Preparation and support for physical activity following hospital discharge after coronary artery bypass graft surgery: A survey of current practice in New Zealand.

BACKGROUND AND PURPOSE: Engagement in physical activity following coronary artery bypass graft (CABG) surgery has many benefits and also many potential barriers, especially during the first few months. It is important to explore current clinical practice before investigating ways to optimally prepare and support people to progressively increase their physical activity post-hospital discharge and to navigate the challenges. The aim of the study was to explore current practice in New Zealand hospital services for preparing and supporting people who have had CABG surgery to engage in physical activity following hospital discharge. METHODS: Locality authorisation to participate in the study was sought from all 11 hospitals providing cardiac surgery services in New Zealand. The most senior health professional responsible for preparing people to engage in physical activity following CABG surgery was invited to participate by completing a purpose designed questionnaire on behalf of their hospital service. Respondents were also requested to provide any patient information handouts regarding progressive physical activity engagement following CABG surgery. RESULTS: Responses were received from all nine hospitals that granted locality authorisation. All nine hospitals prepared people to engage in aerobic exercise prior to discharge, predominantly through the provision of a walking schedule. In contrast, no hospitals provided information about engagement in resistance exercise. There was wide variability in both the advice provided regarding sternal precautions and time to return to activities of daily living. Additionally, the facilitation of some elements of self-management for physical activity, in particular problem solving and providing follow up support outside of the cardiac rehabilitation setting was provided infrequently. DISCUSSION: The findings demonstrated variability in service delivery in a number of areas and highlighted potential areas for improvement in light of what is known from the literature. Provision of follow up support for those unable to access outpatient cardiac rehabilitation is a key need.

Adding self-management of chronic conditions to fall prevention: A feasibility study.

OBJECTIVE: Assess feasibility and impact of adding a long-term condition self-management program (Living a Healthy Life, LHL) into Steady as You Go (SAYGO) fall prevention exercise classes. METHODS: Four-day LHL leader training workshop to deliver six weekly program. Focus groups explored feasibility and acceptability. Chronic disease self-efficacy, balance confidence, health behaviours and status were measured at 6 weeks, 3, 6 and 12 months. RESULTS: Four leaders and 17 participants volunteered. Focus groups revealed that becoming a leader was considered stressful. Participants valued discussions about managing health, strategies for better communication with doctors, keeping track of medications, action plans and nutrition labels. Between 6-week and 12-month follow-up, self-rated health increased. CONCLUSION: Although participants valued LHL information, the low participation rates, time commitment and stress of becoming a leader and leading classes suggest that adding LHL to other fall prevention programs will need further consideration around integration of the programs.

The effectiveness of behaviour change interventions to increase physical activity participation in people with multiple sclerosis: a systematic review and meta-analysis.

OBJECTIVE: A systematic review and meta-analysis was conducted to illustrate whether people with multiple sclerosis engage in more physical activity following behaviour change interventions. DATA RESOURCES: MEDLINE, CINAHL, PubMed, Web of Sciences, Cochrane Library, SCOPUS, EMBASE and PEDro were searched from their inception till 30 April 2015. TRIAL SELECTION: Randomized and clinical controlled trials that used behaviour change interventions to increase physical activity in people with multiple sclerosis were selected, regardless of type or duration of multiple sclerosis or disability severity. DATA EXTRACTION: Data extraction was conducted by two independent reviewers and the Cochrane Collaboration's recommended method was used to assess the risk of bias of each included study. RESULTS: A total of 19 out of 573 studies were included. Focusing on trials without risk of bias, meta-analysis showed that behaviour change interventions can significantly increase physical activity participation (z = 2.20, p = 0.03, standardised main difference 0.65, 95% confidence interval 0.07 to 1.22, 3 trials, I(2) = 68%) (eight to 12 weeks' duration). Behaviour change interventions did not significantly impact on the physical components of quality of life or fatigue. CONCLUSION: Behaviour change interventions provided for relatively short duration (eight to 12 weeks) may increase the amount of physical activity people with multiple sclerosis engage in, but appear to have no effect on the physical components of quality of life and fatigue. Further high quality investigations of the efficacy of behaviour change interventions to increase physical activity participation that focus on dose, long-term impact and method of delivery are warranted for people with multiple sclerosis.

