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1.
Nutrients ; 13(4)2021 Mar 28.
Artículo en Inglés | MEDLINE | ID: mdl-33800577

RESUMEN

Nowadays, it is accepted that the regular practice of exercise and branched-chain amino acids supplementation (BCAAs) can benefit the immune responses in older persons, prevent the occurrence of physical frailty (PF), cognitive decline, and aging-related comorbidities. However, the impact of their combination (as non-pharmacological interventions) in albumin and the inflammatory markers is not fully understood. Therefore, we investigated the effect of a 40-week multifactorial intervention [MIP, multicomponent exercise (ME) associated or not with BCAAs] on plasma levels of inflammatory markers and albumin in frail older persons (≥75 years old) living at residential care homes (RCH). This study consisted of a prospective, naturalistic, controlled clinical trial with four arms of multifactorial and experimental (interventions-wahshout-interventions) design. The intervention groups were ME + BCAAs (n = 8), ME (n = 7), BCAAs (n = 7), and control group (n = 13). Lower limb muscle-strength, cognitive profile, and PF tests were concomitantly evaluated with plasma levels of albumin, anti- and pro-inflammatory cytokines [Interleukin-10 (IL-10) and Tumor Necrosis Factor-alpha (TNF-α) respectively], TNF-α/IL-10 ratio, and myeloperoxidase (MPO) activity at four different time-points: Baseline (T1), after 16 weeks of multifactorial intervention (T2), then after a subsequent 8 weeks washout period (T3) and finally, after an additional 16 weeks of multifactorial intervention (T4). Improvement of cognitive profile and muscle strength-related albumin levels, as well as reduction in the TNF-α levels were found particularly in ME plus BCAAs group. No significant variations were observed over time for TNF-α/IL-10 ratio or MPO activity. Overall, the study showed that MIP triggered slight alterations in the inflammatory and physical function of the frail older participants, which could provide independence and higher quality of life for this population.


Asunto(s)
Aminoácidos de Cadena Ramificada/administración & dosificación , Suplementos Dietéticos , Terapia por Ejercicio/métodos , Fragilidad/prevención & control , Albúmina Sérica/metabolismo , Anciano , Anciano de 80 o más Años , Envejecimiento/fisiología , Biomarcadores/sangre , Cognición/fisiología , Disfunción Cognitiva/prevención & control , Citocinas/sangre , Femenino , Anciano Frágil , Evaluación Geriátrica , Humanos , Masculino , Fuerza Muscular/fisiología , Peroxidasa/sangre , Ensayos Clínicos Pragmáticos como Asunto , Estudios Prospectivos , Calidad de Vida
2.
Medicine (Baltimore) ; 100(17): e25523, 2021 Apr 30.
Artículo en Inglés | MEDLINE | ID: mdl-33907101

RESUMEN

BACKGROUND: The pediatric lung transplant is a very important treatment for patients with end-stage lung diseae, and pulmonary rehabilitation (PR) is also an important factor in determining the prognosis. However, there is no much literature available on pulmonary rehabilitation in pediatric patients' post lung transplant. Through this case report, we would like to present our intensive PR program for pediatric patients' post-lung transplant. PATIENT CONCERNS: The 10-year-old boy's breathing before receiving a lung transplant continued to deteriorate and he eventually became dependent on a wheelchair. DIAGNOSIS: He was diagnosed with infantile acute lymphoblastic leukemia at 6 months of age. At the age of one year, he underwent allogeneic bone marrow transplantation, but was diagnosed with post-transplantation bronchiolitis obliterans (PTBO) two months later. He had a lung transplant at the age of 10. INTERVENTIONS: He was hospitalized and received an initial assessment. This assessment included functional, cognitive, and psychological evaluations. He additionally completed PR exercises twice daily for two weeks. After discharge, he continued to participate in an outpatient-based PR program for three months. During the outpatient phase, PR exercises were performed once weekly, in addition to home-based cognitive training. OUTCOMES: Our intensive post-lung PR program improved our patient's exercise capacity, lung function, and quality of life. As a comprehensive rehabilitation service, our program also included a cognitive training component. CONCLUSION: We describe an intensive PR program tailored to pediatric patients' post-lung transplant. The program was feasible and resulted in improvements in functional exercise capacity, lung function, and quality of life. Future research into our method is necessary for continued improvement of this novel program.


