Therapeutic Exercise Training Research Articles

The Effectiveness of Therapeutic Exercise Interventions With Virtual Reality on Balance and Walking Among Persons With Chronic Stroke: Systematic Review, Meta-Analysis, and Meta-Regression of Randomized Controlled Trials.

Well-targeted balance, walking, and weight-shift training can improve balance capabilities in the chronic phase of stroke. There is an urgent need for a long-term approach to rehabilitation that extends beyond the acute and subacute phases, supporting participation without increasing the demand for health care staff. This study aims to evaluate the effectiveness of therapeutic exercise interventions with virtual reality (VR) training on balance and walking at the activity and participation levels in individuals with chronic stroke, compared with control groups receiving no treatment, conventional physical therapy, specific training, similar treatment, or identical treatment without VR. Studies were searched across 6 databases. The inclusion criteria were as follows: Adults aged 18 years or older with a stroke diagnosis for at least 6 months (population). Therapeutic exercises within a VR environment, using VR glasses or interactive games (intervention). Control groups without the use of VR (including no treatment, conventional physical therapy, specific training, similar treatment without VR, or identical treatment without the additional use of VR; comparison). We evaluated the Berg Balance Scale score, Functional Reach Test performance, Activities-specific Balance Confidence Scale score, Six-minute Walk Test, Two-minute Walk Test, 10-meter Walk Test results, and cadence (outcome measures). We investigated randomized controlled trials (study design). A meta-analysis and a meta-regression analysis were conducted to evaluate whether the content of VR interventions or control groups, as well as the level of VR immersion used, was related to balance or walking outcomes. A total of 43 randomized controlled trials involving 1136 participants were included in this review. The use of VR training in therapeutic exercise interventions had a large effect on balance (standardized mean difference 0.51, 95% CI 0.29-0.72; P<.001) and a moderate effect on walking (standardized mean difference 0.31, 95% CI 0.09-0.53; P=.006) in individuals with chronic stroke, compared with pooled control groups (no treatment, conventional physical therapy, specific training, similar treatment, or identical treatment without the use of VR). According to the meta-regression findings, the content of VR interventions (P=.52), the type of control groups (P=.79), and the level of VR immersion (P=.82) were not significantly related to the pooled balance or walking outcomes. The GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) was moderate for balance and low for walking. Therapeutic exercise training with VR had a positive, albeit moderate, effect on balance and a low impact on walking at the level of activity (capacity), even in the chronic phase of stroke, without serious side effects. The results are applicable to working-aged stroke rehabilitees who are able to walk without assistance. Further research is needed with defined VR methods and outcomes that assess performance at the level of real-life participation.

Analysis of YouTube-Based Therapeutic Content for Children with Cerebral Palsy.

Cerebral palsy (CP) causes movement and posture challenges due to central nervous system damage, requiring lifelong management. During the COVID-19 pandemic, there was limited access to facility-based treatments, which increased the demand for home-based therapies and digital resources. We analyzed the qualitative and quantitative aspects of YouTube videos focusing on CP therapy for children. A total of 95 videos were evaluated for content quality using the modified DISCERN (mDISCERN) tool and Global Quality Scale (GQS). The therapeutic program efficacy was assessed via the International Consensus on Therapeutic Exercise and Training (i-CONTENT) tool, Consensus on Therapeutic Exercise Training (CONTENT) scale, and Consensus on Exercise Reporting Template (CERT), and popularity was measured by the video power index (VPI). YouTube-based therapeutic videos for children with CP generally exhibit reliability in video content and effectiveness in therapeutic programming, and no correlations were found between video popularity and quality. However, the qualitative analysis reveals insufficient mention of uncertainty in the treatment principles within the video content as well as a lack of detailed treatment descriptions encompassing aspects such as intensity, frequency, timing, setting, outcome measurement during and post-treatment, and safety considerations within therapeutic programs. In particular, this tendency was consistent regardless of the uploader's expertise level and the classification of the neuromotor therapy type in contrast to that of the exercise type. YouTube-based content for CP children still has significant limitations in how substantive viewers, such as caregivers, can acquire tailored information and apply practical information to their exercise and treatment programs.

