention of complications, and nutrition. Student learning was assessed using the Interprofessional Socialization and Valuing Scale before and after program implementation as well as focus group interviews after the program was delivered. Student learners felt the program was beneficial to the seniors, but that interprofessional interactions were limited and could be improved by increasing opportunities for communication and designating a clear leader.

대학축구선수의 성취목표성향이 자기관리행동 및 운동몰입에 미치는 영향

The objective of this study is to research the achievement goal orientation of university soccer players, and also to examine the effects of achievement goal orientation on self-management behavior and exercise commitment. As the research subjects, total 244 university soccer players(1st-4th year students) registered in the Korea Football Association were finally selected. Based on the drawn results of this study, the conclusions could be summarized as follows. First, in the results of calculating the Pearson’s correlation coefficient between sub-variables of achievement goal orientation, self-management behavior, and exercise commitment to understand the relation between established variables, there were significant correlations in the significance level as .01. Second, in the results of analyzing the effects of achievement goal orientation on self-management behavior, all the sub-factors of achievement goal orientation such as task goal orientation and ego goal orientation had statistically significant effects on the sub-factors of self-management behavior such as body management, interpersonal management, training management, and psychological management. Third, in the results of analyzing the effects of achievement goal orientation on exercise commitment, all the sub-factors of achievement goal orientation such as task goal orientation and ego goal orientation had statistically significant effects on the sub-factors of exercise commitment such as cognitive commitment and behavioral commitment.

Effectiveness of self-managed home and community exercise interventions in improving physical activity, body adiposity and related health indices in adults living with HIV: a protocol for a systematic review

Background and objectivesDisorders of adipose tissue distribution in people living with the human immunodeficiency virus (HIV) have been associated with significant metabolic derangements that increase their risk of cardiometabolic and other chronic diseases. Systematic reviews focusing on supervised laboratory-based exercise interventions demonstrate that these interventions improve adipose tissue distribution and related health outcomes in people living with HIV (PLWH). However, there is a need to examine the effectiveness of more pragmatic home or community exercise programmes. The aim of this review will be to synthesize existing evidence on the effectiveness of self-managed home or community exercise interventions to improve physical activity levels, adipose tissue distribution and associated health indices in PLWH.MethodsThis review will encompass interventional studies that evaluate the effect of prescribed exercise programmes performed in the home or community with minimal supervision, by adults living with HIV. The following will be searched from inception: PubMed, Embase, Scopus, Cumulative Index to Nursing and Allied Health Literature, Physiotherapy Evidence Database, SPORTDiscus, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and Clinicaltrials.gov. Screening of studies and data extraction will be conducted by two independent reviewers. The risk of bias in included studies will be assessed using version 2 of the Cochrane risk-of-bias tool for randomized trials (RoB 2) and the Risk of Bias In Non-Randomized Studies-of Interventions (ROBINS-I) tool for non-randomized concurrently controlled and single-arm interventional studies. A random effects meta-analysis will be used to pool effect estimates for outcomes of interest (measures of physical activity and body adiposity). However, if pooling is deemed inappropriate due to substantial differences between studies, a narrative synthesis will be performed. This protocol is written according to the Preferred Reporting Items for Systematic reviews and Meta-analysis Protocols 2015 statement (see Additional file 1).DiscussionThis review shall provide evidence to support or disapprove the prescription of self-managed exercise interventions in a particularly vulnerable population. We will equally explore the potential impact of technology in improving physical activity outcomes. Our findings could help guide clinicians involved in the care of PLWH in prescribing exercise and inform the design of future trials and research.Systematic review registrationPROSPERO CRD42021223357.

Feasibility of performance-based and self-reported outcomes in self-managed falls prevention exercise interventions for independent older adults living in the community

