Examining the relationships between environmental barriers and leisure in community-dwelling individuals living with stroke.

OBJECTIVE:: To characterize environmental barriers to leisure participation among individuals living with stroke; examine relationships between environmental barriers and leisure interest and satisfaction; and investigate participant factors associated with the perception of environmental barriers. DESIGN:: Survey. SETTING:: Community. PARTICIPANTS:: Convenience sample of 51 community-dwelling adults less than six months post stroke. INTERVENTIONS:: Not applicable. MAIN OUTCOME MEASURE(S):: Craig Hospital Inventory of Environmental Factors-Short Form. RESULTS:: Physical and structural environmental barriers were reported as the most frequent and large barrier to leisure participation ( n = 26 (51%) rated as "monthly or more," n = 12 (24%) rated as "big problem"). While attitude and support and policy barriers were not as commonly encountered, participants labeled these as "big problem(s)" (attitude and support n = 6 (12%), policy n = 7 (14%)). The presence of depressive symptoms was associated with the frequency in which attitudinal and support (rho = 0.50, P < 0.001), physical and structural (rho = 0.46, P < 0.001), and service and assistance (rho = 0.28, P = 0.04) barriers were reported, as well as magnitude of attitude and support barriers (rho = 0.48, P < 0.001). In multivariable regression analysis, depressive symptoms and walking capacity explained 21% of the variance of the frequency of attitude and support barriers ( P = 0.004), where depressive symptoms was an independent correlate ( P = 0.004). No other factors were associated with environmental barriers to leisure participation. CONCLUSION:: Individuals with stroke report frequent and large physical and structural environmental barriers to leisure participation, which may be associated with the presence of depressive symptoms.

Effects of whole-body vibration on balance and mobility in institutionalized older adults: a randomized controlled trial.

OBJECTIVE: To investigate whether a comprehensive exercise program was effective in improving physical function among institutionalized older adults and whether adding whole-body vibration to the program conferred additional therapeutic benefits. DESIGN: A single-blinded randomized controlled trial was conducted. SETTING: This study was carried out in residential care units. PARTICIPANTS: In total, 73 older adults (40 women, mean age: 82.3 ± 7.3 years) were enrolled into this study. INTERVENTIONS: Participants were randomly allocated to one of the three groups: strength and balance program combined with whole-body vibration, strength and balance program without whole-body vibration, and social and recreational activities consisting of upper limb exercises only. All participants completed three training sessions per week for eight weeks. OUTCOME MEASURES: Assessment of mobility, balance, lower limb strength, walking endurance, and self-perceived balance confidence were conducted at baseline and immediately after the eight-week intervention. Incidences of falls requiring medical attention were recorded for one year after the end of the training period. RESULTS: A significant time × group interaction was found for lower limb strength (five-times-sit-to-stand test; P = 0.048), with the exercise-only group showing improvement (pretest: 35.8 ± 16.1 seconds; posttest: 29.0 ± 9.8 seconds), compared with a decline in strength among controls (pretest: 27.1 ± 10.4 seconds; posttest: 28.7 ± 12.3 seconds; P = 0.030). The exercise with whole-body vibration group had a significantly better outcome in balance confidence (pretest: 39.2 ± 29.0; posttest: 48.4 ± 30.6) than the exercise-only group (pretest: 35.9 ± 24.8; posttest: 38.2 ± 26.5; P = 0.033). CONCLUSION: The exercise program was effective in improving lower limb strength among institutionalized older adults but adding whole-body vibration did not enhance its effect. Whole-body vibration may improve balance confidence without enhancing actual balance performance.

Effects of whole body vibration on muscle spasticity for people with central nervous system disorders: a systematic review.

OBJECTIVES: To examine the effects of whole-body vibration on spasticity among people with central nervous system disorders. METHODS: Electronic searches were conducted using CINAHL, Cochrane Library, MEDLINE, Physiotherapy Evidence Database, PubMed, PsycINFO, SPORTDiscus and Scopus to identify randomized controlled trials that investigated the effect of whole-body vibration on spasticity among people with central nervous system disorders (last search in August 2015). The methodological quality and level of evidence were rated using the PEDro scale and guidelines set by the Oxford Centre for Evidence-Based Medicine. RESULTS: Nine trials with totally 266 subjects (three in cerebral palsy, one in multiple sclerosis, one in spinocerebellar ataxia, and four in stroke) fulfilled all selection criteria. One study was level 1b (PEDro⩾6 and sample size>50) and eight were level 2b (PEDro<6 or sample size ⩽50). All three cerebral palsy trials (level 2b) reported some beneficial effects of whole-body vibration on reducing leg muscle spasticity. Otherwise, the results revealed no consistent benefits on spasticity in other neurological conditions studied. There is little evidence that change in spasticity was related to change in functional performance. The optimal protocol could not be identified. Many reviewed studies were limited by weak methodological and reporting quality. Adverse events were minor and rare. CONCLUSION: Whole-body vibration may be useful in reducing leg muscle spasticity in cerebral palsy but this needs to be verified by future high quality trials. There is insufficient evidence to support or refute the notion that whole-body vibration can reduce spasticity in stroke, spinocerebellar ataxia or multiple sclerosis.