Functional rehabilitation based on therapeutic exercise training in patients with postacute COVID syndrome (RECOVER)

Postacute COVID syndrome (PACS) is common after acute SARS-CoV-2 infection. One of the most frequent and disabling symptoms is exercise intolerance (EI). Recent evidence suggests that EI in PACS has a peripheral (metabolic-neuromuscular) origin, suggesting that exercise training may be an effective treatment. The aim of this study was to assess the role a therapeutic physical exercise program (TPEP) in PACS with EI. This single-center, open-label, randomized clinical trial compared an exercise training program (intervention group) with regular physical activity recommendations (control group) in patients with PACS and EI. The intervention group underwent an 8-week TPEP. The primary endpoint was improvement in functional capacity, assessed as the change in peak VO2. We included 50 participants with PACS (73% women, mean age 47±7.1 years). The intervention group showed a 15% improvement in peak VO2 (peak VO2 pre- and postintervention: 25.5±7.7mL/kg/min and 29.3±4.7 mL/kg/min; P <.001) and a 13.2% improvement in predicted values (92.1±14.3% and 108.4±13.4%; P <.001). No significant changes in VO2 values were observed in the control group. Unlike the control group, the intervention group also showed improvements in all secondary outcomes: quality of life scales, muscle power, maximum inspiratory power, metabolic flexibility, and body fat percentage. The program improved functional capacity in patients with PACS and EI.

Combined effect of orthotic intervention and conventional exercise training on balance and gait performance in cerebral palsy: a randomized controlled trial

BackgroundThis study aimed to examine the combined effect of orthotic intervention and conventional therapeutic exercise training on balance and gait performance in children with cerebral palsy. This study was a randomized control trial. Forty children with dyskinetic cerebral palsy of both genders with ages ranged from 12 to 16 years were included. Participants in the control and study groups received a conventional therapeutic exercise training program for two 2 h ours per session. The treatment program was conducted three sessions per week, for twelve 12 successive weeks. Children in the study group additionally wore TheraTogs orthotic undergarment with the strapping system. Pediatric Balance Scale score and postural stability indices (overall, anteroposterior , and mediolateral) evaluated by the Biodex Balance System were assessed (in both groups) at baseline and after 12 weeks of treatment. The changes of step length, gait cycle time, cadence, and velocity were also measured by an electronic walkway.ResultsChildren in the study group showed significant improvements in the scores of all the measured variables post-treatment compared to the control group (P < 0.05). The P -values for overall, anteroposterior and mediolateral postural stability indices were 0.011, 0.014, and 0.021, respectively. The P -values for Pediatric Balance Scale score, step length, gait cycle time, cadence, and velocity were 0.001, 0.023, 0.041, 0.011, and 0.013 respectively.ConclusionsConventional therapeutic exercise training combined with orthotic intervention were more effective in improving balance and gait performance in children with dyskinetic cerebral palsy.Trial registrationThe ClinicalTrial.gov PRS (NCT04990193).Registered 4 August 2021 - Retrospectively registered.

Effects of Prehabilitation on Functional Capacity in Aged Patients Undergoing Cardiothoracic Surgeries: A Systematic Review.

Background: an increasing number of advanced age patients are considered for cardiothoracic surgeries. Prehabilitation optimizes the patients’ functional capacity and physiological reserve. However, the effectiveness of prehabilitation on physical functioning and postoperative recovery in the scope of cardiothoracic surgery is still uncertain. Objective: to assess the effectiveness of prehabilitation on pre- and/or postoperative functional capacity and physiological reserve in aged patients that are considered for cardiothoracic surgeries. Methods: this systematic review was registered in PROSPERO (CRD42021247117). The searches were conducted in PubMed, Web of Science, Scopus, and Cochrane CENTRAL until 18 April 2021. Randomized clinical trials that compared different prehabilitation strategies with usual care on the pre- and-postoperative results in aged patients undergoing cardiothoracic surgeries were included. Methodological quality was assessed by means of the Jadad scale, and the effectiveness of the interventions according to the Consensus on Therapeutic Exercise Training. Results: nine studies with 876 participants aged from 64 to 71.5 years old were included. Risk of bias was moderate due to the absence of double-blinding. The content of the interventions (multimodal prehabilitation n = 3; based on physical exercises n = 6) and the result measures presented wide variation, which hindered comparison across the studies. In general, the trials with better therapeutic quality (n = 6) reported more significant improvements in physical functioning, cardiorespiratory capacity, and in the postoperative results in the participants under-going prehabilitation. Conclusions: prehabilitation seems to improve functional capacity and postoperative recovery in aged patients undergoing cardiothoracic surgeries. However, due to the significant heterogeneity and questionable quality of the trials, both the effectiveness of prehabilitation and the optimum content are still to be determined.

