Effects of exercise rehabilitation on cardiovascular risk factors in older patients with peripheral arterial occlusive disease.
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OBJECTIVE: The purpose of this study was to determine whether a 6-month exercise rehabilitation program can improve cardiovascular risk factors in patients with peripheral arterial occlusive disease (PAOD). METHODS: Thirty-four patients (mean age, 68 +/- 8 years; range 54-84 years) with PAOD with intermittent claudication (Fontaine stage II) and 14 longitudinal controls of comparable age with stage II PAOD enrolled in an exercise intervention at the University Medical Center and Veterans Affairs Medical Center at Baltimore, Maryland. The main outcome measures were lipid profile (total cholesterol, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol [LDL-C]), fasting glucose, blood pressure, body mass index, treadmill times to onset and maximal claudication pain, cardiopulmonary function (peak oxygen uptake), and ankle/brachial index. RESULTS: With exercise rehabilitation, treadmill times to onset and maximal claudication pain increased by 106% and 64% (P <.0001), whereas peak oxygen uptake increased 7% (P <.05). Exercise rehabilitation lowered total cholesterol and LDL-C levels by 5.2% (P <.005) and 8% (P <.01), respectively. Systolic blood pressure declined by 5.7% (P <.05) with no change in diastolic blood pressure. These changes in cholesterol and LDL-C concentrations were related to their initial values. All other cardiovascular risk factors measured did not change. There was no correlation between improvement of cardiovascular risk factors and functional performance measurements. None of the variables measured changed significantly in the control group. CONCLUSIONS: Exercise rehabilitation not only improves functional performance, but also results in favorable alterations in cardiovascular risk factor profile, which is an important element in the management of PAOD. (+info)
Recruiting patients to randomized trials in primary care: principles and case study.
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BACKGROUND: There are many factors affecting recruitment to trials in primary care, and trials are often jeopardized due to the inability to enter sufficient patient numbers. It is generally agreed that the interest in and commitment of GPs to the project are important, and their forgetfulness and time pressures are major factors which mitigate against maximal recruitment. OBJECTIVES: The aim of this study is to focus on maximizing recruitment of patients to a randomized controlled trial of exercise classes for back pain patients. METHODS: Two distinct methods of recruitment were used. One practice provided a computerized list of names and asked patients' permission, by letter, to be contacted by the researchers. The other 18 practices manually recorded referrals after the consultation by the GP. RESULTS: Referral rates were slower than expected. Many patients either did not fit the inclusion criteria or excluded themselves due to domestic commitments or work. During 24 months, 1588 patients were referred. A total of 187 patients (12%) met the criteria and could be included in the study. The practice which referred patients through a computerized listing contributed 44% of the patients successfully included in the study. CONCLUSIONS: Recruitment rates depended on the method and rate of GP referrals, the proportion of referrals meeting the entry criteria and the proportion of patients available to attend the exercise classes. (+info)
Examination and treatment of a patient with hypermobility syndrome.
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BACKGROUND AND PURPOSE: The purpose of this case report is to present the patient examination, evaluation/diagnosis/prognosis, intervention, and outcome of a patient with hypermobility syndrome (HMS). Hypermobility syndrome has been widely recognized in the rheumatology literature, but it has seldom been discussed in the orthopedic literature and has only recently been described in the physical therapy literature. The signs and symptoms of HMS are common among patients seen in orthopedic physical therapy clinics; however, the underlying HMS may be overlooked while treating individual joints or tissues causing pain. CSE DESCRIPTION: The patient was a 28-year-old woman with complaints of chronic, multiple-joint pain. After years without a diagnosis, a rheumatologist had recently diagnosed underlying HMS. OUTCOMES: Following intervention that emphasized patient education and activity modification, the patient's complaints decreased. DISCUSSION: Recognition of HMS underlying common orthopedic problems may facilitate appropriate patient education and management. (+info)
Comparison of effects of supervised versus self-monitored training programmes in patients with chronic obstructive pulmonary disease.
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The effects of two 8 week programmes of reconditioning in chronic obstructive pulmonary disease (COPD) patients were studied. Forty one subjects (mean+/-SD) 644.5) yrs; forced expiratory volume in one second (FEV1) 1.09+/-0.16 L; 40.6+/-6.2% predicted were randomly assigned either to supervised training on a treadmill, 4 days x week(-1) (group S; n=21) or walking 3 or 4 km in 1 h 4 days x week(-1), self-monitored with a pedometer, with weekly visits to encourage adherence (group SM; n=20). Patients were evaluated with the chronic respiratory diseases questionnaire (CRQ) and two exercise tests on a treadmill: incremental (IT) and constant (CT), above lactic threshold or 70% of maximal oxygen uptake (VO2, max) with arterial blood lactate determinations. Estimated mean work rate of training was 69+/-27 W and 25+/-5 W respectively for groups S and SM. Both types of training produced similar changes in the four dimensions of the CRQ. In group S reconditioning yielded significant (p<0.05) increases in VO2, max and increases in duration, with decreased lactate accumulation, ventilation, CO2 output (VCO2), heart rate (HR) and diastolic blood pressure (DBP) at the end of CT. They also adopted a deeper slower pattern of breathing during exercise. The SM group showed significant (p<0.05) increases in duration, lower HR and DBP at the end of CT. Significantly (p<0.05) different effects between S and SM programmes were changes in VO2, max 100+/-101 mL x min(-1) versus 5+/-101 mL x min(-1)), duration of the CT (8.1+/-4.4 min versus 3.9+/-4.7 min), VCO2 (-94+/-153 mL x min(-1) versus 48+/-252 mL x min(-1)), lactate accumulation (-1.3+/-2.2 mmol x L(-1) versus 0+/-1.2 mmol x L(-1) and respiratory rate at the end of CT (4.3+/-3.4 min(-1) versus -1+/-4.2 min(-1)). Supervised, intense training yields physiological improvements in severe chronic obstructive pulmonary disease patients not induced by self-monitored training. The self-monitored, less intense training, increases submaximal exercise endurance, although to a lesser degree. (+info)
Spinal cord control of movement: implications for locomotor rehabilitation following spinal cord injury.
