Effects of exercise interventions on functioning and health-related quality of life following hospital discharge for recovery from critical illness: A systematic review and meta-analysis of randomized trials.

OBJECTIVE: This systematic review and meta-analysis aimed to analyze the published randomized controlled trials (RCTs) that investigated the effects of exercise interventions on functioning and health-related quality of life following hospital discharge for recovery from critical illness. DESIGN: Systematic review and meta-analysis of RCTs. DATA SOURCES: We searched PubMed/MEDLINE, Cochrane Central Register of Controlled Trials, PEDro data base, and SciELO (from the earliest date available to January 2023) for RCTs that evaluated the effects of physical rehabilitation interventions following hospital discharge for recovery from critical illness. REVIEW METHODS: Study quality was evaluated using the PEDro Scale. Mean differences (MDs), standard MDs (SMD), and 95% confidence intervals (CIs) were calculated. RESULTS: Fourteen studies met the study criteria, including 1259 patients. Exercise interventions improved aerobic capacity SMD 0.2 (95% CI: 0.03-0.3, I2 = 0% N = 880, nine studies, high-quality evidence), and physical component score of health-related quality of life MD 3.3 (95% CI: 1.0-5.6, I2 = 57%, six studies N = 669, moderate-quality evidence). In addition, a significant reduction in depression was observed MD -1.4 (95% CI: -2.7 to -0.1, I2 = 0% N = 148, three studies, moderate-quality evidence). No serious adverse events were reported. CONCLUSION: Exercise intervention was associated with improvement of aerobic capacity, depression, and physical component score of health-related quality of life after hospital discharge for survivors of critical illness.

Digital technology for delivering and monitoring exercise programs for people with cystic fibrosis.

BACKGROUND: Although exercise is recommended as part of the cystic fibrosis (CF) therapeutic routine, adherence to exercise is still limited. Digital health technologies can provide easy-to-access health information and may help improve healthcare and outcomes in individuals with long-term conditions. However, its effects for delivering and monitoring exercise programs in CF have not yet been synthesized. OBJECTIVES: To evaluate the benefits and harms of digital health technologies for delivering and monitoring exercise programs, increasing adherence to exercise regimens, and improving key clinical outcomes in people with CF. SEARCH METHODS: We used standard, extensive Cochrane search methods. The latest search date was 21 November 2022. SELECTION CRITERIA: We included randomized controlled trials (RCTs) or quasi-RCTs of digital health technologies for delivering or monitoring exercise programs in CF. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methods. Our primary outcomes were 1. physical activity, 2. self-management behavior, and 3. pulmonary exacerbations. Our secondary outcomes were 4. usability of technologies, 5. quality of life, 6. lung function, 7. muscle strength, 8. exercise capacity, 9. physiologic parameters, and 10. ADVERSE EVENTS: We used GRADE to assess certainty of evidence. MAIN RESULTS: We identified four parallel RCTs (three single-center and one multicenter with 231 participants aged six years or older). The RCTs evaluated different modes of digital health technologies with distinct purposes, combined with diverse interventions. We identified important methodologic concerns in the RCTs, including insufficient information on the randomization process, blinding of outcome assessors, balance of non-protocol interventions across groups, and whether the analyses performed corrected for bias due to missing outcome data. Non-reporting of results may also be a concern, especially because some planned outcome results were reported incompletely. Furthermore, each trial had a small number of participants, resulting in imprecise effects. These limitations on the risk of bias, and on the precision of effect estimates resulted in overall low- to very low-certainty evidence. We undertook four comparisons and present the findings for our primary outcomes below. There is no information on the effectiveness of other modes of digital health technologies for monitoring physical activity or delivering exercise programs in people with CF, on adverse events related to the use of digital health technologies either for delivering or monitoring exercise programs in CF, and on their long-term effects (more than one year). Digital health technologies for monitoring physical activity Wearable fitness tracker plus personalized exercise prescription compared to personalized exercise prescription alone One trial (40 adults with CF) evaluated this outcome, but did not report data for any of our primary outcomes. Wearable fitness tracker plus text message for personalized feedback and goal setting compared to wearable fitness tracker alone The evidence is very uncertain about the effects of a wearable fitness tracker plus text message for personalized feedback and goal setting, compared to wearable technology alone on physical activity measured by step count at six-month follow-up (mean difference [MD] 675.00 steps, 95% confidence interval [CI] -2406.37 to 3756.37; 1 trial, 32 participants). The same study measured pulmonary exacerbation rates and reported finding no difference between groups. Web-based application to record, monitor, and set goals on physical activity plus usual care compared to usual care alone Using a web-based application to record, monitor, and set goals on physical activity plus usual care may result in little to no difference on time spent in moderate-to-vigorous physical activity measured via accelerometry compared to usual care alone at six-month follow-up (MD -4 minutes/day, 95% CI -37 to 29; 1 trial, 63 participants). Low certainty-evidence from the same trial suggests that the intervention may result in little to no difference on pulmonary exacerbations during 12 months of follow-up (median 1 respiratory hospitalization, interquartile range [IQR] 0 to 3) versus control (median 1 respiratory hospitalization, IQR 0 to 2; P = 0.6). Digital health technologies for delivering exercise programs Web-based versus face-to-face exercise delivery The evidence is very uncertain about the effects of web-based compared to face-to-face exercise delivery on adherence to physical activity as assessed by the number of participants who completed all exercise sessions after three months of intervention (risk ratio 0.92, 95% CI 0.69 to 1.23; 1 trial, 51 participants). AUTHORS' CONCLUSIONS: The evidence is very uncertain about the effects of an exercise program plus the use of a wearable fitness tracker integrated with a social media platform compared with exercise prescription alone and on the effects of receiving a wearable fitness tracker plus text message for personalized feedback and goal setting, compared to a wearable fitness tracker alone. Low-certainty evidence suggests that using a web-based application to record, monitor, and set goals on physical activity plus usual care may result in little to no difference in time spent in moderate-to-vigorous physical activity, total time spent in activity, pulmonary exacerbations, quality of life, lung function, and exercise capacity compared to usual care alone. Regarding the use of digital health technologies for delivering exercise programs in CF, the evidence is very uncertain about the effects of using a wearable fitness tracker plus personalized exercise prescription compared to personalized exercise prescription alone. Further high-quality RCTs, with blinded outcome assessors, reporting the effects of digital health technologies on clinically important outcome measures, such as physical activity participation and intensity, self-management behavior, and the occurrence of pulmonary exacerbations in the long term are needed. The results of six ongoing RCTs identified through our searches may help clarify the effects of different modes of digital health technologies for delivering and monitoring exercise programs in people with CF.

