Weight-bearing Exercise Program Research Articles

Evaluating the Impact of Weight Bearing and Non-Weight Bearing Exercises on Pain and Physical Function in Obese Knee Osteoarthritic Patients: A Randomized Controlled Trial

Background Exercise is advised as a primary treatment for knee OA; however, the best exercise is still unknown among these patients with different comorbid like obesity. Hence, this trial was aimed to identify which regime is more suitable in patients with knee OA and obesity. Methods A randomized controlled trial conducted in Lahore, Pakistan, compared the effectiveness of two exercise regimens i.e. Group A: Weight-bearing functional exercise program and Group B: Quadriceps strengthening through non-weight bearing techniques in obese individuals aged 50 and above with painful medial knee OA. A total of 128 participants were randomly assigned to either group. They attended supervised sessions with a therapist 5 times/week for 12 weeks. Pain and physical function were measured as primary outcomes at baseline and after the intervention. Results The mean age of participants was 57±4.03, with 78 females and 50 males. The results revealed that outcomes were improved in both groups. However, Group B showed more significant results, with a mean of 3.92±0.9, whereas Group A results were also substantial, with a mean of 4.53±1.02. The findings were consistent for physical function, which improved more in Group B with a mean of 42.35±3.02 compared to Group A with a mean of 45.68±81. Conclusion Both groups showed significant improvement in both outcomes. However, participants in non-weight-bearing quadriceps strengthening show more statistically and clinically relevant results. Keywords Exercise, Obesity, Osteoarthritis, Pain, Physical Activity.

Exploring the feasibility, sustainability and the benefits of the GrACE + GAIT exercise programme in the residential aged care setting.

BackgroundThe feasibility and benefits of a 24-week targeted progressive supervised resistance and weight-bearing exercise programme (Group Aged Care Exercise + GAIT (GrACE + GAIT)) in the residential aged care (RAC) setting was investigated as very little peer-reviewed research has been conducted in relation to exercise programmes of this duration in this cohort.MethodsA quasi-experimental study design consisting of two groups (control and exercise) explored a 24-week targeted progressive supervised resistance and weight-bearing exercise programme (GrACE + GAIT) in two RAC facilities in Northern New South Wales, Australia. A total of 42 adults consented to participate from a total of 68 eligible residents (61.7%). The primary outcome measures were feasibility and sustainability of the exercise programme via intervention uptake, session adherence, attrition, acceptability and adverse events. Secondary measures included gait speed and the spatio-temporal parameters of gait, handgrip muscle strength and sit to stand performance.ResultsTwenty-three residents participated in the exercise intervention (mean (SD) 85.4 (8.1) years, 15 females) and 19 in the control group (87.4 (6.6) years 13 females). Exercise adherence was 79.3%, with 65% of exercise participants attending ≥70% of the sessions; 100% of those originally enrolled completed the programme and strongly agreed with the programme acceptability. Zero exercise-related adverse events were reported. ANCOVA results indicated that post-intervention gait speed significantly increased (p < 0.001) with an 18.8% increase in gait speed (m/s).DiscussionThe GrACE + GAIT programme was shown to be feasible and significantly improve adults living in RAC facilities gait speed, handgrip strength and sit to stand performance. These results suggest that the GrACE + GAIT programme is suitable for use in the RAC sector and that it has the potential to reduce disability and improve function and quality of life of the residents.

Effects of a Home‐Based Physical Rehabilitation Program on Tibial Bone Structure, Density, and Strength After Hip Fracture: A Secondary Analysis of a Randomized Controlled Trial

