The implications of physical activity in patients with chronic heart failure

The clinical syndrome of chronic heart failure is increasingly prevalent. It can be considered a multiorgan disorder that may exert a negative physical and psychological influence on a patient. Medication and surgical intervention have important roles to play and have certainly improved both morbidity and mortality in this field, but clearly these interventions alone are not enough. Excessive resource utilization for this group of patients has provided added impetus to research into non-pharmacological interventions. These encompass dietary and other lifestyle measures, including smoking cessation and exercise. Exercise has been shown to favourably affect the functional capacity and quality of life. There is also emerging evidence that it reduces mortality. In the absence of contraindications, regular endurance exercise coupled with strength training is undoubtedly beneficial. As with other cardiovascular research, there is a trend towards recruiting middle-aged males. This effectively means that practitioners need to be cautious when evaluating and/or implementing research evidence. By addressing the implications of physical activity for deconditioned patients with chronic heart failure, a holistic therapeutic regimen is fostered. This has been shown to improve the quality of life of patients and to enhance the quality of service delivered to this patient group.     

The effect of combined therapy (spa and physical therapy) on pain in various chronic diseases

OBJECTIVE: Spa therapy is commonly used in the treatment of daily chronic diseases practice, but its benefits are still the subjects of discussion. This study investigates possible effects of a combined spa and physical therapy program on pain and hemodynamic responses in various chronic diseases. METHODS: The pain intensity and hemodynamic responses of 472 patients involved in a spa and physical therapy program were studied retrospectively. Assessment criteria were pain [Visual Analog Scale (VAS)] and hemodynamic responses (heart rate, blood pressure, respiratory rate). Assessments took place before, immediately after treatment, and after completion of the spa program (before discharge). RESULTS: The patients with ankle arthrosis, fibromyalgia and cervical disc herniation reported the highest VAS score before treatment program (P < 0.05). After the therapy program, VAS scores were seen to decrease compared to before treatment (P < 0.05). The patients with osteoarthritis of the hip (1.3+/-1.2) and soft tissue rheumatism (1.3+/-1.2) had the lowest VAS score before discharge compared to patients with other pathologies (P < 0.05). No statistically significant differences were detected between both sexes in terms of pain improvement (P > 0.05). On discharge, all hemodynamic responses decreased significantly compared to before and immediately after initiation of the therapy program (P < 0.01). CONCLUSION: To decrease pain and high blood pressure without hemodynamic risk, a combined of spa and physical therapy program may help to decrease pain and improve hemodynamic response in patients with irreversible pathologies.     

Exercise therapy and other types of physical therapy for patients with neuromuscular diseases: a systematic review

Cup EH, Pieterse AJ, ten Broek-Pastoor JM, Munneke M, van Engelen BG, Hendricks HT, van der Wilt GJ, Oostendorp RA. Exercise therapy and other types of physical therapy for patients with neuromuscular diseases: a systematic review.

Objective

To summarize and critically appraise the available evidence on exercise therapy and other types of physical therapies for patients with neuromuscular diseases (NMD).

Data Sources

Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews, Medline, CINAHL, EMBASE (Rehabilitation and Physical Medicine), and reference lists of reviews and articles.

Study Selection

Randomized clinical trials (RCTs), controlled clinical trials (CCTs), and other designs were included. Study participants had to have any of the following types of NMD: motoneuron diseases, disorders of the motor nerve roots or peripheral nerves, neuromuscular transmission disorders, or muscle diseases. All types of exercise therapy and other physical therapy modalities were included. Outcome measures had to be at the level of body functions, activities, or participation according to the definitions of the International Classification of Functioning, Disability and Health (ICF).

Data Extraction

Two reviewers independently decided on inclusion or exclusion of articles and rated the methodologic quality of the studies included. All RCTs, CCTs, and other designs only if of sufficient methodologic quality were included in a best evidence synthesis. A level of evidence was attributed for each subgroup of NMD and each type of intervention.

Data Synthesis

Initially 58 studies were included: 12 RCTs, 5 CCTs, and 41 other designs. After methodologic assessment, 19 other designs were excluded from further analysis. There is level II evidence (“likely to be effective”) for strengthening exercises in combination with aerobic exercises for patients with muscle disorders. Level III evidence (“indications of effectiveness”) was found for aerobic exercises in patients with muscle disorders and for the combination of muscle strengthening and aerobic exercises in a heterogeneous group of muscle disorders. Finally, there is level III evidence for breathing exercises for patients with myasthenia gravis and for patients with myotonic muscular dystrophy. Adverse effects of exercise therapy were negligible.

