Proposing Development of Community-based Physical Activity Park for Elderly Population of Pakistan.

Physical inactivity is known to be as performing less than 150 minutes of moderate- to vigorous-intensity physical activity per week. It poses a substantial risk for not only non-communicable, chronic diseases such as stroke, diabetes etc. but also contributes to the global mortality. Evidence suggests that the usual urban green environment is sturdily related to several health paybacks to the elderly population, which includes not only decreased cardiovascular mortality, Type 2 Diabetes risk, but overall improved physical, emotional, and mental health. It also invokes physical activity for community involvement, natural green curative sensory effect, spiritual boost, and leisure recreation to the elderly. Additionally, parks serve to perform activities like exercise, gardening, brisk walk or simply meditation in the natural environment. Unfortunately, in Pakistan, the urban green spaces like parks are scarce. Most people do not have access to well-designed parks. People over the age of 50 and above seem to be most affected by this deficiency. There is a need for specially designed parks that can address the challenges faced by elderly people while exercising. This study summarises the available evidence for designing special open area space in parks for the elderly population across Pakistan and highlights the need for further work to alleviate the global sickness of physical sedentariness among the elderly. Key Words: Older adults, Parks, Physical activity, Physical inactivity.

Effects of Exercise Training in Patients with Lung Cancer during Chemotherapy Treatment.

Background: Cancer is the second greatest cause of death and disability after cardiovascular disease. Objective: To determine the effects of exercise training in patients with lung cancer during chemotherapy treatment. Methods: A randomised clinical trial was conducted in Shaukat Khanum Memorial Cancer Hospital and Institute of Radiotherapy and Nuclear Medicine (IRNUM) Peshawar. A total of 40 participants were randomly divided into two groups: i) the Experimental group (EG, n = 20) and ii) Control group (CG, n = 20). Both groups received exercise training for 4 weeks, with five sessions per week. The EG received pulmonary rehabilitation and aerobic training. The CG received only pulmonary rehabilitation. Both groups were evaluated at baseline and after 6 weeks through Mindful Attention Awareness Scale (MAAS) Urdu version, Six Minute Walk Test (6MWT), digital spirometry, Borgs scale, Hospital Anxiety and Depression Scale (HADs) and Visual Analogue Scale (VAS). Results: Both the EG and CG showed significant improvement in MAAS scores at post-study with a (P < 0.001). The scores of 6MWT were improved significantly in both groups after intervention with a (P = 0.001). The patient's anxiety scores were significantly improved in both groups after intervention with a (P < 0.001), while depression scores were also improved considerably between the two groups at post-level with a (P < 0.001). Regarding spirometry value, both groups showed significant improvement after intervention for forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and FEV1/FVC (P < 0.001). Both groups show significant differences in patient pain intensity and dyspnea at post-level with P < 0.001. Conclusion: This study concluded that pulmonary rehabilitation along with aerobic training can be more effective than pulmonary rehabilitation alone for patients with lung cancer during chemotherapy treatment.

Correlation of fall efficacy scale and Hendrich fall risk model in elder population of Rawalpindi-Islamabad.

OBJECTIVE: To determine the correlation of fall efficacy scale and Hendrich fall risk model in elderly population. METHODS: The correlational study was conducted from February to July 2018 in the twin cities of Islamabad and Rawalpindi, Pakistan, and comprised subjects of either gender aged >65 years from Railway General Hospital, Rawalpindi Eye Donors Organisation Eye Hospital, Water and Power Development Authority General Hospital, as well as Baghban and Mukhtar Ghulam Qadir(MGQ)old people's homes. A pre-designed semi structured questionnaire consisting of Fall Efficacy Scale-International, Hendrich fall risk model along with the necessary demographic information was used for data collection. Data was analysed using SPSS 21. RESULTS: Of the 336 subjects, 270(80.35%) were males. The overall mean age was 70.03±4.52 years. The mean fall risk total score was 5.77±3.43. Mean fall efficacy score was 35.64±16.40. The correlation coefficient for both scales (r=0.420) indicated a direct/intermediate correlation. CONCLUSIONS: There was a positive intermediate relationship between apprehension and risk of fall among the elderly population.

