Physical activity levels of individuals with chronic musculoskeletal disorders: Their relationship with barriers and facilitators.

BACKGROUND: Individuals with chronic musculoskeletal disorders (MSD) often avoid physical activity (PA) and exercise although these are the key factors in managing their condition and pain. OBJECTIVES: To determine the PA levels of individuals with chronic MSD and their relationship with barriers and facilitators. DESIGN: Three hundred and five subjects with five MSD groups; fibromyalgia, myofascial pain, osteoarthritis, periarticular regional pain and degenerative spine problems were included in the study. The visual analogue scale was used to assess pain, the Hospital Anxiety and Depression Scale to assess emotional impact, and the Nottingham Health Profile (NHP) to assess quality of life. PA levels were categorised by the International Physical Activity Questionnaire-Short Form. Perceived barriers and facilitators for PA/exercise were determined by questionnaire. RESULTS: 66 (21.6%) were male, 239 (78.4%) were female. 196 (64.3%) of the subjects were physically inactive, 94 (31.1%) low-active, and 15 (4.6%) sufficiently active. The most frequently reported barriers for PA/exercise were fatigue/feeling too tired (72.1%), pain (66.2%), and lack of motivation/willingness (54.4%). The most frequently reported facilitators were the desire to be in good health (72.8%), enjoying exercise (59.7%), and the desire to keep fit and lose weight (59%). CONCLUSION: The level of PA in individuals with MSD was quite low. Identifying the underlying causes of PA is important since PA/exercise is beneficial for musculoskeletal health. Yet, barriers and facilitators for PA were revealed for this study population. Identifying and understanding these barriers and facilitators would facilitate the individualised PA/exercise programs for both clinical practice and research.

Effects of pulmonary rehabilitation on diaphragm thickness and contractility in patients with chronic obstructive pulmonary disease.

BACKGROUND: Studies are showing that pulmonary rehabilitation (PR) increases diaphragmatic excursion by decreasing hyperinflation in patients with chronic obstructive pulmonary disease (COPD). However, there is a lack of knowledge about its effects on the diaphragm thickness (dt) and contractility. This study aims to evaluate the dt and contractility before and after PR in patients with COPD. METHODS: All subjects participated in an out-patient PR of 6 weeks and 3 sessions per week prospectively. Dyspnea severity, the disease-specific quality of life (St. Georges Respiratory Questionnaire-SGRQ), pulmonary function tests (PFT), exercise capacity, the dt at the end of the expiration and at maximal inspiration (B-mode ultrasound) were evaluated at baseline and after PR. RESULTS: A total of 34 patients with a mean age and FEV1 61.05 ± 8.22 years and 57.9 ± 20.4% predicted respectively showed improvements in exercise capacity and some items of PFT and SGRQ. Diaphragmatic thickness at the end of the expiration also significantly improved regardless of the disease severity and was positively correlated with functional performance. The 6-weeks of PR didn't result in a significant difference in diaphragm contractility.

Assessment for cardiovascular fitness in patients with stroke: which cardiopulmonary exercise testing method is better?

BACKGROUND: Assessment for cardiovascular disease (CVD) is important in stroke patients, both being one of the main factors limiting success in stroke rehabilitation and its increased risk in stroke patients. Reduced exercise capacity after stroke decreases patients' functionality and further increases the risk of CVD. Carefully selected cardiopulmonary exercise testing (CPET) can be safely used to determine the risk of CVD and to prescribe exercise program in stroke rehabilitation. OBJECTIVES: The primary purpose of this study is to determine the most appropriate CPET in patients with stroke. The secondary aim is to determine the relationship between cardiorespiratory fitness and functional status of the patients. METHODS: Two CPETs using treadmill and bicycle ergometer protocols determined with a preliminary study were performed on participants. The main outcome measure was VO2peak. Patients were also evaluated according to Brunnstrom motor staging, Modified Ashworth Scale, Berg Balance Scale, and Functional Independence Measure. RESULTS: In total, 38 patients reached higher VO2peak values at treadmill test compared to bicycle test (p < 0.001). The mean VO2peak reached at treadmill CPET was 62% of the control group where mean VO2peak reached at bicycle was 76% of the control group. No significant correlation was found between Brunnstrom staging, spasticity, Berg Balance Scale, and VO2peak . DISCUSSION: The results of this study indicate that CPET can be performed safely in stroke patients when appropriate protocol was selected and that treadmill was more appropriate to determine cardiorespiratory fitness in this study population.

Development and Validation of a Scale to Measure Fear of Activity in Patients With Coronary Artery Disease (Fact-CAD).