Conclusions

The available evidence is limited, but relevant for clinicians. Future studies should be preferably multicentered, and use an international classification of the variables of exercise therapy and an ICF core set for NMD in order to improve comparability of results.     

Conservative treatment for neck pain: medications, physical therapy, and exercise

This article offers conservative treatment strategies for patients suffering from musculoskeletal causes of neck pain. Basic pharmacology is reviewed, including that of opioids, nonsteroidal anti-inflammatory drugs, adjuvants, and topical analgesics. Moreover, indications for therapeutic exercise, manual therapy, and modalities are reviewed, along with any supporting literature. Treatment considerations with each category of medication and physical therapy are discussed. This article is meant to serve as a resource for physicians to tailor conservative treatment options to their individual patients.     

Feasibility, physical capacity, and health benefits of a multidimensional exercise program for cancer patients undergoing chemotherapy

Cancer patients frequently experience considerable loss of physical capacity and general wellbeing when diagnosed and treated for their disease. The aim of this study was to evaluate the feasibility, physical capacity, and health benefits of a multidimensional exercise program for cancer patients during advanced stages of disease who are undergoing adjuvant or high-dose chemotherapy. The supervised program included high- and low-intensity activities (physical exercise, relaxation, massage, and body-awareness training). A total of 23 patients between 18 and 65 years of age (median 40 years) participated in groups of seven to nine patients for 9 h weekly for 6 weeks. Physical capacity in terms of repetition maximum (RM) and maximal oxygen uptake (VO₂max), physical activity level and psychosocial wellbeing (EORTC QLQ-C30, SF-36, HAD) were compared prior to and after completion of the program. The program was safe and well tolerated. The completion rate was 85.2%. Highly significant increases in physical capacity (1RM, VO₂max) and an improved level of physical activity were achieved. Quality of life and general wellbeing assessments indicated improvements in several measures, but without reaching significance. It is concluded that an exercise program, which combines high- and low-intensity physical activities, may be used to prevent and/or minimize physical inactivity, fatigue, muscle wasting and energy loss in cancer patients undergoing chemotherapy.     

Evaluation of implementation of the ParkFit program: A multifaceted intervention aimed to promote physical activity in patients with Parkinson's disease

Objectives

We recently completed the ParkFit study, a two-year randomized controlled trial including 586 sedentary Parkinson's disease (PD) patients, that evaluated a multifaceted intervention (ParkFit program) to promote physical activity. The results showed that the ParkFit program enables PD patients to become physically more active, suggesting that this intervention should now be further implemented into clinical practice. To facilitate this process, we here evaluate the implementation of the ParkFit program.

Methods

The ParkFit program was evaluated in three ways: (a) experiences of patients and physiotherapists, as investigated using interviews and questionnaires; (b) factors associated with changed activity levels; and (c) subgroup analyses to identify differential effects in subgroups of patients based on baseline physical activity level, age, gender, disease severity, disease duration, and mobility.

Results

The ParkFit program was well received: 73% of patients indicated they would recommend the program to other patients, and 90% of physiotherapists indicated they wanted to use the ParkFit program in other patients. Multiple forward regression analysis resulted in a model with two variables: less baseline physical activity, and better mobility were associated with larger changes in levels of physical activity (R² = 38%). The program was effective in almost all subgroups. In women, most sedentary patients and patients with higher disease severity, the estimated effect size was largest.

Conclusion

We conclude that the ParkFit program was effective in almost all specific subgroups. Therapists and patients experienced no major hurdles. Suggestions for improvement are: (1) improve education for therapists with respect to theories about behavioral change; (2) formulate concrete and specific examples of exercise goals; and (3) pay more specific attention to patients with co morbidities, cognitive dysfunction and a lack of motivation during education     

Effects of dancing on physical activity levels of children and adolescents: a systematic review

