Comparing exercises with and without electromyographic biofeedback in subacromial pain syndrome: A randomized controlled trial.

BACKGROUND: Deficits in movement and muscle activation of scapulohumeral joint are related to Subacromial Pain Syndrome. Electromyography biofeedback during exercise may enhance muscle activation and coordination, and consequently improve pain and shoulder function. METHODS: This study compared the effects of an exercise protocol with and without using electromyographic biofeedback on pain, function and movement of the shoulder complex in subjects with Subacromial Pain Syndrome. A total of 24 patients with subacromial pain (mean age = 46.2 + 8.1;18 women) were randomized to either therapeutic exercise or exercise plus biofeedback to the trapezius and serratus muscles. Pain and shoulder function were evaluated as the primary outcome and range of motion, muscle strength, electromyographic activity and scapulohumeral kinematics as secondary outcomes. The subjects underwent eight weeks of intervention and comparisons were made between groups in baseline, at 4 weeks, 8 weeks, and at 4 weeks post intervention. FINDINGS: There were differences between groups for pain [mean difference = 1.5 (CI 0.3, 3.2) p = 0.01] at 8 weeks in the Exercise group and scapular upward rotation at 60° of arm elevation [mean difference = 13.9 (CI 0.9, 9.3), p = 0.006] in the Biofeedback group. There was no difference for the other variables of scapular kinematics as well as for shoulder function (DASH), muscle strength, range of motion and electromyographic variables. INTERPRETATION: The addition of Biofeedback to the exercise protocol increased upward rotation of the scapula. However, the volunteers who performed only the Exercises had a better response in reducing pain.

International Exercise Recommendations in Older Adults (ICFSR): Expert Consensus Guidelines.

The human ageing process is universal, ubiquitous and inevitable. Every physiological function is being continuously diminished. There is a range between two distinct phenotypes of ageing, shaped by patterns of living - experiences and behaviours, and in particular by the presence or absence of physical activity (PA) and structured exercise (i.e., a sedentary lifestyle). Ageing and a sedentary lifestyle are associated with declines in muscle function and cardiorespiratory fitness, resulting in an impaired capacity to perform daily activities and maintain independent functioning. However, in the presence of adequate exercise/PA these changes in muscular and aerobic capacity with age are substantially attenuated. Additionally, both structured exercise and overall PA play important roles as preventive strategies for many chronic diseases, including cardiovascular disease, stroke, diabetes, osteoporosis, and obesity; improvement of mobility, mental health, and quality of life; and reduction in mortality, among other benefits. Notably, exercise intervention programmes improve the hallmarks of frailty (low body mass, strength, mobility, PA level, energy) and cognition, thus optimising functional capacity during ageing. In these pathological conditions exercise is used as a therapeutic agent and follows the precepts of identifying the cause of a disease and then using an agent in an evidence-based dose to eliminate or moderate the disease. Prescription of PA/structured exercise should therefore be based on the intended outcome (e.g., primary prevention, improvement in fitness or functional status or disease treatment), and individualised, adjusted and controlled like any other medical treatment. In addition, in line with other therapeutic agents, exercise shows a dose-response effect and can be individualised using different modalities, volumes and/or intensities as appropriate to the health state or medical condition. Importantly, exercise therapy is often directed at several physiological systems simultaneously, rather than targeted to a single outcome as is generally the case with pharmacological approaches to disease management. There are diseases for which exercise is an alternative to pharmacological treatment (such as depression), thus contributing to the goal of deprescribing of potentially inappropriate medications (PIMS). There are other conditions where no effective drug therapy is currently available (such as sarcopenia or dementia), where it may serve a primary role in prevention and treatment. Therefore, this consensus statement provides an evidence-based rationale for using exercise and PA for health promotion and disease prevention and treatment in older adults. Exercise prescription is discussed in terms of the specific modalities and doses that have been studied in randomised controlled trials for their effectiveness in attenuating physiological changes of ageing, disease prevention, and/or improvement of older adults with chronic disease and disability. Recommendations are proposed to bridge gaps in the current literature and to optimise the use of exercise/PA both as a preventative medicine and as a therapeutic agent.

