Therapeutic Exercise Program Research Articles

Feasibility of an intensive therapeutic exercise program for frail elderly prior to total hip arthroplasty: two randomized pilot studies

Feasibility of an intensive therapeutic exercise program for frail elderly prior to total hip arthroplasty: two randomized pilot studies

Physical therapy goes App—an innovative at-home exercise program the “Rumpfzirkel” (core circuit) App

Background: Strengthening the body's core muscles through a sustainable at-home exercise program is a key part of nearly every physical therapy intervention. Unfortunately, experience suggests that there is little or no follow through when the patient returns home. Adherence to an at-home exercise program, typically written down on a sheet of paper, requires both discipline and a high level of motivation. To overcome this dilemma, an attractive yet simple home exercise delivery system had to be found. It has been proven that access to a personal trainer significantly improves exercise compliance. Therefore, we speculated that smartphone technology could be used to help improve compliance to at-home therapeutic exercise programs.

Shock wave therapy for spastic plantar flexor muscles in hemiplegic cerebral palsy children

BackgroundThe spastic motor type is the most common form of cerebral palsy (CP). Spastic equines foot is the most frequent deformity in ambulated children with CP. Shock wave therapy on spastic muscles of the upper limb in stroke patients provided a significant reduction in muscle tone. AimThe present study aimed to investigate the efficiency of shock wave therapy on spastic planter flexor muscles and its relation to the gait in spastic hemiplegic cerebral palsy children. MethodsThirty spastic hemiplegic cerebral palsy children from both sexes participated in this study. They were divided randomly into two groups of equal number: Group I (control) included 15 children (6 boys and 9 girls), with mean 5.83±0.34years, received the therapeutic exercises program only. Group II (study) included 15 children (6 boys and 9 girls), with mean age 5.75±0.51years, received the same therapeutic exercises program which was given to the control group, in addition to shock wave therapy for 1week (3 session/week). ResultsComparing the pre and post treatment mean values of the Hoffman reflex/Motor response (H/M) ratio and gait variables, revealed statistically significant differences in these variables in the study group. ConclusionThe shock wave therapy is effective in the treatment of hypertonic muscles which help those children to become more independent and participate in everyday activities.

Efficacy of Superficial Heat Therapy as an Adjunct to Therapeutic Exercise Program in Rehabilitation of Patients with Conservatively Managed Distal End Radius Fractures

Efficacy of Superficial Heat Therapy as an Adjunct to Therapeutic Exercise Program in Rehabilitation of Patients with Conservatively Managed Distal End Radius Fractures

Treatment of vertebral fractures due to osteoporosis

SummaryThe objective of exercise in the treatment of osteoporosis is to improve axial stability through strengthening of back extensor muscles. Therefore, a back extension exercise program specific to one’s musculoskeletal competence and pain can be performed in a sitting position and later advanced to the prone position. When fragility is resolved, back extension is performed against resistance applied to the upper back. A significant reduction in back pain, kyphosis, and risk of falls and an improvement in the level of physical activity have been achieved through the SPEED (Spinal Proprioceptive Extension Exercise Dynamic) program. In addition, the application of a “Posture Training Support” (PTS) using a backpack may decrease kyphosis and pain related not only to compression fractures but also reduce iliocostal friction. Therapeutic exercise should address osteo - porosis-related deformities of axial posture, which can increase risk of fall and fracture. Thus, the role of a therapeutic exercise program is to increase muscle strength safely, decrease immobility-related complications, and prevent fall and fracture. As with pharmacotherapy, therapeutic exercises are individualized.