BackgroundDancing has been suggested to increase the levels of physical activity of the youth. However, it is not clear what are the physiological characteristics of the dance classes for young people, mainly regarding the levels of moderate to vigorous physical activity (MVPA) during classes. It is also unclear if regular engagement in dance practices can contribute with increases in the amounts of daily/weekly MVPA, recommended by health organizations.ObjectivesTo conduct a systematic review verifying the amount of time spent at MVPA (primary outcome), by children and adolescents in the following situations: i) During dance classes, and ii) Before and after dance interventions. Secondary outcomes included: markers of exercise intensity during class, such as oxygen consumption (VO₂) and heart rate (HR); VO₂peak and lipid profile before and after dance interventions.MethodsSix data sources were accessed (MEDLINE, EMBASE, Cochrane Wiley, PEDRO and SCOPUS). Study selection included different designs (acute, cohort, randomized controlled trials and others). Participants were from 6 to 19 years old, regularly engaged in dance practices. Methodological quality was assessed using the Downs and Black checklist. Two independent reviewers extracted characteristics and results of each study.Results3216 articles were retrieved, and 37 included. Studies indicated that dance classes do not achieve 50% of total class time at MVPA. However, there are peaks of HR and VO₂ during dance classes, which reach moderate and vigorous intensities. MVPA/daily/weekly did not improve before and after dance interventions for most of the studies, also VO₂peak did not. The few results on lipid profile showed improvements only in overweight and obese participants.LimitationsLack of meta-analysis, because there were not enough articles to be analyzed on any given outcome of interest, neither under the same study design.ConclusionsResults of individual studies indicated that dance classes did not active 50% of the total time at MVPA levels. This may be related to the absence of improvements in daily/weekly MVPA before and after dance interventions. VO₂ and HR attained peaks of moderateto vigorous intensity during dance classes, suggesting that the structure of the classes may be manipulated to maintain longer periods at MVPA levels. Lack of data on cardiorespiratory fitness and metabolic outcomes limit conclusions on these parameters.Implications of Keys FindsConsidering there are peaks of HR and VO₂ during dance classes, we suggest that the structure of a dance class can be manipulate in order to induce cardiorespiratory and metabolic adaptations. Thus, dancing is a potential strategy to contribute with a healthy life style since the earliest ages. Prospero registration: CRD42020144609     

Knowledge, attitudes and intentions about participation in physical activity of older post-acute hospital inpatients

Objectives

Most older people have suboptimal levels of habitual physical activity. This study investigated the knowledge, attitudes, intentions and barriers to participation in physical activity among older people recovering from acute illness or injury.

Design

A structured face-to-face questionnaire was developed, incorporating previously validated questions for older people.

Setting

Elderly care unit of an urban hospital.

Participants

Of 256 consecutively admitted patients, 66 were eligible and 44 (71% female) completed the interview before discharge.

Main instruments and outcome measures

Questionnaire using open and closed questions. Baseline data included Barthel Index, gait aid, length of hospital stay and grip strength (indicator of frailty).

Results

Median age was 83 years (range 67 to 91), median Barthel Index was 18/20 (range 9 to 20), mean hospital stay was 13.7 days (standard deviation 9.7) and 72% (31/43) were frail. Despite hospitalisation, only 23% (10/44) reported ‘poor’ general health. Knowledge of specific health benefits of physical activity was mixed, and knowledge about hypertension and osteoporosis was poor. Most patients (23/44, 52%) wrongly believed that their habitual activity levels were adequate. Barriers to increasing activity were predominantly related to health, including ‘breathing’ and ‘leg’ problems. Intentions towards future physical activity were varied and unrelated to frailty. Needing to rest and relax was a reason given for not being more active. Few patients (5/44, 11%) recalled being advised to be physically active.

Conclusions

These patients, potential benefactors from increased physical activity, had mixed knowledge and attitudes towards physical activity which was unrelated to frailty. These data provide insights relevant to the design and delivery of exercise-related health messages and interventions.     

健康查体人群健康管理现状及需求的调查

目的：调查健康查体人群健康管理现状及健康需求,以探讨适合特需人群的健康管理服务模式。方法采用描述性研究设计,通过问卷调查方法对62名住院查体者进行健康管理服务需求调查。结果62名被调查者健康意识较强,64．5％每半年或1年做1次体检,71．0％对参与健康管理抱积极态度或不排斥。但健康问题较为突出,47％没有规律性地吃早餐,66％偶尔或者从来不进行体育锻炼。在具体需求方面,91．4％希望有固定人员提供健康服务,62．3％希望能够定期入院体检,57．4％希望提供健康咨询,42．6％期望建立就诊住院绿色通道。结论为适应特需人群对健康管理服务的需求特点,开展健康管理服务需要以慢性病和健康/亚健康人群为工作重点,提供“以患者需要为中心”的人性化服务。     

