Specific Exercise Program Research Articles

The Effect of Specific Balance Training Exercises for Preventing Falls among Elderly Women

All European countries are experiencing significant ageing of the population. As the lifespan of the population increases, so does the prevalence of falls. Falls in older adults are a major public health concern and a main cause of morbidity and disability. More than one-third of persons 65 years of age or older fall each year, and in half of such cases the falls are recurrent. It is very important to maintain physical activity and independence in daily activities in elderly persons as well as to apply appropriate preventive means as soon as possible. Various interventions may be used to promote health, enhance quality life and reduce falls in elderly people: exercises, home modifications, appropriate footwear and walking aids. The purpose of this study was to determine the effect of specific balance training exercises for preventing falls among elderly women. Twenty eight women aged 55–75 years participated in the study. The subjects were randomly divided into two groups: exercise (n = 14, mean age 67.9 ± 6.13 years) and control (n = 14, mean age 68.9 ± 5.31). Exercise group women performed specific – Cawthorne-Cooksey balance training exercises for 4 weeks, 5 times a week. Cawthorne-Cooksey exercises consisted of moving head in sitting and standing positions with eyes open or closed, exercises on a balance platform, and walking around. One training session lasted for 30-35 minutes. No exercise was performed in the control group. Static and dynamic balance was assessed using the Berg Balance Scale, Functional Reach Test, and Tinetti Balance Scale, walking speed was assessed using Timed Up and Go Test. Risk for falls was assessed using Desmond Fall Risk Questionnaire [4]. Subjects were evaluated twice: before and after applying exercise program. More than 50% of women have had a fall in the past years, difficulty walking in the dark or on uneven surfaces, they have experienced loss of balance or a light-headed feeling standing up, and they could not walk a straight line. Only 29% of subjects participated in a regular exercise programme. The results of Berg Balance Scale, Functional Reach Test, Tinetti Balance Scale, Timed Up and Go Test did not differ between groups before applying specific exercise program. Specific exercises significantly improved patients’ static and dynamic balance, reach functions and walking speed, while in the control group the results of all performed tests had tendency to decline. Specific Cawthorne-Cooksey balance training exercises are effective (p < 0.05) in improving balance and preventing falls in elderly women.Keywords: falls, elderly age, balance, risk of falls.

Sagittal spinal alignment in patients with ankylosing spondylitis by rasterstereographic back shape analysis: an observational retrospective study.

Ankylosing spondylitis (AS) is a chronic-inflammatory disorder involving the sacroiliac-joints, spine, and spinal ligaments. A proper understanding of the sagittal plane alignment and posture is essential in managing deformities of the spine. The aim of this study was to evaluate the differences in sagittal plane alignment between patients with AS and healthy subjects by means of rasterstereography and to analyze the relationship between clinical assessments and postural features. Observational retrospective study. This study took place from January 2012 to April 2014 at the rheumatologic out-patient clinic, Umberto I Hospital, Rome, Italy. Forty-six healthy subjects and twenty-five AS patients were enrolled in the study. Spinal posture was measured by the rasterstereographic system Formetric 4D. Trunk inclination, kyphosis angle, lordosis angle, cervical and lumbar plumbline distance, and sagittal pelvic alignment were analyzed. Differences between the two groups in postural parameters were compared (primary outcomes). Multiple regression analysis was used to evaluate if postural parameters could be predicted by the Bath Ankylosing Spondylitis Metrology Index (BASMI) that is a composite index of spinal mobility, disease duration and body mass index (secondary outcomes). Patients with AS showed a significant increase in the kyphosis angle and the cervical plumbline distance and a significant reduction in the lordosis angle and the sagittal pelvic alignment when compared to healthy subjects. According to multiple regression analysis, BASMI influenced the kyphosis angle value with a standardized coefficient β of 1.93, the lordosis-angle value with a standardized coefficient β of -2.79 and sagittal pelvic alignment value with a standardized coefficient-β of -2.93. Rasterstereography has proved to be a valid tool in monitoring change in spinal structure in AS patients and has shown a strong correlation with clinimetric parameters of AS (BASMI). Future studies are needed, with a greater number of patients, in order to better characterize the evidently existing relationship between postural changes in AS patients and rasterstereography. Rasterstereography has proved to be a valid tool in monitoring postural changes in AS patients and has shown a strong correlation with clinical evaluations. Therefore, the assessment of postural characteristics using the rasterstereographic system before and after a specific exercise program would be a reliable and valid advice without exposing subjects to high doses of radiations.