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In recent years, our understanding of the spinal cord's role in movement control has been greatly advanced. Research suggests that body weight support (BWS) walking and functional electrical stimulation (FES), techniques that are used by physical therapists, have potential to improve walking function in individuals with spinal cord injury (SCI), perhaps long after the stage of spontaneous recovery. Walking is one of the most desired goals of people with SCI; however, we are obligated to be judicious in our claims of locomotor recovery. There are few controlled studies that compare outcomes of BWS training or FES with those of conventional interventions, and access to services using BWS training or FES may be restricted under managed care. (+info)
Combined aerobic and resistance exercise training improves functional capacity and strength in CHF.
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This study examined the effect of a novel circuit weight training (CWT) program on cardiorespiratory fitness, muscular strength, and body composition in 13 patients with chronic heart failure (CHF), using a prospective randomized crossover protocol. Peak exercise oxygen uptake (VO(2 peak)) increased after the 8-wk CWT program (19. 5 +/- 1.2 vs. 22.0 +/- 1.5 ml. kg(-1). min(-1), P < 0.01), as did exercise test duration (15.2 +/- 0.9 vs. 18.0 +/- 1.1 min, P < 0. 001). Submaximal exercise heart rate was lower after training at 60 and 80 W (121 +/- 3 vs. 134 +/- 5 beats/min, P < 0.01) as was rate pressure product, whereas ventilatory threshold increased, from 52 +/- 3 to 58 +/- 3% of VO(2 peak) (P < 0.05). CWT also increased maximal isotonic voluntary contractile strength for seven different muscle groups, from 392 to 462 kg (P = 0.001). CWT, an exercise prescription specifically targeting peripheral abnormalities in CHF, improves functional capacity and muscular strength in these patients. (+info)
Exercise prescription in adults with congenital heart disease: a long way to go.
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OBJECTIVE: To determine if appropriate advice had been given to adults with congenital heart disease regarding safe and effective exercise, and to assess pre-existing misconceptions of the potential benefits and dangers of exercise. DESIGN: An anonymous self assessment questionnaire. SETTING: A tertiary referral clinic. PATIENTS: 99 adults (57 men, 42 women) with congenital heart disease, mean age 25.6 years. MAIN OUTCOME MEASURES: The extent and nature of exercise advice given over previous years; a measure of current activity level compared with the American Heart Association recommendations; and an assessment of exercise limiting symptoms and a description of barriers to further exercise. RESULTS: 44% of the cohort assumed all exercise was safe despite their cardiac disease. A health care professional had only raised the issue of specific exercise advice in 28 cases. Of those given instruction it was more common to receive prohibitive advice (30%) than to be encouraged to take more exercise (19%). Despite this 61% were involved in some form of at least light exercise. The most prevalent barriers to exercise were current symptoms (32.3%), lack of interest in exercise (24.2%), and health fears (16.1%). CONCLUSIONS: The education of adults with congenital heart disease regarding exercise and its potential benefits and limitations is suboptimal even in a specialist clinic. (+info)
Abdominal muscle response during curl-ups on both stable and labile surfaces.
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BACKGROUND AND PURPOSE: With the current interest in stability training for the injured low back, the use of labile (movable) surfaces, underneath the subject, to challenge the motor control system is becoming more popular. Little is known about the modulating effects of these surfaces on muscle activity. The purpose of this study was to establish the degree of modulating influence of the type of surface (whether stable or labile) on the mechanics of the abdominal wall. In this study, the amplitude of muscle activity together with the way that the muscles coactivated due to the type of surface under the subject were of interest. SUBJECTS: Eight men (mean age=23.3 years [SD=4.3], mean height=177.6 cm [SD=3.4], mean weight=72.6 kg [SD=8.7]) volunteered to participate in the study. All subjects were in good health and reported no incidence of acute or chronic low back injury or prolonged back pain prior to this experiment. METHODS: All subjects were requested to perform 4 different curl-up exercises-1 on a stable surface and the other 3 on varying labile surfaces. Electromyographic signals were recorded from 4 different abdominal sites on the right and left sides of the body and normalized to maximal voluntary contraction (MVC) amplitudes. RESULTS: Performing curl-up exercises on labile surfaces increased abdominal muscle activity (eg, for curl-up on a stable surface, rectus abdominis muscle activity was 21% of MVC and external oblique muscle activity was 5% of MVC; for curl-up with the upper torso on a labile ball, rectus abdominis muscle activity was 35% of MVC and external oblique muscle activity was 10% of MVC). Furthermore, it appears that increases in external oblique muscle activity were larger than those of other abdominal muscles. CONCLUSION AND DISCUSSION: Performing curl-ups on labile surfaces changes both the level of muscle activity and the way that the muscles coactivate to stabilize the spine and the whole body. This finding suggests a much higher demand on the motor control system, which may be desirable for specific stages in a rehabilitation program. (+info)