Tailored Exercise Program Research Articles

Early Implementation of Exercise to Facilitate Recovery After Breast Cancer Surgery

Recovery of shoulder function following breast cancer surgery is crucial for physical functioning and quality of life. While early implementation of shoulder rehabilitation exercises may enhance recovery, the optimal timing and exercise program remain unclear. To investigate whether an early exercise intervention, initiated 1 day postsurgery and continued for 1 month through subsequent visits, could improve shoulder range of motion (ROM) and strength in patients with breast cancer. A parallel-group, 2-arm randomized clinical trial was conducted between June 2020 and October 2021 at the Breast Cancer Center in Seoul, South Korea. Fifty-six patients (of 119 screened) with early-stage breast cancer who were scheduled for partial or total mastectomy were randomized into a tailored resistance exercise group (n = 28) or a usual care group (n = 28). Data were analyzed from November 2021 to June 2022. The exercise intervention commenced 1 day postsurgery and consisted of 4 supervised exercise education sessions corresponding with surgeon visits and daily home-based exercises for the first postoperative month. Tailored programs, including stretching and strength exercises, were adjusted based on individual shoulder function recovery status. Primary end points were shoulder ROM and strength at 1 and 6 months postsurgery. Physical activity, body composition, and quality of life were assessed at 6 months. Of 56 patients randomized (mean [SD] age, 50.3 [6.6] years), 54 completed the trial (96%), with 100% and 97% compliance to supervised and home-based exercise sessions, respectively. At 1 month postsurgery, 19 (67.9%) in the exercise group had fully recovered shoulder strength compared to 1 (3.6%) in the usual care group (P < .001). At 6 months, 22 (78.6%) in the exercise group had fully recovered shoulder ROM and 24 (85.7%) had fully recovered strength compared to 6 (21.4%) and 5 (17.9%), respectively, in the usual care group (P < .001). The exercise group exhibited less loss in muscle mass and improved physical activity and quality of life compared to the usual care group. In this trial, 1-month tailored exercise program, initiated immediately after breast cancer surgery and supplemented with supervised sessions coinciding with surgeon visits, significantly improved shoulder function in patients with breast cancer. WHO International Clinical Trials Registry identifier: KCT0006997.

Tailored exercise programmes for fibromyalgia: a clinical practical guide.

To evaluate the role of exercise in the management of fibromyalgia syndrome (FM) by addressing its complex pathogenesis involving central sensitisation, autonomic dysfunction, inflammation, and neurological irregularities, and examining how exercise impacts symptom exacerbation caused by external stressors and comorbid conditions. This review synthesises evidence from current literature focusing on the benefits of structured and personalised exercise programmes in FM management. It discusses the importance of specifying exercise type, intensity, frequency, duration, and progression tailored to individual patient needs and clinical objectives. Regular physical activity effectively mitigates core aetiopathogenetic mechanisms of FM and improves associated conditions such as stress and obesity. It also provides benefits for preventing other chronic diseases, enhancing well-being, and promoting healthy ageing. Structured and personalised exercise programmes that start with a low-demand protocol and gradually increase exercise volume are most beneficial, by improving patient compliance and reducing the risk of adverse effects. Effective management of FM requires a patient-centred approach integrating both pharmacological and non-pharmacological treatments, with exercise playing a pivotal role. Personalised exercise prescriptions that consider FM patients' specific needs and limitations are crucial for optimising treatment outcomes and enhancing quality of life.

근골격계통증이 있는 근로자들에게 맞춤형 운동프로그램이 통증, 기능, 삶의 질, 우울 정도에 미치는 영향

근골격계통증이 있는 근로자들에게 맞춤형 운동프로그램이 통증, 기능, 삶의 질, 우울 정도에 미치는 영향

Emerging trends in management of long COVID with a focus on pulmonary rehabilitation: A review.