Chest Expander Spring a Low Cost Home Physiotherapy-Based Exercise Rehabilitation after Total Hip Arthroplasty

Background: The demand for total hip arthroplasty (THA) is rising. Postoperative exercise rehabilitation helps patients recover normal joint functions by strengthening the muscles surrounding the replaced hip joint. In the face of rapidly increasing health care costs, ensuring widespread, cost-effective rehabilitation is a priority. However, the high cost of professionally supervised exercise rehabilitation programs limits access to program participation and, thus, to optimal recover of normal joint functions. Therefore, the development of an effective home-based, self-monitored exercise rehabilitation program is critical to promote the optimal recovery of THR patients. Purpose: The aim of this study was to assess the feasibility, evaluate the effectiveness of a specific Progressive Resistance Exercise program for improving hip muscles strength, resorting hip joint mobility and address the functional needs of the patient treated with primary total hip arthroplasty. Additionally; spreading the idea of a low-cost post-operative rehabilitation program using chest expander spring. Study Design: Prospective case series study. Patients and Methods: This was a prospective single-center clinical study with a 12-week intervention program carried out in an outpatient clinic and in home based. 120 patients (84 males) had been enrolled in this study to which primary total hip arthroplasty had been done. Patients were evaluated preoperatively, at baseline, 2 weeks postoperative, one week following last visit of follow-up and at 6 months postoperatively. Clinical outcome measures involved: Harris Hip Score (HHS), Oxford Hip Score (OHS), WOMAC activity score, range of hip movements (ROM), Timed Get Up and GO Test and 6 Minutes walking test. Results: The study included 120 patients (84 males). The mean age 65.3 years (range = 53-76 years). Results of clinical functional outcomes showed a progressive improvement at follow ups regarding : Harris Hip Score, Oxford Hip Score, WOMAC activity score ( related to pain, stiffness and physical functions), range of hip motions, time effect for Get up-and-go test and 6-minute walking distance test. The improvement is more achieved in last follow up visit and after 6 months postoperative. Conclusions: The study demonstrates that this novel low-cost solution holds promise in rehabilitation after THA, ensuring better clinical outcomes than conventional rehabilitation while reducing dependence on human resources. Considering the low cost and convenience of a home-based resistance training program, health professionals should consider this and similar exercise programs when providing guidance to THR patients particularly in low-income countries.

Moderate-Intensity Aerobic Exercise Restores Appetite and Prefrontal Brain Activity to Images of Food Among Persons Dependent on Methamphetamine: A Functional Near-Infrared Spectroscopy Study.

The brain prefrontal control system is critical to successful recovery from substance use disorders, and the prefrontal cortex (PFC) regulates striatal reward-related processes. Substance-dependent individuals exhibit an increased response to drug rewards and decreased response to natural, nondrug rewards. Short-term aerobic exercise can ameliorate craving and inhibitory deficits in methamphetamine users, but the effect of exercise on food reward is unknown. This study used functional near-infrared spectroscopy (fNIRS) to measure the effects of moderate- and high-intensity short-term aerobic exercise on prefrontal activity related to food images and recorded the subjective feelings of appetite in methamphetamine-dependent users. In total, 56 men who met the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) criteria for methamphetamine dependence, with a mean (SD) body mass index of 24.7 (3.5) kg/m2 and age of 30.2 (5.1) years, were randomly assigned to one of two exercise groups: moderate intensity (n = 28; 65%–75% of maximum heart rate) and high intensity (n = 28; 76%–85% of heart rate maximum). Each group also performed a resting control session for 35 min 1 week before or after the exercise, in a counterbalanced order. Mean oxygenated hemoglobin concentration changes in the PFC when viewing visual food cues were assessed by fNIRS, and subjective feelings of appetite were self-rated using visual analog scales after moderate- or high-intensity aerobic exercise and after the resting control session. A continuous-wave NIRS device was used to obtain functional data: eight sources and seven detectors were placed on the scalp covering the PFC, resulting in 20 channels per participant. We found that moderate-intensity aerobic exercise significantly increased both, the activation of the left orbitofrontal cortex (OFC) to images of high-calorie food (P = 0.02) and subjective sensations of hunger (F(1,54) = 7.16, P = 0.01). To our knowledge, this study provides the first evidence that moderate-intensity aerobic exercise increases OFC activity associated with high-calorie food images and stimulates appetite in methamphetamine-dependent individuals. These changes suggest that exercise may reestablish the food reward pathway hijacked by drugs and restore sensitivity to natural rewards. This evidence may contribute to the development of specific exercise programs for populations with methamphetamine dependence.