Assessment of knowledge, attitude and practice of basic life support among physical therapy practitioners in Rawalpindi and Islamabad.

OBJECTIVE: To assess the level of knowledge, attitude and practice of basic life support among physical therapy practitioners. METHODS: The descriptive cross-sectional study was conducted at Riphah International University, Islamabad, Pakistan, from February to July 2018, and comprised data collected from physical therapy practitioners working at four public-sector hospitals in Rawalpindi and Islamabad. A 30-item structured questionnaire adapted from the American Heart Association was used. Data was analysed using SPSS 21. RESULTS: Of the 100 subjects, 65(65%) were females and 35(35%) were males. The overall mean age was 25.54±3.76 years. The mean score of BLS knowledge and practice was 7.27±1.79 and 3.77±1.65 respectively. of the total, 61(61%) had received prior basic life support training, and the difference in knowledge and practice scores between trained and untrained professionals was significant (p<0.05). Gender-based difference was significant (p=0.02). All (100%) participants showed positive attitude towards basic life support training. CONCLUSIONS: Physical therapy practitioners possessed average basic life support knowledge, but practising skills were lacking.

Effectiveness of resistance interval training versus aerobic interval training on peak oxygen uptake in patients with myocardial infarction.

Cardiac rehabilitation reduces the risk factors and improves the aerobic exercise capacity of patients after they have experienced cardiac events. This study compared the effects of two types of interval training in patients with myocardial infarction (MI). A single-blinded randomised controlled trial was conducted on 26 patients with MI which included 16 males and 10 females. After screening via non-probability convenience sampling, patients were randomised into two groups using toss and trial method. The control group was given aerobic interval training (AIT), consisting intervals of stationary cycling and walking on the treadmill. The experimental group received both AIT as well as resistance interval training comprising exercises of the upper and lower limbs. After 6 weeks, the outcomes of peak oxygen uptake (VO2) and 6-minute walk test distance (6MWT) were measured against the baseline. Non-parametric tests were applied for statistical analysis. In the group comparison, the experimental group showed significant improvement in peak VO2 and 6MWT (p=0.003 and 0.003 respectively), as well as in the quality of life measures. The combination of resistance interval training plus AIT proved more effective in improving cardiac outcomes and aerobic capacity.

Combined Effect of Aerobic and Resistance Interval Training on Ejection Fraction in Myocardial Infarction.

This study was conducted to determine whether combination of aerobic and resistance interval training had superior effects than aerobic interval training alone on ejection fraction, cholesterol, and triglycerides in myocardial infarction patients, at Pakistan Railway General Hospital Rawalpindi from July to December 2016. Patients were randomly allocated in interventional (n=13) and control group (n=13) using toss and trial method. Aerobic interval training at 65%-85% of target heart rate was performed in three intervals in both groups; whereas, resistance training at 30-50% of one repetition maximum was added in experimental group. The outcomes were measured before and after six weeks. Ejection fraction was significantly (p=0.029) improved in interventional group 55 (10) as compared to control group 50 (5). Cholesterol levels also showed significant decrease (p=0.021) in control group. The study concluded that combined training has superior effect in improving ejection fraction; whereas, aerobic interval training alone is more effective than combine training in improving cholesterol.

Effects Of Cardiovascular Conditioning Exercises On Quality Of Life In Patients With Dilated Ardiomyopathy In Pakistan.

BACKGROUND: Dilated Cardiomyopathy (DCM) is the most frequently diagnosed cardiomyopathy in Pakistan and patients have significant muscles dysfunction which affects their quality of life (QOL). Available evidence have supported the role of moderate intensity exercise for improving QOL but no such studies have been conducted in Pakistan so far. METHODS: A single blinded randomized controlled trial was conducted in two different hospitals of Rawalpindi from September 2016-February 2017. Both genders clinically stable DCM patients with ejection fraction <40% were selected through purposive non-probability sampling and randomized to Training group and Control group (n=30 each). Training group protocol included bicycling on lower limb ergometer 4days/week on alternate days for 8 weeks. Patients in control group received usual care. Patients were assessed thrice during 8-week protocol. The tools used included structured questionnaire with different standard scales like 6 Minute Walk Test, Modified Medical Research Council Scale, Modified Borg Scale and Minnesota Living with Heart Failure Questionnaire. Data was analysed on SPSS 21 software. RESULTS: Prior to conditioning in training group, 6 (21%) patients reported good and 23 (79%) have poor QOL whereas in control group 14 (56%) have good and 11 (44%) have poor QOL on MLHFQ score. After 8 weeks in training group, 28 (96%) patients reported excellent QOL and in control group, 11 (44%) reported good and 14(56%) have poor QOL on MLHFQ score. Between the groups analysis depicted highly significant p-values for QOL and New York Heart Association (NYHA) class (p<0.001). CONCLUSION: Supervised cardiac conditioning program significantly improves Quality of life and NYHA functional class in dilated cardiomyopathy.