Therapeutic physical exercise for lower limb overpronation in young athletes

IntroductionThe prevalence of biomechanical alterations in the the lower limbs in school-age children is increasing. The aim of this study was to assess the effectiveness of a therapeutic exercise program (TEP) in child athletes with lower limb overpronation during gait. MethodsRelevant databases (PubMed and SCOPUS) were searched. A total of 58 young athletes (aged 9–12 years) were evaluated, of which 10 had lower limb overpronation. All subjects underwent biomechanical analysis including all relevant angles, as follows: the Helbing angle, the tibiofemoral angle, and the Fick angle in both limbs. In the first phase of the study, the natural evolution of pathological gait was observed for a period of 3 months. Then, the children participated in a TEP intervention program for three further months. Finally, a six-month follow-up was performed to determine whether there was recurrence of pathological gait. ResultsAs many as 17% (10/58) of the 58 children examined had a pathological gait pattern. In the first phase, we observed the natural evolution of lower limb overpronation during gait for three months. After the intervention all biomechanical parameters significantly improved, and all subjects in the case group adopted a nearly normal gait pattern. At six months after the intervention all children maintained a normal gait pattern. ConclusionsOur three-month TEP-based intervention was efficient in making young athletes with a pathological gait pattern adopt a normal gait pattern, which was maintained at six months after the intervention.

Effect of a new physical therapy concept on dynamic balance in children with spastic diplegic cerebral palsy

BackgroundTreadmill gait training as a therapeutic resource in the rehabilitation of children with cerebral palsy (CP) has recently been the focus of many studies; however, still little is known regarding the effect of antigravity treadmill (AGT) on dynamic balance in children with spastic diplegia. Aim of the studyThis study aims to evaluate the effect of gait training using AGT on standing balance of the spastic diplegic cerebral palsy (SDCP) children. Subjects and methods30 SDCP children (6–8years old), from both sexes, participated in this study. They were divided randomly into 2 groups: control group (group A) and study group (group B). The control group received a specially designed therapeutic exercise program; while the study group received gait training using AGT, for 20min, 3 times weekly, for 3months, in addition to the same exercise program given to the control group. The Biodex balance system was used for the assessment of the dynamic postural control of all participants. ResultsThe results revealed no significant difference when comparing the pretreatment mean values of the 2 groups, while significant improvement was observed in all the measured variables of the 2 groups when comparing their pre and post treatment mean values. A significant difference was also observed when comparing the post treatment results of the 2 groups in favor of the study group. ConclusionIt can be concluded that gait training using AGT could be used as an effective method for improving standing balance for children with SDCP.

The impact of an exercise therapy on psychosocial health of children with benign epilepsy: A pilot study

ObjectivesThe purposes of the current study were to test the feasibility of exercise therapy for children with benign epilepsy with centrotemporal spikes (BECTS) and to collect pilot data about the impact of exercise therapy on neurocognitive, emotional, and behavioral outcomes. MethodsTen children with BECTS (9.7±1.42years) participated in a therapeutic exercise program consisting of ten supervised exercise sessions and home-based exercises for five weeks. Electroencephalography (EEG), seizure frequency, and neurocognitive and psychological factors, including attention, executive function, depression, anxiety, behavioral problems, and quality of life, were assessed before and after the exercise program. ResultsNo clinical symptoms were observed to worsen during the study, demonstrating that the exercise therapy was safe and also feasible. After five weeks of exercise therapy, significant improvements in neurocognitive domains such as simple visual and auditory attention, sustained attention, divided attention, psychomotor speed, and inhibition–disinhibition were observed. Furthermore, parent ratings of internalizing behavioral problems and social problems and mood-related well-being from quality of life improved after exercise therapy. Although not statistically significant, trends were noted toward improvement in children's self-reports of negative mood/somatization, parent reports of somatic complaints, and general health on a quality-of-life measure. ConclusionsA five-week structured exercise program was successfully implemented, with preliminary data suggesting beneficial impact on neurocognitive and psychobehavioral function. Exercise therapy should be further evaluated as a part of a comprehensive treatment program for children with benign epilepsy.

Lumbosacral pain: Delivery of care to patients in the United Kingdom Podchufarova E.