A randomized controlled trial of weight-bearing versus non-weight-bearing exercise for improving physical ability after usual care for hip fracture

OBJECTIVE: To compare the effects of weight-bearing and non-weight-bearing home exercise programs and a control program on physical ability (strength, balance, gait, functional performance) in older people who have had a hip fracture. DESIGN: Randomized controlled trial with 4-month follow-up. SETTING: Australian community-dwellers (82%) and residents of aged care facilities who had completed usual care after a fall-related hip fracture. PARTICIPANTS: One hundred twenty older people entered the trial, 40 per group (average age +/- standard deviation, 79+/-9y) and 90% completed the 4-month retest. INTERVENTION: Home exercise prescribed by a physical therapist. MAIN OUTCOME MEASURES: Strength, balance, gait, and functional performance. RESULTS: At the 4-month retest, there were differences between the groups in the extent of improvement since the initial assessment for balance (F(10,196)=2.82, P<.001) and functional performance (F(6,200)=3.57, P<.001), but not for strength (F(12,190)=1.09, P=.37) or gait (F(8,200)=.39, P=.92). The weight-bearing exercise group showed the greatest improvements in measures of balance and functional performance (between-group differences of 30%-40% of initial values). CONCLUSIONS: A weight-bearing home exercise program can improve balance and functional ability to a greater extent than a non-weight-bearing program or no intervention among older people who have completed usual care after a fall-related hip fracture.     

Current physical therapy care of patients undergoing breast reconstruction for breast cancer: a survey of practice in the United Kingdom and Brazil

BackgroundIn both the United Kingdom (UK) and Brazil, women undergoing mastectomy should be offered breast reconstruction. Patients may benefit from physical therapy to prevent and treat muscular deficits. However, there are uncertainties regarding which physical therapy program to recommend.ObjectiveThe aim was to investigate the clinical practice of physical therapists for patients undergoing breast reconstruction for breast cancer. A secondary aim was to compare physical therapy practice between UK and Brazil.MethodsOnline survey with physical therapists in both countries. We asked about physical therapists’ clinical practice.Results181 physical therapists completed the survey, the majority were from Brazil (77%). Respondents reported that only half of women having breast reconstruction were routinely referred to physical therapy postoperatively. Contact with patients varied widely between countries, the mean number of postoperative sessions was 5.7 in the UK and 15.1 in Brazil. The exercise programs were similar for different reconstruction operations. Therapists described a progressive loading structure over time: range of motion (ROM) was restricted to 90° of arm elevation in the first two postoperative weeks; by 2–4 weeks ROM was unrestricted; at 1–3 months muscle strengthening was initiated, and after three months the focus was on sports-specific activities.ConclusionOnly half of patients having a breast reconstruction are routinely referred to physical therapy. Patients in Brazil have more intensive follow-up, with up to three times more face-to-face contact with a physical therapist than in the UK. Current practice broadly follows programs for mastectomy care rather than being specific to reconstruction surgery.     

Access and perceived need for physical and occupational therapy in chronic arthritis

Purpose.?Physical and occupational therapy are beneficial for persons with chronic arthritis; however, access is problematic. The goal was to examine issues related to access to these services for patients with chronic arthritis.

Methods.?We used two data sources: 1) questionnaires sent to a random sample of 600 family physicians and to all 85 rheumatologists in the province of Quebec; and 2) interviews of 211 patients with physician-confirmed chronic arthritis recruited from 34 primary care settings in Quebec.

Results.?Only 11.5% of family physicians and 31.7% of rheumatologists referred patients with rheumatoid arthritis (RA) to rehabilitation, whereas 60.4% of family doctors referred patients with osteoarthritis. Only 26.1% of patients felt that they required rehabilitation and this was associated with lower self-efficacy (OR: 0.84, 95% CI: 0.72, 0.99) and higher educational level (OR: 2.10, 95% CI: 1.01, 4.36).

Conclusion.?Family physicians are less likely to refer patients with RA to therapy. Only about a quarter of patients with chronic arthritis treated in primary care perceived the need for these services. Efforts to improve arthritis care should address education of physicians and patients regarding the benefits of rehabilitation and there should be efforts to increase therapy resources in order to enhance access.     