2406 The Role of Exercise in Decreasing Ongoing Pain in the Post-Excision Endometriosis Population

Study Objective Endometriosis is a painful disease affecting quality of life in nearly 176 million women worldwide. Even post excision of endometriosis patients may continue to experience pain across multiple systems from gynecological pain to abdominal and musculoskeletal pain. Current best practices leaves women with the disease few options beyond surgery, especially for those suffering with central sensitization and nerve up-regulation due to the long term adaptations of the disease. Pelvic Physical Therapy can be a critical component to mobilize the body post operatively. An exercise prescription designed by a physical therapist may help integrate and quiet long standing nerve patterns thereby returning the woman with endometriosis back to her best possible quality of life. Design 35 women with endometriosis following excision of endometriosis were given a specific exercise program to help with nerve and pain not reduced by surgery alone. The CHPPS questionnaire was administered at onset of physical therapy and then at the 3 and 9 month mark. Setting Outpatient Private Physical Therapy Practice. Patients or Participants People with Endometriosis, post excision of the disease by a specialist. Interventions Specific Exercise prescription was given to 35 patients with endometriosis. Measurements and Main Results Of the 35 women, 24 reported increases in quality of life, 6 reported changes in pain but no increase in quality of life and 5 did not complete the study either due to compliance. Conclusion Women with endometriosis experience on average an 8 year diagnostic delay from onset of symptoms to treatment. This delay may increase issues within the central nervous system, additionally the overwhelming pain may cause a patient to become deconditioned. Even after the disease is removed, pain may remain. An exercise prescription by a pelvic physical therapist may help increase quality of life.

IMPORTÂNCIA DA PREPARAÇÃO FÍSICA PARA O PACIENTE COM DOENÇA DE PARKINSON

TEIXEIRA, M.E. e PEREIRA, J.L. Importância da preparação física para o paciente com doença de Parkinson. Revista Científica JOPEF, Vol.28, n.1, pp.29-43, 2019. Parkinson's disease (PD) is a chronic progressive neurodegenerative disease described by the first in 1897 as "tremor paralysis." Its symptoms are variable, the most characteristic being tremor of the hands and loss of balance and muscular strength. It usually affects men over the age of 60, but there are forms that can occur in younger individuals. The progression of symptoms causes the quality of life of the patient to deteriorate significantly, leading to the inability to perform daily activities. In addition to pharmacological treatment, physical exercise has been indicated as a way to attenuate and slow the progression of symptoms. The objective of this work is to carry out an integrative review of literature on the subject, in which articles published over the last 10 years have been analyzed, thus seeking to update the theme. In general, it was possible to perceive a positive effect of the practice of specific physical exercise programs in patients with PD, with improvement of the quality of life. In vitro studies also demonstrated the protective effect of physical exercise on the onset of the disease. Keywords: Parkinson's disease; Physical exercise; Neuroprotection; Quality of life.