Asunto(s)
Bronquiolitis Obliterante/cirugía , Terapia por Ejercicio/métodos , Trasplante de Pulmón/rehabilitación , Terapia Respiratoria/métodos , Trasplante de Médula Ósea/efectos adversos , Bronquiolitis Obliterante/etiología , Bronquiolitis Obliterante/fisiopatología , Niño , Tolerancia al Ejercicio , Humanos , Pulmón/fisiopatología , Masculino , Leucemia-Linfoma Linfoblástico de Células Precursoras/terapia , Resultado del Tratamiento
4.
JAMA ; 325(13): 1266-1276, 2021 04 06.
Artículo en Inglés | MEDLINE | ID: mdl-33821898

RESUMEN

Importance: Supervised high-intensity walking exercise that induces ischemic leg symptoms is the first-line therapy for people with lower-extremity peripheral artery disease (PAD), but adherence is poor. Objective: To determine whether low-intensity home-based walking exercise at a comfortable pace significantly improves walking ability in people with PAD vs high-intensity home-based walking exercise that induces ischemic leg symptoms and vs a nonexercise control. Design, Setting, and Participants: Multicenter randomized clinical trial conducted at 4 US centers and including 305 participants. Enrollment occurred between September 25, 2015, and December 11, 2019; final follow-up was October 7, 2020. Interventions: Participants with PAD were randomized to low-intensity walking exercise (n = 116), high-intensity walking exercise (n = 124), or nonexercise control (n = 65) for 12 months. Both exercise groups were asked to walk for exercise in an unsupervised setting 5 times per week for up to 50 minutes per session wearing an accelerometer to document exercise intensity and time. The low-intensity group walked at a pace without ischemic leg symptoms. The high-intensity group walked at a pace eliciting moderate to severe ischemic leg symptoms. Accelerometer data were viewable to a coach who telephoned participants weekly for 12 months and helped them adhere to their prescribed exercise. The nonexercise control group received weekly educational telephone calls for 12 months. Main Outcomes and Measures: The primary outcome was mean change in 6-minute walk distance at 12 months (minimum clinically important difference, 8-20 m). Results: Among 305 randomized patients (mean age, 69.3 [SD, 9.5] years, 146 [47.9%] women, 181 [59.3%] Black patients), 250 (82%) completed 12-month follow-up. The 6-minute walk distance changed from 332.1 m at baseline to 327.5 m at 12-month follow-up in the low-intensity exercise group (within-group mean change, -6.4 m [95% CI, -21.5 to 8.8 m]; P = .34) and from 338.1 m to 371.2 m in the high-intensity exercise group (within-group mean change, 34.5 m [95% CI, 20.1 to 48.9 m]; P < .001) and the mean change for the between-group comparison was -40.9 m (97.5% CI, -61.7 to -20.0 m; P < .001). The 6-minute walk distance changed from 328.1 m at baseline to 317.5 m at 12-month follow-up in the nonexercise control group (within-group mean change, -15.1 m [95% CI, -35.8 to 5.7 m]; P = .10), which was not significantly different from the change in the low-intensity exercise group (between-group mean change, 8.7 m [97.5% CI, -17.0 to 34.4 m]; P = .44). Of 184 serious adverse events, the event rate per participant was 0.64 in the low-intensity group, 0.65 in the high-intensity group, and 0.46 in the nonexercise control group. One serious adverse event in each exercise group was related to study participation. Conclusions and Relevance: Among patients with PAD, low-intensity home-based exercise was significantly less effective than high-intensity home-based exercise and was not significantly different from the nonexercise control for improving 6-minute walk distance. These results do not support the use of low-intensity home-based walking exercise for improving objectively measured walking performance in patients with PAD. Trial Registration: ClinicalTrials.gov Identifier: NCT02538900.