Weight‐bearing physical activity may decrease or prevent bone deterioration after hip fracture. This study investigated the effects of a home‐based physical rehabilitation program on tibial bone traits in older hip fracture patients. A population‐based clinical sample of men and women operated for hip fracture (mean age 80 years, 78% women) was randomly assigned into an intervention (n = 40) and a standard care control group (n = 41) on average 10 weeks postfracture. The intervention group participated in a 12‐month home‐based rehabilitation intervention, including evaluation and modification of environmental hazards, guidance for safe walking, nonpharmacological pain management, motivational physical activity counseling, and a progressive, weight‐bearing home exercise program comprising strengthening exercises for the lower legs, balance training, functional exercises, and stretching. All participants received standard care. Distal tibia (5% proximal to the distal end plate) compressive bone strength index (BSI; g2/cm4), total volumetric BMD (vBMDTOT; mg/cm3), and total area (CSATOT; mm2), as well as midtibia (55%) strength–strain index (SSI; mm3), cortical vBMD (vBMDCO; mg/cm3), and ratio of cortical to total area (CSACO/CSATOT) were assessed in both legs by pQCT at baseline and at 3, 6, and 12 months. The intervention had no effect (group × time) on either the distal or midtibial bone traits. At the distal site, BSI of both legs, vBMDTOT of the fractured side, and CSATOT of the nonfractured side decreased significantly over time in both groups 0.7% to 3.1% (12 months, p < 0.05). At the midshaft site, CSACO/CSATOT and SSI of both legs, and vBMDCO of the fractured leg, decreased significantly over time in both groups 1.1% to 1.9% (12 months, p < 0.05). Trabecular and cortical bone traits of the tibia on the fractured and the nonfractured side deteriorated throughout follow‐up. The home‐based physical rehabilitation intervention aimed at promoting mobility recovery was unable to prevent bone deterioration in older people after hip fracture. © 2019 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.

Hippocampal volume and vasculature before and after exercise in treatment-resistant schizophrenia

BackgroundSchizophrenia is associated with poor cognitive function and elevated cardiometabolic disease risk. These health concerns may exacerbate neurocognitive dysfunction associated with hippocampal abnormalities, particularly hippocampal volume reductions. Regular exercise is thought to improve symptom severity, reduce depression, and improve cognition in schizophrenia, and may trigger exercise-mediated hippocampal growth. The potential for the benefits of exercise for treatment-resistant schizophrenia patients has not been clearly assessed. This study aims to assess the effect of exercise on hippocampal plasticity and clinical outcomes in chronic schizophrenia. MethodsSeventeen DSM-IV criteria schizophrenia or schizoaffective disorder patients completed a customized moderate intensity 12-week aerobic or weight-bearing exercise program. Adherence rates were 83% ± 9.4%) with 70% of participants completing the entire exercise program. Concomitant neuroimaging, clinical and cognitive assessments were obtained at baseline and 12-weeks. ResultsAt follow-up, symptom severity scores (t(16) = −16.8, p. ≤ 0.0001) and social functioning (t(16) = 4.4, p. = 0.0004) improved. A trend for improved depression scores (t(16) = −2.0, p. = 0.06) with no change in anxiety, or extrapyramidal symptoms were seen. Hippocampal volume increased (t(16) = −2.54, p. = 0.02), specifically in the left CA-1 field (F(16) = −2.33, p. = 0.03). Hippocampal vascular volume was unchanged. Change in hippocampal volume and vascular volume was not significantly correlated with change in symptom severity or affect scores. ConclusionsAdjunct exercise may accelerate symptom improvement in treatment-resistant psychosis patients. While the underlying mechanism remains unclear, these results indicate that chronic schizophrenia patients experience hippocampal plasticity in response to exercise. Study registrationClinical Trials.govNCT01392885.

The Effect of a Muscle Weight-Bearing and Aerobic Exercise Program on the Body Composition, Muscular Strength, Biochemical Markers, and Bone Mass of Obese Patients Who Have Undergone Gastric Bypass Surgery.

The effect of an exercise program on the body composition, muscular strength (MS), biochemical markers, and bone mineral density (BMD) of individuals undergoing gastric bypass is unclear. We assessed lean mass (LM), MS, bone remodeling markers, and BMD before and after supervised weight-bearing and aerobic exercise training in obese patients who underwent Roux-en-Y gastric bypass (RYGB). This study included 37 obese patients (81.1% women, mean age 38.2years, mean body mass index 42.4±0.5kg/m2). Whole body densitometry was used to evaluate pre- and postoperative BMD, total body fat, and LM. Serum calcium, parathyroid hormone, 25-hydroxyvitamin D, and bone remodeling markers were measured. MS was determined through the concentric 10 repetition maximum test. Postoperatively, participants were divided into two groups: the training group, who followed an exercise program (TG, n=18), and the control group, who did not (CG, n=19). After 1year, the TG showed a lower decrease in total BMD and at the lumbar spine and right hip compared with the CG (p<0.001). The TG had lower mass reduction and an increase in upper limb LM compared with the CG (both p<0.05). There was no significant difference between groups in bone markers or calcium metabolism. MS was higher in the TG than the CG (p<0.05). The supervised exercise program attenuated lumbar spine and right hip BMD loss and improved LM in the arms and overall MS but did not affect bone remodeling.