Could a specific exercise programme prevent injury in elite orienteerers? A randomised controlled trial

ObjectivesTo determine the effect of a specific exercise programme on preventing lower extremity injury in adult elite orienteerers. DesignRandomised controlled trial. SettingElite orienteering. ParticipantsSixty-two orienteerers (n = 32/30, male/female) were randomized and followed over 14 weeks. The intervention group completed an exercise programme 4 times per week. Main outcome measuresNumber of substantial injuries, average substantial injury prevalence and incidence of ankle sprains over the competitive season. In per-protocol analyses, compliance rate to exercise programme was considered. ResultsNo significant differences between control and intervention group were found for substantial injured orienteerers (OR 0.50, 95% CI 0.19–1.34), number of substantial injuries (OR 0.46, 95% CI 0.18–1.13) and incidence of ankle sprains (p = 0.775). In per-protocol analyses, significant differences in substantial injured orienteerers (difference −7.9%, OR 0.25, 95% CI 0.06–0.97) and number of substantial injuries (difference −8.5%, OR 0.26, 95% CI 0.07–0.92) in favour for the orienteers completing the exercises at least twice a week, compared to the control group, were found. ConclusionsAn exercise programme, consisting of balance and jump exercises, is suggested to be performed at least twice per week in order to reduce the risk of lower extremity injury in elite orienteerers.

The Effect of a 20-Week Corrective Exercise Program on Functional Movement Patterns in Youth Elite Male Soccer Players.

Poor functional movement patterns negatively affect the ability to perform fundamental movements with precision and efficiency, increasing injury risk in athletes. To examine the effect of a 20-week corrective exercise program during the competitive season on functional movement patterns in youth elite male soccer players. Cohort study. Team facilities. Sixty-five youth elite male soccer players (age: 15.89 [0.53]y; weight: 67.42 [6.78]kg; and stature: 175.20 [6.34]cm). Of the 4 teams, 2 were randomly selected to take part in the corrective program. Thus, the players were placed into 2 groups: corrective exercise program and control group. Corrective exercise program. Functional Movement Screen (FMS) was used to assess the presence of dysfunctional, asymmetrical, and painful movements in the players before and after the intervention period. In addition to considering the FMS total score (FMStotal), we separated the screen into 3 parts: FMSmove, FMSflex, and FMSstab. A repeated-measures analysis of variance was conducted to determine the effectiveness of the training program on FMS scores. The chi-square test was performed to determine whether there were significant changes in the frequencies of asymmetric and dysfunctional movements after 20 weeks. No athlete experienced severe injuries during the intervention period. There was a significant group by time interaction (P < .01) for FMStotal, FMSmove, and FMSstab, in which only the corrective exercise program increased their scores after the intervention period (P < .05). A chi-square analysis showed a significant (P < .05) decrease in asymmetric and dysfunctional movements at the follow-up in corrective exercise program, whereas these changes were not observed in the control group. Youth elite soccer players demonstrate a high prevalence of asymmetric movements during FMS testing, but their functional movement patterns can be improved during the competitive season following a specific corrective exercise program.

Does pectoralis minor stretching provide additional benefit over an exercise program in participants with subacromial pain syndrome? A randomized controlled trial

BackgroundAdaptive shortening of the pectoralis minor is one of the biomechanical mechanisms associated with subacromial pain syndrome (SPS). ObjectiveTo compare the effects of an exercise program alone with an exercise program in combination with pectoralis minor stretching in participants with SPS. DesignRandomized controlled trial. MethodsEighty adult participants with SPS were randomly allocated to two groups. The control group (n = 40) received a 12-week specific exercise program and the intervention group (n = 40) received the same program plus stretching exercises of the pectoralis minor muscle. The primary outcome measure was shoulder function assessed by a Constant−Murley questionnaire, and the secondary outcomes were the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, visual analog scale (VAS), and pectoralis minor resting length. ResultsThe present study shows no difference between the two interventions according to the Constant−Murley questionnaire (1.5 points; p = 0.58), VAS at rest (0.2 cm; p = 0.11), VAS at movement (0.5 cm; p = 0.08), and pectoralis minor resting length (0.3 cm; p = 0.06). The DASH questionnaire showed greater functional improvement in the control group (5.4 points; p = 0.02). Finally, only pectoralis minor length index showed difference statistical significant in favor of intervention group (0.3%; p = 0.04). ConclusionIn the short-term, the addition of a program of stretching exercises of the pectoralis minor does not provide significant clinical benefit with respect to functional improvement or pain reduction in participants with SPS. Trial registrationBrazilian registry of clinical trials UTN number U1111-1210-3555. Registered 5 March 2018.