BackgroundLittle is known about associations between performance-based measurements and self-reported scales, nor about ceiling effects or sensitivity to change to evaluate effects in the target population for self-managed exercise interventions. This study aimed to explore the feasibility of using performance-based outcomes for gait speed, functional leg strength and balance, and self-reported outcomes of falls-efficacy and functional ability in two self-managed falls prevention exercise interventions for community dwelling older adults.MethodsIndependent living, community-dwelling older adults (n = 67) exercised with one of two self-managed falls prevention exercise programmes, a digital programme (DP) or a paper booklet (PB) in a 4-month participant preference trial. Pre- and post-assessments, by blinded assessors, included Short Physical Performance Battery (SPPB) and 30s Chair stand test (30s CST). Participants completed self-reported questionnaires: Activities-specific and Balance Confidence scale (ABC), Iconographical Falls Efficacy Scale (Icon-FES), Late-Life Function and Disability Instrument Function Component (LLFDI-FC). In addition, improvement in balance and leg strength was also self-rated at post-assessment. Participants’ mean age was 76 ± 4 years and 72% were women.ResultsCeiling effects were evident for the balance sub-component of the SPPB, and also indicated for ABC and Icon-FES in this high functioning population. In SPPB, gait speed, 30s CST, and LLFDI-FC, 21–56% of participants did not change their scores beyond the Minimal Clinically Important Difference (MCID). At pre-assessment all performance-based tests correlated significantly with the self-reported scales, however, no such significant correlations were seen with change-scores. Improvement of performance-based functional leg strength with substantial effect sizes and significant correlations with self-reported exercise time was shown. There were no differences in outcomes between the exercise programmes except that DP users reported improved change of leg strength to a higher degree than PB users.ConclusionThe LLFDI-FC and sit-to-stand tests were feasible and sensitive to change in this specific population. The balance sub-component of SPPB and self-reported measures ABC and Icon-FES indicated ceiling effects and might not be suitable as outcome measures for use in a high functioning older population. Development and evaluation of new outcome measures are needed for self-managed fall-preventive interventions with high functioning community-dwelling older adults.

The development of a complex intervention to support exercise self-management for people with Parkinson's

The development of a complex intervention to support exercise self-management for people with Parkinson's

Step It Up: Increasing Physical Activity for Adults With Autism Spectrum Disorder and Intellectual Disability Using Supported Self-Management and Fitbit Technology

Adults with autism spectrum disorder and intellectual disability often do not engage in healthy levels of physical activity despite its many benefits. We conducted a randomized control trial to evaluate the effectiveness and feasibility of the Step It Up program, which used supported self-management strategies, on daily step counts, health measures, and perceived quality of life for adults with autism spectrum disorder and intellectual disability. Forty participants, ages 18 to 57, were randomly assigned to a control or intervention group. Males accounted for 70.6% of participant gender. Both groups received Fitbits and Fitbit training, and they participated in pre- and post-assessments. The intervention group participated in the Step It Up program. Participants in the intervention group had significantly higher step counts and lost more weight. Feasibility and acceptability were also high. This study provides valuable data on using a supported self-managed exercise program as well as insight into its feasibility in home settings.

INCLUDING EXERCISE SELF-MANAGEMENT AS PART OF INPATIENT REHABILITATION IS FEASIBLE, SAFE AND EFFECTIVE FOR PATIENTS WITH COGNITIVE IMPAIRMENT.

ObjectiveTo test the feasibility, safety and effectiveness of the My Therapy programme for inpatients with mild-moderate cognitive impairment.DesignObservational pilot study.PatientsRehabilitation inpatients with mild-moderate cognitive impairment.MethodsDuring their inpatient admission, participants received My Therapy, a programme that can increase the dose of rehabilitation through independent self-practice of exercises, outside of supervised therapy. Outcomes included My Therapy participation, falls, Functional Independence Measure (FIM) and 10-m walk test. Outcomes were compared with those of participants without cognitive impairment from the original My Therapy study (n = 116) using χ 2 and independent t-tests.ResultsEight participants with mild-moderate cognitive impairment (mean (standard deviation (SD)) age 89.6 years (4.8); 3 women) were included. All participants completed the My Therapy programme on at least one day of their admission, with no associated falls. Participants had an 8.4 s (SD 5.1) reduction in their 10-m walk test and a 21.5 point (SD 11.1) improvement on FIM scores from admission to discharge. There were no significant between-group differences in feasibility, safety or effectiveness for participants with and without cognitive impairment.ConclusionThis pilot study has shown that including exercise self-management as part of inpatient rehabilitation is feasible, safe and effective for patients with cognitive impairment.LAY ABSTRACTThis study aimed to determine whether it was practical, safe and effective for patients in a rehabilitation hospital with memory or thinking problems to participate in a programme called My Therapy. My Therapy aimed to increase the dose of rehabilitation through independent self-practice of exercises, outside of supervised therapy sessions. There were 8 participants in the study and all of them reported completing the My Therapy programme on at least one day of their rehabilitation stay. There were no falls relating to My Therapy participation. Participants improved their walking speed and function during their rehabilitation stay. There were no differences in the results between people with and without memory or thinking problems, in terms of practicality, safety or effectiveness. This study has shown that including exercise self-management as part of rehabilitation is practical, safe and effective for patients with memory or thinking problems.