Asunto(s)
Terapia por Ejercicio/métodos , Enfermedad Arterial Periférica/terapia , Caminata , Anciano , Biopsia , Femenino , Humanos , Isquemia/terapia , Extremidad Inferior/irrigación sanguínea , Extremidad Inferior/patología , Masculino , Músculo Esquelético/patología , Enfermedad Arterial Periférica/patología , Enfermedad Arterial Periférica/fisiopatología , Prueba de Paso
5.
BMJ ; 373: n740, 2021 04 06.
Artículo en Inglés | MEDLINE | ID: mdl-33824131

RESUMEN

OBJECTIVE: To test whether StandingTall, a home based, e-health balance exercise programme delivered through an app, could provide an effective, self-managed fall prevention programme for community dwelling older people. DESIGN: Assessor blinded, randomised controlled trial. SETTING: Older people living independently in the community in Sydney, Australia. PARTICIPANTS: 503 people aged 70 years and older who were independent in activities of daily living, without cognitive impairment, progressive neurological disease, or any other unstable or acute medical condition precluding exercise. INTERVENTIONS: Participants were block randomised to an intervention group (two hours of StandingTall per week and health education; n=254) or a control group (health education; n=249) for two years. MAIN OUTCOME MEASURES: The primary outcomes were the rate of falls (number of falls per person year) and the proportion of people who had a fall over 12 months. Secondary outcomes were the number of people who had a fall and the number who had an injurious fall (resulting in any injury or requiring medical care), adherence, mood, health related quality of life, and activity levels over 24 months; and balance and mobility outcomes over 12 months. RESULTS: The fall rates were not statistically different in the two groups after the first 12 months (0.60 falls per year (standard deviation 1.05) in the intervention group; 0.76 (1.25) in the control group; incidence rate ratio 0.84, 95% confidence interval 0.62 to 1.13, P=0.071). Additionally, the proportion of people who fell was not statistically different at 12 months (34.6% in intervention group, 40.2% in control group; relative risk 0.90, 95% confidence interval 0.67 to 1.20, P=0.461). However, the intervention group had a 16% lower rate of falls over 24 months compared with the control group (incidence rate ratio 0.84, 95% confidence interval 0.72 to 0.98, P=0.027). Both groups had a similar proportion of people who fell over 24 months (relative risk 0.87, 95% confidence interval 0.68 to 1.10, P=0.239), but the proportion of people who had an injurious fall over 24 months was 20% lower in the intervention group compared with the control group (relative risk 0.80, 95% confidence interval 0.66 to 0.98, P=0.031). In the intervention group, 68.1% and 52.0% of participants exercised for a median of 114.0 min/week (interquartile range 53.5) after 12 months and 120.4 min/week (38.6) after 24 months, respectively. Groups remained similar in mood and activity levels. The intervention group had a 0.03 (95% confidence interval 0.01 to 0.06) improvement on the EQ-5D-5L (EuroQol five dimension five level) utility score at six months, and an improvement in standing balance of 11 s (95% confidence interval 2 to 19 s) at six months and 10 s (1 to 19 s) at 12 months. No serious training related adverse events occurred. CONCLUSIONS: The StandingTall balance exercise programme did not significantly affect the primary outcomes of this study. However, the programme significantly reduced the rate of falls and the number of injurious falls over two years, with similar but not statistically significant effects at 12 months. E-health exercise programmes could provide promising scalable fall prevention strategies. TRIAL REGISTRATION: ACTRN12615000138583.


Asunto(s)
Accidentes por Caídas/prevención & control , Terapia por Ejercicio/métodos , Telemedicina/métodos , Heridas y Traumatismos/prevención & control , Accidentes por Caídas/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Humanos , Vida Independiente , Masculino , Cooperación del Paciente/estadística & datos numéricos , Estudios Prospectivos , Calidad de Vida , Método Simple Ciego , Resultado del Tratamiento , Heridas y Traumatismos/epidemiología , Heridas y Traumatismos/etiología
6.
Top Spinal Cord Inj Rehabil ; 27(1): 121-134, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33814890