지적장애와 일반인 남성의 장기간 체중부하운동 참여가 요추와 대퇴골경부 골밀도 및 신체구성에 미치는 융합적 효과

The purpose of this study was to determined the converge effects of weight-bearing exercise on lumbar, femur neck BMD and body compositions in intellectual disabilities and normal men. Nineteen men were participated for this study, they are divided into two groups(intellectual disabilities, n=9, and normal men, n=10). All subjects are accomplished on weight-bearing exercise (music rope-jumping) program for 60 minutes a day, 3 days a week throughout 12 weeks. Two-way ANOVA with repeated measures was used to determine differences between and within the intellectual and normal groups for dependent variables. The statistically significant level was set at 0.05. In this study, there were a significant differences on the bone mineral density of lumbar and femur neck level after exercise training in both groups (respectively p<.01, p<.001). Also, I found that there were effectively decreased on body weight, percent of body fat, and BMI levels after exercise training for 12 weeks in both groups (respectively p<.001). Therefore, music rope-jump exercise program may suggested to be one of the ideal training methods for enhancing and the convergence positive effect of bone mineral density and body compositions in intellectual and normal person.

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.

The impact of adding weight-bearing exercise versus nonweight bearing programs to the medical treatment of elderly patients with osteoporosis.

Background:Osteoporosis is a major public health problem affecting the elderly population, particularly women. The objective of the study was to evaluate the effects of adding weight-bearing exercise as opposed to nonweight-bearing programs to the medical treatment of bone mineral density (BMD) and health-related quality of life (HRQoL) of elderly patients with osteoporosis.Materials and Methods:Participating in the study were 40 elderly osteoporotic patients (27 females and 13 males), with ages ranging from 60 to 67 years, who were receiving medical treatment for osteoporosis. They were assigned randomly into two groups: Group-I: Twenty patients practiced weight-bearing exercises. Group-II: Twenty patients did nonweight-bearing exercises. All patients trained for 45-60 min/session, two sessions/week for 6 months. BMD of the lumbar spine, right neck of femur, and right distal radial head of all patients were measured by dual-energy X-ray absorptiometry before and after both treatment programs. In addition, the QoL was measured by means of the HRQoL “ECOS-16” questionnaire.Results:T-tests proved that mean values of BMD of the lumbar spine, right neck of femur and right distal radial head were significantly increased in both groups with greater improvement in the weight-bearing group. The QoL was significantly improved in both groups, but the difference between them was not significant.Conclusion:Addition of weight-bearing exercise program to medical treatment increases BMD more than nonweight-bearing exercise in elderly subjects with osteoporosis. Furthermore, both weight-bearing and nonweight-bearing exercise programs significantly improved the QoL of patients with osteoporosis.

Muscle strength, physical fitness and well-being in children and adolescents with juvenile idiopathic arthritis and the effect of an exercise programme: a randomized controlled trial

BackgroundDecreased muscle strength, fitness and well-being are common in children and adolescents with juvenile idiopathic arthritis (JIA) compared to healthy peers. Biological drugs have improved health in children with JIA, but despite this pain is still a major symptom and bone health is reported as decreased in the group. The improvement made by the biological drugs makes it possible to more demanding exercises. To jump is an exercise that can improve bone heath, fitness and muscle strength. The aim of the study was to see if an exercise programme with jumps had an effect on muscle strength, physical fitness and well-being and how it was tolerated.MethodsMuscle strength and well-being were studied before and after a 12-week exercise programme in 54 children and adolescents with JIA, 9–21 years old. The participants were randomized into an exercise and a control group. Muscle strength, fitness and well-being were documented before and after the training period and at follow-up after 6 months. Physical activity in leisure time was documented in diaries. The fitness/exercise programme was performed at home three times a week and included rope skipping and muscle strength training exercises.Assessment included measurement of muscle strength with a handheld device, and with Grip-it, step-test for fitness with documentation of heart rate and pain perception and two questionnaires (CHAQ, CHQ) on well-being.ResultsThere were no differences between exercise and control group regarding muscle strength, grip strength, fitness or well-being at base line. Muscle weakness was present in hip extensors, hip abductors and handgrip. For the exercise group muscle strength in hip and knee extensors increased after the 12-week exercise programme and was maintained in knee extensors at follow-up. There was no change in fitness tested with the individually adapted step-test. The CHQ questionnaire showed that pain was common in the exercise group and in the control group. There were only small changes in the CHAQ and CHQ after the training period. The fitness/exercise programme was well tolerated and pain did not increase during the study.ConclusionsA weight bearing exercise programme, with muscle strength training with free weights and rope skipping was well tolerated without negative consequences on pain. It also improved muscle strength in the legs and can be recommended for children and adolescents with JIA.