Diabetes pathogenesis and management: the endothelium comes of age.

Endothelium, acting as a barrier, protects tissues against factors that provoke insulin resistance and type 2 diabetes and itself responds to the insult of insulin resistance inducers with altered function. Endothelial insulin resistance and vascular dysfunction occur early in the evolution of insulin resistance-related disease, can co-exist with and even contribute to the development of metabolic insulin resistance, and promote vascular complications in those affected. The impact of endothelial insulin resistance and vascular dysfunction varies depending on the blood vessel size and location, resulting in decreased arterial plasticity, increased atherosclerosis and vascular resistance, and decreased tissue perfusion. Women with insulin resistance and diabetes are disproportionately impacted by cardiovascular disease, likely related to differential sex-hormone endothelium effects. Thus, reducing endothelial insulin resistance and improving endothelial function in the conduit arteries may reduce atherosclerotic complications, in the resistance arteries lead to better blood pressure control, and in the microvasculature lead to less microvascular complications and more effective tissue perfusion. Multiple diabetes therapeutic modalities, including medications and exercise training, improve endothelial insulin action and vascular function. This action may delay the onset of type 2 diabetes and/or its complications, making the vascular endothelium an attractive therapeutic target for type 2 diabetes and potentially type 1 diabetes.

The management of lower back pain using pilates method: assessment of content exercise reporting in RCTs

Purpose To evaluate the quality of the reporting of exercise interventions with Pilates method for the treatment of lower back pain (LBP) in adults. Materials and methods Two independent evaluators selected randomized controlled trials (RCTs) of moderate and high methodological quality included in a Cochrane Systematic Review (SR) and from an additional updated search in the following databases: CENTRAL, MEDLINE, EMBASE, CINAHL, PEDro and SPORTDiscus. Three assessment tools (Consensus on Therapeutic Exercise Training (CONTENT) scale, Template for Intervention Description and Replication (TIDieR) checklist and Consensus on Exercise Reporting Template (CERT) checklist) were utilized by three pairs of two independent researchers trained. The scales’ concordance was measured using the Kappa coefficient. Results Ten RCTs were included. The CONTENT scale score was 5.3 (± 1.33) out of 9 points; the TIDieR checklist was 8.5 (± 1.71) out of 12 points and the CERT checklist was 9.5 (± 3.62) out of 19 points. The CONTENT and CERT had moderate concordance, while there was fair concordance between the other tools. Conclusions The overall reporting quality for the Pilates exercises in ten moderate-to-high quality RTCs for the management of LBP was low according to CONTENT scale and CERT checklist and high according to TIDieR checklist. Implications for Rehabilitation Reporting of Pilates exercise program in moderate-to-high quality RCTs for the management of lower back pain remains incomplete. Pilates exercise program should be personalized and contextualized to individual participants. There may be a need to consider adding to or combining the information available from various trials.

Intervention reporting and dissemination of information for the management of hand osteoarthritis