RESUMEN

Background: Physical deconditioning and inactivity following spinal cord injury (SCI) are associated with multiple cardiometabolic risks. To mitigate cardiometabolic risk, exercise is recommended, but it is poorly established whether arm cycling exercise (ACE) or functional electrical stimulation (FES) leg cycling yields superior benefits. Objectives: To determine the adaptations of 16 weeks of FES cycling and ACE on exercise energy expenditure (EEE), cardiorespiratory fitness (CRF), and obesity after SCI. Methods: Thirteen physically untrained individuals were randomly assigned to FES (n = 6) or ACE (n = 7) exercise 5 days/week for 16 weeks. Pre- and post-intervention EEE, peak oxygen consumption (absolute and relative VO2Peak), and work were assessed using indirect calorimetry, while body composition was measured by dual-energy x-ray absorptiometry. Results: Main effects were found for peak power (p < .001), absolute (p = .046) and relative (p = .042) VO2Peak, and peak work (p = .013). Compared to baseline, the ACE group increased in EEE (+85%, p = .002), peak power (+307%, p < .001), VO2Peak (absolute +21%, relative +22%, p ≤ .024), peak work (19% increase, p = .003), and total body fat decreased (-6%, p = .05). The FES group showed a decrease in percentage body fat mass (-5%, p = .008). The ACE group had higher EEE (p = .008), peak power (p < .001), and relative VO2Peak (p = .025) compared to postintervention values in the FES group. Conclusion: In the current study, ACE induced greater increases in EEE and CRF, whereas ACE and FES showed similar results on body fat. Exercise promotional efforts targeting persons with SCI should use both FES and ACE to reduce sedentary behavior and to optimize different health parameters after SCI.


Asunto(s)
Composición Corporal/fisiología , Capacidad Cardiovascular/fisiología , Terapia por Estimulación Eléctrica/métodos , Metabolismo Energético/fisiología , Terapia por Ejercicio/métodos , Obesidad/terapia , Traumatismos de la Médula Espinal/terapia , Adulto , Enfermedades Cardiovasculares/prevención & control , Terapia Combinada , Prueba de Esfuerzo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Obesidad/etiología , Obesidad/fisiopatología , Consumo de Oxígeno/fisiología , Traumatismos de la Médula Espinal/complicaciones , Traumatismos de la Médula Espinal/fisiopatología , Adulto Joven
7.
Top Spinal Cord Inj Rehabil ; 27(1): 109-120, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33814889

RESUMEN

Spinal cord injury (SCI) results in an array of cardiometabolic complications, with obesity being the most common component risk of cardiometabolic disease (CMD) in this population. Recent Consortium for Spinal Cord Medicine Clinical Practice Guidelines for CMD in SCI recommend physical exercise as a primary treatment strategy for the management of CMD in SCI. However, the high prevalence of obesity in SCI and the pleiotropic nature of this body habitus warrant strategies for tailoring exercise to specifically target obesity. In general, exercise for obesity management should aim primarily to induce a negative energy balance and secondarily to increase the use of fat as a fuel source. In persons with SCI, reductions in the muscle mass that can be recruited during activity limit the capacity for exercise to induce a calorie deficit. Furthermore, the available musculature exhibits a decreased oxidative capacity, limiting the utilization of fat during exercise. These constraints must be considered when designing exercise interventions for obesity management in SCI. Certain forms of exercise have a greater therapeutic potential in this population partly due to impacts on metabolism during recovery from exercise and at rest. In this article, we propose that exercise for obesity in SCI should target large muscle groups and aim to induce hypertrophy to increase total energy expenditure response to training. Furthermore, although carbohydrate reliance will be high during activity, certain forms of exercise might induce meaningful postexercise shifts in the use of fat as a fuel. General activity in this population is important for many components of health, but low energy cost of daily activities and limitations in upper body volitional exercise mean that exercise interventions targeting utilization and hypertrophy of large muscle groups will likely be required for obesity management.


Asunto(s)
Metabolismo Energético , Terapia por Ejercicio/métodos , Obesidad/complicaciones , Obesidad/terapia , Traumatismos de la Médula Espinal/complicaciones , Traumatismos de la Médula Espinal/terapia , Humanos , Conducta Sedentaria
8.
Medicine (Baltimore) ; 100(17): e25730, 2021 Apr 30.
Artículo en Inglés | MEDLINE | ID: mdl-33907166