Attrition and adherence of young women to aerobic exercise: Lessons from the WISER study

The purpose of this report is to identify factors associated with attrition and adherence of young women to a 16-week randomized aerobic exercise intervention on biomarkers associated with breast cancer risk. The exercise group was prescribed a progressive weight-bearing aerobic exercise program consisting of 30 minute workouts, 5 times/wk for 16weeks. Adherence was calculated as the average minutes of exercise per week during participation in the study. Of the total of 212 women randomized into the exercise intervention 46 dropped out, of which 82.5% dropped out during the earlier stages of exercise suggesting that reasons for withdrawal may have been related to difficulties with initiating physical activity. Time commitment or lack of time was the primary reason for withdrawal. Drop outs reported lower physical activity at baseline than study completers (p=.0007). Although 78% of the 212 randomized participants completed the exercise intervention, only 4.7% of the participants exercised for at least 150min/wk during the entire study period. Significant predictors of adherence were self-reported physical activity at baseline and depression scores. We conclude that predictors of adherence to exercise in our population of young women are similar to those reported for older adults. We also found that young women are more likely to exercise at moderate to vigorous intensity for 90 to 120min rather than 150min per week, even when participating in a highly structured exercise intervention.

A Moderate-Intensity Weight-Bearing Exercise Program for a Person With Type 2 Diabetes and Peripheral Neuropathy

The exercise guidelines for people with diabetes mellitus and peripheral neuropathy (DM+PN) have recently changed to allow moderate-intensity weight-bearing exercise, but there are few reports in the literature describing appropriate weight-bearing exercise for those with DM+PN. This case report describes a successful and safe progressive exercise program for an individual with DM+PN. The patient was a 76-year-old man with a 30-year history of DM+PN. He participated in a 12-week, moderate-intensity, progressive exercise program (heart rate approximately 75% of maximum heart rate; rate of perceived exertion=11-13; 3 times per week) involving walking on a treadmill, balance exercises, and strengthening exercises for the lower extremities using body weight resistance. Measurements were taken before and after the 12 weeks of exercise. The patient's Six-Minute Walk Test distance increased from 1,200 to 1,470 ft. His Physical Performance Test score did not change. His Foot and Ankle Ability Measure questionnaire score improved from 89 to 98. Dorsiflexor and plantar-flexor peak torque increased (dorsiflexor peak torque: right side=4.5-4.6 N·m, left side=2.8-3.8 N·m; plantar-flexor peak torque: right side=44.7-62.4 N·m, left side=40.8-56.0 N·m), as did his average daily step count (6,176-8,273 steps/day). Close monitoring of the plantar surface of the feet indicated that the exercise program was well tolerated and there were no adverse events. This case report describes a moderate-intensity exercise program that was successful in increasing some measures of muscle strength, physical function, and activity without causing injury in an individual with DM+PN.

Effect of a High‐Intensity Functional Exercise Program on Functional Balance: Preplanned Subgroup Analyses of a Randomized Controlled Trial in Residential Care Facilities