Regression of lumbar disc herniation with a self-managed comprehensive exercise program: A case report

Background: Conservative therapeutic interventions may improve the regression of lumbar disc herniations, reducing the demand for surgical intervention. However, the vast number of conservative methods, variability in treatment combinations, including patient treatment preferences, delay the time-to-recovery and impact the recovery rates of patients. Current study presents the methods and outcomes of 15-week self-managed functional rehabilitation training. Case presentation: Patient is a 40-year-old recreational female runner with L4-L5 disc herniation, which occurred after lifting a heavy object three weeks prior. After initial three weeks of rehabilitation program, patient’s pain reduced from 8/10 to 5/10 to VAS scale, and after 12 weeks of stabilization and functional program, patient has regained full functionality with pain score of 0/10 on VAS scale. Conclusion: The presented case demonstrates that a self-managed functional rehabilitation exercise program may lead to regression of lumbar disc herniation and full reduction of symptoms after 15 weeks.

Recruitment strategies and reach of a digital fall-prevention intervention for community-dwelling older adults.

BackgroundTo have an impact on the population's health, preventive interventions have to reach a large proportion of the intended population. Digital solutions show potential for providing wider access to fall preventive exercise. However, there is a lack of knowledge about how to reach the target group. The aim of this study was to describe the recruitment process used in the Safe Step randomised controlled trial and the characteristics of the participants reached.MethodsSeveral recruitment methods, both digital and non-digital, were adopted to reach the intended sample size. Sociodemographic parameters from the baseline questionnaire were used to describe participant characteristics. The characteristics were also compared to a representative sample of older adults in the Swedish population.ResultsIn total, 1628 older adults were recruited. Social media proved to be the most successful recruitment strategy, through which 76% of the participants were recruited. The participants reached had a mean age of 75.9 years, lived in both urban and rural locations, were already frequent users of the Internet and applications (smartphone/tablet) (79.9%), had higher education (71.9%), and a large proportion were women (79.4%). In comparison with the general population participants in the Safe Step study were more highly educated (p < 0.001), women in the study more frequently lived alone (p < 0.001) and men more often reported poorer self-rated health (p = 0.04). Within the study, men reported a faster deteriorating balance (p = 0.003) and more prescribed medication (p < 0.001) than women.ConclusionRecruitment via social media is a useful strategy for reaching older adults, especially women and frequent users of the Internet, for a fully self-managed and digital fall prevention exercise intervention. This study underlines that a range of interventions must be available to attract and suit older adults with different functional statuses and digital skills.

Maximising Abilities, Negotiating and Generating Exercise options (MANAGE) in people with multiple sclerosis: A feasibility randomised controlled trial

Objective To investigate the feasibility and preliminary efficacy of a group self-management exercise and education program in people with multiple sclerosis. Design Feasibility randomised controlled trial. Setting Outpatient rehabilitation facility. Subjects Twenty-three adults (age 48.6 (11.7) years) recruited from a Multiple Sclerosis Clinic register. Interventions The intervention group undertook a 12-week group program incorporating behaviour change education, exercise and community integration. This was compared with a waitlist control group. Main measures Feasibility was measured by recruitment, adherence and safety. Efficacy outcomes included measures of physical function (6-metre and 6-min walk, Functional Reach) and self-report questionnaires (fatigue, quality of life, exercise benefits and barriers) at baseline, 6, 12 and 24 weeks. Results Of 74 individuals identified through the register, 48 (65%) were contacted and deemed eligible, and 23 (48%) agreed to participate. There was high adherence for attendance at education (57 of 72, 79%) and exercise (135 of 174, 78%) sessions. No adverse safety events occurred within the intervention sessions. Missed attendances at assessment sessions was high (5 to 8 participants missed at each time point) predominately due to health issues. The intervention group demonstrated positive changes in walking endurance, Functional Reach and fatigue, whereas the control had some reductions in walking speed and more perceived exercise barriers. Conclusions The MANAGE program appears feasible and safe for people with mild-to-moderate multiple sclerosis, with high adherence to exercise and education sessions. Future trials should consider strategies such as flexible scheduling or alternative methods of data collection to improve follow-up assessment attendance.

