Does fear of activity predict exercise capacity in patients with coronary artery disease in both sexes? A cross-sectional multicenter study.

Objectives: This study aimed to identify whether fear of activity predicts exercise capacity in patients with coronary artery disease (CAD) and whether there is a difference between sexes regarding this relationship. Patients and methods: One hundred ninety-seven patients (145 males, 52 females; mean age: 56.3±10.8 years; range, 22 to 80 years) with a diagnosis of CAD or cardiac event in the previous one to 60 months were enrolled in this cross-sectional multicenter study between November 2015 and February 2017. Demographic and clinical features were recorded. Fear of activity was assessed by the fear of activity scale in patients with CAD (FactCAD). A 6-min walk test was used to assess exercise capacity. Results: Female participants were older, less educated, and less employed (p=0.045, p=0.048, and p<0.001, respectively) than males. Prevalence of myocardial infarction was higher in males. Comorbidities were higher in females. Multiple linear regression predicted 6-min walk distance (6MWD) based on FactCAD, sex, and education level with an r-squared of 0.321 (p<0.001). Fear of activity had an effect on walking distance in males (each additional score of FactCAD predicts a decrease of 1.3 m in 6MWD), together with disease duration, presence of chronic pulmonary disease, and low back pain, whereas fear of activity was not a predicting factor on walking distance in females. Age, education, and presence of angina predicted 6MWD in females. Conclusion: This study emphasizes that fear of activity is one of the predictors of 6MWD in males with CAD, and its assessment is recommended as a possible barrier to rehabilitation.

Comparison of the Effects of Myofascial Meridian Stretching Exercises and Acupuncture in Patients with Low Back Pain.

Background: Acupuncture and myofascial meridians show great anatomical and clinical compatibility. Objectives: We aimed to compare the effects of myofascial meridian stretching exercises and acupuncture in patients with low back pain. Methods: We randomized 81 subjects with acute/subacute low back pain into three groups: an acupuncture (A) group, a myofascial meridian stretching (MMS) group, and a control (C) group. We recorded the Numerical Rating Scale (NRS) and Roland- Morris Disability Questionnaire (RMQ) scores at baseline and weeks two and six. We evaluated posterior pelvic tilt and transversus abdominis muscle strenghth with a pressure biofeedback unit, back extensor muscle strength by the Sorenson test, and lumbar range of motion (ROM) with an inclinometer. Group A received acupuncture (BL 57 and BL 62 acupoints) and stretching exercises according to the posterior superficial line were applied to the MMS group. Results: Improvements in the NRS score were more prominent in group A than in group C (p = 0.004). The RMQ score improvement between baseline and weeks two and six was more prominent in groups A and MMS (p < 0.001, p = 0.001, respectively). The Sorenson test showed significant improvement between the baseline and week two in groups A and MMS (p = 0.004, p < 0.001, respectively). The increase in lumbar ROM measurement in the MMS group between baseline and week two was significantly higher than in groups A and C (p = 0.009, p < 0.001, respectively). Conclusion: Stretching exercises according to the myofascial meridian system and acupuncture contributed to improved symptoms in the first two weeks in patients with acute/subacute low-back pain.

Association between abdominal muscle activity and lumbar muscle morphology, and their role in the functional assessment of patients with low back pain: A cross-sectional study.

OBJECTIVES: The study aims to investigate the relationship between abdominal muscle activity and the cross-sectional area (CSA) of the lumbar muscles and assess their role in the functional assessment of patients with chronic non-specific low back pain (CNSLBP). METHODS: 142 patients with CNSLBP were included in this study. Disability levels were evaluated with the Roland-Morris Low Back Pain and Disability Questionnaire. The functional assessments of the participants were evaluated with a 6-minute walk test. Abdominal muscle activity was measured using a pressure biofeedback unit. The CSA of the bilateral multifidus, erector spinae, and psoas muscles were measured T2-weighted MRI images at the L2-L5 levels. RESULTS: Significant correlations were found between the abdominal muscle activity during the posterior pelvic tilt movement and the CSA of the erector spinae muscle at the L4 and L5 levels, and the psoas muscle at the L2-L5 levels (correlation coefficient range from 0.32 to 0.48). Abdominal muscle activity yielded a significant additional contribution to the variance on the functional assessment (R2 change=0.101). CONCLUSIONS: The relationship of abdominal muscle activity with lumbar muscles and the contribution of muscle activities to functional assessment should be considered in the management of patients with CNSLBP.