Long COVID, or post-acute sequelae of COVID-19 (PASC), represents a complex condition with persistent symptoms following SARS-Cov-2 infection. The symptoms include fatigue, dyspnoea, cognitive impairment, decreased quality of life in variable levels of severity. Potential mechanisms behind long COVID include vascular damage, immune dysregulation and viral persistence. Diagnosing long COVID involves medical evaluation by multidisciplinary team and assessment of persistent symptoms with scoring systems in development. Treatment strategies are symptom-focused, encompassing multidisciplinary care, rehabilitation and tailored exercise programmes. Pulmonary rehabilitation, an effective and critical component of long COVID management, has shown promise, particularly for patients with respiratory symptoms such as dyspnoea. These programmes, which combine exercise, breathing techniques, education and psychological support, improve symptoms, quality of life and overall recovery. Innovative technologies, such as telemedicine, wearable devices, telerehabilitation, are transforming long COVID management. Telemedicine facilitates consultations and interventions, eliminating healthcare access barriers. Wearable devices enable remote and continuous monitoring of patients during their rehabilitation activities. Telerehabilitation has proven to be safe and feasible and to have high potential for COVID-19 recovery. This review provides a concise overview of long COVID, encompassing its definition, prevalence, mechanisms, clinical manifestations, diagnosis and management approaches. It emphasizes the significance of multidisciplinary approach in diagnosis and treatment of long COVID, with focus on pulmonary rehabilitation and innovative technology advances to effectively address the management of long COVID.

EFFECTS OF A PRESCRIBED, SUPERVISED EXERCISE PROGRAMME ON HEALTH-RELATED QUALITY OF LIFE IN ONCOLOGY PATIENTS: A RETROSPECTIVE OBSERVATIONAL COHORT STUDY

INTRODUCTION &amp; AIMS Individuals diagnosed with cancer experience significant physical and psychosocial consequences from oncological treatment. Based on current research, exercise therapy may be a valuable non-pharmacological approach to improve health-related quality of life (HRQoL). However, the effectiveness of individually tailored exercise programs to improve quality of life in real-world settings is understudied. The current study aims to analyse preliminary clinical data regarding the impact of tailored exercise supervised within an Australian private day hospital (LIFT) on HRQoL in individuals diagnosed with cancer. METHODS A retrospective longitudinal cohort study was conducted on adults diagnosed with cancer who attended the LIFT clinical service for at least 12 months between 2020 and 2023. QoL and symptoms were assessed using the Functional Assessment of Cancer Treatment – General Questionnaire (FACT-G). Data collected included diagnosis (type and stage), medical treatment, session frequency, and demographic data. RESULTS Overall, 40 patients (age=67.0±16.8 years) met the inclusion criteria. A within-group analysis demonstrated significant findings in the subscales of emotional wellbeing (p = 0.008) and functional wellbeing (p = 0.003), and significance was also found in the total FACT-G score (p = 0.0019). Interestingly, while not statistically significant, a clinically significant difference in HRQoL was found between individuals completing ≤1 or ≥ 2 supervised exercise sessions per week at LIFT cancer care centre, favouring those completing ≥ 2 sessions. CONCLUSION Preliminary analysis indicated that a “real-world” individualised supervised moderate-vigorous exercise within a day hospital has the potential to significantly improve HRQoL outcomes in individuals diagnosed with cancer.

Physical fitness in children with Marfan and Loeys-Dietz syndrome: associations between cardiovascular parameters, systemic manifestations, fatigue, and pain