Ask the Expert: What Is the Exercise “Prescription” That You Provide to Your Patients?

Ask the Expert: What Is the Exercise “Prescription” That You Provide to Your Patients?

Effects of Obesity and Exercise on Bone Marrow Progenitor Cells after Radiation.

The late effects of radiation therapy can have significant consequences for the health and quality of life of long-term cancer survivors. Radiation induces persistent alterations in hematopoietic stem and progenitor cells (HSPC) and the bone marrow environment; however, how relevant host factors such as obesity and exercise differentially regulate HSPC content and the bone marrow environment after radiation exposure remains unknown. The purpose of this investigation was to evaluate how the combination of obesity and exercise training modulates HSPC and their niche after sublethal radiation exposure in mice. Mice fed either a control or a high-fat diet to induce obesity remained sedentary or underwent a progressive treadmill exercise program. At 13 wk of age, mice were irradiated (3 Gy) and continued their specific diets and exercise program for four more weeks. Exercise-trained mice had significantly higher quantities of several HSPC subpopulations and bone marrow stromal cell populations, whereas HSPC subpopulations were significantly lower in obese mice after radiation. Reactive oxygen species content was significantly decreased in HSPC with exercise training. Proteomics analysis of bone marrow supernatant revealed clustering of biologically relevant changes in exercise-trained mice. Functional evaluation of bone marrow supernatant revealed a significant increase in leukemia blast viability in obese mice but not in the exercise-trained mice (P < 0.05). Together, these data suggest that exercise training partially restores the negative effects of obesity on HSPC and their niche after radiation exposure. As such, exercise training should be considered to mitigate the late effects of radiation therapy on the hematopoietic system for cancer survivors with or without obesity who have undergone radiation therapy.

How to Incorporate Bariatric Training Into Your Fellowship Program.

How to Incorporate Bariatric Training Into Your Fellowship Program.

Effects of exercise programs on kyphosis and lordosis angle: A systematic review and meta-analysis.

Many authors are interested in the effects that a specific exercise program could have on sagittal spinal curvatures. The purpose of this study was to determine the effects of different exercise programs on thoracic kyphosis and lumbar lordotic angle. This meta-analysis adhered to the PRISMA guideline and it was registered at PROSPERO. Five electronic databases (Pub Med, Cochrane, WOS, PEDro and EBSCO) were searched up to 31 July 2018. Eligible studies were randomized controlled trials that applied an exercise intervention and measured a kyphosis and/or lordotic angle. Study quality was performance by PEDro score. Risk of bias was assessed using the SIGN 50 checklist for randomized controlled trials. External validity was assessed using the EVAT. Ten randomized controlled trials were included for systematic review and meta-analysis. Meta-analysis with a random effect model was performed to infer the pooled estimated standardized mean difference. All studies were RCTs and they involved a total of 284 cases and 255 controls. Seven studies measured kyphosis angle. A large significant effect of the exercise on kyphosis was identified (SMD = -1.400 (95% CI-2.150 a -0.660), p = 0.000). Four studies assessed lordotic angle and moderate but not significant improvement was shown (SMD = -0.530 (95% CI-1.760 a -0.700), p = 0.401). The results suggest that exercise programs may have a positive effect on thoracic kyphosis angle, but no clear effect on lordotic angle. This systematic review suggests that strengthening rather than stretching could be more relevant for kyphosis and both qualities are important for lordosis. It is necessary to conduct more randomized controlled trials to assess the effects of strengthening and/or stretching program on kyphosis and lordotic angle and to establish the type of the exercise that is better for maintaining the sagittal disposition within normal ranges.