Effects of therapeutic interventions on pain due to plantar fasciitis: A systematic review and meta-analysis.

OBJECTIVE: To determine the effects of different therapeutic interventions that have ever been evaluated in randomized controlled trials on pain due to plantar fasciitis. METHODS: We searched different electronic databases until September 2022. Mean differences (MDs) and 95% confidence intervals (CIs) were calculated. The Grading of Recommendations Assessment, Development and Evaluation was used to evaluate the overall certainty evidence. RESULTS: A total of 236 studies met the study criteria, including 15,401 patients. Botulinum toxin MD -2.14 (CI: -4.15, -0.14), micronized dehydrated human amnion/chorion membrane injection MD -3.31 (CI: -5.54, -1.08), dry needling MD -2.34 (CI: -4.64, -0.04), low-dye taping MD -3.60 (CI: -4.16, -3.03), low-level laser therapy MD -2.09 (CI: -2.28, -1.90), myofascial releases MD -1.79 (CI: -2.63, -0.94), platelet-rich plasma MD -2.40 (CI: -4.16, -0.63), radiofrequency MD -2.47 (CI: -4.65, -0.29), and stretching MD -1.14 (CI: -2.02, -0.26) resulted in being effective treatments for pain when compared to the control in the short term. In the medium and long term, only extracorporeal shock wave therapy MD -0.97 (CI: -1.13, -0.81)/MD -2.49 (CI: -3.17, -1.82) was effective for improving pain when compared to the control. CONCLUSIONS: Considering the available studies, this systematic review and meta-analysis showed that different therapeutic interventions seem to be useful strategies for improving pain in patients with plantar fasciitis. In the medium and long term, only extracorporeal shock wave therapy was effective in improving pain when compared to the control.

Predictors of extubation failure in neurocritical patients: A systematic review.