Children with Marfan (MFS) and Loeys-Dietz syndrome (LDS) report limitations in physical activities, sports, school, leisure, and work participation in daily life. This observational, cross-sectional, multicenter study explores associations between physical fitness and cardiovascular parameters, systemic manifestations, fatigue, and pain in children with MFS and LDS. Forty-two participants, aged 6–18 years (mean (SD) 11.5(3.7)), diagnosed with MFS (n = 36) or LDS (n = 6), were enrolled. Physical fitness was evaluated using the Fitkids Treadmill Test’s time to exhaustion (TTE) outcome measure. Cardiovascular parameters (e.g., echocardiographic parameters, aortic surgery, cardiovascular medication) and systemic manifestations (systemic score of the revised Ghent criteria) were collected. Pain was obtained by visual analog scale. Fatigue was evaluated by PROMIS® Fatigue-10a-Pediatric-v2.0-short-form and PROMIS® Fatigue-10a-Parent-Proxy-v2.0-short-form. Multivariate linear regression analyses explored associations between physical fitness (dependent variable) and independent variables that emerged from the univariate linear regression analyses (criterion p < .05). The total group (MFS and LDS) and the MFS subgroup scored below norms on physical fitness TTE Z-score (mean (SD) −3.1 (2.9); −3.0 (3.0), respectively). Univariate analyses showed associations between TTE Z-score aortic surgery, fatigue, and pain (criterion p < .05). Multivariate analyses showed an association between physical fitness and pediatric self-reported fatigue that explained 48%; 49%, respectively, of TTE Z-score variance (F (1,18) = 18.6, p ≤ .001, r2 = .48; F (1,15) = 16,3, p = .01, r2 = .49, respectively). Conclusions: Physical fitness is low in children with MFS or LDS and associated with self-reported fatigue. Our findings emphasize the potential of standardized and tailored exercise programs to improve physical fitness and reduce fatigue, ultimately enhancing the physical activity and sports, school, leisure, and work participation of children with MFS and LDS.What is Known:• Marfan and Loeys-Dietz syndrome are heritable connective tissue disorders and share cardiovascular and systemic manifestations.• Children with Marfan and Loeys-Dietz syndrome report increased levels of disability, fatigue and pain, as well as reduced levels of physical activity, overall health and health-related quality of life.What is New:• Physical fitness is low in children with Marfan and Loeys-Dietz syndrome and associated with self-reported fatigue.• Our findings emphasize the potential of standardized and tailored exercise programs to improve physical fitness and reduce fatigue, ultimately enhancing the physical activity and sports, school, leisure, and work participation of children with Marfan and Loeys-Dietz syndrome.

Muscle stiffness indicating mission crew health in space

Muscle function is compromised by gravitational unloading in space affecting overall musculoskeletal health. Astronauts perform daily exercise programmes to mitigate these effects but knowing which muscles to target would optimise effectiveness. Accurate inflight assessment to inform exercise programmes is critical due to lack of technologies suitable for spaceflight. Changes in mechanical properties indicate muscle health status and can be measured rapidly and non-invasively using novel technology. A hand-held MyotonPRO device enabled monitoring of muscle health for the first time in spaceflight (> 180 days). Greater/maintained stiffness indicated countermeasures were effective. Tissue stiffness was preserved in the majority of muscles (neck, shoulder, back, thigh) but Tibialis Anterior (foot lever muscle) stiffness decreased inflight vs. preflight (p < 0.0001; mean difference 149 N/m) in all 12 crewmembers. The calf muscles showed opposing effects, Gastrocnemius increasing in stiffness Soleus decreasing. Selective stiffness decrements indicate lack of preservation despite daily inflight countermeasures. This calls for more targeted exercises for lower leg muscles with vital roles as ankle joint stabilizers and in gait. Muscle stiffness is a digital biomarker for risk monitoring during future planetary explorations (Moon, Mars), for healthcare management in challenging environments or clinical disorders in people on Earth, to enable effective tailored exercise programmes.

Exercise, cancer, and the cardiovascular system: clinical effects and mechanistic insights.

Cardiovascular diseases and cancer are the leading causes of death in the Western world and share common risk factors. Reduced cardiorespiratory fitness (CRF) is a major determinant of cardiovascular morbidity and cancer survival. In this review we discuss cancer- induced disturbances of parenchymal, cellular, and mitochondrial function, which limit CRF and may be antagonized and attenuated through exercise training. We show the impact of CRF on cancer survival and its attenuating effects on cardiotoxicity of cancer-related treatment. Tailored exercise programs are not yet available for each tumor entity as several trials were performed in heterogeneous populations without adequate cardiopulmonary exercise testing (CPET) prior to exercise prescription and with a wide variation of exercise modalities. There is emerging evidence that exercise may be a crucial pillar in cancer treatment and a tool to mitigate cardiotoxic treatment effects. We discuss modalities of aerobic exercise and resistance training and their potential to improve CRF in cancer patients and provide an example of a periodization model for exercise training in cancer.