To evaluate whether age, sex, depression, dementia disorder, nutritional status, or level of functional balance capacity influences the effect of a high-intensity functional weight-bearing exercise program on functional balance. Preplanned subgroup analyses of a randomized controlled trial. Nine residential care facilities. One hundred ninety-one people aged 65 to 100 dependent in activities of daily living and with Mini-Mental State Examination scores of 10 or greater. A high-intensity functional weight-bearing exercise program or a control activity, each comprising 29 sessions over 3 months. Functional balance capacity was assessed blindly using the Berg Balance Scale (BBS) at baseline, 3 months, and 6 months. The BBS consists of 14 tasks, common in everyday life, such as standing up from sitting and, while standing, reaching forward or turning 360°. Interactions between allocation to activity group and each subgroup were evaluated according to the intention-to-treat principle. The subgroup analyses revealed no statistically significant interaction for age, sex, depression, dementia disorder, nutritional status, or level of functional balance capacity at 3 (P=.65, .65, .51, .78, .09, .67, respectively) or 6 (P=.69, .62, .20, .94, .48, .85, respectively) months. In addition, at 3 and 6 months there was no significant interaction for cognitive level (P=.28, .47, respectively) or number of depressive symptoms (P=.85, .49, respectively). Older age, female sex, depression, mild to moderate dementia syndrome, malnutrition, and severe physical impairment do not seem to have a negative effect on functional balance from a high-intensity functional weight-bearing exercise program. Consequently, people with these characteristics in residential care facilities should not be excluded from offers of rehabilitation including high-intensity exercises.

Evaluation of bone mineral density in children with perinatal brachial plexus palsy: Effectiveness of weight bearing and traditional exercises

(1) To investigate any evidence of bone mineral density (BMD) changes in children with Perinatal Brachial Plexus Palsy (PBPP). (2) To detect any relationship between these changes and the child age, weight, height, BMI, power index, gender, ethnicity, and the side affected. (3) To determine any possible effects of a designed weight bearing exercise program and the traditional one upon BMD of those children. Randomized single blind controlled trial. A convenience sampling strategy was used to obtain 45 children with unilateral PBPP. Their ages ranged from 3 to 10 years. They were randomly divided to three equal groups. Groups were, then, randomly assigned to either interventions [Weight Bearing Exercises Program (WBEP) or Traditional Exercises Program (TEP)] or to the control treatment. Dual Energy X-Ray Absorptiometry (DXA) was used to evaluate BMD for all children at entry and approximately after six months treatment period. We detected significant low entry level measurements of all BMD parameters of the affected side when compared to that of the unaffected sides (p=0.000). The mean value of the entry level calculated Z score for the affected side of all study children was equal to -1.12 ± 0.327 being in the osteopenic risk range. Furthermore, thirty children (66.7%) recorded less than (-1) Z score being in this risky range. Also, we recorded a significant improvement of all BMD parameters of the affected side after treatment in favor of the WBEP group when compared to that of the control and TEP groups (p=0.02, p=0.03 respectively for the affected both bones BMD parameter). BMD is significantly reduced in PBPP children. The retardation of bone accrual increases as the child height and weight decreases and the degree of paralysis increases. WBEP significantly promoted BMD improvement when compared to the TEP.

Height loss rate as a marker of vitamin D deficiency in men with osteoporosis

Height loss rate as a marker of vitamin D deficiency in men with osteoporosis

Effects of a Structured Weight-Bearing Exercise Program on Bone Metabolism Among Breast Cancer Survivors: A Feasibility Trial

Purpose Treatments for breast cancer, specifically hormonal therapy, accelerate bone loss (BL) among breast cancer survivors, leading to osteoporosis and an increase in fracture risk. Tai Chi Chuan (TCC) is a moderate form of weight-bearing exercise, equivalent to walking, and it has been shown to improve aerobic capacity and strength among breast cancer survivors and might also be effective in slowing bone loss in breast cancer survivors. This pilot study compared the influence of TCC with that of standard support therapy (ST; exercise control) on BL biomarkers among breast cancer survivors. Patients and Methods Randomly assigned breast cancer survivors (N = 16; median age, 53 years; < 30 months after treatment) completed 12 weeks (3 times per week, 60 minutes per session) of TCC or ST. Serum levels of N-telopeptides of type I collagen (NTx), a marker of bone resorption, and bone-specific alkaline phosphatase (BSAP), a marker of bone formation, were determined according to enzyme-linked immunosorbent assay at baseline and after the intervention. Results Using analysis of covariance, survivors in the TCC group experienced a greater increase in levels of bone formation (BSAP [μg/L]: before, 8.3; after, 10.2; change, 1.9 μg/L and 22.4%), compared with survivors in ST (BSAP [μg/L]: before, 7.6; after, 8.1; change, 0.5 μg/L [6.3%]). Survivors in the TCC group also experienced a significant decrease in bone resorption (NTx [nanomoles bone collagen equivalent; nmBCE]: before, 17.6; after, 11.1; change, −6.5 nmBCE; −36.9%), whereas women in the ST group did not (NTx [nmBCE]: before, 20.8; after, 18.8; change, −2.0 nmBCE; −9.6%). Conclusion This pilot study suggests that weight-bearing exercise exerts positive effects on BL, through increased bone formation and decreased bone resorption. Further examinations of the influence of TCC on bone health are warranted.