OBJECTIVE: The objective of this study was to identify predictors of extubation failure in neurocritical patients. METHODS: This was systematic review performed through a bibliographic search of the databases PubMed/Medline, Lilacs, SciELO, and Web of Science, from February 2020 to October 2021. Cohort studies that investigated the predictors of extubation failure were included, defined as the need for reintubation within 48 h after extubation, in adult neurocritical patients. The risk-of-bias assessment was performed using the Newcastle-Ottawa Scale, for cohort studies. RESULTS: Eight studies, totaling 18 487 participants, were included. A total of 15 predictors for extubation failure in neurocritical patients have been identified. Of these, four were the most frequent: low score on the Glasgow Coma Scale (motor score ≤5, 8T-10T), female gender, time on mechanical ventilation (≥7 days, ≥ 10 days), and moderate or large secretion volume. CONCLUSIONS: In addition to the conventional parameters of weaning and extubation, other factors, such as a low score on the Glasgow Coma Scale, female gender, mechanical ventilation time, and moderate or large secretion volume, must be taken into account to prevent extubation failure in neurocritical patients in clinical practice.

The impact Of high-intensity interval training On functioning And health-related quality Of life In post-stroke patients: A systematic review With meta-analysis.

OBJECTIVE: To examine the effects of high-intensity interval training on the functioning and health-related quality of life of post-stroke patients. METHODS: We searched the following electronic databases: MEDLINE/Pubmed, Cochrane Central Register of Controlled Trials, PEDro database, and Scielo up to January 2022 for randomized controlled trials that investigated the effects of high-intensity interval training in post-stroke patients. Two reviewers selected the studies independently. Study quality was evaluated using the PEDro scale. The mean difference (MD), standard mean difference (SMD), and 95% confidence intervals (CIs) were calculated. RESULTS: Nine studies met the study criteria (375 patients). The age of the participants ranged from 55.8 to 72.1 years. The studies included patients within 2 weeks of stroke onset to patients longer than 1 month of stroke. High-intensity interval training resulted in improvement in cardiorespiratory fitness (peak oxygen uptake) MD (3.8 mL/kg/min, 95% CI: 2.62, 5.01, n = 91), balance MD 5.7 (95% CI: 3.50, 7.91; N = 64), and gait speed SMD (0.2 m/s; 95% CI: 0.05, 0.27; N = 100) compared with continuous aerobic training. The health-related quality of life did not differ between the groups. Compared to usual care, high-intensity interval training improved the cardiorespiratory fitness SMD (0.5 95% CI: 0.14, 0.81, n = 239). No serious adverse events were observed. CONCLUSIONS: The findings of this systematic review show that high-intensity interval training was more efficient than continuous aerobic training to gain cardiorespiratory fitness, balance and gait speed in post-stroke patients. In addition, compared to usual care, high-intensity interval training improved cardiorespiratory fitness.

Effects of neuromuscular electrical stimulation on exercise capacity, muscle strength and quality of life in COPD patients: A Systematic Review with Meta-Analysis.

OBJECTIVE: To determine the effects of neuromuscular electrical stimulation on disabilities and activity limitation of individuals affected by chronic obstructive pulmonary disease. DATA SOURCES: MEDLINE, PEDro database, Cochrane Controlled Trials Register, and SciELO, were searched from inception until October 2021. REVIEW METHODS: Inclusion criteria were patients with COPD, randomized controlled trials comparing neuromuscular electrical stimulation alone or combined conventional pulmonary rehabilitation and neuromuscular electrical stimulation versus control or sham or pulmonary rehabilitation in disabilities and activity limitation in COPD. There were no mandatory language or publication date restrictions. Two reviewers selected studies independently. Weighted mean differences and 95% confidence intervals were calculated. Results 32 studies met the study criteria, including 1.269 participants. Neuromuscular electrical stimulation improved exercise capacity (MD 1.10, 95% CI: 0.33, 1.86, N = 147), and muscle strength (0.53, 95% CI: 0.20, 0.87, N = 147) compared to sham group. Combined neuromuscular electrical stimulation and conventional rehabilitation improved exercise capacity (MD 34.28 meters, 95% CI: 6.84, 61.73, N = 262) compared to conventional rehabilitation alone. No adverse events were reported. CONCLUSIONS: Neuromuscular electrical stimulation resulted in small improvement in disabilities and activity limitation (below the MCID) in COPD. Thus, the inclusion of neuromuscular electrical stimulation in rehabilitation programs must consider the cost Because of inadequate methodological conduction and reporting of methods, some studies were of low quality.

Effects of Foot Orthoses on Pain and the Prevention of Lower Limb Injuries in Runners: Systematic Review and Meta-Analysis.