Biodanza as a Nonpharmacological Dance Movement-Based Treatment in Older People With Alzheimer's Disease: An Italian Pilot Study in 2 Tuscan Nursing Homes.

The aim of this pilot, feasibility study was to assess health improvements in 16 institutionalized older people with Alzheimer's disease, after the Biodanza intervention, a nonpharmacological dance movement-based treatment. Biodanza significantly decreased agitated and neuropsychiatric behaviors. Effectiveness studies will be performed in order to assess the implication of such interventions.

A Randomized Controlled Trial on the Efficacy of Integrated Yoga on Pregnancy Outcome.

Physiological and biochemical changes occur in pregnancy to nurture the developing fetus. Pregnancy-related experience is unique to every woman. Pregnancy symptoms and complications can range from mild to severe. Many women can lower their risk by performing different therapies. In this context, the present study targets to evaluate the efficacy of integrated yoga consisting of (asanas and pranayama) on pregnancy to reduce the risk of complications. This study is a prospective randomized controlled single-blinded trial with parallel arms: the intervention arm received specific integrated yoga therapy; the control arm received routine standard care from 18 to 22 weeks of gestation until delivery. The incidence of preeclampsia and preterm delivery was lower in the intervention arm. Women in the intervention arm delivered at higher gestational age. Apgar scores and birth weights of neonates were significantly higher in the intervention arm. The findings suggest that yoga is a safe and effective intervention during pregnancy to reduce or prevent pregnancy-related complications. However, further randomized controlled trials are needed to provide firmer evidence regarding the utility and validity of yoga intervention during pregnancy.

Graded motor imagery training as a home exercise program for upper limb motor function in patients with chronic stroke: A randomized controlled trial.

PURPOSE: Although several types of occupational therapy for motor recovery of the upper limb in patients with chronic stroke have been investigated, most treatments are performed in a hospital or clinic setting. We investigated the effect of graded motor imagery (GMI) training, as a home exercise program, on upper limb motor recovery and activities of daily living (ADL) in patients with stroke. METHODS: This prospective randomized controlled trial recruited 42 subjects with chronic stroke. The intervention group received instruction regarding the GMI program and performed it at home over 8 weeks (30 minutes a day). The primary outcome measure was the change in motor function between baseline and 8 weeks, assessed the Manual Function Test (MFT) and Fugl-Meyer Assessment (FMA). The secondary outcome measure was the change in ADL, assessed with the Modified Barthel Index (MBI). RESULTS: Of the 42 subjects, 37 completed the 8-week program (17 in the GMI group and 20 controls). All subjects showed significant improvements in the MFT, FMA, and MBI over time (P < .05). However, the improvements in the total scores for the MFT, FMA, and MBI did not differ between the GMI and control groups. The MFT arm motion score for the GMI group was significantly better than that of the controls (P < .05). CONCLUSIONS: The GMI program may be useful for improving upper extremity function as an adjunct to conventional rehabilitation for patients with chronic stroke.

'Probably better than any medication we can give you': General practitioners' views on exercise and nutrition in cancer.

BACKGROUND AND OBJECTIVES: Exercise and healthy eating patterns are effective in improving health-related quality of life for patients with cancer. However, little is known about general practitioners' (GPs') views and experiences regarding providing exercise and nutrition recommendations to their patients with cancer. The aim of this study was to 1) report GPs' experiences of providing nutrition and exercise advice to their patients and 2) identify perceived barriers and enablers to implementation of exercise and nutrition advice throughout the cancer journey from the GP perspective. METHOD: Twenty-three semi-structured interviews were conducted, and transcripts coded by two independent researchers. A thematic analysis was performed to derive main themes. RESULTS: Four main themes were identified: the importance of exercise and nutrition recommendations for patients with cancer, the influence of the patient agenda, the influence of additional training or personal interest of the GP, and limitations of the primary care setting. DISCUSSION: Increased communication between primary and tertiary care, availability of resources, professional development opportunities and access to allied health services is needed to further support GPs to deliver exercise and nutrition information to their patients with cancer. This study provides evidence of GPs' desire to be involved in supporting the healthy exercise and nutrition habits of their patients with cancer and presents avenues for future research and resource development.