A variety of exercise programs are recognized to be effective for the management of hand osteoarthritis (HOA). It is important to report the essential elements of these exercise programs for clinicians to replicate properly and facilitate their implementation with individuals who suffers from HOA, especially if they are found to be effective programs. The objective of this article was to assess content reporting using three exercise reporting standardized assessment tools among exercise interventions randomized controlled trials (RCTs) involving individuals with HOA. A descriptive study was used. Two pairs of trained assessors independently identified, selected, and scored the reporting quality of the exercise programs of RCTs on the management of HOA using three standardized assessment tools: the Consensus on Exercise Reporting Template (CERT) checklist, Consensus on Therapeutic Exercise Training (CONTENT) scale, and Template for Intervention Description and Replication (TIDieR) checklist to review the quality of reporting of 11 RCTs included in a recent Ottawa Panel guideline. Based on consensus reached by two different pairs of reviewers and an arbitrator, the mean total scores for the 11 included exercise programs were reported as follows: the mean total score for the CERT, CONTENT, and TIDieR was 10.58/19±4.34, 3.27/9±1.90, and 5.92/12±2.54, respectively. The overall Pearson's Correlation (r) between the methodological quality and intervention reporting was 0.86, 0.71, and 0.54 for moderate-to-high RCTs and 0.47, 0.79, and 0.42 for fair-to-poor methodological quality for the CERT checklist, CONTENT scale, and TIDieR checklist, respectively. The intervention reporting in the management of HOA is poor among low-, moderate-, and high-quality clinical trials. The least reported information was intervention parameters related to behavior change. Improving reporting is recommended to ensure replication of effective exercise programs to enhance quality of life of individuals with HOA.

Assessing the reporting quality of physical activity programs in randomized controlled trials for the management of juvenile idiopathic arthritis using three standardized assessment tools

BackgroundThe reporting quality of physical activity (PA) programs in randomized controlled trials (RCTs) for the management of juvenile idiopathic arthritis (JIA) remains unknown. This study aimed to assess and compare the reporting quality of PA programs in RCTs for the management of JIA using three difference standardized assessment tools, and to describe the elements that were similar and different between these tools.MethodsA systematic search was conducted for moderate-to high-quality RCTs of PA programs in JIA, published up until January 2019. Two reviewers independently included 10 RCTs and scored the reporting quality of PA programs using the following tools: Consensus on Exercise Reporting Template (CERT) checklist, Consensus on Therapeutic Exercise Training (CONTENT) scale, and Template for Intervention Description and Replication (TIDieR) checklist.ResultsResults showed that reporting of PA programs in 10 moderate- to high-quality RCTs for JIA management remains incomplete. The average reporting quality (± standard deviation) for all RCTs combined was moderate for the three standardized assessment tools with 70.8 (±14.3)% for the TIDieR checklist, 53.2 (±20.2)% for the CERT checklist, and 70.0 (±18.9)% for the CONTENT scale. Despite some overlap, the three standardized assessment tools (TIDieR, CERT, CONTENT) included different elements resulting in different scores. All tools assess elements linked to PA programs (provider, location, timing, personalization and adherence), but the CERT checklist includes other essential elements (e.g., additional resources, motivational strategies, adverse events).ConclusionsThe lack of complete reporting of PA programs in RCTs for the management of JIA and the variation in scores and assessed elements among standardized assessment tools show the need to improve reporting. Using the most comprehensive standardized tool (i.e., the CERT) and providing accessible supplemental information on PA programs may improve the reporting quality of PA programs in RCTs and help reproduce PA programs in research and clinical practice.

Hip Fracture With Resistance to Care

Hip Fracture With Resistance to Care

Effects of selected therapeutic aerobic exercise on remedial case of premenstrual syndrome in case of Arba Minch University

Purpose: The purpose of this study was to assess the effect of selected therapeutic 12 weeks regular aerobic exercise on remedial case of premenstrual syndrome students. Materials: A quasi-experimental study was used on a randomly selected 30 female students aged 18 to 30 years who meet the eligibility criteria at Arba Minch University. Participants were divided in to two groups: experimental group (n=15) and control group (n=15) for comparison purpose. The therapeutic aerobic exercise duration was 40-60 minutes and carried out for 12 weeks with three sessions per week. In this study the premenstrual symptoms questionnaire consists of 8 domains of used. The domains were pain, concentration, behavioral change, autonomic reactions, water retention, negative effect, arousal and control. A paired t-test statistical method was used for data analysis. SPSS version 20 was used for data management and analysis. Result: The study found mean scores of negative reaction decreased after 12 weeks with a frequency of 3 per week therapeutic aerobic training in the experimental group but not in the control. Further, a statistically significant change was observed for all measured variables for experimental group. However, there was no a statistically significant change for the controls. The selected therapeutic aerobic exercise training program on treating premenstrual syndrome had a significance effects on experimental group and students who practiced for twelve weeks with a repetition of three times per week. Conclusion: Twelve weeks of regular therapeutic aerobic exercise with three sessions per a week with intensity of 40 to 60 minutes reduces the severity of feeling premenstrual syndrome symptoms (PMS).