Effects of a high-intensity functional exercise programme on depressive symptoms and psychological well-being among older people living in residential care facilities: A cluster-randomized controlled trial

Objectives: To evaluate the effects of a high-intensity functional exercise programme on depressive symptoms and psychological well-being among older people dependent in activities of daily living (ADL) and living in residential care facilities. Method: Cluster-randomized controlled study. Participants were 191 older people, aged 65–100, dependent in ADL and with Mini Mental State Examination scores between 10 and 30. One-hundred (52%) of the participants had a diagnosed dementia disorder. A high-intensity functional weight-bearing exercise programme and a control activity were performed in groups. Sessions were held five times over each two week period for three months, a total of 29 times. The outcome measures, Geriatric Depression Scale (GDS-15) and Philadelphia Geriatric Center Morale Scale (PGCMS) were blindly assessed at baseline, three and six months. Results: At baseline, mean ± SD (range) for GDS was 4.4 ± 3.2 (0–14), and for PGCMS 11.0 ± 3.5 (2–17). There were no significant differences in GDS or PGCMS between the exercise and the control group at the three and six month follow-ups in the total sample. Among people with dementia, there was a between-group difference at three months in PGCMS scores in favour of the exercise group. Conclusion: A high-intensity functional exercise programme seems generally not to influence depressive symptoms or psychological well-being among older people dependent in ADL and living in residential care facilities. An individualized and multifactorial intervention may be needed in this group. However, an exercise programme as a single intervention may have a short-term effect on well-being among people with dementia.

A randomized trial of weekly high-dose calcitriol and weight-bearing exercise for cancer treatment–induced bone loss (CTIBL) and bone metabolism in ER+ breast cancer (BC) patients.

9100 Background: CTIBL is a long-term side effect of hormone therapy (HT) and occurs in up to 80% of women being treated for BC. Daily calcitriol (active vitamin D) therapy improves bone metabolism and bone mineral density (BMD), but hypercalcemia is a common side effect. Weight-bearing exercise also enhances bone metabolism and BMD. The aim of this pilot trial is to examine the effect of novel weekly, high-dose calcitriol therapy in combination with weight-bearing exercise on bone metabolism in BC patients. Methods: 40 female ER+, non-metastatic BC patients receiving HT were randomized to 1 of 4 arms for 12 weeks: 1) weekly, high- dose calcitriol (45 μg QW), 2) an individualized weight-bearing exercise program, 3) both, or 4) a daily multivitamin (control). Bone resorption (N- telopeptide of Type I Collagen [NTx]) and bone formation (bone-specific alkaline phosphatase [BSAP]) were measured and changes from baseline to week 12 were calculated. We also created a bone metabolism index [BOMI] (Δ BOMI= Δ Z-score BSAP - Δ Z-score NTx), which comprehensively represents the balance between resorption and formation. Results: Data from the first 16 patients show calcitriol therapy was well-tolerated, with only 8% indicating grade 1 hypercalcemia and no instances of hypercalcemia at grade ≥ 2. A significant increase in bone formation was found for individuals receiving calcitriol + exercise (Δ BSAP= +11.1 μ g/L; p=0.03) and calcitriol (Δ BSAP= +8.6 μ g/L; p=0.04) compared to the control group (Δ BSAP= -4.8 μ g/L). Increases in the bone metabolism index were greater for participants receiving calcitriol + exercise (BOMI=0.98; p=0.24), calcitriol (BOMI=0.58; p=0.49), and exercise (BOMI=0.39; p=0.71) compared to participants in the control group (BOMI=0.16). Conclusions: Calcitriol therapy at 45 μ g QW was well tolerated and interim analyses demonstrate that the combination of calcitriol and weight-bearing exercise may be effective at improving bone metabolism and reducing CTIBL. Clinical trials are warranted to determine the effect of weekly high-dose calcitriol therapy and weight-bearing exercise on BMD in ER+ BC patients. Funding: NCI R25CA10618. No significant financial relationships to disclose.