Practical implications for providing physical activity counseling for the older adult: An integrative review.

BACKGROUND: Physical inactivity in the older adult is associated with functional decline, increased fall risk, and threatens the ability of the older adult to live independently. Nurse practitioners, with their expertise in health promotion and chronic disease management, are well positioned to provide physical activity (PA) counseling. However, there is a gap in the literature describing a practical formula for providing PA counseling and PA prescriptions for clinical practice. OBJECTIVE: The objective of this integrative review was to synthesize the literature related to counseling interventions designed to increase PA among older adults and provide practical recommendations for incorporating recommendations into practice. DATA SOURCES: Five different databases were searched along with ancestry searching of relevant articles. Eligible studies tested methods of recommending PA for adults age ≥65 years, including in-person counseling, phone calls, written information, and exercise prescriptions. CONCLUSIONS: Health care providers are able to motivate older adults to increase PA in the short term. Diverse health care disciplines are efficacious at motivating older adults to increase PA. Various counseling interventions can be used with varying amounts of time investment. IMPLICATIONS FOR PRACTICE: Physical activity counseling is an underused but effective intervention for increasing PA in older adults. Older adults respond well to advice to increase their PA especially with the addition of a written exercise prescription. Basing PA counseling interventions on a theoretical construct such as social cognitive theory or transtheoretical stages of change theory improves the efficacy of the interventions.

ONS Guidelines™ for Cancer Treatment-Related Hot Flashes in Women With Breast Cancer and Men With Prostate Cancer.

PURPOSE: Hot flashes are a common and troublesome side effect of surgery or endocrine therapy. They may lead to physical and psychological distress and negatively affect quality of life. This clinical practice guideline presents evidence-based recommendations for pharmacologic, behavioral, and natural health product interventions for treatment-related hot flashes in patients with breast or prostate cancer. METHODOLOGIC APPROACH: An interprofessional panel of healthcare professionals with patient representation prioritized clinical questions and patient outcomes for the management of hot flashes. Systematic reviews of the literature were conducted. The GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach was used to assess the evidence and make recommendations. FINDINGS: The panel agreed on 14 pharmacologic, behavioral, and natural health recommendations. IMPLICATIONS FOR NURSING: Conditional recommendations include the use of antidepressants rather than no treatment, physical activity rather than no treatment, and the avoidance of gabapentin and dietary supplements in the treatment of hot flashes. SUPPLEMENTARY MATERIAL CAN BE FOUND AT&NBSP;HTTPS: //onf.ons.org/ons-guidelines-hot-flashes-supplementary-material.

EMS-effect of Exercises with Music on Fatness and Biomarkers of Obese Elderly Women.

Background and objectives: Electromyostimulation (EMS) has been shown to improve body composition, but what biomarkers it affects has not been investigated. The purpose of this study was to compare the EMS-effect of exercises with music on fatness and biomarker levels in obese elderly. Materials and Methods: Twenty-five women were randomly classified into a control group (CON) and EMS group (EMSG). EMS suits used in this study enabled the simultaneous activation of eight pairs with selectable intensities. Program sessions of EMS were combined with exercises of listening to music three times a week for eight weeks. Although both groups received the same program, CON did not receive electrical stimuli. Results: Compared with CON, a significant effect of the EMS intervention concerning decreased fatness, as well as an increased skeletal muscle mass and basal metabolic rate, were evident. Tumor necrosis factor-a, C-reactive protein, resistin, and carcinoembryonic antigen of biomarkers were significantly different in the groups by time interaction. Similarly, the positive changes caused by EMS were represented in lipoprotein-cholesterols. Conclusions: The results indicate that a significant effect due to the EMS intervention was found concerning body composition and biomarkers in obese elderly women.

Synergy Between Licensed Rehabilitation Professionals and Clinical Exercise Physiologists: Optimizing Patient Care for Cancer Rehabilitation.