Convergent validity and reproducibility of the International classification of functioning,disability and health (ICF) core set for the physical health of community-dwelling older adults

BackgroundPhysical health is an important factor for what is considered successful aging. Using valid and reproducible tools to classify PH of older adults may help to develop appropriate rehabilitation protocols for this population.ObjectiveTo evaluate the convergent validity and reproducibility of the International Classification of Functioning, Disability and Health (ICF) core set to classify the physical health of older adults.MethodsA total of 101 older adults were evaluated for handgrip strength, physical performance (Short Physical Performance Battery), and physical activity level (International Physical Activity Questionnaire). Physical health was classified with the ICF core set (14 categories of body functions, 4 of body structures, 9 of activity and participation, and 3 environmental factors) and an impairment index was calculated for each component.ResultsHigher levels of physical activity were associated to lower impairment index in the body function and activity and participation components, but was not associated to environmental factors. Better physical performance and handgrip strength were also related to lower impairment index in all components. The Intraclass Correlation Coefficient analysis indicated good reproducibility for body function, body structure, the capacity component of the activity and participation, and for two environmental factors (use of medications and assistive devices), but moderate reproducibility for the performance component of activity and participation, and poor reproducibility for the environmental factor related to access to health services.ConclusionThe ICF core set for the physical health of older adults is a valid and reproducible tool and can be used in clinical practice and research.     

运动处方改善乳腺癌术后化疗患者体能的探讨

目的:促进乳腺癌术后化疗患者的体能恢复.方法:将120例行乳腺癌标准根治术术后化疗的患者随机分成实验组和对照组,对照组根据身体状况自行运动,实验组按护士为其制定的运动处方进行规律锻炼.分别在入院时、术后1周、术后5周、术后9周对患者进行体能指标的测定.结果:实验组术后的心功能、肺活量明显高于对照组,两组握力无显著性差异.结论:运动处方可显著提高乳腺癌术后化疗患者的体能储备,此方法也为I临床提高乳腺癌患者体能提出了积极、有效的干预模式.     

中英两国护士对自身体力活动及健康促进的态度与体验

目的 了解中英两国护士体力活动及相关健康促进的知识、态度、体验.方法 应用内容分析法对中英护士体力活动与健康促进调查中的开放性问题进行分析.结果 护理工作是影响护士体力活动的重要原因,两国护士均希望医院能为医护人员提供活动场所或机会.英国护士对于体力活动的理解更为深入,对于健康促进角色有较强的认同感.中国护士对于自身体力活动的关注高于健康促进.结论 应当针对护士开展体力活动教育培训与健康促进,同时也应对于护士职业性体力活动进行更为深入的研究.     

Development and evaluation of the health belief model scale for exercise

ObjectivesThis study was aimed to develop a health belief model scale for exercise among Chinese residents to describe the relationships between health beliefs and exercise for promoting residents to adopt or maintain exercise programs.MethodsParticipants were from two projects, Project 1 with 3833 participants and Project 2 with 7319 participants. A pool of 21 items was developed based on a small-scale qualitative study about health beliefs of exercise and literature. Internal consistency and construct validity of the scale were evaluated with Cronbach’s α coefficient, exploratory factor analysis (EFA), confirmatory factor analysis (CFA) and second-order confirmatory factor analysis.ResultsA final version of 18 items loaded on six factors which could explain 60.30-% of variance was observed after EFA. The internal consistency of the final version with 18 items performed in Project 1 was acceptable (0.609). The reliability of the six subscales was good with Cronbach’s α coefficient of 0.628, 0.713, 0.628, 0.801, 0.676 and 0.838 for perceived benefits, perceived objective barriers, perceived subjective barriers, self-efficacy, perceived severity and cues to action, respectively. CFA and second-order CFA indicated a good fit to data.ConclusionsThe Health Belief Model Scale for Exercise(HBMS-E) is a valid and reliable instrument to assess health beliefs of exercise among residents in China. Understanding the health beliefs of exercise will help health professionals to develop effective interventions for health and evaluate the effectiveness.     

健康教育对慢性心功能不全病人药物治疗的价值

目的提高慢性心功能不全(CHF)病人药物治疗效果和治疗依从性,改善生存质量。方法用问卷法分析100例住院CHF病人实施健康教育前后药物治疗相关知识的掌握程度。结果健康教育前41.9%的CHF病人对药物治疗相关知识了解不足,教育后知识掌握程度有明显提高(P<0.01)。结论对CHF病人实施药物治疗的健康教育是一种投入少、效果好的方式,对提高药物疗效和治疗依从性,稳定病情,改善生存质量,密切护患关系,节省医疗费用,减轻家庭和社会负担具有非常重要的作用。