Goal-directed therapeutic exercise for paediatric posterior fossa brain tumour survivors: a qualitative analysis of experiences

PurposeTo explore child and parent experiences of a 12-week goal-directed therapeutic exercise intervention in paediatric posterior fossa brain tumours survivors and to identify features of the program that influenced program adherence and acceptability.MethodsEleven interviews were conducted; five parent-child dyads (mothers = 83%) and one parent only (mean child age = 10.6 ± 3.0 years; 83% male). Posterior fossa brain tumour survivors, who participated in a weekly goal-directed exercise program for 12 weeks, completed semi-structured interviews to discuss their experience of the program. An inductive content analysis was undertaken. Interviews were transcribed, imported into NVivo and independently coded by two reviewers. Code and content categories were iteratively discussed and refined.ResultsFive content categories were generated: (1) perceived improvements, (2) program logistics, (3) activity selection, (4) connection with the therapist and (5) options for technology. All participants valued the tailored exercise program and described improvements in movement competence. Children and their parents discussed preferring home- and community-based locations and favoured face-to-face delivery. Occasionally, parents reported difficulty completing the home program due to low child motivation or family time restrictions. Multiple families suggested an interactive digital application would be an effective delivery channel for the supplemental home-based program.ConclusionA goal-directed exercise program delivered at home and in community-based locations was considered valuable and helpful for improving movement competence in paediatric survivors of posterior fossa brain tumour.Trial registrationACTRN12619000841178 June 12, 2019

Effectiveness of Aerobic Training on Lung Volume, Exercise Capacity and Gait Speed in Individuals with Chronic Kidney Disease

Background: Kidney disease (CKD) is a disorder in which the kidneys have been damaged and are unable tofilter blood as effectively as they should. As a result, extra fluid and waste from the circulation linger in the body,potentially leading to various health issues like heart disease and stroke. This also causes swelling in the lowerlimb causing reduced mobility and altered lung volume. This reduction in mobility can be improved with exercise.Aerobic training has been proved to be one of the most effective treatments for improving lung volume capacity.Aerobic training using cycling exercise can improve both lung volume capacity and mobility together.Purpose: To analyze the Effect of Aerobic training and lung volume and gait speed capacity in individuals withchronic kidney disease.Materials and Methods: Sixty individuals with chronic kidney disease were selected according to inclusionand exclusion criteria in which 48 individuals completed the study and 12 quit. These individuals were treatedwith bed side cycling and spirometry for 8 weeks, 1 session per day. Their Pretreatment Gait speed test scoring,3-minute walk test, were recorded. After the treatment duration the same test was repeated.Results: There is an Improvement in Gait speed and 3-minute walk test after giving incentive spirometry stage ofCKD Individuals. No adverse events were observed during and after the treatment.Conclusion: Individuals with CKD need aerobic training to improve their lung volume capacity. The currentstudy concludes that there is an improvement in Gait speed and 3-minute walk test after the treatment session ofincentive spirometry and Bedside cycle ergometer.Clinical Significance: This study’s clinical significance lies in assessing how aerobic training impacts lung volumecapacity in chronic kidney disease patients. Improved lung function may lead to better cardiovascular health,enhanced quality of life, and reduced complications. These findings could support tailored exercise programs toimprove the well-being and overall health of individuals with chronic kidney disease.

Cancer exercise app design

Background: Exercise is important for the health of people living with and beyond cancer. Yet most cancer survivors do not receive advice or referral to exercise oncology rehabilitation programs. A smartphone delivered exercise oncology app could minimize many of the barriers to exercise that these individuals face. Objective: To develop an exercise oncology application that provides a tailored exercise program (based on exercise history, current physical function, etc.) and adapts to user’s fatigue levels to minimize many of the barriers faced by clinicians, patients and people in underserved areas. Methods: The algorithms in the app were developed based on previous research. The individualized exercise prescription is based on the user’s daily level of fatigue, and if the user is on treatment, type and duration of treatment, and current fitness level. Results: Developed an easy to navigate, read and use app with reminders to exercise and positive feedback for reaching one’s goals. Conclusion: Cancer Exercise is a unique app that provides a tailored exercise oncology program for cancer survivors. Additional research is needed to see how the app may benefit people living in rural and underserved communities.

