Unsupervised Home-based Exercise Program Research Articles

Vigorous vs. moderate exercise to improve glucose metabolism in inactive women with polycystic ovary syndrome and insulin resistance: a pilot randomized controlled trial of two home-based exercise routines

To study the impact of vigorous vs. moderate exercise on metabolic parameters in polycystic ovary syndrome (PCOS). Randomized controlled trial. Unsupervised home-based exercise program. Patients with PCOS on the basis of the Rotterdam criteria with insulin resistance. Participants were block randomized to a home-based exercise program of 75 minutes of vigorous exercise or 150 minutes of moderate exercise per week, for 8 weeks total. Changes in glucose, insulin, and insulin resistance. In total, 36 participants were randomized, of whom 20 completed the study. The percentage changes from baseline at 4 and 8weeks for fasting glucose, insulin, and homeostatic model assessment for insulin resistance did not significantly differ between the groups, except for the change in the 8-week glucose level, which was more favorable in the moderate arm (8.06% [standard deviation, 6.44%] in the vigorous group compared with -0.32% [standard deviation, 4.91%] in the moderate group). The absolute values of the main outcomes (fasting glucose, insulin, and homeostatic model assessment for insulin resistance) at baseline and 4 and 8 weeks did not significantly differ between trial arms. When assessing the change from baseline at 4 and 8 weeks, overall and within each trial arm, only the 8-week fasting glucose level was significantly greater than the baseline value in the vigorous arm (93.5 [95% confidence interval, 88.7-98.3] vs. 86.8 [95% confidence interval, 81.1-92.4]). Unsupervised short-term exercise programs may not achieve significant metabolic improvements in patients with PCOS, regardless of vigorous vs. moderate intensity. Future studies should investigate this question in larger sample sizes and longer or structured exercise programs. ClinicalTrials.gov identifier, NCT02303470.

Cost and outcomes of Hospital-based Usual cAre versus Tele-monitor self-directed Rehabilitation (HUATR) in patients with total knee arthroplasty: A randomized, controlled, non-inferiority trial

To evaluate the clinical efficacy and cost-effectiveness of telemonitored self-directed rehabilitation (TR) compared with hospital-based rehabilitation (HBR) for patients with total knee arthroplasty (TKA). In this randomized, non-inferiority clinical trial, 114 patients with primary TKA who were able to walk independently preoperatively were randomized to receive HBR (n=58) or TR (n=56). HBR comprised at least five physical therapy sessions over 10weeks. TR comprised a therapist-led onboarding session, followed by a 10-week unsupervised home-based exercise program, with asynchronous monitoring of rehabilitation outcomes using a telemonitoring system. The primary outcome was fast-paced gait speed at 12weeks, with a non-inferiority margin of 0.10m/s. For economic analysis, quality-adjusted-life-years (QALY) was the primary economic outcome (non-inferiority margin, 0.027 points). In Bayesian analyses, TR had >95% posterior probability of being non-inferior to HBR in gait speed (week-12 adjusted TR-HBR difference, 0.02m/s; 95%CrI, -0.05 to 0.10m/s; week-24 difference, 0.01m/s; 95%CrI, -0.07 to 0.10m/s) and QALY (0.006 points; 95%CrI, -0.006 to 0.018 points). When evaluated from a societal perspective, TR was associated with lower mean intervention cost (adjusted TR-HBR difference, -S$227; 95%CrI, -112 to -330) after 24weeks, with 82% probability of being cost-effective compared with HBR at a willingness to pay of S$0/unit of effect for the QALYs. In patients with uncomplicated TKAs and relatively good preoperative physical function, home-based, self-directed TR was non-inferior to and more cost-effective than HBR over a 24-week follow-up period. TR should be considered for this patient subgroup.

Physiotherapy improves motor function in patients with the Parkinson variant of multiple system atrophy: A prospective trial