RESUMEN

BACKGROUND: Sleep disorders after stroke is one of the most common neuropsychiatric complications and is associated with increased risk of death and poor functional outcomes. Some evidence shows that patients with sleep disorders after stroke benefit from exercise intervention. However, this result is still conflicting. This study aims to explore the effects of exercise on sleep disorders after stroke and to establish safe and effective exercise prescriptions. METHODS AND ANALYSIS: The databases including Google Scholar, Pubmed, Embase, and Cochrane library will be searched using pre-specified search strategies. Randomized controlled trials and non-randomized prospective controlled cohort studies regarding exercise for sleep disorders after stroke will be included. The primary outcome is the Pittsburgh Sleep Quality Index (PSQI) scale. The secondary outcomes are adverse events associated with exercise and all deaths. The methodological quality of each study will be evaluated by the physiotherapy evidence database scale. The heterogeneity will be evaluated using the I2 test. If I2 > 50%, random effects models will be used in the analysis; otherwise, fixed effects models will be used to pool the data. RESULTS: This study will assess the efficacy and safety of exercise for sleep disorders after stroke. CONCLUSIONS: Our findings will be helpful for clinicians to examine the clinical decision-making in the treatment of sleep disorders after stroke using exercise intervention. ETHICS AND DISSEMINATION: Ethical approval is not required because this study is a secondary analysis. The results of this study will be disseminated through journals and academic exchanges. SYSTEMATIC REVIEW REGISTRATION NUMBER: INPLASY202130106.


Asunto(s)
Terapia por Ejercicio/métodos , Trastornos del Sueño-Vigilia , Rehabilitación de Accidente Cerebrovascular , Accidente Cerebrovascular/complicaciones , Humanos , Metaanálisis como Asunto , Proyectos de Investigación , Trastornos del Sueño-Vigilia/etiología , Trastornos del Sueño-Vigilia/psicología , Trastornos del Sueño-Vigilia/terapia , Accidente Cerebrovascular/psicología , Rehabilitación de Accidente Cerebrovascular/métodos , Rehabilitación de Accidente Cerebrovascular/psicología , Revisiones Sistemáticas como Asunto , Resultado del Tratamiento
11.
Medicine (Baltimore) ; 100(8): e24864, 2021 Feb 26.
Artículo en Inglés | MEDLINE | ID: mdl-33663110

RESUMEN

BACKGROUND: This study aimed to describe the effects of a 90-minute group-based constraint-induced movement therapy protocol (CIMT) on upper extremity (UE) rehabilitation in poststroke patients. METHOD: The study was a case series clinical study with 6 patients with chronic stroke admitted to the institutional integrated clinic. Ten 90-minute CIMT sessions were administered, based on the principles of the original therapy. On completion of the protocol, participants underwent group care once a week, for 1 hour a day. For comparison purposes, the Wolf Motor Function Test (WMFT), Motor Activity Log (MAL), and Canadian Occupational Performance Measure (COPM) were applied on admission, shortly after completing the protocol, and 3 months after completion. In addition, the MAL and shaping tasks were applied daily. RESULTS: There was a statistically significant difference only in the MAL Amount of Use Scale applied daily between the 2nd (3.56) and 9th (3.31) and 2nd and 10th days (4.49) (P = .004), with a moderate effect size (d' = 0.46), and in the average value of shaping repetitions between the 1st (16.10) and 2nd (6.00) and 1st and 10th tasks (7.00) (P = .014), with a moderate effect size (d' = 0.35). CONCLUSION: The 90-minute CIMT protocol resulted in significant improvements in use of the more affected arm in activities of daily living during the 2-week protocol. Additional research with a larger sample and a control group is needed to confirm its effectiveness.


Asunto(s)
Terapia por Ejercicio/métodos , Terapia Ocupacional/métodos , Rehabilitación de Accidente Cerebrovascular/métodos , Extremidad Superior/fisiopatología , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino
12.
Am J Phys Med Rehabil ; 100(4): 359-366, 2021 04 01.
Artículo en Inglés | MEDLINE | ID: mdl-33727518

RESUMEN

OBJECTIVE: The aim of the study was to verify the effect of a virtual rehabilitation protocol for patients with Parkinson disease, primarily assessing striatal dopamine transporters and secondarily motor symptoms and quality of life. DESIGN: Nineteen patients with Parkinson disease underwent an 8-wk virtual rehabilitation protocol using XBOX 360S. Evaluation of dopamine transporters was performed by single-photon emission computed tomography using TRODAT-1 as the radioligand. Participants were clinically assessed using the Unified Parkinson Disease Rating Scale to quantify motor symptoms. Moreover, the Parkinson Disease Questionnaire and Short-Form Health Status Survey were used to assess quality of life and the Berg Balance Scale to assess balance. RESULTS: Regarding our primary outcome, dopamine transporter was significantly increased in the putamen contralateral to the clinically most affected body side (P = 0.034) considering preintervention and postintervention measurements. Furthermore, we observed significant improvement in Unified Parkinson Disease Rating Scale (10-point reduction, P = 0.001), Parkinson Disease Questionnaire (11.3-point reduction, P = 0.001), Short-Form Health Status Survey ("Functional capacity," P = 0.001; "Pain," P = 0.006; and "Mental Health" domains, P < 0.001), and Berg Balance Scale (5-point increase, P = 0.015). CONCLUSIONS: In our group of Parkinson disease patients, this virtual rehabilitation protocol enabled a dopamine transporter increase in the region of the putamen contralateral to the clinically most affected body side. Moreover, motor signs and quality of life were significantly improved.