Musculoskeletal pain syndromes are one of the most common causes of disability and referral to a medical specialist. Seven million consultations for lumbosacral pain are annually carried out in the United Kingdom. Examination of patients with back pain. Three levels of health care delivered to patients with back pain in the United Kingdom may be arbitrarily identified. Level 1 is outpatient: a general practitioner jointly with a manipulative therapist, a physiotherapist, a rehabilitation specialist, and mid-level health workers render care to patients with insignificant and mild pain syndrome; Level 2 is also outpatient, which involves the participation of a hospital or multidisciplinary team consultant, for example, in a musculoskeletal pain service or a specialized pain center; Level 3 is to deliver care at neurosurgical or orthopedic hospital, by applying invasive interventions. Acute back pain is a benign condition in the vast majority of cases; there is no need for additional instrumental and laboratory studies; but spinal X-ray study, computed tomography (СT scan), or magnetic resonance imaging (MRI), general blood and urine tests are required when marked neurological and somatic disorders are present. Management of patients with acute lumbosacral pain is to inform a patient about the benign nature of the disease; to exclude bed rest; to explain the need to maintain normal activity; to train how to correctly lift weights and to maintain normal posture; to refer for manual and exercise therapy in order to return to normal motor activity; to use proven effective medication. In most cases, acute back pain goes away spontaneously for a short period of time; an active treatment approach is considered to be optimal. Nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen are used for analgesia if required. Patients who show no improvement after 4 weeks of treatment need rescreening for markers of potentially dangerous spinal diseases, as well as determination of the signs of psychosocial ill-being and correction of therapy with consideration for identified disorders. Management of patients with subacute and chronic pain (persisting for >6 weeks, but <1 year) involves the regular reconsideration of whether the diagnosis of nonspecific back pain is correct in order to rule out possible specific causes. MRI is indicated when a patient is decided to be referred for surgical treatment or there is presumptive evidence for spinal tumors, infectious, inflammatory, or traumatic injury, or cauda equina syndrome. It is optimal to start treatment with a program of therapeutic exercises, manual therapy, or acupuncture. Drug therapy encompasses NSAIDs, acetaminophen, and opioids to treat intensive pain syndrome.

Effectiveness of phototherapy incorporated into an exercise program for osteoarthritis of the knee: study protocol for a randomized controlled trial.

BackgroundOsteoarthritis is a chronic disease with a multifactor etiology involving changes in bone alignment, cartilage, and other structures necessary to joint stability. There is a need to investigate therapeutic resources that combine different wavelengths as well as different light sources (low-level laser therapy and light-emitting diode therapy) in the same apparatus for the treatment of osteoarthritis. The aim of the proposed study is to analyze the effect of the incorporation of phototherapy into a therapeutic exercise program for individuals with osteoarthritis of the knee.Methods/DesignA double-blind, controlled, randomized clinical trial will be conducted involving patients with osteoarthritis of the knee. Evaluations will be performed using functional questionnaires before and after the treatment protocols, in a reserved room with only the evaluator and participant present, and no time constraints placed on the answers or evaluations. The following functional tests will also be performed: stabilometry (balance assessment), dynamometry (muscle strength of gluteus medius and quadriceps), algometry (pain threshold), fleximeter (range of motion), timed up-and-go test (functional mobility), and the functional reach test. The participants will then be allocated to three groups through a randomization process using opaque envelopes: exercise program, exercise program + phototherapy, or exercise program + placebo phototherapy, all of which will last for eight weeks.DiscussionThe purpose of this randomized clinical trial is to analyze the effect of the incorporation of phototherapy into a therapeutic exercise program for osteoarthritis of the knee. The study will support the practice based on evidence to the use of phototherapy in individuals with a diagnosis of osteoarthritis of the knee. Data will be published after the study is completed.Trial registrationThe protocol for this study has been submitted to Clinical Trials, registration number NCT02102347, on 29 March 2014.

Progressive Therapeutic Exercise Program for Successful Treatment of a Postpartum Woman With a Severe Diastasis Recti Abdominis

Progressive Therapeutic Exercise Program for Successful Treatment of a Postpartum Woman With a Severe Diastasis Recti Abdominis

Exercise for osteoarthritis of the hip.