A Case Study of The Effects of Low-Intensity Therapeutic Exercise Training on a Patient Suffering from General Weakness And Mild Neural Problem Caused by Heart Failure Due to Coronary Artery Obstruction and Hypoxic Brain Damage

A Case Study of The Effects of Low-Intensity Therapeutic Exercise Training on a Patient Suffering from General Weakness And Mild Neural Problem Caused by Heart Failure Due to Coronary Artery Obstruction and Hypoxic Brain Damage

A study of the description of exercise programs evaluated in randomized controlled trials involving people with fibromyalgia using different reporting tools, and validity of the tools related to pain relief

Rationale: Exercise programs for the management of fibromyalgia are well recognized as being effective. However, the incomplete descriptions of exercise programs make replication and implementation difficult. Also, existing reporting tools have not been validated in relation to pain relief as well as with each other. Objectives: This study aimed to evaluate the description of exercise programs in randomized control trials for the management of fibromyalgia using different assessment tools, and the correlations of each tool in relation to effectiveness of pain relief of fibromyalgia, and the correlations between each tool. Method/Results: Through a consensus made by two different pairs of reviewers and an arbitrator, the mean total scores for the exercise programs were reported: 10.61/19 for Consensus on Exercise Reporting Template; 4.17/12 for Template for Intervention Description and Replication; 7.05/12 for the Consensus on Therapeutic Exercise Training; and 2.50/4 (aerobic) and 2.36/5 (flexibility and resistance) for the 2016 American College of Sports Medicine guidelines. This demonstrates generally low reporting scores (less than 60% out of the total number of items were reported). Overall, low correlations (Cohen’s kappa value, ranging from −0.47 (poor) to 0.313 (fair)) were found between all tools and pain relief. Good to excellent correlations (0.680–0.908) among the reporting tools were shown. Conclusion: Incomplete descriptions of exercise programs were consistently shown among the randomized clinical trials assessed in this study. The overall weak correlations demonstrated that the reporting tools have the limited ability to determine whether exercise programs were or were not effective for pain relief among individuals with fibromyalgia.

Suivi et évaluation sur une année de projets élaborés en réhabilitation respiratoire

Pulmonary rehabilitation inevitably contains two essential components: therapeutic education and exercise training. The principal aim of this study was to evaluate the evolution over a year of the realization of plans determined during a pulmonary rehabilitation program (PRP). At the end of a PRP the patient made plans in accordance with his health condition. A telephone enquiry was undertaken at 3, 7 and 12 months to evaluate the progress of the plans, the motivation to perform them, dyspnoea and quality of life. The data of 65 patients were analyzed (87 inclusions). Fifty-seven percent of the plans continued for one year. Walking had an adherence rating of 71%. Loss of motivation appeared to be the main cause for stopping (20%). Quality of life remained stable (p=0.39) and an increase in dyspnoea, though statistically significant (p<0.01), was of no clinical relevance. The majority of plans were maintained but without clinical effect on the quality of life or the level of dyspnoea. Decreased motivation was the major limitation to realization or continuation of the plans. New studies will have to be implemented to analyze the factors which lead to this decrease.

Circulating MicroRNA Markers for Pulmonary Hypertension in Supervised Exercise Intervention and Nightly Oxygen Intervention