Asunto(s)
Proteínas de Transporte de Dopamina a través de la Membrana Plasmática/metabolismo , Terapia por Ejercicio/métodos , Enfermedad de Parkinson/diagnóstico por imagen , Enfermedad de Parkinson/rehabilitación , Telerrehabilitación/métodos , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermedad de Parkinson/fisiopatología , Calidad de Vida , Encuestas y Cuestionarios , Tomografía Computarizada de Emisión de Fotón Único , Juegos de Video
13.
J Med Internet Res ; 23(3): e22548, 2021 03 18.
Artículo en Inglés | MEDLINE | ID: mdl-33734088

RESUMEN

BACKGROUND: The recent onset of the COVID-19 pandemic has highlighted the need to reduce barriers to access physical therapy and associated care through the use of web-based programs and telehealth for those seeking treatment for low back pain (LBP). Despite this need, few studies have compared the effectiveness of clinic-based versus web-based or telehealth services. OBJECTIVE: This study aims to compare the clinical outcomes of clinic-based multidisciplinary therapy in an integrated practice unit (C-IPU) model with online integrated multidisciplinary therapy (O-IPU) in individuals undergoing conservative care for LBP. METHODS: A total of 1090 participants were prospectively recruited to participate in a clinical trial registry (NCT04081896) through the SpineZone rehabilitation IPU program. All participants provided informed consent. Participants were allocated to the C-IPU (N=988) or O-IPU (N=102) groups based on their personal preferences. The C-IPU program consisted of a high-intensity machine-based core muscle resistance training program, whereas the O-IPU program consisted of therapist-directed home core strengthening exercises through a web-based platform. Changes in LBP symptom severity (Numeric Pain Rating Scale), disability (Oswestry Disability Index), goal achievement (Patient-Specific Functional Scale), and frequency of opioid use were compared between the C-IPU and O-IPU groups using multivariate linear regression modeling adjusted for age, gender, treatment number, program duration, and baseline pain and disability. RESULTS: Approximately 93.03% (1014/1090) of the participants completed their recommended programs, with no group differences in dropout rates (P=.78). The C-IPU group showed greater pain relief (P<.001) and reductions in disability (P=.002) than the O-IPU group, whereas the O-IPU group reported greater improvements in goal achievement (P<.001). Both programs resulted in reduced opioid use frequency, with 19.0% (188/988) and 21.5% (22/102) of participants reporting cessation of opioid use for C-IPU and O-IPU programs, respectively, leaving only 5.59% (61/1090) of participants reporting opioid use at the end of their treatment. CONCLUSIONS: Both in-clinic and web-based multidisciplinary programs are beneficial in reducing pain, disability, and opioid use and in improving goal achievement. The differences between these self-selected groups shed light on patient characteristics, which require further investigation and could help clinicians optimize these programs. TRIAL REGISTRATION: ClinicalTrials.gov NCT04081896; https://clinicaltrials.gov/ct2/show/NCT04081896.