CONTEXT: A variety of approaches have been proposed to prevent lower limb injuries in runners. However, the evidence for the effectiveness of interventions to reduce lower limb pain and injury after intensive running is very weak. OBJECTIVE: The authors performed a systematic review to investigate the effects of foot orthoses on pain and the prevention of lower limb injuries in runners. EVIDENCE ACQUISITION: The authors searched the MEDLINE/PubMed, Physiotherapy Evidence Database, Scielo, and Cochrane Central (from inception to February 2022) databases for randomized controlled trials that evaluated the effects of foot orthoses in runners. The authors then calculated mean differences and 95% confidence intervals from these trials. Heterogeneity was assessed using the I2 test. Furthermore, the authors compared the criteria between runners with foot orthoses and ones with no intervention (control group). EVIDENCE SYNTHESIS: Twelve studies (5321 runners) met our review criteria. The control and the foot orthoses group sustained 721 (37%) and 238 (24%) injuries, respectively. Compared with the control group, the use of foot orthoses resulted in a significant reduction in lower limb injury risk (risk ratio = 0.6; 95% confidence interval, 0.5-0.7; P = .00001, I2 = 54%; 7 studies, N = 2983: moderate-quality evidence). Moreover, the foot orthoses group corresponded to a 40% reduction in the risk of developing lower limb injuries. CONCLUSIONS: The use of foot orthoses may help reduce the incidence of lower limb injuries and pain in runners.

Effect of exercise on epicardial adipose tissue in adults: a systematic review and meta-analyses.

According to previous epidemiological studies, we can reduce the thickness of epicardial fat and improve cardiovascular risk factors through exercise, and the changes may depend on the form of exercise. We systemically reviewed published studies that evaluated exercise intervention on epicardial adipose tissue (EAT) levels. We included randomized controlled trials (RCTs) comparing one exercise with another exercise or diet for the treatment to reduce EAT. We used fixed effects models for meta-analyses; effects of exercise on outcomes were described as mean differences (MD) or standardized difference of means (SMD) was used, their 95% confidence intervals (CI). Five RCTs were included (n = 299), 156 in exercise group and 143 in the control. In comparison to the control group, exercise significantly reduced EAT (SMD - 0.57, 95%CI - 0.97 to - 0.18) and waist circumference (MD - 2.95 cm, 95%CI - 4.93 to - 0.97). Exercise did not have an effect on BMI (MD - 0.23 kg/m2, 95%CI - 0.73 to 0.27), weight (MD - 0.06 kg, 95%CI - 1.46 to 1.34), or HDL (SMD 0.26, 95%CI - 0.06 to 0.57).VO2 was significantly increased by exercise (SMD 1.58, 95%CI 1.17 to 1.99). Risk of bias was high for 3 studies, and GRADE quality of evidence was very low to moderate. Exercise reduced epicardial adipose tissue and waist circumference, and did not have effect on weight, BMI, or HDL. Newer trials with better design and methods are necessary to improve the quality of the evidence. PROSPERO registration number (CRD42018096581).

Endomyocardial fibrosis: past, present, and future.

Endomyocardial fibrosis (EMF) is a neglected idiopathic disorder, predominant in tropical and subtropical regions of the developing world. It is characterized by fibrotic thickening of the endocardium and myocardium of one or both ventricles. EMF was an important cause of heart failure which accounted for up to 20% of the cases in endemic areas of Africa (rural community in Mozambique), but during the last few years, incidents of the disease have decreased considerably. Although its pathogenesis and etiology are not fully understood, its pathology resembles conditions such as eosinophilic cardiomyopathy and hypereosinophilic syndrome. Extensive fibrosis of the ventricular endocardium causing architectural distortion, impaired filling, and valvular insufficiency defines the disease. Confined to peculiar and limited geographical areas, the etiology remains blurred and it carries a grim prognosis. Medical care currently remains very challenging as one-third to half of patients with an advanced disease die within 2 years. Surgery in the correct setting can increase survival and especially in patients with advanced heart failure.

The effect of facilitated tucking position during painful procedure in pain management of preterm infants in neonatal intensive care unit: a systematic review and meta-analysis.