Current international treatment guidelines recommending therapeutic exercise for people with symptomatic hip osteoarthritis (OA) report are based on limited evidence. To determine whether land-based therapeutic exercise is beneficial for people with hip OA in terms of reduced joint pain and improved physical function and quality of life. We searched five databases from inception up to February 2013. All randomised controlled trials (RCTs) recruiting people with hip OA and comparing some form of land-based therapeutic exercise (as opposed to exercises conducted in water) with a non-exercise group. Four review authors independently selected studies for inclusion. We resolved disagreements through consensus. Two review authors independently extracted data, assessed risk of bias and the quality of the body of evidence for each outcome using the GRADE approach. We conducted analyses on continuous outcomes (pain, physical function and quality of life) and dichotomous outcomes (proportion of study withdrawals). We considered that seven of the 10 included RCTs had a low risk of bias. However, the results may be vulnerable to performance and detection bias as none of the RCTs were able to blind participants to treatment allocation and, while most RCTs reported blinded outcome assessment, pain, physical function and quality of life were participant self reported. One of the 10 RCTs was only reported as a conference abstract and did not provide sufficient data for the evaluation of bias risk.High-quality evidence from nine trials (549 participants) indicated that exercise reduced pain (standardised mean difference (SMD) -0.38, 95% confidence interval (CI) -0.55 to -0.20) and improved physical function (SMD -0.38, 95% CI -0.54 to -0.05) immediately after treatment. Pain and physical function were estimated to be 29 points on a 0- to 100-point scale (0 was no pain or loss of physical function) in the control group; exercise reduced pain by an equivalent of 8 points (95% CI 4 to 11 points; number needed to treat for an additional beneficial outcome (NNTB) 6) and improved physical function by an equivalent of 7 points (95% CI 1 to 12 points; NNTB 6). Only three small studies (183 participants) evaluated quality of life, with overall low quality evidence, with no benefit of exercise demonstrated (SMD -0.07, 95% CI -0.23 to 0.36). Quality of life was estimated to be 50 points on a norm-based mean (standard deviation (SD)) score of 50 (10) in the general population in the control group; exercise improved quality of life by 0 points. Moderate-quality evidence from seven trials (715 participants) indicated an increased likelihood of withdrawal from the exercise allocation (event rate 6%) compared with the control group (event rate 3%), but this difference was not significant (risk difference 1%; 95% CI -1% to 4%). Of the five studies reporting adverse events, each study reported only one or two events and all were related to increased pain attributed to the exercise programme.The reduction in pain was sustained at least three to six months after ceasing monitored treatment (five RCTs, 391 participants): pain (SMD -0.38, 95% CI -0.58 to -0.18). Pain was estimated to be 29 points on a 0- to 100-point scale (0 was no pain) in the control group, the improvement in pain translated to a sustained reduction in pain intensity of 8 points (95% CI 4 to 12 points) compared with the control group (0 to 100 scale). The improvement in physical function was also sustained (five RCTs, 367 participants): physical function (SMD -0.37, 95% CI -0.57 to -0.16). Physical function was estimated to be 24 points on a 0- to 100-point scale (0 was no loss of physical function) in the control group, the improvement translated to a mean of 7 points (95% CI 4 to 13) compared with the control group.Only five of the 10 RCTs exclusively recruited people with symptomatic hip OA (419 participants). There was no significant difference in pain or physical function outcomes compared with five studies recruiting participants with hip or knee OA (130 participants). Pooling the results of these 10 RCTs demonstrated that land-based therapeutic exercise programmes can reduce pain and improve physical function among people with symptomatic hip OA.

Effectiveness of a program of therapeutic exercises on the quality of life and lumbar disability in women with Stress Urinary Incontinence

Stress Urinary Incontinence (SUI) is a common condition and can cause social isolation and decreased quality of life. The literature demonstrates that perineal exercises are effective in promoting urinary continence and lumbar stability. This uncontrolled (group) pilot study, using a pre-test-post-test design, investigated whether a weekly session of Holistic Gymnastics(®) conducted during a one-year period, could change outcomes in a group of twenty women diagnosed with SUI. In the first and last evaluation, the subjects underwent a clinical examination and were asked to complete two questionnaires, one regarding quality of life and the other about lumbar disability. Improvement in the quality of life was observed in nine out of ten domains. There was also an improvement in lumbar disability. These results suggest that a program with therapeutic exercises can be effective in controlling urinary incontinence and improve the quality of life and lumbar disability in woman with SUI.