OBJECTIVES: To differentiate between rehabilitation and exercise training and propose how rehabilitation professionals and exercise physiologists can collaborate to optimize cancer survivor care. DATA SOURCE: Professional organizations and peer-reviewed manuscripts. CONCLUSION: Both professions offer complementary skillsets that, when integrated, optimize the ability of the cancer care team to implement more effective survivorship care plans. Future models of care must incorporate efficient communications between the cancer rehabilitation program and oncology team, include various reimbursement/payment/funding options, and continuously assess program efficacy. IMPLICATIONS FOR NURSING PRACTICE: Nurses must be cognizant of physical needs (ie, functional and conditioning status) and cancer-related comorbidities when referring cancer survivors for exercise reconditioning.

The Role and Scope of Prehabilitation in Cancer Care.

OBJECTIVES: To recognize cancer prehabilitation as a pretreatment regimen to increase functional status for patients requiring cancer treatment. This article presents current evidence addressing the efficacy and benefits of prehabilitation regimens in different cancer survivor populations. DATA SOURCES: Studies and case reports in the PubMed database. CONCLUSION: Cancer prehabilitation may improve outcomes. Prehabilitation may include targeted or whole-body exercise, nutrition, education, psychologic counseling, and smoking cessation. Opportunities exist to further improve access to and delivery of multimodal prehabilitation, and nurses play a critical role in connecting patients to these services. IMPLICATIONS FOR NURSING PRACTICE: Oncology nurses who are knowledgeable of cancer treatment-related effects are poised to assess survivors for existing impairments, advocate for prehabilitation for existing and potential morbidities, and monitor functional status over time. As patient educators, they are key to informing cancer survivors about the role of prehabilitation.

2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.

OBJECTIVE: To develop an evidence-based guideline for the comprehensive management of osteoarthritis (OA) as a collaboration between the American College of Rheumatology (ACR) and the Arthritis Foundation, updating the 2012 ACR recommendations for the management of hand, hip, and knee OA. METHODS: We identified clinically relevant population, intervention, comparator, outcomes questions and critical outcomes in OA. A Literature Review Team performed a systematic literature review to summarize evidence supporting the benefits and harms of available educational, behavioral, psychosocial, physical, mind-body, and pharmacologic therapies for OA. Grading of Recommendations Assessment, Development and Evaluation methodology was used to rate the quality of the evidence. A Voting Panel, including rheumatologists, an internist, physical and occupational therapists, and patients, achieved consensus on the recommendations. RESULTS: Based on the available evidence, either strong or conditional recommendations were made for or against the approaches evaluated. Strong recommendations were made for exercise, weight loss in patients with knee and/or hip OA who are overweight or obese, self-efficacy and self-management programs, tai chi, cane use, hand orthoses for first carpometacarpal (CMC) joint OA, tibiofemoral bracing for tibiofemoral knee OA, topical nonsteroidal antiinflammatory drugs (NSAIDs) for knee OA, oral NSAIDs, and intraarticular glucocorticoid injections for knee OA. Conditional recommendations were made for balance exercises, yoga, cognitive behavioral therapy, kinesiotaping for first CMC OA, orthoses for hand joints other than the first CMC joint, patellofemoral bracing for patellofemoral knee OA, acupuncture, thermal modalities, radiofrequency ablation for knee OA, topical NSAIDs, intraarticular steroid injections and chondroitin sulfate for hand OA, topical capsaicin for knee OA, acetaminophen, duloxetine, and tramadol. CONCLUSION: This guideline provides direction for clinicians and patients making treatment decisions for the management of OA. Clinicians and patients should engage in shared decision-making that accounts for patients' values, preferences, and comorbidities. These recommendations should not be used to limit or deny access to therapies.

Training with FES-assisted cycling in a subject with spinal cord injury: Psychological, physical and physiological considerations.