We performed a systematic review and meta-analysis to investigate the effects of facilitated tucking position during painful procedure in pain management of preterm infants. We searched MEDLINE, PEDro, SciELO and the Cochrane Library (until June 2019) for randomized controlled trials. An α value ≤ 0.05 was considered significant. Heterogeneity among studies was examined with Cochran's Q and I2 statistic, in which values greater than 40% were considered indicative of high heterogeneity and random-effects model was chosen. Analyses were performed with Review Manager 5.3. Fifteen studies met the eligibility criteria, including 664 preterm infants. The meta-analyses showed a significant reduction in pain of - 1.02 (95% CI - 1.7 to - 0.4, N = 216) during endotraqueal suctioning for participants in the facilitated tucking position group (FTPG) compared with routine care group. The meta-analyses showed a non-significant difference in pain - 0.3 (95% CI - 2.05 to - 1.4, N = 88) during heel stick for participants in the FTPG compared with oral glucose group. The meta-analyses showed a non-significant difference in pain for participants in the FTPG compared with oral opioid group 0.2 (95% CI - 1.4 to 1.8, N = 140).Conclusion: Facilitated tucking position may improve the pain during painful procedures.What is Known:• Exposure of premature babies to painful procedures is associated with changes in brain development, regardless of other factors.• Facilitated tucking reduces the expression of pain in premature infants.What is New:• Facilitated tucking position was efficient in pain management of preterm infants when compared to routine care.• Facilitated tucking compared to opioid or oral glucose did not achieve a significant reduction in pain intensity.

Effects of water-based exercise on functioning and quality of life in people with Parkinson's disease: a systematic review and meta-analysis.

AIM: To investigate the effects of the water-based exercise on balance, mobility, mobility and functional independence, functional performance, fear of falling and quality of life in people with Parkinson's disease. METHODS: We searched pubmed/MEDLINE, Cochrane Central Register of Controlled Trials, PEDro data base and SciELO to June 2020 for randomised controlled trials that investigated the effects of water-based exercise in people with Parkinson's disease. Two comparisons were made: water-based exercise versus usual care and water-based exercise versus land-exercise. The main outcomes were Balance, Confidence, Mobility, Unified Parkinson's Disease Rating Scale and quality of life. Mean differences (MD) with 95% confidence interval (CI) were calculated, and heterogeneity was assessed using the I2 test. RESULTS: Fifteen randomised controlled trials were found (435 people). Compared to usual care, water-based exercise resulted in improvement in balance MD (9.1, 95% CI: 6.5, 11.8, N = 45). Water-based exercise resulted in improvement in balance MD (3.1, 95% CI: 1.2, 5.0, N = 179), mobility MD (-2.2, 95% CI: -3.3, -1.0, N = 197) and quality of life MD (-5.5, 95% CI: -11, -0.07, N = 98) compared to land-based exercise, but without significant difference in functional performance MD (0.01, 95% CI: -2.6 to 2.7, N = 69). Land-based exercise resulted in improvement in fear of falling MD (-3.5, 95% CI: -5.6, -1.3, N = 58) compared to water-based exercise. CONCLUSION: Water-based exercise was more efficient than land-based exercise and/or usual care in improving balance, mobility and quality of life in people with Parkinson's disease.

Addition of specific hip strengthening exercises to conventional rehabilitation therapy for low back pain: a systematic review and meta-analysis.

OBJECTIVE: To examine the effectiveness of hip strengthening exercises in reducing pain and disability in persons with low back pain. METHODS: We searched for randomized controlled clinical trials on MEDLINE, the Physiotherapy Evidence Database, the Cochrane Central Register of Controlled Trials, LILACS, Scielo and CINAHL from the earliest date available to June 2020. Studies that included hip strengthening exercises for persons with low back pain and included pain and/or disability as an outcome measure were evaluated by two independent reviewers. Mean difference (MD), and 95% confidence interval (CI) were estimated by random effect models. RESULTS: Five studies met the eligibility criteria (309 patients). Four studies included hip strengthening in conjunction with other interventions, while one study evaluated hip strengthening as a standalone intervention. Hip strengthening exercises improved pain (MD -5.4 mm, 95% CI: -8.9 to -1.8 mm), and disability (MD -2.9; 95% CI: -5.6 to -0.1) in persons with low back pain compared to interventions in which hip strengthening was not utilized. The quality of evidence for the pain outcome, was assessed as being moderate. The quality of evidence for the outcome of self-reported disability, was assessed as being low. CONCLUSION: Addition of specific hip strengthening exercises to conventional rehabilitation therapy may be beneficial for improving pain and disability in persons with low back pain.