Background and objectivesGait impairment and reduced mobility are disabling symptoms of multiple system atrophy. While physiotherapy is increasingly recognized as a valuable supplement to pharmacotherapy for patients with Parkinson's disease, data on the efficacy of physiotherapy for multiple system atrophy are lacking. This study aimed to explore the feasibility of two consecutive exercise-based interventions in patients with multiple system atrophy. Subjects and MethodsWe included 10 patients with the parkinsonian variant of multiple system atrophy and 10 patients with Parkinson's disease, matched for gender and Hoehn & Yahr stage (≤3). Interventions consisted of a five-day inpatient physiotherapy program followed by a five-week unsupervised home-based exercise program. Outcomes included instrumented gait analysis, patient questionnaires, clinical rating scales and physical tests. Patients were examined at baseline, after the first inpatient treatment and again after the home-based intervention. Additionally, a structured telephone interview was performed immediately after the second intervention period. ResultsBoth patient groups exhibited a similar improvement of gait after the interventions, as measured by instrumented gait analysis. These effects reached their maximum level after inpatient physiotherapy and remained stable following the home-based exercise program. Patient questionnaires also showed improvements after the interventions, but motor clinical rating scales did not. ConclusionOur pilot results suggest that a short-term bout of physiotherapy is feasible, safe and improves gait performance in patients with multiple system atrophy. This highlights the potential of physiotherapy for this disabling condition where pharmacotherapy typically achieves poor effects. The present findings warrant a larger controlled study.

Telerehabilitation in Multiple Sclerosis: Results of a Randomized Feasibility and Efficacy Pilot Study.

A prospective, randomized, three-arm, evaluator blinded study to demonstrate the feasibility of a telerehabilitation (TR) program in individuals with ambulatory deficits secondary to Multiple Sclerosis (MS) and evaluate its efficacy when compared to conventional on-site physical therapy (PT) was completed. Thirty participants were evaluated at baseline and randomized to one of three groups with intervention lasting 8 weeks: Group 1 (control)- customized unsupervised home-based exercise program (HEP) 5 days a week; Group 2 (TR)- remote PT supervised via audio/visual real-time telecommunication twice weekly; Group 3 (PT)- in-person PT at the medical facility twice weekly. Outcomes included patient reported outcomes (PROs) obtained through questionnaires, and measurements of gait and balance performed with bedside tests and a computerized system. Functional gait assessment improved from baseline in all three groups. There were no significant differences between the TR and the conventional PT groups for a variety of outcome measures. TR is a feasible method to perform PT in persons with MS and has comparable efficacy to conventional in-person PT as measured by patient reported outcomes and objective outcomes of gait and balance.

Effectiveness of a multifactorial falls prevention program in community-dwelling older people when compared to usual care: study protocol for a randomised controlled trial (Prevquedas Brazil)

BackgroundFalling in older age is a major public health concern due to its costly and disabling consequences. However very few randomised controlled trials (RCTs) have been conducted in developing countries, in which population ageing is expected to be particularly substantial in coming years. This article describes the design of an RCT to evaluate the effectiveness of a multifactorial falls prevention program in reducing the rate of falls in community-dwelling older people.Methods/designMulticentre parallel-group RCT involving 612 community-dwelling men and women aged 60 years and over, who have fallen at least once in the previous year. Participants will be recruited in multiple settings in Sao Paulo, Brazil and will be randomly allocated to a control group or an intervention group. The usual care control group will undergo a fall risk factor assessment and be referred to their clinicians with the risk assessment report so that individual modifiable risk factors can be managed without any specific guidance. The intervention group will receive a 12-week Multifactorial Falls Prevention Program consisting of: an individualised medical management of modifiable risk factors, a group-based, supervised balance training exercise program plus an unsupervised home-based exercise program, an educational/behavioral intervention. Both groups will receive a leaflet containing general information about fall prevention strategies. Primary outcome measures will be the rate of falls and the proportion of fallers recorded by monthly falls diaries and telephone calls over a 12 month period. Secondary outcomes measures will include risk of falling, fall-related self-efficacy score, measures of balance, mobility and strength, fall-related health services use and independence with daily tasks. Data will be analysed using the intention-to-treat principle.The incidence of falls in the intervention and control groups will be calculated and compared using negative binomial regression analysis.DiscussionThis study is the first trial to be conducted in Brazil to evaluate the effectiveness of an intervention to prevent falls. If proven to reduce falls this study has the potential to benefit older adults and assist health care practitioners and policy makers to implement and promote effective falls prevention interventions.Trial registrationClinicalTrials.gov (NCT01698580)

Exercise and relaxation intervention for patients with advanced lung cancer: a qualitative feasibility study