Optimal frequency/time combination of whole body vibration training for developing physical performance of people with sarcopenia: a randomized controlled trial.

OBJECTIVE: To determine whether frequency and exposure time to whole body vibration influenced its effects on physical performance in seniors with sarcopenia. DESIGN: Randomized controlled trial Setting: A university sports training laboratory. SUBJECTS: Eighty community dwelling seniors with sarcopenia were recruited. INTERVENTIONS: Participants were randomly divided into 4 groups, namely, low-frequency (LG: 20Hz x 720s), medium-frequency (MG: 40Hz x 360s), high-frequency (HG: 60Hz x 240s) and control (CG: no extra training) for 12 weeks of whole body vibration training and 12 weeks of follow-up. MAIN MEASURES: Assessments were done at baseline, mid-intervention, post-intervention, mid-follow-up, and final follow-up for five-repetition sit-to-stand, 10-meter walking test with self-preferred speed and timed-up-and-go test. RESULTS: There was significant time × group interaction effect in timed-up-and-go test (F12, 304 = 3.333, effect size = 0.116, p < 0.001). Between-group differences in percentage change from baseline were significant between medium-frequency group and control group on all outcome variables after 12-week whole body vibration training (Five-repetition sit-to-stand test: 10.46 ± 2.28 (-16.12%), p = 0.008; 10-meter walking test: 1.05 ± 0.16 (11.18%), p = 0.04; Timed-up-and-go test: 11.32 ± 1.72 (-15.08%), p = 0.001). CONCLUSION: With the total number of vibrations controlled, the combination of 40Hz and 360s of whole body vibration has the best outcome on physical performance of people with sarcopenia.

Core stability exercise is as effective as task-oriented motor training in improving motor proficiency in children with developmental coordination disorder: a randomized controlled pilot study.

OBJECTIVE: To compare the effectiveness of a core stability program with a task-oriented motor training program in improving motor proficiency in children with developmental coordination disorder (DCD). DESIGN: Randomized controlled pilot trial. SETTING: Outpatient unit in a hospital. PARTICIPANTS: Twenty-two children diagnosed with DCD aged 6-9 years were randomly allocated to the core stability program or the task-oriented motor program. INTERVENTION: Both groups underwent their respective face-to-face training session once per week for eight consecutive weeks. They were also instructed to carry out home exercises on a daily basis during the intervention period. MAIN MEASURES: Short Form of the Bruininks-Oseretsky Test of Motor Proficiency (Second Edition) and Sensory Organization Test at pre- and post-intervention. RESULTS: Intention-to-treat analysis revealed no significant between-group difference in the change of motor proficiency standard score (P=0.717), and composite equilibrium score derived from the Sensory Organization Test (P=0.100). Further analysis showed significant improvement in motor proficiency in both the core stability (mean change (SD)=6.3(5.4); p=0.008) and task-oriented training groups (mean change(SD)=5.1(4.0); P=0.007). The composite equilibrium score was significantly increased in the task-oriented training group (mean change (SD)=6.0(5.5); P=0.009), but not in the core stability group (mean change(SD) =0.0(9.6); P=0.812). In the task-oriented training group, compliance with the home program was positively correlated with change in motor proficiency (ρ=0.680, P=0.030) and composite equilibrium score (ρ=0.638, P=0.047). CONCLUSION: The core stability exercise program is as effective as task-oriented training in improving motor proficiency among children with DCD.

Physical exercise attenuates cognitive decline and reduces behavioural problems in people with mild cognitive impairment and dementia: a systematic review.

QUESTIONS: What is the effect of physical exercise on cognitive decline and behavioural problems in people with mild cognitive impairment (MCI) or dementia? What is the effect of physical exercise on particular domains of cognitive function? How do training protocols and patients' characteristics influence the outcomes? DESIGN: Systematic review and meta-analysis of randomised trials. PARTICIPANTS: People with MCI or dementia as their primary diagnosis. INTERVENTION: Physical exercise. OUTCOME MEASURES: Cognitive function including global cognition, memory, executive function, reasoning, attention, language, and behavioural problems. RESULTS: Forty-six trials involving 5099 participants were included in this review. Meta-analysis of the data estimated that aerobic exercise reduced the decline in global cognition, with a standardised mean difference (SMD) of 0.44, 95% CI 0.27 to 0.61, I2 = 69%. For individual cognitive functions, meta-analysis estimated that exercise lessened working memory decline (SMD 0.28, 95% CI 0.04 to 0.52, I2 = 40%). The estimated mean effect on reducing the decline in language function was favourable (SMD 0.17), but this estimate had substantial uncertainty (95% CI -0.03 to 0.36, I2 = 67%). The effects of exercise on other cognitive functions were unclear. Exercise also reduced behavioural problems (SMD 0.36, 95% CI 0.07 to 0.64, I2 = 81%). CONCLUSION: Physical exercise can reduce global cognitive decline and lessen behavioural problems in people with MCI or dementia. Its benefits on cognitive function can be primarily attributed to its effects on working memory. Aerobic exercise at moderate intensity or above and a total training duration of > 24 hours can lead to a more pronounced effect on global cognition.