Prevention of falls for adults with intellectual disability (PROFAID): a feasibility study.

PURPOSE: A novel physiotherapy intervention for people with intellectual disability (ID) to improve balance was developed and evaluated in a feasibility study which quantitatively assessed potential benefits on measures of balance, gait and activity participation, and qualitatively explored its acceptability, utility and feasibility. METHODS: Participants were 27 adults with mild to profound ID (mean age 53 years SD 10.9). We used a mixed methods approach: an uncontrolled before-after study (data analysed with the related samples sign test) and a qualitative interview evaluation (data analysed with the general inductive approach). Balance, gait and participation were assessed at baseline and 6 months after introduction of the physiotherapy intervention with four standardised measures and two questionnaires. RESULTS: Appropriate exercises and a physical activity could be found for all participants, irrespective of the level of ID, although for many this required a high level of assistance from support staff. Only the Balance Scale for ID changed significantly by a median score of 2 (95% CI = 0.00-2.50, p = 0.04). No other outcomes changed significantly. Four themes emerged: "Understanding the intervention"; "Routine and reality"; "Remembering what I have to do" and "What happens beyond the study itself"? CONCLUSIONS: The findings provide some evidence for the benefit, acceptability, utility and feasibility of the intervention justifying further evaluation. IMPLICATIONS FOR REHABILITATION: Falling is a frequent and serious problem for many adults with intellectual disability. Two to three exercises targeted at increasing lower limb strength and challenging balance, performed each day as part of daily routine may help improve balance in adults with intellectual disability. The importance of exercising needs to be stressed to those who support adults with intellectual disability to encourage ongoing adherence.

Fall-Related Injuries in a Cohort of Community-Dwelling Older Adults Attending Peer-Led Fall Prevention Exercise Classes.

BACKGROUND AND PURPOSE: To investigate reported injuries and circumstances and to estimate the costs related to falls experienced by older adults participating in Steady As You Go (SAYGO) peer-led fall prevention exercise classes. METHODS: A 12-month prospective cohort study of 207 participants attending community-based SAYGO classes in Dunedin, New Zealand. Types and costs of medical treatment for injuries and circumstances of falls were obtained via standardized fall event questionnaires and phone-administered questionnaires. RESULTS: Eighty-four percent completed the study (160 females, 14 males, mean age = 77.5 [standard deviation = 6.5] years). More than a third of the total falls (55/148 total falls, 37%) did not result in any injuries. Most injuries (45%, n = 67) were sprains, grazes, and bruises. Medical attention was sought 26 times (18%), out of which 6 participants (4%) reported fractures (none femoral). The majority of falls occurred while walking. More falls and injuries occurred outdoors (n = 55). The number of times medical treatment was sought correlated with the number of falls in the previous year (r = 0.50, P = .02). The total number of years attending SAYGO was a significant predictor of lower total number of injuries (stepwise regression ß = -0.157, t = -1.99, P = .048). The total cost of medical treatment across all reported injurious falls was estimated at NZ$6946 (US$5415). DISCUSSION: Older adults participating in SAYGO appear to sustain less severe injuries following a fall than previously reported. More falls and injuries occurred outdoors, suggesting better overall health of these participants. The role of long-term participation in fall prevention exercise classes on injurious falls warrants further investigation.

Long-term participation in peer-led fall prevention classes predicts lower fall incidence.

OBJECTIVE: To investigate the association between length of participation in Steady As You Go (SAYGO) peer-led fall prevention exercise classes for older adults and 12-month fall incidence. DESIGN: Twelve-month prospective cohort study. SETTING: Community settings. PARTICIPANTS: Older adults (N=207; 189 women, 18 men) aged ≥ 65 y (mean age ± SD, 77.7 ± 6.6 y) actively participating in SAYGO classes. INTERVENTION: Peer-led fall prevention exercise classes. MAIN OUTCOME MEASURES: Twelve-month prospective fall incidence data were collected by monthly calendars. Falls in the previous year and number of years of SAYGO participation were obtained by baseline questionnaire. Class attendance was monitored weekly by class attendance records. RESULTS: Mean length ± SD of SAYGO participation was 4.3 ± 2.5 years (range, 1-10 y). Average class attendance was 69%. Crude fall rate was .75 per person-year. Fall incidences at 12 and 24 months were highly correlated (r=.897, P<.001). Longer SAYGO participation (≥ 3 y) resulted in a lower 12-month fall incidence (incidence rate ratio, .90; 95% confidence interval, .82-.99; P=.03) compared with a shorter duration of participation (1-2 y). CONCLUSIONS: SAYGO appears to be an effective fall prevention intervention with a high attendance rate and a lower fall incidence with long-term participation. Prospective controlled studies on long-term participation in peer-led fall prevention exercise programs are needed to confirm and extend these findings.