Enhancing Cognitive Abilities and Delaying Cognitive Decline in the Elderly through Exercise-based Health Management Systems

Objective: This review aims to provide a comprehensive overview of the theoretical frameworks, empirical evidence, critical analysis, practical implications, and future research directions related to tailored exercise programs and their impact on cognitive health in the elderly. Material and Methods: The study used a systematic literature review approach to evaluate the effectiveness of tailored exercise programs on cognitive abilities and decline in the elderly. Data collection involved searching databases like PubMed, PsycINFO, Scopus, and Google Scholar, along with manual searches of reference lists. Inclusion criteria focused on peer-reviewed studies with participants aged 60 and above, involving tailored exercise interventions with measurable cognitive outcomes. Results: The article reviews evidence on the role of exercise in improving cognitive functions in the elderly. It explores theoretical models explaining the impact of exercise on cognition and evaluates different types of exercise, such as aerobic, strength training, and yoga. The article also investigates how these interventions can delay cognitive decline, addresses the quality and limitations of existing studies, and suggests future research directions. Conclusion: The literature emphasizes the need for personalized exercise programs based on individual capabilities and environmental considerations to optimize cognitive benefits.

Engagement and Interest Through Physical Activities among Senior High School Students at Muntinlupa National High School

Educators were challenged to implement and integrate a wide variety of physical activities that promote the development of the overall well-being of their students. The study used descriptive correlational analysis to measure, describe, and understand the possible relationship between student interest and their engagement in any form of physical activity. Using a 5-point Likert scale, 31 respondents from the Senior High School students were asked to answer the survey questionnaire made by the researchers. Results show that students were interested in engaging in physical activities is high, as they “Agree” (5.45 mean score) when they perceive that the activities presented align with their interests and create a positive environment. Additionally, students’ engagement in physical activities is influenced by their interests, as they “Strongly Agree” (4.56 mean score) with the role of interests in how committed or motivated they are to engage in physical activities. Furthermore, researchers analyzed the relationship between student level of interest and engagement using the Pearson Correlation Moment Product. The results indicated a positive “Very High Relationship” between the two variables (r value = 0.93). The results emphasized the role of the personal and social interests of students in their engagement in any form of physical activity. Recognizing this natural relation between the two variables can provide vital information to educators on creating tailored exercise programs, recognizing the multifaceted nature of engagement in physical activities, and emphasizing the identification of influencing factors for effective strategies.

The VENERE Study: EffectiVenEss of a Rehabilitation Treatment With Nordic Walking in ObEse or OveRweight Diabetic PatiEnts With Cardiovascular Disease

BackgroundNordic walking (NW) has several potential benefits for individuals with cardiovascular (CV) disease, type 2 diabetes, and obesity and/or overweight. NW improves cardiovascular health, including exercise capacity and blood pressure control. NW enhances glycemic control and insulin sensitivity in diabetes, and aids in weight management and body composition improvement. NW offers additional advantages, such as improvement in muscular strength, joint mobility, physical activity levels, and psychological well-being. MethodsThis open-label study with 3 arms will aim to evaluate the efficacy, safety, and adherence to exercise prescription in obese and/or overweight diabetic patients with CV complications. The primary objective will be to assess the CV performance of participants after a 6-month and a 12-month follow-up period, following a 3-month NW intervention, compared with standard rehabilitation, and with cardiological counseling (control group) training lasting 3 months. ResultsThe results of the study will provide valuable insights into the comparative effectiveness of a NW intervention vs standard rehabilitation and control group training in improving CV performance in obese and/or overweight diabetic patients with CV complications. Additionally, safety and adherence data will help inform the feasibility and sustainability of the exercise prescription over an extended period. ConclusionsThese findings may have implications for the development of tailored exercise programs for this specific patient population, with the aim of optimizing CV health outcomes. Clinical Trials RegistrationNCT05987410

Effect of Bicycle Ergometer Training and Nordic Walking Training on Improving Functional Exercise Capacity in Asthma Patients.