Aplicación de un programa de ejercicio terapéutico en población adulta con discapacidad intelectual

ObjectiveTo determine the effect of a therapeutic exercise program on functional physical capacity in persons with intellectual disabilities. Material and methodsA quasi-experimental study was conducted with a final sample of 24adults with intellectual disabilities, aged between 24 and 60years old, which was randomized into an experimental group (11men and 6women) and a control group (6men and 1woman). Functional fitness was assessed before a therapeutic exercise program, 10weeks immediately after the program, and 6months after the end of it. ResultsOn comparing the results obtained in the pre-intervention and post-intervention period from the two groups, it was observed that the group that the therapeutic exercises had better scores (P<.01) than the control group on the variables: aerobic endurance, leg strength, arm strength, agility, and coordination. On comparing the results obtained inthe pre-intervention period with those at 6months after completion of the program, the group that performed exercise therapy continued to show better scores (P<.05) in leg strength, arm strength and aerobic endurance, compared to the control group. ConclusionsThe application of a ten-week therapeutic exercise program, improved scores on the variables of functional fitness, measured by the Senior Fitness Test, in adults with intellectual disabilities. The effect of the intervention program has a duration of less than 6months, a period after which the scores returned to baseline.

Effect of a 6-week program of physical therapy on the risk of falls in women with type II diabetes

AbstractAim of the study. The aim of this study The aim of this study was to assess the impact of the six-week therapeutic exercise program on the risk of falls in women with type II diabetes.Material and methods. The study included 15 women suffering from type II diabetes for more than 10 years. The patients have participated in a six-week non-public physiotherapy programme in the Private Outpatient Therapeutic and Rehabilitation Clinic “ZDROWIE” in Oława. To assess the risk of falls, we used the short form of The Falls Risk Assessment System.All participants were subjected to two series of measurements, before and after treatment, during which we examined the rate of falls by five functional tests. In addition, women have evaluated their own subjective assessment of the balance by means of a numerical ten-point visual analogue scale.Results. The therapeutic exercise programme used contributed significantly to reducing the rate of falls (with Z-score =1.14 on the Z-score = 0.09) by improving the performance of quadriceps muscle strength, balance, reaction time and proprioception. There was also an increase in the subjective assessment of self-sustainability.Conclusions. Regular exercise aimed at improving sensorimotor function reduces the impact of falls risk in women with type II diabetes. Physical activity has a positive effect on the stability of posture.

CSM 2014 Sports Physical Therapy Section Poster Presentations (Abstracts SPO1228–SPO1309, SPO6761)

CSM 2014 Sports Physical Therapy Section Poster Presentations (Abstracts SPO1228–SPO1309, SPO6761)

Effect of Weight-bearing Therapeutic Exercise on the Q-angle and Muscle Activity Onset Times of Elite Athletes with Patellofemoral Pain Syndrome: A Randomized Controlled Trial.

[Purpose] The purpose of this study was to determine the effect of a weight-bearing therapeutic exercise program for elite athletes diagnosed as having patellofemoral pain syndrome (PFPS). [Subjects] The subjects were 34 elite athletes from the Seoul T Center. They were randomly allocated to three groups: an elastic band exercise group (EBG), a sling exercise group (SEG), or a control group (CG). [Methods] Therapeutic exercises were performed 3 times a week for 8 weeks. The visual analogue scale (VAS) hamstring length, and static and dynamic Q angles were used to test the exercise effect of the exercises, as well as the onset time of electromyographic activity of vastus medialis oblique (VMO) and vastus lateralis (VL). [Results] Decrease of the dynamic Q-angle in EBG was significant and significantly greater than that in CG. The decrease in VAS in SEG was significant and significantly greater than that in CG. There were significant differences in the VL and VMO activity onset times in SEG between pre- and post-test, and their differences between pre- and post-test were also significantly different. [Conclusion] Weight-bearing therapeutic exercise is hoped that clinicians will use this information for better implementation of effective exercise methods for elite athletes with PFPS.