Exercise capacity in axial spondyloarthritis and associated factors: A cross-sectional controlled study.

OBJECTIVE: To examine the associations between exercise capacity (EC), cardiovascular (CV) risk factors and disease-related variables in axial spondyloarthritis (AxSpA) patients. METHODS: In this cross-sectional controlled study, CV risk profile data, physical activity, 10-year CV event risk estimated by the Framingham model and Ankylosing Spondylitis Disease Activity Score - C-reactive protein were recorded. A maximal treadmill exercise test by Bruce protocol was administered. Analyses of covariance were performed with adjustments for age, smoking status and physical activity level. Linear regression analysis was performed to study the association between EC and related CV risk factors. RESULTS: Thirty-eight patients and 38 age-gender matched controls were recruited between May and October 2014. Patients had significantly lower EC than controls (MD 2.2; metabolic equivalents 0.91-3.49; P = .001). The difference remained significant after adjustments (P = .001). There were significant correlations between EC and age, 10-year CV event risk, body mass index (BMI) and waist circumference for patients and controls (P < .001 and P < .05, respectively). There was a significant relationship between EC and total cholesterol, triglycerides and heart rate recovery (HRR) in patients (P = .04, P < .001 and P = .006, respectively). High-density lipoprotein - cholesterol was significantly higher, and BMI was significantly lower in nonradiographic AxSpA patients (P = .026 and P = .03 respectively). Age and triglyceride levels were found as the significant predictors for EC in the AxSpa group (for age ß = -.105, P = .003; for triglycerides ß = -.016 P = .003). CONCLUSION: Exercise capacity was significantly lower and attenuated HRR was significantly associated with low EC and high 10-year CV event risk in AxSpA patients.

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.

Breaking bad news in spinal cord injury; a qualitative study assessing the perspective of spinal cord injury survivors in Turkey.

Prior abstract publication: 2nd Medical Rehabilitation Congress; Nov 4-7, 2010; Ankara, Turkey Objective: This study aims to investigate the process of breaking bad news from the perspective of spinal cord injury survivors. DESIGN: A cross sectional, qualitative study. SETTING: Community. PARTICIPANTS: Fourteen spinal cord injury survivors. INTERVENTIONS: Subjects participated in a semi-structured interview about 'when', 'where' 'by whom' and 'how' they received and 'would' prefer to receive bad news. OUTCOME MEASURES: Answers to 'how' questions were coded according to SPIKES protocol (Setting, Perception, Invitation, Knowledge, Empathizing, Summary). RESULTS: Eight participants (57%) reported that they received bad news from a physician, mostly during rehabilitation. All would prefer to be informed by a physician and majority preferred to be gradually informed during rehabilitation. Half were not satisfied with the content of information. Only half felt that his/her physiatrist understood his/her emotional distress. Majority of participants who received bad news from physicians reported that the setting was private and their family members accompanied them. CONCLUSION: Most spinal cord injury survivors were unsatisfied with knowledge and emotional support provided by rehabilitation physicians. Participants would prefer to receive bad news by a senior physiatrist in a planned meeting during rehabilitation.

Effects of aerobic exercise on pain sensitivity, heart rate recovery, and health-related quality of life in patients with chronic musculoskeletal pain.