Asunto(s)
Terapia por Ejercicio/métodos , Dolor de la Región Lumbar/rehabilitación , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Femenino , Humanos , Internet , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Resultado del Tratamiento , Adulto Joven
14.
J Rehabil Med ; 53(4): jrm00180, 2021 Apr 12.
Artículo en Inglés | MEDLINE | ID: mdl-33723616

RESUMEN

OBJECTIVE: To evaluate the effects of a rehabilitation programme for lumbopelvic pain after childbirth. METHODS: Women with lumbopelvic pain 3 months postpartum were included in a randomized controlled trial. Patients in the intervention group (n = 48) received pelvic floor muscle training combined with neuromuscular electrical stimulation of the paraspinal muscles for 12 weeks, while patients in the control group (n = 48) received neuromuscular electrical stimulation for 12 weeks. Outcomes were measured with the Triple Numerical Pain Rating Scale (NPRS), Modified Oswestry Disability Questionnaire (MODQ) and Short-Form Health Survey-36 (SF-36). RESULTS: The NPRS score was significantly better in the intervention group at 12 weeks compared with the control group (p = 0.000). The MODQ score was significantly better at 6 and 12 weeks compared with the control group (p = 0.009 and p = 0.015, respectively). The mean value of the Physical Components Summary of the SF-36, was significantly better in the intervention group at 6 weeks (p = 0.000) and 12 weeks (p = 0.000) compared with the control group, but there was no significant improvement in Mental Components Summary of the SF-36. CONCLUSION: A postpartum programme for women with lumbopelvic pain is feasible and improves the physical domain of quality of life.


Asunto(s)
Terapia por Ejercicio/métodos , Región Lumbosacra/fisiopatología , Dolor/rehabilitación , Diafragma Pélvico/fisiopatología , Periodo Posparto/fisiología , Calidad de Vida/psicología , Adulto , Femenino , Humanos , Embarazo
15.
Int J Mol Sci ; 22(4)2021 Feb 15.
Artículo en Inglés | MEDLINE | ID: mdl-33671926

RESUMEN

The picture of chronic liver diseases (CLDs) has changed considerably in recent years. One of them is the increase of non-alcoholic fatty liver disease. More and more CLD patients, even those with liver cirrhosis (LC), tend to be presenting with obesity these days. The annual rate of muscle loss increases with worsening liver reserve, and thus LC patients are more likely to complicate with sarcopenia. LC is also characterized by protein-energy malnutrition (PEM). Since the PEM in LC can be invariable, the patients probably present with sarcopenic obesity (Sa-O), which involves both sarcopenia and obesity. Currently, there is no mention of Sa-O in the guidelines; however, the rapidly increasing prevalence and poorer clinical consequences of Sa-O are recognized as an important public health problem, and the diagnostic value of Sa-O is expected to increase in the future. Sa-O involves a complex interplay of physiological mechanisms, including increased inflammatory cytokines, oxidative stress, insulin resistance, hormonal disorders, and decline of physical activity. The pathogenesis of Sa-O in LC is diverse, with a lot of perturbations in the muscle-liver-adipose tissue axis. Here, we overview the current knowledge of Sa-O, especially focusing on LC.


Asunto(s)
Cirrosis Hepática/complicaciones , Cirrosis Hepática/metabolismo , Obesidad/etiología , Obesidad/metabolismo , Sarcopenia/etiología , Sarcopenia/metabolismo , Tejido Adiposo/metabolismo , Citocinas/metabolismo , Disbiosis/metabolismo , Terapia por Ejercicio/métodos , Ayuno , Humanos , Resistencia a la Insulina , Cirrosis Hepática/dietoterapia , Cirrosis Hepática/tratamiento farmacológico , Obesidad/dietoterapia , Obesidad/tratamiento farmacológico , Desnutrición Proteico-Calórica/metabolismo , Sarcopenia/dietoterapia , Sarcopenia/tratamiento farmacológico
16.
Int J Mol Sci ; 22(4)2021 Feb 18.
Artículo en Inglés | MEDLINE | ID: mdl-33670492

RESUMEN

Physically active behavior has been associated with a reduced risk of developing certain types of cancer and improved psychological conditions for patients by reducing anxiety and depression, in turn improving the quality of life of cancer patients. On the other hand, the correlations between inactivity, sedentary behavior, and overweight and obesity with the risk of development and progression of various cancers are well studied, mainly in middle-aged and elderly subjects. In this article, we have revised the evidence on the effects of physical activity on the expression and release of the adipose-tissue-derived mediators of low-grade chronic inflammation, i.e., adipokines, as well as the adipokine-mediated impacts of physical activity on tumor development, growth, and metastasis. Importantly, exercise training may be effective in mitigating the side effects related to anti-cancer treatment, thereby underlining the importance of encouraging cancer patients to engage in moderate-intensity activities. However, the strong need to customize and adapt exercises to a patient's abilities is apparent. Besides the preventive effects of physically active behavior against the adipokine-stimulated cancer risk, it remains poorly understood how physical activity, through its actions as an adipokine, can actually influence the onset and development of metastases.