Effects of Lower Limb Cycle Training on Echocardiographic Parameters of Left Ventricle in Dilated Cardiomyopathy Patients.

OBJECTIVE: To determine the effect of lower limb ergometric training on echocardiographic parameters of left ventricle in dilated cardiomyopathy (DMC) patients. STUDY DESIGN: Randomized control trial. PLACE AND DURATION OF STUDY: Rawalpindi Institute of Cardiology, Rawalpindi, Pakistan, from September 2016 to February 2017. METHODOLOGY: Clinically stable patients with DCM (n=60), were randomly allocated into an interventional group with two-month interventional program and a non-trained control group (n=30 each). Treatment protocol for interventional group was lower limb ergometer exercise for 8 weeks, 4 days/week. Pre and post-treatment echocardiography was done in both groups at baseline and after 8 weeks. SPSS 21 was used for data analysis. RESULTS: The median (IQR) age of the patients was 51 (18) years in interventional group and 62 (11) years in control group. Male to female ratio was 18:9 in control group and 17:12 in Interventional group. Statistically significant results were detected within the groups regarding ejection fraction (EF), left ventricular internal dimension systole (LVIDS) and left ventricular internal diastolic dimension (LVIDD) (p <0.001). CONCLUSION: Exercise training with lower limb ergometer was effective in improving the ejection fraction and left ventricular dimensions in patients with dilated cardiomyopathies.

Effect of Early ≤ 3 Mets (Metabolic Equivalent of Tasks) of Physical Activity on Patient's Outcome after Cardiac Surgery.

OBJECTIVE: To determine the effect of <3 Mets (Metabolic Equivalent of Tasks) of physical activity on zero postoperative days for improving hemodynamic and respiratory parameters of patients after cardiac surgeries. STUDY DESIGN: Randomized control trial. PLACE AND DURATION OF STUDY: BARMWTHospital, Rawalpindi, from March to August 2015. METHODOLOGY: Arandomized controlled trial was conducted on 174 CABG and valvular heart disease patients undergoing cardiac surgical procedures. After selection of sample via non-probability purposive sampling, they were randomly allocated into interventional group (n=87) and control group (n=87). Treatment protocol for experimental group was ≤3 Mets of physical activity, i.e. chest physiotherapy, sitting over edge of bed, standing and sitting on chair at bedside, on zero postoperative day but the control group was treated with conventional treatment on first postoperative day. Pre- and post-treatment assessment was done in control and interventional groups on both zero and first postoperative days. Data was analyzed on SPSS version 21. RESULTS: The patients' mean age was 51.86 ±13.76 years. Male to female ratio was 132:42. Statistically significant differences in respiratory rate and SpO2 (p=0.000 and 0.000, respectively) were found between both groups. Among ABG's, PCO2 and pH showed significant differences with p values of 0.039 and <0.001, respectively. No significant differences were observed between both groups regarding electrolytes (Na+, K+, Cl-, p-values of 0.361, 0.575 and 0.120 respectively) and creatinine (p=0.783). Marked improvement in oxygen saturation, dyspnea and a fall in systolic BPwas seen in interventional group. There was also observed to be a reduction in the length of ICU stay among interventional group patients as frequency with percentage of total stay was compared to control group. CONCLUSION: Early physical activity (≤3 METS) post-cardiac surgeries prevent respiratory complications through improvement in dyspnea, respiratory rate, and oxygen saturation.