Rationale: Therapeutic exercise training has been shown to significantly improve pulmonary hypertension (PH), including 6-min walking distance and right heart function. Supplemental nightly oxygen also has therapeutic effects. A biomarker tool that could query critical gene networks would aid in understanding the molecular effects of the interventions.Methods: Paired bio-banked serum (n = 31) or plasma (n = 21) samples from the exercise or oxygen intervention studies, respectively, and bio-banked plasma samples (n = 20) from high altitude induced PH in cattle were tested. MicroRNAs (miRNAs) markers were chosen for study because they regulate gene expression, control the function of specific gene networks, and are conserved across species.Results: miRNAs that control muscle (miR-22-3p, miR-21-5p) or erythrocyte function (miR-451a) were chosen based on pilot experiments. Plasma samples from cattle that developed PH in high altitude had significantly higher miR-22-3p/(relative to) miR-451a values when compared to control cattle tolerant to high altitude. Measurements of miR-22-3p/miR-451a values in serum from patients receiving exercise training showed that the values were significantly decreased in 74.2% of the samples following intervention and significantly increased in the remainder (25.8%). In samples obtained after exercise intervention, a higher composite miRNA value, made of miR-22-3p and miR-21-5p/miR-451a and spike RNA, was significantly decreased in 65% of the samples and significantly increased in 35% of the samples. In the study of nightly oxygen intervention, when comparing placebo and oxygen, half of the samples showed a significant down-ward change and the other half a significant up-ward change measuring either of the miRNA markers. Samples that had a downward change in the miRNA marker following either intervention originated from patients who had a significantly higher 6-min-walking-distance at baseline (mean difference of 90 m or 80 m following exercise or oxygen intervention, respectively) when compared to samples that had an upward change in the miRNA marker.Conclusion: These natural animal model and human sample studies further highlight the utility of miRNAs as future biomarkers. The different directional changes of the miRNA markers following supervised exercise training or nightly oxygen intervention could indicate different PAH molecular pathomechanisms (endotypes). Further studies are needed to test this idea.

Efectos de los ejercicios de resistencia en el linfedema posmastectomía, una revisión sistemática

El objetivo de este trabajo fue realizar una revisión sistemática para conocer los efectos que tiene un programa de ejercicio de resistencia en pacientes con linfedema asociado a cáncer de mama o en riesgo de presentarlo. Se realizó una búsqueda bibliográfica durante el mes de febrero de 2017 en el buscador PubMed y en las bases de datos Medline, Cinahl, PEDro y Scopus utilizando los siguientes términos MESH: lymphedema, Exercise Therapy, Therapeutic exercise y Resistance Training. Tras la aplicación de los criterios de inclusión (ensayos clínicos publicados en revistas científicas, entre el 1/01/2012 y el 31/03/2017, en idioma castellano o inglés y con programa de ejercicio efectuado sobre mujeres) y de exclusión (artículos duplicados y aquellos que no tuviesen relación con el objetivo descrito en el trabajo) se obtuvieron un total de 13 artículos, en los cuales se somete a los sujetos a un programa de ejercicios de resistencia. La mayoría de los estudios analizados muestran una baja calidad metodológica medida con la escala PEDro. En 11 de ellos participan mujeres con linfedema asociado a cáncer de mama, mientras que en los otros 2 las participantes presentan riesgo de padecer linfedema posmastectomía. Los resultados de esta revisión muestran que tanto las mujeres con linfedema asociado a cáncer de mama como las que tienen riesgo de padecerlo pueden llevar a cabo un programa de entrenamiento de resistencia sin exacerbar el linfedema. Los datos obtenidos hacen pensar que este tipo de pacientes pueden llevar a cabo un programa de ejercicios de resistencia sin miedo a exacerbar su dolencia, consiguiendo en el proceso un aumento de la fuerza muscular y una mejor calidad de vida. The objective of this review was to test the effects of a resistance exercise programme in patients with or at risk of breast cancer-associated lymphoedema. A literature search conducted during the month of February 2017 in the PubMed search engine and in the Medline, Cinahl, PEDro and Scopus databases using the following MESH terms: lymphedema, Exercise Therapy, Therapeutic exercise and Resistance Training. A total of 13 articles were obtained after the inclusion criteria were applied (clinical trials published in scientific journals between 01/01/2012 and 03/31/2017, in Spanish or English and with an exercise programme undertaken by women); and the exclusion criteria (duplicate articles and articles unrelated to the objective of the paper). Most of the studies analysed were of poor methodological quality as measured by the PEDro scale. Women with breast cancer-associated lymphoedema participated in 11 studies and women at risk of postmastectomy lymphoedema participated in the remaining 2. The results of this review show that both women with breast cancer-associated lymphoedema and those at risk can undergo resistance training without exacerbating lymphoedema. The data obtained suggest that these patients can carry out a resistance exercise programme without fear of exacerbating their disease, achieving in the process increased muscle strength and a better quality of life.