Introduction Asthma is a chronic respiratory condition characterized by inflammation of the airway leading to breathlessness. Exercise training has been recognized as a valuable component in the management of asthma, enhancing lung function and overall well-being. Bicycle ergometer training and Nordic walking are two distinct forms of exercise that have been shown to improve cardiovascular fitness and respiratory function. Despite the potential benefits of these exercises, limited research directly compares their efficacy in improving functional capacity specifically in asthma patients. The study thus aims to address this gap by providing personalized, tailored exercise programs for asthma patients. Methods A single-blinded experimental study using a simple random sampling method was conducted. A sample of 40 subjects was recruited for the study based on inclusion and exclusion criteria and were assigned into two groups. Group A subjects were trained with a bicycle ergometer and Group B subjects were trained with Nordic walking. The intervention was given to both groups for 12 weeks. The outcome measures used were the six-minute walk test, Modified Borg Scale, and Mini Asthma Quality of Life Questionnaire. Results A baseline analysis of outcome measures was done, which was followed up by a post-test analysis after 12 weeks. Pre-test and post-test data were compared using a paired t-test.Intergroup analysis was done by an independent t-test. Both groups showed significant improvement in post-test results. On comparing the two groups, Group A showed significant improvement as compared to Group B. Conclusion The study concludes that bicycle ergometer training is effective in improving functional capacity and enhancing the quality of life in asthma patients.

Integrating Artificial Intelligence for Improved Management of Frozen Shoulder and Complications in Breast Cancer Surgery: A Perspective from Thailand

Breast cancer is a leading cause of mortality among women worldwide, necessitating surgical interventions like lumpectomy, mastectomy, or modified radical mastectomy. However, these procedures often lead to postoperative complications, such as frozen shoulder, significantly impacting patients’s quality of life. This review focuses on the challenges associated with frozen shoulder and other complications following breast cancer surgery. It proposes the integration of Artificial Intelligence (AI) in assessment and intervention as a cost- effective solution. Frozen shoulder, also known as adhesive capsulitis, affects around 22.2% of breast cancer patients, particularly those undergoing axillary approaches. It is frequently accompanied by Axillary Web Syndrome (AWS) and Post-Mastectomy Pain Syndrome (PMPS), resulting in pain, limited range of motion, and compromised functional abilities. Conservative treatments, including exercises and rehabilitation programs, have shown positive outcomes in managing these symptoms. Previous studies have demonstrated the effectiveness of exercises, joint mobilization techniques, and home-based exercise programs in improving muscle strength, range of motion, and functional ability in breast cancer survivors. Abnormal neuromuscular control and kinematic distortions in shoulder and spinal movements have also been identified, highlighting the significance of neuromuscular training for shoulder joint complex recovery. The integration of AI in the assessment and intervention of frozen shoulder can offer cost-effective solutions and reduce waiting times at healthcare centers in Thailand. AI technologies can enable precise evaluations and personalized treatment plans, optimizing patient outcomes and resource utilization. In conclusion, physical therapy plays a crucial role in managing frozen shoulder and other complications following breast cancer surgery. Evidence-based practices, including comprehensive patient education, tailored exercise programs, manual therapy techniques, and pain management strategies, are essential for effective treatment. Integrating AI in assessment and intervention can further enhance outcomes and alleviate the burden on healthcare resources.

Longer-term quality of care, effectiveness, and cost-effectiveness of implementing a model of care for osteoarthritis: A cluster-randomized controlled trial

To assess the quality of care, effectiveness, and cost-effectiveness over 12 months after implementing a structured model of care for hip and knee osteoarthritis (OA) in primary healthcare as compared to usual care. In this pragmatic cluster-randomized, controlled trial with a stepped-wedge cohort design, we recruited 40 general practitioners (GPs), 37 physiotherapists (PTs), and 393 patients with symptomatic hip or knee OA from six municipalities (clusters) in Norway. The model included the delivery of a 3-hour patient education and 8-12 weeks individually tailored exercise programs, and interactive workshops for GPs and PTs. At 12 months, the patient-reported quality of care was assessed by the OsteoArthritis Quality Indicator questionnaire (16 items, pass rate 0-100%, 100%=best). Costs were obtained from patient-reported and national register data. Cost-effectiveness at the healthcare perspective was evaluated using incremental net monetary benefit (INMB). Of 393 patients, 109 were recruited during the control periods (control group) and 284 were recruited during interventions periods (intervention group). At 12 months the intervention group reported statistically significant higher quality of care compared to the control group (59% vs. 40%; mean difference: 17.6 (95% confidence interval [CI] 11.1, 24.0)). Cost-effectiveness analyses showed that the model of care resulted in quality-adjusted life-years gained and cost-savings compared to usual care with mean INMB €2020 (95% CI 611, 3492) over 12 months. This study showed that implementing the model of care for OA in primary healthcare, improved quality of care and showed cost-effectiveness over 12 months compared to usual care. ClinicalTrials.gov NCT02333656.