Mental Health of Adults Treated in Adolescence with Scoliosis-Specific Exercise Program or Observed for Idiopathic Scoliosis

Objective. To examine general mental health in adult males and females, who in adolescence participated in a scoliosis-specific therapeutic exercise program or were under observation due to diagnosis of scoliosis. Design. Registry-based, cross-sectional study with retrospective data collection. Methods. Sixty-eight subjects (43 women) aged 30.10 (25–39) years, with mild or moderate scoliosis (11–36° Cobb angle), and 76 (38 women) nonscoliotic subjects, aged 30.11 (24–38) years, participated. The time period since the end of the exercise or observation regimes was 16.5 (12-26) years. Beck Depression Inventory (BDI) and General Health Questionnaire (GHQ-28) scores were analyzed with the χ 2 and U tests. Multiple regression analyses for confounders were also performed. Results. Intergroup differences of demographic characteristics were nonsignificant. Scoliosis, gender, participation in the exercise program, employment, and marital status were associated with BDI scores. The presence of scoliosis and participation in the exercise program manifested association with the symptoms. Higher GHQ-28 “somatic symptoms” subscale scores interacted with the education level. Conclusions. Our findings correspond to the reports of a negative impact of the diagnosis of scoliosis and treatment on mental health. The decision to introduce a therapeutic program in children with mild deformities should be made with judgment of potential benefits, risks, and harm.

Physical activity in the prevention of peripheral artery disease in the elderly

Aging is a well-known cardiovascular risk factor and cardiovascular diseases (CVD) are estimated to be the most common cause of death in the elderly. Peripheral arterial disease (PAD) represents an important clinical manifestation of CVD leading to increase morbidity and mortality, especially in elderly population. The correct management of PAD population includes the prevention of cardiovascular events and relief of symptoms, most commonly intermittent claudication. Progressive physical activity is an effective treatment to improve walking distance and to reduce mortality and cardiovascular events in patients with PAD, however the ability to effectively engage in physical activity often declines with increasing age. The maintenance and increase of reserve functional capacity are important concepts in the elderly population. Ultimately, the goal in participation of physical activity in the healthy elderly population is maintenance and development of physical functional reserve capacity. Therefore, for individuals suffering of PAD, appropriate physical activity in the form of supervised exercise may serve as a primary therapy. Although there are few direct comparisons of therapeutic exercise programs vs. pharmacological or surgical interventions, these increases in walking distance are greater than those reported for the most widely used agents for claudication, pentoxyphylline, and cilostazol. Despite a reduction in mortality and improvement of quality of life caused by physical activity in the PAD population, the molecular, cellular, and functional changes that occur during physical activity are not completely understood. Therefore, this review article aims at presenting an overview of recent established clinical and molecular findings addressing the role of physical activity on PAD in the older population.

A Terapia Aquática como Coadjuvante na Variação do Humor em Mulheres Pós-Menopáusicas

Objective: To observe the influence of an aquatic therapeutic exercise program on menopausal symptoms and depression in a group of menopausal women. Material and Methods: This was a longitudinal intervention study, with a quantitative approach and pre- and post-treatment measures in a population of menopausal women. Instruments for data collection: Blatt and Kuppermann Menopausal Index and Black & Yesavage Geriatric Depression Scale. Data were analyzed using the software Statistical Package for Social Sciences (SPSS) version 16.0 for Windows, in addition to Wilcoxon statistical test and Spearman’s correlation test. Results: The mean (SD) of menopausal symptoms before and after intervention was found to be 11.73 (9.90) and 7.60 (5.60), respectively, with a significant difference (z=-3.293; p=0.001) between pre- and post-treatment measures. For symptoms of depression, means (SD) of 13.3 (5.5) and 9.0 (5.9) were observed before and after intervention, with a significant difference (z=-2.003; p=0.045) between pre- and post-treatment measures, confirmed by the Spearman correlation test. Conclusion: Hydrotherapy was found to provide physical and functional benefits, such as relief of heat waves and improvement in mood and body image, increasing female self-esteem and reducing depression symptoms abundantly found in menopausal women. DESCRIPTORS Climacteric. Menopause. Depression. Hydrotherapy. Exercise.