Effect of Aerobic Exercise on Peak Oxygen Consumption, VE/VCO2 Slope, and Health-Related Quality of Life in Patients with Heart Failure with Preserved Left Ventricular Ejection Fraction: a Systematic Review and Meta-Analysis.

PURPOSE OF REVIEW: The aim of this study was to determine the effects of aerobic exercise on peak oxygen uptake (peak VO2), minute ventilation/carbon dioxide production (VE/VCO2 slope), and health-related quality of life (HRQoL) among patients with heart failure (HF) and preserved ejection fraction (HFpEF). RECENT FINDINGS: We conducted a Cochrane Library, MEDLINE/PubMed, Physiotherapy Evidence Database, and SciELO search (from 1985 to May 2019) for randomized controlled trials that evaluated the effects of aerobic exercise in HFpEF patients. We calculated the mean differences (MD) and 95% confidence interval (CI). Ten intervention studies were included providing a total of 399 patients. Compared with control, aerobic exercise resulted in improvement in peak VO2 MD 1.9 mL kg-1 min-1 (95% CI 1.3 to 2.5; N = 314) and HRQoL measured by Minnesota Living with Heart Failure MD 5.4 (95% CI - 10.5 to - 0.2; N = 256). No significant difference in VE/VCO2 slope was found between participants in the aerobic exercise group and the control group. The quality of evidence for peak VO2 and HRQoL was assessed as being moderate. Aerobic exercise moderately improves peak VO2 and HRQoL and should be considered a strategy of rehabilitation of HFpEF individuals.

Lower limb muscle strength in patients with low back pain: a systematic review and meta-analysis.

OBJECTIVE: To systematically review the published studies that compare lower limb muscle strength in patients with low back pain to matched healthy controls. METHODS: We searched Medline, SciELO, Cumulative Index to Nursing and Allied Health (CINAHL), and Scopus up until December 2017. Studies comparing lower limb muscle strength in people diagnosed with low back pain to healthy control participants were included in the systematic review. RESULTS: 14 studies, which included 951 healthy controls and 919 patients with low back pain, fulfilled the inclusion criteria. Meta-analysis revealed a lower muscle strength of hip abductor/extensors and knee extensors in patients with low back pain in comparison to healthy controls. The average strength of hip abductors (Five studies, SMD=0.7 95% CI: 0.49 to 0.9) and hip extensors (Two studies, SMD=0.93, 95% CI: 0.62 to 1.23) was significantly lower in patients with low back pain compared to that of healthy controls. Knee extensor muscle strength was significantly lower in patients with low back pain compared to healthy controls (Three studies, WMD=0.31 Nm/kg, 95% CI: 0.1 to 0.5). The meta-analysis indicated a no significant difference in knee flexor muscle strength in patients with low back pain compared to healthy controls. CONCLUSIONS: Lower limb muscle is impaired in patients with low back pain.

Effects of isokinetic muscle strengthening on muscle strength, mobility, and gait in post-stroke patients: a systematic review and meta-analysis.

OBJECTIVE:: To investigate whether isokinetic muscle strengthening improves muscle strength, mobility, and gait in post-stroke patients. METHODS:: We searched for randomized controlled trials at PubMed/Medline, SciELO, PEDro, and Cochrane Central Register of Controlled Trials, from the earliest date available to June 2018. Randomized controlled trials that examined the effects of isokinetic muscle strengthening versus other rehabilitation interventions or control in post-stroke patients were included. Study quality was evaluated using the PEDro scale. Weighted mean difference (WMD) and 95% confidence intervals (CIs) were calculated, and heterogeneity was assessed using the I2 test. RESULTS:: In total, 13 studies (347 patients) focusing on the use of isokinetic in rehabilitation following stroke were included. All trials were of low-to-moderate quality. Isokinetic muscle strengthening improved muscle strength WMD 0.8 (95% CI: 0.2, 1.4; N = 96), mobility WMD -2.03 seconds (95% CI: -2.9, -1.1; N = 111) and gait speed WMD 0.9 m/s (95% CI: 0.05, 1.8; N = 87). CONCLUSION:: Isokinetic muscle strengthening seems to be a useful strategy for improving muscle strength, mobility, and gait in post-stroke patients.

Water-Based Exercise on Functioning and Quality of Life in Poststroke Persons: A Systematic Review and Meta-Analysis.