Physical exercise improves strength, balance, mobility, and endurance in people with cognitive impairment and dementia: a systematic review.

QUESTION: Does physical exercise training improve physical function and quality of life in people with cognitive impairment and dementia? Which training protocols improve physical function and quality of life? How do cognitive impairment and other patient characteristics influence the outcomes of exercise training? DESIGN: Systematic review with meta-analysis of randomised trials. PARTICIPANTS: People with mild cognitive impairment or dementia as the primary diagnosis. INTERVENTION: Physical exercise. OUTCOME MEASURES: Strength, flexibility, gait, balance, mobility, walking endurance, dual-task ability, activities of daily living, quality of life, and falls. RESULTS: Forty-three clinical trials (n=3988) were included. According to the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) system, the meta-analyses revealed strong evidence in support of using supervised exercise training to improve the results of 30-second sit-to-stand test (MD 2.1 repetitions, 95% CI 0.3 to 3.9), step length (MD 5cm, 95% CI 2 to 8), Berg Balance Scale (MD 3.6 points, 95% CI 0.3 to 7.0), functional reach (3.9cm, 95% CI 2.2 to 5.5), Timed Up and Go test (-1second, 95% CI -2 to 0), walking speed (0.13m/s, 95% CI 0.03 to 0.24), and 6-minute walk test (50m, 95% CI 18 to 81) in individuals with mild cognitive impairment or dementia. Weak evidence supported the use of exercise in improving flexibility and Barthel Index performance. Weak evidence suggested that non-specific exercise did not improve dual-tasking ability or activity level. Strong evidence indicated that exercise did not improve quality of life in this population. The effect of exercise on falls remained inconclusive. Poorer physical function was a determinant of better response to exercise training, but cognitive performance did not have an impact. CONCLUSION: People with various levels of cognitive impairment can benefit from supervised multi-modal exercise for about 60minutes a day, 2 to 3days a week to improve physical function. [Lam FMH , Huang MZ, Liao LR, Chung RCK, Kwok TCY, Pang MYC (2018) Physical exercise improves strength, balance, mobility, and endurance in people with cognitive impairment and dementia: a systematic review. Journal of Physiotherapy 64: 4-15].

Optimal frequency/time combination of whole-body vibration training for improving muscle size and strength of people with age-related muscle loss (sarcopenia): A randomized controlled trial.

AIM: To determine the optimal combination of frequency and exposure time of a whole-body vibration (WBV) training program for improving muscle performance of older people with age-related muscle loss. METHODS: A total of 80 community-dwelling older adults with age-related muscle loss were randomly divided into four equal groups, namely, low-frequency long duration (20 Hz × 720 s), medium-frequency medium duration (40 Hz × 360 s), high-frequency short duration (60 Hz × 240 s) and control (no training) for 12-week WBV training and 12-week follow up. Assessments were carried out at baseline, mid-intervention, post-intervention, mid-follow up, follow up for the cross-sectional area of the vastus medialis, isometric knee extension strength at 90°, and isokinetic knee extension at 60°/s and 180°/s. RESULTS: There was a significant time × group interaction effect in isokinetic knee extension at 180°/s. Significant time effects were found in all muscle strength outcome variables. Group differences in percentage change from baseline were significant between medium-frequency medium duration and control on isokinetic knee extension at 180°/s and 60°/s. No changes were found in the cross-sectional area of the vastus medialis. CONCLUSIONS: With the total number of vibrations controlled, the combination of 40 Hz and 360 s of WBV exercise had the best outcome among all other combinations tested. The improvements in knee extension performance can be maintained for 12 weeks after cessation of WBV training. Geriatr Gerontol Int 2017; 17: 1412-1420.

Reducing sedentary time and fat mass may improve glucose tolerance and insulin sensitivity in adults surviving 6 months after stroke: A phase I pilot study.