Clinical spinal instability: 10 years since the derivation of a clinical prediction rule. A narrative literature review

Between 2005 and 2015 significant changes in the clinical decision making paradigm for the treatment of spinal instability occurred. This was largely motivated by a clinical prediction rule (CPR) derivation study that was developed to specifically identify patients with low back pain who are more likely to respond positively to lumbar stabilization exercises. This is a narrative literature review on the recent advances physiotherapy has made in the treatment of clinical spinal instability. Literature discussing the conservative treatment of lumbar spinal instability published from 2005-2015 was identified with electronic searches of PubMed (MEDLINE) Advanced search, Web of Science, BIOSIS Previews, MEDLINE (EBSCO), SportDISCUS (EBSCO), CINAHL (EBSCO), PEDro, Scopus and Cochrane and reviewed. Five systematic reviews, 2 with meta-analyses, and 1 systematic review on the quality of systematic reviews were found. There seems to be some benefit from specific stabilization exercise programs in regards to pain reduction, but they might not be more effective than other forms of exercise. The currently existing CPR for stabilization exercises is not far enough developed to use in clinical practice and is not validated as of yet. Stabilization exercises seem to decrease chronic low back pain, although it is not clear that this pain has to be caused by clinical spinal instability. Caution should be exercised when using CPRs in the clinic; they are not meant to be strict treatment guidelines, but rather a tool that helps facilitate clinical decision-making.

Improving Cognitive Performance of 9-12 Years Old Children: Just Dance? A Randomized Controlled Trial.

Exercise is assumed to have positive effects on children’s cognitive performance. However, given the inconclusive evidence for the long-term effects of exercise, it is difficult to advice schools on what specific exercise programs can improve children’s cognitive performance. In particular, little is known about the effects of small exercise programs that may be feasible in daily school practice. Therefore, we assessed the effects of a 9-weeks program consisting of daily exercise breaks on children’s cognitive performance, aerobic fitness and physical activity levels. We conducted a cluster-randomized controlled trial in 21 classes of eight Dutch primary schools. A total of 512 children aged 9–12 years participated. The exercise intervention had a duration of 9 weeks and consisted of a daily 10-min classroom-based exercise break of moderate to vigorous intensity. Before and after the intervention, we used four cognitive tasks (i.e., the Attention Network Test, Stroop test, d2 test of attention and Fluency task) to measure children’s cognitive performance in domains of selective attention, inhibition and memory retrieval. In addition, we measured aerobic fitness with a Shuttle Run test and physical activity during school hours by accelerometers. We analyzed data using mixed models, adjusting for baseline scores, class and school. After 9 weeks, there were no intervention effects on children’s cognitive performance or aerobic fitness. Children in the intervention group spent 2.9 min more of their school hours in moderate to vigorous physical activity as compared to the children in the control group. In conclusion, daily 10-min exercise breaks in the classroom did not improve, nor deteriorate cognitive performance in children. The exercise breaks had no effect on children’s fitness, and resulted in 2.9 min more time spent in moderate to vigorous physical activity during school hours. Daily exercise breaks can be implemented in the classroom to promote children’s physical activity during school time, without adverse effect on their cognitive performance.

THE EFFECTS OF PHYSICAL ACTIVITY ON THE BALANCE OF THE ELDERLY

Daily physical activity is necessary for good quality of life among the elderly. It usually happens that with the advent of years, the extent of exercise decreases among the elderly, which could have negative effects on their health. It is very important to point out that if the health results allow it, it is never too late to begin with programmed training and physical exercise. If it is carried out under supervision, the possibility of injury is significantly reduced. The subject matter of this research are studies published from 2000 to 2016, which focused on the effects of physical activity on the balance of individuals over the age of 60. The aim of this review is the compilation of the appropriate literature on physical activity, as well as the clarification on whether there are effects of the physical activity on the balance of the elderly. This overview included 24 research papers. The results of this study confirm the positive effect of physical activity on the balance of the elderly. It has been proven that several weeks of a standardized exercise program, based on the increase in joint mobility, cardio-vascular exercise, strengthening the stability of the pelvic region, and proprioceptive exercise can improve balance skills and reduce the perception of pain. For elderly individuals with specific risk factors for falls, the recommendation is specific aquatic exercise programs which will improve balance and strengthen the lower extremities.

