RESUMO
BACKGROUND AND PURPOSE: The international Consensus on Therapeutic Exercise aNd Training (i-CONTENT) tool is a new instrument developed to evaluate the therapeutic quality of exercise interventions. Home-based exercise has been shown to improve physical fitness in older adults, but its effects may be influenced by therapeutic quality. The purpose of this systematic review was to describe the therapeutic quality of home-based exercise interventions for community-dwelling older adults and examine the relationship between therapeutic quality and changes in physical fitness. METHODS: Six electronic databases and 2 clinical trial registries were searched for randomized controlled trials investigating the effects of home-based exercise on physical fitness in community-dwelling older adults (≥60 years). Therapeutic quality was evaluated using the i-CONTENT tool for items of patient selection, type of exercise, safety, type/timing of outcomes, exercise dose, and adherence. International Consensus on Therapeutic Exercise aNd Training items were used to explain heterogeneity in meta-regression analyses. Risk of bias, certainty of evidence and credibility of analyses were assessed. RESULTS: Thirty-six trials (n = 6157 participants) were identified. Most studies (≥66.7%) had high or probably high therapeutic quality for i-CONTENT items, except exercise dose (47.2%) and adherence (16.7%). Interventions improved upper- (N = 20 trials; standardized mean difference [SMD] = 0.39; 95% CI, 0.13-0.64; low certainty of evidence) and lower-body strength (N = 28; SMD = 0.42; 95% CI, 0.08-0.77; very low certainty), and aerobic fitness (N = 8; SMD = 0.42; 95% CI, 0.08-0.77; very low certainty). For exercise dose, low- or probably low-quality studies negatively influenced effects on upper- (estimated ß = -.48; P = .049; moderate credibility) and lower-body strength (estimated ß = -.77; P = .048; moderate credibility). For adherence, low- or probably low-quality studies negatively influenced effects on aerobic fitness (estimated ß = -.97; P = .02; low credibility). CONCLUSIONS: Home-based exercise may improve upper- and lower-body strength, as well as aerobic fitness in older adults. However, the effectiveness of interventions is affected by inadequate dosing of exercise programs and adherence issues. Physical therapists should have the best available evidence to support their clinical decision making, especially when designing and monitoring home programs.
RESUMO
BACKGROUND: Many individuals develop excess skin (ES) following massive weight loss (MWL). Patient-reported outcomes demonstrate that abdominal ES negatively impacts perceived physical function which is improved by abdominal body contouring surgery (ABCS). However, the effect of ABCS on objective measures of physical function is unknown. OBJECTIVES: The aim of this study was to examine the impact of ABCS on objective measures of physical function in individuals who have undergone MWL. METHODS: Patients who have undergone MWL with abdominal ES (grade, ≥2) underwent the following physical function assessments: 9-item modified physical performance test (mPPT), chair stand, star excursion balance test (SEBT), timed up and go (TUG), modified agility T test, and 6-minute walk test (6-MWT). Perception of physical exertion and BODY-Q questionnaire scales were also collected. Nonsurgical controls (nâ =â 21) and those who had undergone ABCS (nâ =â 6) after the first visit performed a second physical function assessment 8 to 12 weeks later to allow for postoperative healing. RESULTS: No ceiling or floor effect was detected for any physical function measure. The intraclass correlation coefficient was 0.78 (95% CI, 0.44, 0.91) for the mPPT and >0.80 for all other measures. The effect sizes were 0.74 (75% CI, 0.19, 1.28) for the mPPT, 0.54 (75% CI, 0.00, 1.08) for the SEBT, -0.63 (75% CI, -1.17, -0.09) for the modified agility T test, and 0.79 (75% CI, 0.24, 0.13) for the 6-MWT. CONCLUSIONS: The mPPT and tests involving dynamic balance, agility, and walking were reliable and showed medium to large effect sizes, suggesting that these tests may be sensitive to change following ABCS.
Assuntos
Contorno Corporal , Humanos , Estudos Prospectivos , Cicatrização , Redução de PesoRESUMO
The effect of resistance training with higher- and lower-loads on muscle mass and strength has been extensively studied, while changes in muscle endurance have received less attention. This trial aimed to assess the effect of training load on absolute muscle endurance (AME) and relative muscle endurance (RME). Sixteen untrained women (22.7 ± 3.3 yr: mean ± SD) had one arm and leg randomly assigned to train with higher loads (HL; 80-90% 1RM), and the contralateral limbs trained with lower loads (LL; 30-50% 1RM) thrice weekly to volitional fatigue for 10 weeks. Heavy and light load AME and RME, strength, and muscle mass were assessed pre- and post-training. Strength increased more in the HL compared to LL leg (P < 0.01), but similar increases in strength were observed between upper body conditions (P = 0.46). Lower body heavy and light load AME improved in both conditions, but HL training induced a larger improvement in heavy load AME (HL: 9.3 ± 4.3 vs. LL: 7.5 ± 7.1 repetitions, time × limb P < 0.01) and LL training induced a larger improvement in light load AME (LL: 24.7 ± 22.2 vs. HL: 15.2 ± 16.7 repetitions, time × limb P = 0.04). In the upper body, HL and LL training induced similar increases in both heavy (time × limb P = 0.99), and light load (time × limb P = 0.16) AME. Dual-energy X-ray absorptiometry showed no change in leg fat-and-bone-free mass (FBFM) for either condition, and an increase in only LL arm FBFM. AME improved in a manner specific to the training loads used. ClinicalTrials.gov (NCT04547972).