Healthcare provider beliefs about exercise and fatigue in people with multiple sclerosis.

This study describes the experiences of four groups of healthcare providers who facilitate exercise interventions for people with multiple sclerosis (MS)-related fatigue. Fatigue is a complex symptom frequently experienced by people with MS, yet it is poorly understood by clinicians and clinical researchers. Historically, clinicians have recommended less physical activity in order to limit fatigue; however, recent experimental studies suggest that regular exercise provides health benefits with little increase in fatigue. We used interpretive description methodology to guide data collection and analysis. Four groups of healthcare providers participated in either focus group discussions or individual interviews. Transcripts were analyzed for key meanings. Healthcare providers described their perceptions of the "nature of fatigue" and how this raised "professional challenges," specifically "barriers to implementation" of interventions, "stirring conflict" among interdisciplinary members, and "modifying roles." The nature of fatigue and professional challenges influenced clinician practice by "demanding creativity" with regard to exercise prescription and advice. Healthcare providers are encouraged to consider strategies of active listening and careful observation when providing individualized exercise programs for people with MS-related fatigue. In addition, recognition and understanding of the complex nature of fatigue by the interdisciplinary team might facilitate more positive exercise experiences for this population.

How does fatigue influence community-based exercise participation in people with multiple sclerosis?

PURPOSE: Regular exercise is considered important for long-term health outcomes and fatigue management in persons with multiple sclerosis (MS); however, little is known about the experiences of individuals with MS-related fatigue, who participate in community-based exercise activities. The aim of this study was to describe the experiences of people with MS-related fatigue, who engaged in community-based exercise activities in order to discover how fatigue influenced their exercise participation. METHOD: In this study, we used qualitative methodology based on the interpretive description approach to collect and analyse data. Individuals with MS, who experienced fatigue and regularly participated in community-based exercise activities, were interviewed. Interviews were audiotaped and transcribed verbatim. Data were analysed using an inductive thematic approach with multi-step verification strategies. RESULTS: We found that perceived control over MS-related fatigue influenced exercise choices in our participants. Furthermore, perceived control over fatigue was influenced by seven factors: wellness philosophy, a related goal, belief that control was possible, feeling safe and supported, ability to manage limits, being satisfied with trade-offs and positive definition of self. CONCLUSION: Identification of factors influencing perceived control over fatigue will assist health care providers when facilitating community exercise choices for people with MS.

The impact of bilateral therapy on upper limb function after chronic stroke: a systematic review.

PURPOSE: To determine the evidence for bilateral therapy interventions aimed at improving upper limb (UL) function in adults with a range of UL activity limitations due to a first time chronic stroke. METHOD: Seven databases were searched prior to 2008 for articles reporting experimental studies investigating bilateral UL interventions on functional outcome in participants with a first stroke, 6 or more months prior. Included articles were evaluated with the quality index, a tool which evaluates the quality of both randomised and non-randomised studies. Data relating to study design and functional outcome were extracted. RESULTS: Nine articles were included; three reported on randomised controlled trials (RCT) and six on cohort studies. Eight studies incorporated a mechanical device as their bilateral intervention. Bilateral arm training with rhythmic auditory cueing (BATRAC) was the most commonly used mechanically based intervention, and three of the four uncontrolled BATRAC studies reported significant improvements in UL function post-intervention, however these results were not substantiated by a RCT study of the BATRAC intervention. One study demonstrated significant functional improvements after 6 days of training with a non-mechanical bilateral task. Of the four studies that performed a follow-up assessment, three reported significant improvement in UL function. Quality index ratings of the included studies ranged from 18 to 25 out of 27. CONCLUSION: There is some evidence that bilateral therapy improves function in adults with chronic stroke, however more quality RCTs are required to strengthen this evidence.