Effects of activity pacing in patients with chronic conditions associated with fatigue complaints: a meta-analysis.

A meta-analysis was conducted to (1) determine the effect of activity pacing interventions on fatigue, physical functioning and physical activity among patients with chronic conditions associated with fatigue complaints, and to (2) examine potential moderator effects of trial characteristics (components of intervention and amount of patient-provider contact). Six studies were included in the meta-analysis. Relevant content of the studies was extracted and rated on methodological quality. Random-effects modeling was used to pool data across studies. Medium (standardized mean difference =0.50) and marginal (standardized mean difference =0.34) effects were found for fatigue at post-treatment and follow-up respectively. Inconsequential effects were found for physical functioning and activity (standardized mean difference =0.08-0.30) at both assessment points. Subgroup analyses revealed components of intervention and amount of patient-provider contact were not the source of variance. Minimal patient-provider contact had an effect on fatigue comparable in magnitude to more intensive contact. This meta-analysis of activity pacing in patients with fatigue complaints suggests that activity pacing might have sustained beneficial effects on fatigue management, in particular on fatigue reduction. The divergence in effects for all outcomes suggests that alternative ways such as tailoring advice to individual's behavior toward physical activity may be more successful.Implications for rehabilitationIn a relatively small sample this meta-analysis shows fatigue severity improved after activity pacing interventions and provides a basis to integrate activity pacing in activity stimulation programs for persons with chronic conditions.Activity pacing can feasibly be implemented within standard health care to manage fatigue and physical activity behaviors in persons with chronic conditions.

Feasibility of Three Novel Forms of Passive Exercise in a Multisensory Environment in Vulnerable Institutionalized Older Adults with Dementia.

BACKGROUND: Increasing physical activity levels in patients with dementia can reduce pathology severity and progression of the disease. However, physical activity programs can be challenging to adhere to for this vulnerable population. Three novel forms of passive exercise in a multisensory environment may be feasible alternatives for patients who can no longer be involved in physical activity. OBJECTIVE: To determine the feasibility of three different forms of passive exercise in a multisensory environment in inactive institutionalized older adults with dementia. METHODS: 120 patients with dementia participated in this single blind randomized controlled trial (64.5% female, age 85.3±6.8 years Mini-Mental State Examination range 0-29). Ninety participants were randomly assigned to one of the three intervention groups: Therapeutic Motion Simulation (TMSim), Whole Body Vibration (WBV), and TMSim + WBV. Participants received 6 weeks of passive exercise, 4 sessions a week, 4 (WBV) to 12 (TMSim and TMSim + WBV) minutes per session. Feasibility of the novel forms of passive exercise was evaluated based on attendance, compliance, (proxy) experience scores, adverse events and drop-out rates. RESULTS: On average 87.9% of the offered intervention sessions were attended. All three forms of passive exercise were well appreciated by the participants (7.3 on a scale from 0 to 10). Intervention related drop-out rates were reasonable (12.2%) and no serious adverse events occurred. CONCLUSION: The novel passive exercise interventions TMSim, WBV, and TMSim + WBV are feasible to apply in patients at all stages of dementia. More research is needed to establish effectiveness of passive exercise to limit adverse effects of dementia.

Beneficial Effects of Whole Body Vibration on Brain Functions in Mice and Humans.

The biological consequences of mechanical whole body vibration (WBV) on the brain are not well documented. The aim of the current study was to further investigate the effects of a 5-week WBV intervention on brain functions. Mice (C57Bl/6J males, age 15 weeks) were exposed to 30 Hz WBV sessions (10 minutes per day, 5 days per week, for a period of 5 weeks; n = 10). Controls received the same intervention without the actual vibration (n = 10). Humans (both genders, age ranging from 44-99 years) were also exposed to daily sessions of 30 Hz WBV (4 minutes per day, 4 days per week, for a period of 5 weeks; n = 18). Controls received the same protocol using a 1 Hz protocol (n = 16). Positron emission tomography imaging was performed in the mice, and revealed that glucose uptake was not changed as a consequence of the 5-week WBV intervention. Whole body vibration did, however, improve motor performance and reduced arousal-induced home cage activity. Cognitive tests in humans revealed a selective improvement in the Stroop Color-Word test. Taken together, it is concluded that WBV is a safe intervention to improve brain functioning, although the subtle effects suggest that the protocol is as yet suboptimal.

Passive exercise to improve quality of life, activities of daily living, care burden and cognitive functioning in institutionalized older adults with dementia - a randomized controlled trial study protocol.

BACKGROUND: Dementia affects cognitive functioning, physical functioning, activities of daily living (ADLs), and quality of life (QOL). Pharmacological treatments to manage, cure or prevent dementia remain controversial. Therefore development of non-pharmacological approaches to prevent, or at least delay the onset and progression of dementia is urgently needed. Passive exercise is proposed to be such a non-pharmacological alternative. This study primarily aims to investigate the effects of three different forms of passive exercise on QOL and ADLs of institutionalized patients with dementia. The secondary aims are to assess the effects of three different forms of passive exercise on cognitive functioning and physical functioning of institutionalized patients with dementia as well as on care burden of both the primary formal and primary informal caregivers of these patients. METHODS: This is a multicenter randomized controlled trial. Three forms of passive exercise are distinguished; motion simulation (MSim), whole body vibration (WBV), and a combination of both MSim + WBV. Intervention effects are compared to a control group receiving regular care. Institutionalized patients with dementia follow a six-week intervention program consisting of four 4-12 min sessions a week. The primary outcome measures QOL and ADLs and secondary outcome measure care burden are assessed with questionnaires filled in by the primary formal and informal caregivers of the patient. The other secondary outcome measures cognitive and physical functioning are assessed by individual testing. The four groups are compared at baseline, after 6 weeks of intervention, and 2 weeks after the intervention has ended. DISCUSSION: This study will provide insight in the effects of different forms of passive exercise on QOL, ADLs, cognitive and physical functioning and care burden of institutionalized patients with dementia and their primary formal and informal caregivers. The results of this study might support the idea that passive exercise can be an efficient alternative for physical activity for patients not able to be or stay involved in active physical exercise. TRIAL REGISTRATION: The Netherlands National Trial Register ( NTR6290 ). Retrospectively registered 29 March 2017.