Self-Managed Music-Guided Exercise Intervention Improved Upper and Lower Extremity Muscle Strength for ICU Survivors-A Pilot Randomized Controlled Study.

ObjectiveThe objective of this study was to evaluate effects of a self-managed music-guided exercise intervention on muscle strength among intensive care unit (ICU) survivors. Methods We used a two-arm randomized-controlled trial. Following ICU discharge, eligible participants were assigned to one of two groups: music group (n = 13) or active control group (n = 13). The music group was taught to self-manage upper and lower extremity exercise movements by listening to an individualized music-guided playlist twice daily for 5 days. The active control group was provided an exercise brochure and advised to perform the same exercises at the same intervals. Dynamometers were used to measure muscle strength. T-tests and Weighted GEE models were used for testing the intervention effect between groups. Results Twenty-six subjects were enrolled. The mean age was 62.8 (SD = 13.8), 53.8% were male, 65.4% were Caucasian, and the mean APACHE severity of illness score was 59 (SD = 23.4). Reasons for ICU admission were mainly cardiac and medical. The music group showed significant improvements in handgrip, plantar flexion, leg extension, elbow flexion, and shoulder adduction strengths on left and right sides. Additionally, left and right leg extensor and left plantar flexor strengths showed significant post-differences, and small to moderately large effect sizes, between the music group and control group. Conclusion These findings suggest that a music-guided exercise intervention has the potential to improve muscle strength in ICU survivors and prevent further post-ICU deterioration in ICU survivors. Future trials should build upon these preliminary findings.

Motivating Adherence to Exercise Plans Through a Personalized Mobile Health App: Enhanced Action Design Research Approach.

BackgroundPhysical inactivity is a global issue that affects people’s health and productivity. With the advancement of mobile technologies, many apps have been developed to facilitate health self-management. However, few studies have examined the effectiveness of these mobile health (mHealth) apps in motivating exercise adherence.ObjectiveThis study aims to demonstrate the enhanced action design research (ADR) process and improve the design of mHealth apps for exercise self-management. Specifically, we investigate whether sending motivational messages improves adherence to exercise plans, whether the motivational effect is affected by personality, the impact of message type and repetition, and the process of involving a field experiment in the design process and learning new design principles from the results.MethodsThis formative research was conducted by proposing an enhanced ADR process. We incorporated a field experiment into the process to iteratively refine and evaluate the design until it converges into a final mHealth app. We used the Apple ResearchKit to develop the mHealth app and promoted it via trainers at their gyms. We targeted users who used the app for at least two months. Participants were randomly assigned to 1 of the 12 groups in a 2×3×2 factorial design and remained blinded to the assigned intervention. The groups were defined based on personality type (thinking or feeling), message type (emotional, logical, or none), and repetition (none or once). Participants with different personality types received tailored and repeated messages. Finally, we used the self-reported completion rate to measure participants’ adherence level to exercise plans. By analyzing users’ usage patterns, we could verify, correct, and enhance the mHealth app design principles.ResultsIn total, 160 users downloaded the app, and 89 active participants remained during the 2-month period. The results suggest a significant main effect of personality type and repetition and a significant interaction effect between personality type and repetition. The adherence rate of people with feeling personality types was 18.15% higher than that of people with thinking types. Emotional messages were more effective than logical messages in motivating exercise adherence. Although people received repeated messages, they were more likely to adhere to exercise plans. With repeated reminders, the adherence rates of people with thinking personality types were significantly improved by 27.34% (P<.001).ConclusionsThis study contributes to the literature on mHealth apps. By incorporating a field experiment into the ADR process, we demonstrate the benefit of combining design science and field experiments. This study also contributes to the research on mHealth apps. The principles learned from this study can be applied to improve the effectiveness of mHealth apps. The app design can be considered a foundation for the development of more advanced apps for specific diseases, such as diabetes and asthma, in future research.

Community-Based Physical Rehabilitation After Percutaneous Coronary Intervention for Acute Myocardial Infarction.