CONTEXT: People with spinal cord injury (SCI) experience the effects of a sedentary lifestyle very early on. Literature data suggest that programs using FES-assisted cycling would contribute to reduce the consequences of physical inactivity. The objective was to assess the feasibility of 12-month training on a FES-assisted bike of a subject with paraplegia for 21 years, T3, Asia Impairment Scale (AIS) A. An evaluation of morbidity, self-esteem, satisfaction, quality of life and duration of pedaling was performed. The impact on pain, cardiorespiratory function, body composition and bone metabolism were also assessed. FINDINGS: The acceptability score of the training constraints increased from 51 to 59/65 and satisfaction was high around 8/10. The pedaling duration increased from 1' to 26' on the recumbent bike and from 1' to 15' on open terrain. No significant changes were found with BMD and cardiorespiratory measures during exercise tests. SF 36 showed significant improvement of more than 10% and the Rosenberg Self Esteem score rapidly improved from 36 to 39/40. At the end of the training, the patient reached the objective of the Cybathlon 2016 by covering 750 m in less than 8 minutes, at an average speed of 5.80 km/hr. CONCLUSION/CLINICAL RELEVANCE: A person with high and complete level of SCI for more than 20 years can undertake this type of challenge if the prerequisites are met; this training is without danger if the safety precautions are respected; the challenge of participating in a competition had a powerful impact on JP's self-esteem and perceived quality of life.

Exercise is medicine in oncology: Engaging clinicians to help patients move through cancer.

Multiple organizations around the world have issued evidence-based exercise guidance for patients with cancer and cancer survivors. Recently, the American College of Sports Medicine has updated its exercise guidance for cancer prevention as well as for the prevention and treatment of a variety of cancer health-related outcomes (eg, fatigue, anxiety, depression, function, and quality of life). Despite these guidelines, the majority of people living with and beyond cancer are not regularly physically active. Among the reasons for this is a lack of clarity on the part of those who work in oncology clinical settings of their role in assessing, advising, and referring patients to exercise. The authors propose using the American College of Sports Medicine's Exercise Is Medicine initiative to address this practice gap. The simple proposal is for clinicians to assess, advise, and refer patients to either home-based or community-based exercise or for further evaluation and intervention in outpatient rehabilitation. To do this will require care coordination with appropriate professionals as well as change in the behaviors of clinicians, patients, and those who deliver the rehabilitation and exercise programming. Behavior change is one of many challenges to enacting the proposed practice changes. Other implementation challenges include capacity for triage and referral, the need for a program registry, costs and compensation, and workforce development. In conclusion, there is a call to action for key stakeholders to create the infrastructure and cultural adaptations needed so that all people living with and beyond cancer can be as active as is possible for them.

Thermotherapy Combined With Therapeutic Exercise Improves Muscle Strength and Depression in Patients With Ischemic Stroke.

PURPOSE: The study examined the effect of home-based thermotherapy combined with therapeutic exercise on muscle strength and depression in patients with ischemic stroke via a weekly evaluation over 4 weeks. DESIGN/METHODS: A quasi-experimental, pre-/posttest research design without a control group was employed. A total of 22 patients participated. Self-reported daily logs were used to evaluate intervention adherence over the study period. The manual muscle testing and Aphasic Depression Rating Scale were administered at baseline and weekly for 4 weeks. RESULTS: Muscle strength in both the upper and lower limbs significantly increased (p < .05), whereas the depression score significantly decreased (p < .05). CONCLUSION: The intervention increased muscle strength and decreased depression during the first 3 months after stroke onset. The significant effects were found beginning during the third week of the intervention. CLINICAL RELEVANCE: This intervention is inexpensive and can be easily applied by caregivers at home.

Videogames in the Treatment of Obstructive Respiratory Diseases: A Systematic Review.

Introduction: Millions of people suffer from obstructive respiratory conditions globally. Including videogames in rehabilitation programs can be an interesting alternative to traditional programs or a complementary activity. Objective: To explore the use of videogames in the treatment of patients with obstructive respiratory diseases. Methods: A systematic literature search was performed to identify randomized clinical trials evaluating the effects of videogames on health outcomes in patients with respiratory obstructive diseases. The following databases were searched: PubMed, Web of Science, ScienceDirect, and Scopus. The methodological quality of the studies included was assessed with the Downs and Black quality assessment method. Results: Nine articles were included, of which three used videogames as physical training methods and managed to improve exercise capacity, strength, quality of life, and symptoms. The remaining six articles used videogames to educate patients about the disease and showed slight improvements in knowledge of the disease and use of medication. Conclusion: The results of this review show that videogames are a very useful complementary therapy. They can contribute to enhance rehabilitation programs, as they improve exercise capacity, muscle strength, quality of life, severity, control, and knowledge of the disease. Videogames should be supervised by a professional so that programs can be tailored to patients, proposing different activities in the game and controlling the correct performance, and generating an increase in adherence to treatment. Registry: prospective register of systematic reviews (PROSPERO) CRD42018094094.