The Effect of a High‐Intensity Functional Exercise Program on Activities of Daily Living: A Randomized Controlled Trial in Residential Care Facilities

To evaluate whether a high-intensity functional weight-bearing exercise program reduces dependency in activities of daily living (ADLs) in older people living in residential care facilities, focusing on people with dementia. Randomized, controlled trial. Nine residential care facilities. One hundred ninety-one older people dependent in ADLs and with a Mini-Mental State Examination score of 10 or greater. One hundred (52.4%) of the participants had dementia. A high-intensity functional weight-bearing exercise program or a control activity consisting of 29 sessions over 3 months. The Barthel ADL Index; follow-up at 3 months (directly after the intervention) and 6 months with intention-to-treat analyses. There were no statistically significant differences between the groups regarding overall ADL performance. Analyses for each item revealed that a smaller proportion of participants in the exercise group had deteriorated in indoor mobility at 3 months (exercise 3.5% vs control 16.0%, P=.01) and 6 months (7.7% vs 19.8%, P=.03). For people with dementia, there was a significant difference in overall ADL performance in favor of the exercise group at 3 months (mean difference 1.1, P=.03) but not at 6 months. A high-intensity functional weight-bearing exercise program seems to reduce ADL decline related to indoor mobility for older people living in residential care facilities. The program does not appear to have an overall effect on ADLs. In people with dementia, the exercise program may prevent decline in overall ADL performance, but continuous training may be needed to maintain that effect.

Clinical results and radiographical evaluation of opening wedge high tibial osteotomy for spontaneous osteonecrosis of the knee

We evaluated the clinical outcomes, in terms of early weight bearing, of using opening wedge high tibial osteotomy (OWHTO) to treat spontaneous osteonecrosis of the medial femoral condyle of the knee (SONK) using TomoFix and artificial bone substitute. Damaged cartilage tissue was removed and drilling of the necrotic area followed by OWHTO was performed in 30 knees from 30 patients with an average age of 71 years (range 58-82) at the time of operation. Patients were allowed to undertake partial weight-bearing exercises 1 week after the osteotomy procedure, with all patients performing full weight-bearing exercise at 2 weeks post-surgery. The mean follow-up period was 40 months (range 24-62). All of the SONK patients could walk with a full weight-bearing load, using only a T-cane, at 2 weeks after undergoing OWHTO. Clinical assays, including the mean American Knee Society Score and Function Score, showed significant improvements from 51 to 93 points, and 58 to 93 points, respectively. Prior to surgery, the average femoro-tibial angle (FTA) during standing was 181 (1 degree anatomical varus) and had significantly changed to 170 (10 degrees valgus) at the time of follow-up. There were no cases of non-union, or implant failure in any of our patients. In addition, none of the patients could sit in the Japanese style prior to surgery, but 21 of 30 patients (70%) could do so after treatment. Arthroscopic findings could be observed in 24 out of 30 cases at implant removal. Necrotic area in each case was covered with fibrous cartilage-like tissue completely. Drilling of the necrotic area followed by OWHTO with TomoFix and artificial bone substitute is an effective treatment for SONK as it results in pain alleviation and regeneration of the fibrous cartilage tissue over the necrotic legion. In addition, an early weight-bearing exercise program is possible after this procedure and full weight-bearing can be achieved at two weeks after surgery.

Mobility training after hip fracture: a randomised controlled trial

to compare the effects of two different exercise programmes after hip fracture. assessor-blinded randomised controlled trial. hospital rehabilitation units, with continued intervention at home. 160 people with surgical fixation for hip fracture transferred to inpatient rehabilitation. in addition to other rehabilitation strategies, the intervention group received a higher dose (60 min/day) exercise programme conducted whilst standing and the control group received a lower dose exercise programme (30 min/day) primarily conducted whilst seated/supine. The primary outcome measures were knee extensor muscle strength in the fractured leg and walking speed, measured at 4 and 16 weeks. 150 participants (94% of those recruited) completed the trial. There were no differences between the groups for the two primary outcome measures. Post hoc analyses revealed increased walking speed among those in the higher dose, weight-bearing exercise group with cognitive impairment at 4 and 16 weeks. there was no benefit (or harm) due to the higher dose, weight-bearing exercise programme with respect to the primary outcome measures. However, people with hip fracture and cognitive impairment gained greater benefit from the higher dose programme than from the lower dose programme.