OBJECTIVE: To investigate the effects of water-based exercise on functioning and quality of life in poststroke persons. DATA SOURCES: We searched the following electronic database: MEDLINE, PeDro, Scielo, and the Cochrane Central Register of Controlled Trials up to September 2018 Study Selection: Only randomized controlled trials were included. Two review authors screened the titles and abstracts and selected the trials independently. DATA EXTRACTION: Two review authors independently extracted data of the included trials, using standard data-extraction model. We analyzed the pooled results using weighted mean differences, and standardized mean difference and 95% confidence intervals (CIs) were calculated. DATA SYNTHESIS: Twenty-four studies met the study criteria, but only 15 studies were included on meta-analyses. The studies presented moderate methodological quality, due to the lack of blinding of subjects and therapists and the nonperformance of the intention-to-treat analysis. Water-based exercise compared with land exercise had a positive impact on: muscle strength balance gait speed and mobility aerobic capacity and functional reach. Combined water-based exercise and land exercise was more effective than land exercise for improving balance, gait speed, and functional reach. The meta-analysis showed significant improvement in role limitations due to physical functioning and emotional problems, in vitality general mental health, social functioning, and bodily pain for participants in the water-based exercise and land exercise group versus land exercise group. CONCLUSIONS: Water-based exercise may improve muscle strength, balance, mobility, aerobic capacity, functional reach, joint position sense, and quality of life in poststroke persons and could be considered for inclusion in rehabilitation programs.

The Effects of Functional Training, Bicycle Exercise, and Exergaming on Walking Capacity of Elderly Patients With Parkinson Disease: A Pilot Randomized Controlled Single-blinded Trial.

OBJECTIVES: To compare the effects of functional training, bicycle exercise, and exergaming on walking capacity of elderly with Parkinson disease (PD). DESIGN: A pilot randomized, controlled, single-blinded trial. SETTING: A state reference health care center for elderly, a public reference outpatient clinic for the elderly. PARTICIPANTS: Elderly individuals (≥60 years of age; N=62) with idiopathic PD (stage 2 to 3 of modified Hoehn and Yahr staging scale) according to the London Brain Bank. INTERVENTION: The participants were randomly assigned to three groups. Group 1 (G1) participated in functional training (n=22); group 2 (G2) performed bicycle exercise (n=20), and group 3 (G3) trained with Kinect Adventures (Microsoft, Redmond, WA) exergames (n=20). MAIN OUTCOME MEASURES: The primary outcome measure was the 6-minute walk test (6MWT); secondary outcome measures were the 10-m walk test (10MWT), sitting-rising test (SRT), body mass index, Parkinson Disease Questionnaire-39, World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0), and 15-item Geriatric Depression Scale. RESULTS: All groups showed significant improvements in 6MWT (G1 P=.008; G2 P=.001; G3 P=.005), SRT (G1 P<.001; G2 P=.001; G3 P=.003), and WHODAS 2.0 (G1 P=.018; G2 P=.019; G3 P=.041). Only G3 improved gait speed in 10MWT (P=.11). G1 (P=.014) and G3 (P=.004) improved quality of life. No difference was found between groups. CONCLUSIONS: Eight weeks of exergaming can improve the walking capacity of elderly patients with PD. Exergame training had similar outcomes compared with functional training and bicycle exercise. The three physical exercise modalities presented significant improvements on walking capacity, ability to stand up and sit, and functionality of the participants.

The impact of high-intensity inspiratory muscle training on exercise capacity and inspiratory muscle strength in heart failure with reduced ejection fraction: a systematic review and meta-analysis.