INTRODUCTION: Deranged glycaemic control is common post-stroke, increasing risks of recurrent stroke and development of diabetes. The aim of the study is to examine glucose metabolism in relation to body composition, physical activity and sedentary time post-stroke. PATIENTS AND METHODS: Observational study: Non-diabetic adults, unable to walk independently, were recruited within 2 weeks of first stroke. Primary outcome: 2-h glucose level (mmol/l, oral glucose tolerance test), assessed at baseline and 6 months. Homeostasis Model Assessment of Insulin Sensitivity, total body fat and lean mass (dual energy X-ray absorptiometry), sedentary time (lying or sitting), standing and walking (PAL2 accelerometer) were assessed at baseline, 1, 3 and 6 months. Generalised estimating equations were used to examine change over time and associations between outcome measures. RESULTS: Thirty-six participants (69.5 years (standard deviation 11.7), 13 (36.1%) female, moderate stroke severity (National Institute of Health Stroke Scale 11.5 (interquartile range 9.75, 16)). Within 6 months, adjusting for age and National Institute of Health Stroke Scale, every month 2-h glucose reduced by 4.5% (p < 0.001), Homeostasis Model Assessment of Insulin Sensitivity improved 3% (p = 0.04) and fat mass decreased 490 g (95% confidence interval 325, 655; p = 0.01). For every extra kilogram of body fat, 2-h glucose increased by 1.02 mmol/L (95% confidence interval 1.01, 1.02; p = 0.001); Homeostasis Model Assessment of Insulin Sensitivity reduced by 0.98% (95% confidence interval 0.97, 0.99; p = 0.001). Time spent sedentary reduced from 98.5% of measurement period (interquartile range 94.3, 99.8) to 74.3% (interquartile range 65.5, 88.6), by 2.8% monthly (95% confidence interval 1.8, 3.9, p < 0.001). For every additional 5% sedentary time, 2-h glucose increased by 1.05 mmol/L (95% confidence interval 1.04, 1.07; p < 0.001). CONCLUSION: Reducing sedentary time and fat mass within 6 months of stroke may improve glucose tolerance and insulin resistance.

Whole body vibration therapy in fracture prevention among adults with chronic disease.

Due to various physical impairments, individuals with chronic diseases often live a sedentary lifestyle, which leads to physical de-conditioning. The associated muscle weakness, functional decline and bone loss also render these individuals highly susceptible to falls and fragility fractures. There is an urgent need to search for safe and effective intervention strategies to prevent fragility fractures by modifying the fall-related risk factors and enhancing bone health. Whole body vibration (WBV) therapy has gained popularity in rehabilitation in recent years. In this type of treatment, mechanical vibration is delivered to the body while the individual is standing on an oscillating platform. As mechanical loading is one of the most powerful stimuli to induce osteogenesis, it is proposed that the mechanical stress applied to the human skeleton in WBV therapy might be beneficial for enhancing bone mass. Additionally, the vibratory signals also constitute a form of sensory stimulation and can induce reflex muscle activation, which could potentially induce therapeutic effects on muscle strength and important sensorimotor functions such as postural control. Increasing research evidence suggests that WBV is effective in enhancing hip bone mineral density, muscle strength and balance ability in elderly patients, and could have potential for individuals with chronic diseases, who often cannot tolerate vigorous impact or resistance exercise training. This article aims to discuss the potential role of WBV therapy in the prevention of fragility fractures among people with chronic diseases.

Tibial bone geometry in chronic stroke patients: influence of sex, cardiovascular health, and muscle mass.

This study aimed to examine the geometry of the tibia in chronic stroke survivors. Fifty-five ambulatory individuals with chronic stroke were included in the study. pQCT was used to obtain a cross-sectional scan of the tibia at the 30% site on both the paretic and nonparetic sides. Leg lean mass was derived from a total body scan using DXA. Each subject was also evaluated for peak oxygen consumption rate, spasticity, and functional mobility. Paired t-tests were used to compare the pQCT parameters between the two sides. Multiple linear regression analysis was used to identify the significant determinants of tibial bone strength index (BSI). In men, marrow cavity area on the paretic side was significantly greater than the nonparetic side (p = 0.011), whereas the total bone area showed no significant side-to-side difference (p = 0.252). In women, total bone area on the paretic side was significantly smaller than the nonparetic side (p = 0.003), whereas the marrow cavity area had no side-to-side difference (p = 0.367). Peak oxygen consumption (r(2) = 0.739, F(5,49) = 22.693, p < 0.001) and paretic leg lean mass (r(2) = 0.802, F(6,48) = 32.475, p < 0.001) remained independently associated with tibial BSI, after controlling for age, sex, body mass index, years since stroke onset, and physical activity level. The geometry of the tibia in stroke patients showed sex-specific side-to-side differences. The results suggested that, whereas endosteal resorption was apparent in men, periosteal resorption was more predominant in women. The results also highlight the potential importance of promoting cardiovascular health and leg muscle mass in enhancing bone geometry in chronic stroke survivors.