Obesity Associated Hypertension in Admitted Patients

The close association of excess adiposity and elevated blood pressure is well documented. The role of obesity as a contributing factor for resistant hypertension, cardiovascular disease, and cerebrovascular disease is recognized. Given that exercise training could be used to treat both obesity and elevated blood pressure when patients are admitted for trauma care, identifying obesity-associated systolic hypertension may help with long-term control of the root causes for these illnesses. PURPOSE: To examine the relationship between body composition, blood pressure, and other measures collected on patient admittance. METHODS: Data were collected from 2,306 consecutive patients admitted to a Level 1 trauma center between July, 2012 and June 2015. Patients with head trauma or traumatic brain injury were not analyzed. Patients were considered obese if their BMI was ≥ 30. Multiple linear regression was used to examine the effect of obesity on blood pressure. Other significant variables were examined from the database that contributed to the prediction model. RESULTS: Significant predictors of systolic hypertension included blood lactate, age, obesity, pulse pressure, pH, %O2 saturation and hemoglobin levels (R=0.464; p<0.001). Holding all other variables constant, obesity was associated with a 9.7 mmHg increase in systolic blood pressure (p=0.009). A mild (3 mmHg) increase in diastolic blood pressure was noted, but was not found to be statistically significant (p=0.172). CONCLUSIONS: The demonstrated relationship between obesity and systolic blood pressure illustrates the need for integrated blood pressure and obesity treatment with exercise training. Therapeutic exercise focused on weight loss goals will likely ameliorate elevated systolic blood pressure. Weight management discussions are challenging, and often avoided by health professionals, but these data show that concomitant antihypertensive medication with therapeutic exercise training may be warranted for prevention of subsequent cardiovascular and cerebrovascular diseases.

Effects of therapeutic exercise training on systemic inflammation in smoke exposed mice

Effects of therapeutic exercise training on systemic inflammation in smoke exposed mice

Exercise Strategies to Counteract Brain Aging Effects.

Stimulating structural and functional adaptation that improves cognitive performance in specific tasks is the major objective of therapeutic exercise training. In this review we briefly summarize central physiological mechanisms activated by exercise. We further discuss the influence of different kinds of exercise on cognitive improvement. In particular, the effects on cognitive function of aerobic endurance, resistance and respiratory exercise, and combinations thereof are presented. The accumulating evidence reinforces the position that regular aerobic, and possibly also resistance training, offers a powerful tool to cope with biologic aging of central nervous system functions. Nevertheless, the potential magnitude of cognition improvement or restrain of age-related cognition deterioration and the quantity of physical activity required to induce meaningful responses remain to be clarified.

Physiotherapy practice patterns in Intensive Care Units of Nepal: A multicenter survey.

Context:As physiotherapy (PT) is a young profession in Nepal, there is a dearth of insight into the common practices of physiotherapists in critical care.Aims:To identify the availability of PT services in Intensive Care Units (ICUs) and articulate the common practices by physiotherapists in ICUs of Nepal.Settings and Design:All tertiary care hospitals across Nepal with ICU facility via an exploratory cross-sectional survey.Subjects and Methods:An existing questionnaire was distributed to all the physiotherapists currently working in ICUs of Nepal with 2 years of experience. The survey was sent via E-mail or given in person to 86 physiotherapists.Statistical Analysis Used:Descriptive and inferential statistics according to nature of data.Results:The response rate was 60% (n = 52). In the majority of hospitals (68%), PT service was provided only after a physician consultation, and few hospitals (13%) had established hospital criteria for PT in ICUs. Private hospitals (57.1%) were providing PT service in weekends compared to government hospitals (32.1%) (P = 0.17). The likelihood of routine PT involvement varied significantly with the clinical scenarios (highest 71.2% status cerebrovascular accident, lowest 3.8% myocardial infarction, P < 0.001). The most preferred PT treatment was chest PT (53.8%) and positioning (21.2%) while least preferred was therapeutic exercise (3.8%) irrespective of clinical scenarios.Conclusions:There is a lack of regular PT service during weekends in ICUs of Nepal. Most of the cases are treated by physiotherapists only after physician's referral. The preferred intervention seems to be limited only to chest PT and physiotherapists are not practicing therapeutic exercise and functional mobility training to a great extent.