We aimed to investigate the effects of aerobic exercise on pain perception, sensitivity, and health-related quality of life; to assess its effect on parasympathetic tonus by analysis of heart rate recovery; and to examine the effects of parasympathetic tone on pain sensitivity in patients with chronic musculoskeletal pain. Fifty patients with chronic musculoskeletal pain were randomized into two groups: control group (C group) and aerobic exercise group (AE group). Both groups received conventional physical therapy for 2 weeks; the AE group performed submaximal aerobic exercise on a treadmill for 30 min additionally. Exercise test, pressure-pain threshold measurement, short form-36, and visual analog scale were administered initially and finally for evaluation. Visual analog scale scores in both groups decreased significantly after treatment (P<0.001). Pressure-pain threshold sum increased significantly in the AE group, remaining unchanged in the C group. Increase in exercise test duration was significant in the AE group compared with the C group (P=0.0002). Heart rate recovery did not change with therapy in the groups. For short form-36, the AE group showed alterations in role limitations because of physical problems and general health perceptions; both groups showed a significant improvement in the physical function and bodily pain subscales, but mental health significantly improved only in C group. Short-term aerobic exercise along with conventional physical therapy decreased pain sensitivity and increased aerobic capacity, with significant improvements in health-related quality of life.

Breaking bad news to patients with spinal cord injury in Turkey - physiatrists' perspective.

OBJECTIVE: To explore Turkish physiatrists' experiences and opinions about breaking bad news (BBN) to patients with spinal cord injury (SCI). DESIGN: A cross sectional study. SETTING: Turkey. PARTICIPANTS: Sixty-nine physiatrists completed a questionnaire about experiences and opinions regarding BBN and self-assessment of communication skills (CS). RESULTS: Eleven percent of specialists and 53% of residents were trained on basic CS. All participants believed that physiatrists should play a role in BBN and the majority reported that they delivered the bad news in their clinic. Sixty-seven percent believed that the primary responsibility belongs to physiatrists. Sixty-eight percent reported that the most appropriate time for BBN is during rehabilitation. Self-assessments of CS were considered satisfactory in most steps of SPIKES protocol. Twenty percent told absolute truth to patients while 80% stated that they did so sometimes or partially. Only 41% confirmed that they do not use unrealistic statements to comfort patients. Fewer than 60% stated that they performed the most appropriate and excellent behaviors for items in "empathy" section. CONCLUSION: Physiatrists had different opinions about the style of BBN. Self-assessments of CS were optimistic, however physiatrists were not fully satisfied with their empathy skills.

Risk factors associated with work-related musculoskeletal disorders in dentistry.

PURPOSE: To evaluate musculoskeletal system-related complaints; identify regions at risk in dentists by observing and inquiring the dentists at work; and find out the associations with age, sex, working years, academic position and departments, positions during work and daily working hours. METHODS: Modified Nordic Questionnaire (m-nMQ) was used to evaluate pain, hospital admissions and absenteeism. Quick Exposure Check (QEC) form was utilized to assess risk exposure levels related with low-back, neck, hand-wrist and shoulder-arm. RESULTS: 163 dentists were included the most painful regions were found to be back (66.9%), neck (65%) and low back (64.4%). Musculoskeletal symptoms were more prevalent in women and research assistants. QEC scores were found to be lower in those who performed regular exercises. CONCLUSION: Dentists should be educated about ergonomics at the beginning of their professional life.

The effect of 4-week aerobic exercise program on postural balance in postmenopausal women with osteoporosis.

The aim of this study is to evaluate the effect of submaximal aerobic exercise program on postural balance in postmenopausal women with osteoporosis. Twenty-five postmenopausal women without osteoporosis and 28 postmenopausal women with osteoporosis enrolled in this study. Balance ability of all subjects was measured by timed up and go test (TUG), four square step test (FSS), Berg balance scale (BBS) and Kinesthetic ability trainer 3000. After completion of initial measurements of balance, postmenopausal women with osteoporosis attended the submaximal aerobic exercise program on treadmill. At the end of the exercise program, balance tests were repeated. Balance tests of postmenopausal women without osteoporosis were repeated approximately 4-weeks after the initial measurement. There was statistically significant improvement in all balance scores in the postmenopausal women with osteoporosis after exercise training whereas there were no statistically significant differences in the scores of postmenopausal women without osteoporosis who did not exercise. This study showed that a 4-week submaximal aerobic exercise program provided significant improvements in static and dynamic balances in postmenopausal osteoporotic women.