Is the use of pedometers feasible for identifying the volume and intensity of a balance specific exercise programme for older adults

Is the use of pedometers feasible for identifying the volume and intensity of a balance specific exercise programme for older adults

Early Detection and Treatment of Subclinical Lymphedema in Patients with Breast Cancer.

Background: Early identification and treatment of subclinical lymphedema may prevent development of advanced stages and its related complications. We aimed to detect subclinical lymphedema and to evaluate the effects of early treatment program on the development of clinical lymphedema, upper extremity functions, and quality of life in patients with subclinical lymphedema. Methods and Results: Twenty-five women who were diagnosed having subclinical lymphedema were enrolled in the study. The patients were informed about lymphedema and its risk factors, and skin care and exercises to prevent the development of lymphedema. Self-reported symptoms, arm volumes, upper extremity functions, quality of life were evaluated before and after treatment. Tightness and numbness were found to have a good correlation with affected arm volume. Volume of the affected arm, percentage volume difference between the arms, upper extremity functions, and quality-of-life scores improved significantly at the end of the treatment. Conclusions: It is crucial to have early detection and treatment of subclinical lymphedema to prevent the development of established lymphedema in breast cancer survivors. Information about lymphedema and its risk factors, skin care, and home-based specific exercise program improves self-reported symptoms, volume measurements, functioning, and quality of life in patients with subclinical lymphedema.

Pain Perception in Clarinetists with Playing-Related Pain After Implementing a Specific Exercise Program.

Wind musicians suffer injuries resulting from muscle overuse and poor postural habits, often due to the lack of required physical fitness. For this reason, it is important to study and analyze the characteristics of their activity in order to select appropriate preventive exercises. 10 clarinetists, who were experiencing joint pain due to instrumental practice, followed a specific program of physical activity, 3 times a week for 2 months. To assess postural changes after its implementation, the Langlade test and muscle pain scale were used at the beginning and the end of the program. The results show a significant decrease in perceived pain (p<0.001) and changes in the dorsal spine (p=0.001). Given the relationship between the improvement in the Langlade item, which refers to the correct position of the shoulder blades, and muscle pain, with a correlation level of 0.582, it can be said that a change in the shoulder girdle position leads to a decrease of pain in that area. In this pilot study of 10 clarinetists, a regular program of physical activity for 9 weeks led to an observable change in posture and a reduction in pain using self-report measures.

Physicians' and Pharmacists' Clinical Considerations for Elderly Patients with Type 2 Diabetes Mellitus: The IMPLICA2 Study.

Management of elderly patients with type 2 diabetes mellitus (T2DM) is complex due to their age-related conditions. Several clinical guidelines provide specific recommendations for management of these patientsbut little is known about their implementation in clinical practice. To describe physician and community pharmacist perceptions and routine clinical practice in the management of elderly T2DM patients. Cross-sectional study. A total of 993 physicians and 999 community pharmacists completed the questionnaire. More physicians than pharmacists agreed on the need to establish more flexible HbA1c targets for elderly (79.4% vs. 30.6%; p < 0.001) and frail (92.6% vs. 31.4%; p < 0.001) patients than for the general diabetic population. HbA1c targets < 7.5% for elderly patients and < 8.5% for frail patients (as recommended by the principle guidelines) were set by 38.9% and 28.7% of physicians, respectively. Furthermore, 62.8% of physicians stated they follow guideline recommendations but, based on their prescription decisions for hypothetical patients, less than 50% were aligned with them. In addition, 73.1% of physicians monitor treatment adherence, mainly by using dispensing control (59.1%). Specific nutritional approaches for elderly patients are provided by 62.9% of physicians and 56.0% of pharmacists, whilst 57.4% and 21.7%, respectively, deliver specific physical exercise programs. Low adherence to guideline recommendations (i.e. setting more stringent HbA1c targets or delaying treatment intensification) may lead to suboptimal glycaemic control in elderly patients. The standardization of processes, extensive monitoring of patient treatment adherence and providing advice regarding specific personal lifestyle habits may improve the management of elderly T2DM patients.