Lung cancer patients experience loss of physical capacity, dyspnea, pain, reduced energy and psychological distress. The aim of this study was to explore feasibility, health benefits and barriers of exercise in former sedentary patients with advanced stage lung cancer, non-small cell lung cancer (NSCLC) (III-IV) and small cell lung cancer (SCLC) (ED), undergoing chemotherapy. The intervention consisted of a hospital-based, supervised, group exercise and relaxation program comprising resistance-, cardiovascular- and relaxation training 4 h weekly, 6 weeks, and a concurrent unsupervised home-based exercise program. An explorative study using individual semi-structured interviews (n=15) and one focus group interview (n=8) was conducted among the participants. Throughout the intervention the patients experienced increased muscle strength, improvement in wellbeing, breathlessness and energy. The group exercise and relaxation intervention showed an adherence rate of 76%, whereas the patients failed to comply with the home-based exercise. The hospital-based intervention initiated at time of diagnosis encouraged former sedentary lung cancer patients to participation and was undertaken safely by cancer patients with advanced stages of disease, during treatment. The patients experienced physical, functional and emotional benefits. This study confirmed that supervised training in peer-groups was beneficial, even in a cancer population with full-blown symptom burden and poor prognosis.

Review: exercise helps relieve pain in patients with hip osteoarthritis

ED FROM Hernandez-Molina G, Reichenbach S, Zhang B, et al. Effect of therapeutic exercise for hip osteoarthritis pain: results of a meta-analysis. Arthritis Rheum 2008;59:1221–8. Correspondence to: Dr G Hernandez-Molina,...

Efficacy of a fitness centre-based exercise programme compared with a home-based exercise programme in traumatic brain injury: A randomized controlled trial

To compare the effects of a supervised fitness centre-based exercise programme with an unsupervised home-based exercise programme on cardiorespiratory fitness and psychosocial functioning in people with traumatic brain injury. Multi-centre, assessor-blinded, parallel group, randomized controlled trial. Sixty-two participants with severe traumatic brain injuries, who could walk at a speed exceeding 1 m/sec, discharged from 3 brain injury units. The fitness centre group completed a combined fitness and strength training exercise programme supervised by a personal trainer in a local fitness centre 3 times per week for 12 weeks. The home group completed a similar exercise programme unsupervised at home. Cardiorespiratory fitness measured using the modified 20-m shuttle test. Both groups improved in fitness: the maximal velocity achieved on the modified 20-m shuttle test increased with intervention and was maintained at follow-up. However, the difference between groups was not significant (mean between-group difference (95% confidence interval) 0 m/sec (-0.6 to 0.6) at the end of intervention). There were also no between-group differences in psychosocial functioning at the end of intervention or at follow-up. Both interventions were equally effective at improving cardiorespiratory fitness in adults with traumatic brain injuries.

Physiological and Functional Impact of an Unsupervised but Supported Exercise Programme for Claudicants

Objectives To evaluate an unsupervised home-based exercise programme for physiological, functional, and quality of life impact in patients with symptomatic peripheral arterial disease. Design Prospective cohort with exercise intervention. Materials Human performance laboratory with non-invasive haemodynamic assessment facilities. Methods Forty-seven patients with symptomatic peripheral arterial disease (mean age 67.6 ± 7 years, 33 males) participated in an unsupervised home-based exercise programme. Heart rate (HR), ankle brachial blood pressure index (ABPI), leg blood flow (BF), and blood lactate were measured before and after a graded treadmill walk at baseline and after the 12-week exercise programme. Maximum walking distance (MWD) during the treadmill walk was measured at baseline and 12 weeks. Exercise compliance, functional parameters, and quality of life (VascuQoL) were assessed by questionnaire. Results MWD, leg BF, and VascuQoL scores increased significantly, while resting HR, exercise HR, and end of walk rate-pressure-product (RPP) decreased significantly after 12 weeks. Exercise compliance was significantly correlated with increase in MWD (r = 0.89, p < 0.001) and QOL score improvement (r = 0.61, p < 0.001). Conclusions This supported but unsupervised exercise programme generated improvements in walking distance and leg blood flow without detectable increases in cardiorespiratory work. Exercise compliance is related to MWD and VascuQoL score in a dose-response manner.

Unsupervised home exercise and/or self-monitoring of symptoms does not improve pain or function in patients with osteoarthritis

Summary of Ravaud P, Giraudeau B, Logeart I, Larguier JS, Rolland D, Treves R, Euller-Ziegler L, Bannwarth B and Dougados M (2004): Management of osteoarthritis (OA) with an unsupervised home based exercise programme and/or patient administered assessment tools. A cluster randomised controlled trial with a 2×2 factorial design. Annals of Rheumatic Disease 63: 703–708. (Prepared by Gro Jamtvedt, Norwegian Directorate for Health and Social Affairs and Kåre Birger Hagen, National Resource Centre for Rehabilitation in Rheumatology, Oslo, Norway)