OA04 Muscle weakness in chronic rheumatic diseases: the need for early diagnosis and tailored exercise programme

OA04 Muscle weakness in chronic rheumatic diseases: the need for early diagnosis and tailored exercise programme

Factors associated with glycemic control and diabetes complications in a group of Saudi patients with type 2 diabetes.

Poor glycemic control is a risk factor for micro and macrovascular complications of diabetes. The aim of this study was to assess the prevalence and factors related to suboptimal glycemic control and diabetes complications in a group of patients with type 2 diabetes mellitus (T2DM). This cross-sectional descriptive study conducted in Al Qassim region, Saudi Arabia. Two hundred patients with T2DM were enrolled. Demographic, social, and self-care behavior data were collected. A thorough clinical evaluation was done. Glycated hemoglobin, lipid, and kidney profile results were recorded. Mann-Whitney test was used to compare different groups. For comparing categorical data, Chi-square (χ2) test was performed. Multivariate logistic regression analyses used to detect predictors of poor glycemic control and macrovascular and microvascular complications. The median age of patients was 58 years, and 62% of them were males. Only 22.5% of patients had glycated hemoglobin <7%. Forty-four patients (22%) had evidence of macrovascular complications. Retinopathy, neuropathy, and nephropathy were found in 42.5%, 32.5%, and 12%, respectively. Longer diabetes duration was significantly associated with poor glycemic control (OR = 1.006, P < .005). The age of the patients was independently associated with macrovascular complications (OR = 1.050, P = .029). Hyperlipidemia was significantly associated with neuropathy (OR = 0.229, P = .043) and retinopathy (OR = 12.887, P = .003). Although physical activity was lower in patients with suboptimal glycemic levels (P = .024), cardiovascular disease (P = .030), neuropathy (P < .001), retinopathy (P < .001), and nephropathy (P = .019), multivariate analysis showed that it was only independently associated with neuropathy (OR = 0.614, P = .001). The prevalence of suboptimal glycemic control is high in the studied population. Effective health measures are urgently needed to stop diabetes complications, especially retinopathy and neuropathy. Elderly people with long durations of diabetes, and lower physical activity should be the focus of the interventions. Tailored exercise programs are particularly needed for better diabetes control and for the prevention of complications in patients with T2DM.

Older persons' expressed perceptions on exercise programs in long-term care institutions: Influence of professionals and institutions

ObjectiveTo explore the perceptions of institutionalised older people about the professionals and institutions regarding exercise programs in long-term care institutions Design, setting, and participantsA qualitative study was carried out using focus group discussions. Forty-seven institutionalised participants (≥ 65 years old) with a score of > 23 in the Mini-Mental State Examination (MMSE) were recruited. ResultsMost participants believed that the frequency of the exercise sessions could be increased by enhancing the number of staff assisting them and by adapting the facilities to their needs. They also suggested using outdoor spaces and avoiding childish activities and treatment. Participants’ beliefs were grouped into three major themes (i) Perceptions about the health professionals delivering the exercise programs (ii) Perceptions about the institution or centre regarding exercise programs; (iii) Perceptions about the exercise programs. ConclusionParticipants proposed certain changes that could take place in the institutions to promote engagement with exercise programs: tailored exercise programs, avoiding puerile treatment, increasing the number of staff members, and the creation of well-equipped spaces to perform the exercise. Practical implicationsProfessionals should spend time designing tailored exercise programs and avoid puerile treatment. Institutions must review the need for spaces and the personnel assigned.