Supplementation of Adiantum capillus-veneris Modulates Alveolar Apoptosis under Hypoxia Condition in Wistar Rats Exposed to Exercise.

Background and Objectives: Several studies have reported that some conditions such as exercise and hypoxia induce DNA damage and dysfunction and apoptosis. Some plant foods contain numerous bioactive compounds and anti-inflammatory properties that can help fight DNA damage. Therefore, the current study evaluated the effect of supplementation of Adiantum capillus-veneris (ACV) extract on Bax/B-cell lymphoma 2 (Bcl-2) ratio apoptotic index and remodeling of pulmonary alveolar epithelial cells in lung tissue of healthy Wistar rats during stressful conditions (hypoxia). Materials and Methods: Twenty-seven Wistar male rats (four-week old, 72 ± 9 g) were randomly assigned into three groups: normoxic, sedentary, and not-supplemented (NG, n = 9); exercise and hypoxia and not-supplemented (HE, n = 9); and exercise and hypoxia and supplemented group (HS, n = 9). The NG remained sedentary in the normoxia environment for nine weeks. The HE group participated in a high-intensity (IT) program for six weeks, then remained sedentary in the hypoxia environment for three weeks. The low-pressure chamber simulated a ~2800 M altitude 24 h/d. HS participated in IT, then entered and remained sedentary in the hypoxia environment for three weeks, and they consumed 500 mg per kg of body weight ACV extract. Results: The Bax/Bcl-2 ratio of the HE group increased significantly (+50.27%, p ≤ 0.05), the average number of type I pneumocytes was reduced significantly (-18.85%, p ≤ 0.05), and the average number of type II pneumocytes was increased significantly (+14.69%, p ≤ 0.05). Also, after three weeks of consuming the ACV extract, the HS group in comparison with the HE group had their Bax/Bcl-2 ratio reduced significantly (-24.27%, p ≤ 0.05), the average number of type I pneumocytes increased significantly (+10.15%, p ≤ 0.05), and the average number of type II pneumocytes reduced significantly (-7.18%, p ≤ 0.05). Conclusion: The findings show that after three weeks of hypoxia following six weeks of high-intensity interval training in Wistar rats, the Bax/Bcl-2 ratio and the number of type II pneumocytes were increased and the number of type I pneumocytes was reduced significantly. These results strongly suggest that an apoptosis state was induced in the lung parenchyma, and consuming ACV extract modulated this state.

Aquatic Exercise Program for Individuals With Osteoarthritis: Pain, Stiffness, Physical Function, Self-Efficacy.

PURPOSE: This research was conducted to determine the effects of an aquatic exercise program on pain, stiffness, physical function, and self-efficacy in individuals with osteoarthritis. DESIGN: A randomized controlled trial. METHODS: Participants in the experimental group participated in the aquatic exercise program three times a week for 8 weeks; participants in the control group did not. FINDINGS: The mean scores of the experimental group on the pain, stiffness, and difficulty in carrying out physical functions subscales of the Western Ontario and McMaster Universities Osteoarthritis Index decreased significantly, whereas those of the control group decreased very little. The mean scores of the experimental group on the Arthritis Self-Efficacy Scale and the isokinetic muscle strength measurements increased, but those of the control group did not change in the final measurements. The difference between the groups was statistically significant. CONCLUSIONS: Through the study, it was determined that the aquatic exercise program decreased pain, stiffness, and difficulty in carrying out physical functions and increased self-efficacy and muscle strength of individuals with osteoarthritis. CLINICAL RELEVANCE: The aquatic exercise program can be used by nurses as a reference in the management of osteoarthritic patients' health status.