OBJECTIVE:: Inspiratory muscle training (IMT) improves prognostic clinical variables in patients with heart failure. However, the optimal intensity for increasing those outcomes remains unclear. Thus, we aimed to determine whether high-intensity inspiratory muscle training (HIIMT) improves exercise capacity and respiratory muscle strength in patients with heart failure with reduced ejection fraction (HFrEF). METHODS:: We searched for randomized controlled clinical trials at MEDLINE, the Cochrane Central Register of Controlled Trials, the Physiotherapy Evidence Database, SciELO and CINAHL from the earliest date available to May 2018. Primary studies on HIIMT against low-intensity IMT or sham-IMT that evaluated exercise capacity and inspiratory muscle strength were included. Two independent reviewers evaluated the eligibility of studies retrieved from the databases. Disagreements were resolved by discussion or by a third reviewer. Weighted mean difference (WMD), standardized mean difference (SMD) and 95% confidence interval (CI) were estimated by random effect models. RESULTS:: Five studies met the eligibility criteria (138 patients). HIIMT improved VO2peak (WMD 2.65 mL kg-1 min-1; 95% CI: 2.2 to 3.1 mL kg-1 min-1), walking tests (SMD 1.71; 95% CI: 0.83 to 2.59) and maximal inspiratory pressure (WMD 16.63 cmH2O; 95% CI: 10.34 to 22.91 cmH2O). The estimate for potential risks of adverse events was not performed because of the low prevalence of reports in primary studies. CONCLUSION:: HIIMT seems to be a useful strategy for improving exercise capacity and inspiratory muscle strength in HFrEF patients.

Effects of upper limb resistance exercise on aerobic capacity, muscle strength, and quality of life in COPD patients: a randomized controlled trial.

OBJECTIVE:: To evaluate the effects of upper limb resistance exercise on the functional capacity, muscle function, and quality of life in patients with chronic obstructive pulmonary disease. SETTING:: Clinical School of Physiotherapy in a Public University of Brazil. SUBJECTS:: 58 patients were recruited; of these, 7 were excluded and 51 individuals were enrolled. INTERVENTION:: Control group performed warm-up, aerobic exercise, inspiratory muscle training, and session stretching, followed by massage therapy. The treatment group performed warm-up, aerobic exercise, inspiratory muscle training, three sets of upper limb resistance exercise, and session stretching, followed by massage therapy. Total three sessions per week for eight weeks. PRIMARY OUTCOME MEASURES:: 6-minute walk test, respiratory and peripheral muscle strength, dyspnea, and quality of life. Normality of the data was tested using the Shapiro-Wilk test; paired analysis of variance was used for intergroup analyses. RESULTS:: 51 patients (25 in the control group and 26 in the treatment group); 41% of the subjects were men. Mean forced expiratory volume was 2.6 ± 0.6 L, and mean body mass index was 27.3 ± 7.0 kg/m2. The upper limb resistance exercise resulted in significantly greater benefit in terms of exercise capacity (88.5 ± 81.9 m, P = 0.043), inspiratory muscle strength (22.9 ± 24.2 cm H2O, P = 0.001), upper limb muscle strength (2.3 ± 3.1 kg, P = 0.027), and quality of life scores (-15.3 ± 10.9 points, P = 0.000). CONCLUSION:: Upper limb resistance exercise improved the exercise capacity, respiratory muscle strength, and quality of life.

Intradialytic exercise training modalities on physical functioning and health-related quality of life in patients undergoing maintenance hemodialysis: systematic review and meta-analysis.

OBJECTIVE: To determine the effects of different intradialytic exercise training modalities on physical functioning and health-related quality of life of maintenance hemodialysis patients. METHODS: We searched MEDLINE, Cochrane Trials Register and CINAHL for controlled trials that evaluated the effects of intradialytic exercise training for maintenance hemodialysis patients and published from the earliest available date to December 2017. Weighted mean difference and 95% confidence interval (CI) were calculated, and heterogeneity was assessed using the I2 test. RESULTS: Fifty-six studies met the study criteria, comprising a total of 2586 patients. Compared with no exercise, combined aerobic and resistance exercise resulted in significant improvement in peak VO2 weighted mean difference (5.1 mL kg-1 min-1; 95% CI: 3.4, 6.8 mL kg-1 min-1), depression symptoms (-7.32; 95% CI -9.31, -5.33) and both physical function (10.67 points; 95% CI 1.08, 20.25 points) and vitality (10.01 points; 95% CI 4.30, 15.72 points) domains of health-related quality of life. Resistance exercise alone was significantly associated with improvement in the 6-minute walk test distance (30.2 m; 95% CI 24.6, 35.9 m), knee extensor strength (0.6 N; 95% CI 0.1, 1.0 N) and Physical Component Score of health-related quality of life (9.53 points; 95% CI -3.09, 22.15 points) when compared with control group. Aerobic exercise alone was not significantly associated with aerobic capacity and quality of life improvement. CONCLUSION: The results provide support to interventions that combine intradialytic aerobic and resistance exercises to improve physical functioning and quality of life in end-stage renal disease patients undergoing hemodialysis.