To determine whether a community-based physical rehabilitation program could improve the prognosis of patients who had undergone percutaneous coronary intervention after acute myocardial infarction, we randomly divided 164 consecutive patients into 2 groups of 82 patients. Patients in the rehabilitation group underwent 3 months of supervised exercise training, then 9 months of community-based, self-managed exercise; patients in the control group received conventional treatment. The primary endpoint was major adverse cardiac events (MACE) during the follow-up period (25 ± 15.4 mo); secondary endpoints included left ventricular ejection fraction, 6-minute walk distance, and laboratory values at 12-month follow-up. During the study period, the incidence of MACE was significantly lower in the rehabilitation group (13.4% vs 24.4%; P <0.01). Cox proportional hazards regression analysis indicated a significantly lower risk of MACE in the rehabilitation group (hazard ratio=0.56; 95% CI, 0.37-0.82; P=0.01). At 12 months, left ventricular ejection fraction and 6-minute walk distance in the rehabilitation group were significantly greater than those in the control group (both P <0.01), and laboratory values also improved. These findings suggest that community-based physical rehabilitation significantly reduced MACE risk and improved cardiac function and physical stamina in patients who underwent percutaneous coronary intervention after acute myocardial infarction.

Lifestyle, exercise and activity package for people living with progressive multiple sclerosis (LEAP-MS): protocol for a single-arm feasibility study

BackgroundWe have co-designed a tailored blended physiotherapy intervention for people with progressive multiple sclerosis (PwPMS) who often struggle to access support for physical activity. Underpinned by self-management principles, the Lifestyle, Exercise and Activity Package for people with Multiple Sclerosis (LEAP-MS) intervention incorporates face-to-face or online physiotherapy coaching sessions with an accompanying online physical activity platform. The LEAP-MS platform is a multi-user system enabling user and physiotherapist to co-create activity plans. The LEAP-MS platform consists of an information and activity suite, interactive components enabling selection of exercises into an activity programme, goal setting and activity logging. The platform also facilitates online remote support from a physiotherapist through an embedded online messaging function. We aim to evaluate the LEAP-MS platform in a feasibility trial.MethodsLEAP-MS will be evaluated within a single-arm feasibility study with embedded process evaluation. After registration and initial eligible screening, 21 participants will be required to complete baseline self-completion measures. This will be followed by an initial home-based or online coaching session with a physiotherapist (who has received tailored self-management and digital resource training) and access to the online intervention for an initial 3-month period. During this period, participants are given the option to request up to five further home-based or online physiotherapy coaching sessions. Follow-up questionnaires and semi-structured interviews will be administered 3 months after baseline with participants and intervention physiotherapists. The LEAP-MS platform will be available to participants for a further 3 months. Usage of the LEAP-MS platform will be tracked during the full 6-month period and final follow-up will be conducted 6 months after baseline.DiscussionFeasibility outcomes (recruitment, retention, intervention uptake and safety) will be reported. The process evaluation will be undertaken to identify possible mechanisms for any observed effects. The data will inform full-scale evaluations of this co-produced, blended physiotherapy intervention.Trial registrationClinicalTrials.gov, NCT03951181. Registered 15 May 2019

A randomized controlled trial on the effect of focal thermal therapy at acupressure points treating osteoarthritis of the knee

BackgroundOsteoarthritis of the knee is a common degenerative joint disorder in our ageing population. A combination of thermal therapy with a self-management exercise have shown a positive effect in the management of osteoarthritis of the knee. This study aimed to compare the effectiveness of topical heat pack versus focal application of heat therapy at the acupressure points in the treatment of osteoarthritis of the knee.MethodsA randomized controlled trial was conducted in 76 patients with osteoarthritis of the knee, diagnosed by an experienced orthopedic surgeon. Following inclusion and exclusion selection, patients were randomly allocated to group 1 (Heat pack) or group 2 (Thermal gun). All patients received 30 min of treatment in each session, twice a week for 4 weeks. They also received an education program and taught home knee exercises. Outcome measurements were the visual analog scale (VAS) for pain intensity, muscle power, knee ROM, WOMAC and SF-12v2.ResultsIn the Thermal gun group, function and total scores (WOMAC) and Physical Composite Scale (SF-12v2) were significantly improved after 8 sessions. Quadriceps strength was significantly improved after 8 weeks (from 4.42 to 4.63; p = 0.02). In the Heat pack group, flexion was significantly improved after 8 sessions (p = 0.02). Mean VAS scores after Heat pack treatment was consistently better (lower) than mean VAS scores after Thermal gun treatment.ConclusionThe combination of focal thermal therapy at acupressure points is a viable conservative treatment in osteoarthritis of the knee. The pressure at the acupressure points has a synergistic benefit than topical thermal therapy alone.Trial registrationClinicalTrials.gov, NCT04735029Date of registration: February 2, 2021 (Retrospectively registered)