OBJECTIVE: To develop and validate a scale to measure fear of activity in patients with coronary artery disease. DESIGN: Psychometric study. SETTING: Outpatient cardiology clinics. PARTICIPANTS: The scale was applied to patients who had myocardial infarction, coronary artery bypass grafting, or percutaneous coronary intervention within the last 12 months (N=250). INTERVENTIONS: A scale for fear of activity in patients with coronary artery disease (Fact-CAD) was created through semistructured focus group interviews with patients. Face and content validity of Fact-CAD was verified. MAIN OUTCOME MEASURES: Psychometric analysis included model fit, unidimensionality, reliability, local dependency, differential item functioning, and external construct validity. Analyses were performed using the Rasch Analysis Model. RESULTS: Fact-CAD scale was a reliable (high Person Separation Index of 0.89) and valid (unidimensional, no misfit, local independency supported, no residual correlations) measure of fear of activity. Three items showed differential item functioning according to employment status, marital status, and angina pectoris, which were not assigned as real item bias by experts and remained in the model. CONCLUSION: Fact-CAD was supported by Rasch analysis as a psychometrically valid scale to evaluate fear of activity in patients with coronary artery disease.

Does aerobic exercise affect the hypothalamic-pituitary-adrenal hormonal response in patients with fibromyalgia syndrome?

[Purpose] The hypothalamic-pituitary-adrenal (HPA) axis in the etiopathogenesis of fibromyalgia is not clear. This study aimed to analyze the effects of a 6-week aerobic exercise program on the HPA axis in patients with fibromyalgia and to investigate the effects of this program on the disease symptoms, patients' fitness, disability, and quality of life. [Subjects and Methods] Fifty fibromyalgia patients were randomized to Group 1 (stretching and flexibility exercises at home for 6 weeks) and Group 2 (aerobic exercise three times a week and the same at-home exercises as Group 1 for 6 weeks). Serum levels of cortisol, adrenocorticotropic hormone, insulin-like growth factor-1, and growth hormone were analyzed at baseline and at the end of, and 1 hr after an exercise stress test. [Results] Group 2 showed better improvement in morning stiffness duration and pain. Growth hormone levels significantly increased after intervention and cortisol levels significantly decreased at time-time interaction in both groups. No significant differences in adrenocorticotropic hormone and insulin-like growth factor-1 were found. [Conclusion] The results of this study seem to support the hypothesis that there is a dysregulation of the HPA axis in patients with FM, and that a six-week exercise program can influence symptoms and affect the HPA axis hormones.

Assessment of the relatives or spouses cohabiting with the fibromyalgia patients: is there a link regarding fibromyalgia symptoms, quality of life, general health and psychologic status?

It was aimed to investigate the existence of the symptoms related to fibromyalgia in the first-degree relatives or spouses of the patients and to assess the psychologic and general health status of these individuals and the correlation of these with the patients' status. Thirty-seven patients with FS, 32 first-degree relatives or spouses of the patients and 30 healthy subjects as a control group were included. Symptoms related to FS were recorded in all subjects. Fibromyalgia Impact Questionnaire and Nottingham Health Profile were used to assess the components of functional status and quality of life. General health status was evaluated by General Health Questionnaire. Beck Depression Inventory and Beck Anxiety Inventory were used to assess the psychologic status. There were significant differences in the frequency of the symptoms between three groups (P < 0.05). Symptoms and signs related to of relatives/spouses of the patients and healthy controls were found to be significantly lower than those of the patients. GHQ, BAI and BDI scores of patients were found to be significantly higher than relative/spouses and control groups (P < 0.05). There were statistically significant differences between three groups in energy level, pain, sleep and physical abilities subscores of NHP (P < 0.05). No significant differences were detected in NHP subscores between relative/spouses of the patients and controls (P > 0.05). No fibromyalgia symptoms or signs were detected in the relatives/spouses. The general health status, psychologic status and quality of life were found to be not impaired in relatives/spouses of the patients with FS.

The utility of the Faces Pain Scale in the assessment of shoulder pain in Turkish stroke patients: its relation with quality of life and psychologic status.

This study was planned to investigate the utility of the vertical Faces Pain Scale (FPS) in the assessment of pain in stroke patients using the shoulder pain model and to assess its utility in the Turkish patient population. The secondary aim was to analyze the association of FPS with the quality of life and depression in the study population.Thirty stroke patients (group I) and 30 controls (group II),all suffering from shoulder pain were included in the study.The patients with subacute shoulder pain and with no other known diseases and impairments were recruited as a control group. Shoulder pain was evaluated by the commonly used pain scales including the Visual Analogue Scale, Likert Pain Scale and 0­10 Numerical Rating Scale besides FPS. Depression was screened using Beck Depression Inventory (BDI) and quality of life was evaluated using Short Form-36 (SF-36). FPS showed good correlations with the other pain scales in both the groups(r= 0.950­0.972 and 0.674­0.926, respectively). In group I,there were significant correlations between FPS and physical functioning, pain and emotional role subscales of SF-36 (r= ­ 0.432, 0.707 and ­ 0.461, respectively).Although there was a low correlation between the FPS and BDI scores, it was not statistically significant. In group II,FPS showed significant correlations with the BDI scores and all subscales of SF-36 except social functioning and vitality (r= ­ 0.679 to 0.848). FPS had a high degree of convergent validity and can be used in the assessment of shoulder pain in stroke patients. It may be a good alternative for pain assessment especially in patients with speech disorders and illiterate patients.