Asunto(s)
Adipoquinas/metabolismo , Adiposidad/fisiología , Terapia por Ejercicio/métodos , Ejercicio Físico/fisiología , Neoplasias/terapia , Tejido Adiposo/metabolismo , Humanos , Metástasis de la Neoplasia , Neoplasias/metabolismo , Neoplasias/patología , Obesidad/metabolismo , Obesidad/fisiopatología , Calidad de Vida
17.
Medicine (Baltimore) ; 100(13): e25019, 2021 Apr 02.
Artículo en Inglés | MEDLINE | ID: mdl-33787585

RESUMEN

BACKGROUND: We aimed to assess the efficacy of resistance exercise in rheumatoid arthritis (RA) in randomized controlled trials (RCTs). METHOD: PubMed, the Cochrane Library, and Embase were searched according to the index words to identify eligible RCTs, and relevant literature sources were also searched. The latest search was done in August 2019. Odds ratios (OR), mean difference (MD), and 95% confidence interval (95% CI) were used to analyze the main outcomes. RESULT: Seventeen RCTs were included in the meta-analysis with 512 patients in the resistance exercise group and 498 patients in the control group. The results showed that compared with the control group, resistance exercise significantly decreased disease activity score in 28 joints (DAS-28) scores (standard mean difference [SMD]: -0.69, 95% CI: -1.26 to -0.11), reduced erythrocyte sedimentation rate (ESR) (SMD: -0.86, 95% CI: -1.65 to -0.07), and shortened the time of 50 ft. walking (SMD: -0.64, 95% CI: -0.99 to -0.28). No significant difference was observed in visual analog scale (VAS) scores (SMD: -0.61, 95% CI: -1.49-0.27) and health assessment questionnaire (HAQ) scores (weighted mean difference: -0.10, 95% CI: -0.26-0.06). CONCLUSION: Resistance exercise showed reducing DAS-28 score, ESR score, and the time of 50 ft. walking in RA patients compared with the control group. However, high quality multicenter RCTs with larger sample sizes to confirm the conclusion.


Asunto(s)
Artritis Reumatoide/terapia , Terapia por Ejercicio/métodos , Entrenamiento de Resistencia/métodos , Adulto , Anciano , Artritis Reumatoide/sangre , Artritis Reumatoide/fisiopatología , Sedimentación Sanguínea , Femenino , Humanos , Masculino , Persona de Mediana Edad , Ensayos Clínicos Controlados Aleatorios como Asunto , Índice de Severidad de la Enfermedad , Resultado del Tratamiento , Velocidad al Caminar
18.
Medicine (Baltimore) ; 100(13): e25128, 2021 Apr 02.
Artículo en Inglés | MEDLINE | ID: mdl-33787595

RESUMEN

BACKGROUND AND OBJECTIVE: Systematically review the current published literature on the impact of exercise training (ET) in chronic heart failure (CHF) patients who were conducted cardiac resynchronization therapy (CRT). METHODS: PubMed, EMBASE, and the Cochrane Library of Controlled Trails databases were searched for trials comparing the additional effects of ET in CHF patients after CRT implantation with no exercise or usual care control up until 2020.03.07. We independently screened the literature, extracted data, employed the tool for the assEssment of Study qualiTy and reporting in EXercise (TESTEX) to evaluate study quality and risk of bias, and performed meta-analysis with Revman 5.3 software. RESULTS: Eight trials were identified for qualitative analysis and 7 randomized controlled trails (RCTs) included 235 participants (120 ET; 115 controls) for quantitative analysis. The results showed that the maximal workload (mean difference [MD] 26.32 W, 95% CI 19.41-33.23; P < .00001, I2 = 0%) and the exercise duration (MD 68.95 seconds, 95% CI 15.41-122.48; P = .01, I2 = 76%) had significant improvement in the ET group versus control. Subgroup analysis showed that compared with control, the change in peak oxygen uptake (VO2) (MD 3.05 ml/kg/minute, 95% CI 2.53-3.56; P < .00001, I2 = 0%), left ventricular ejection fraction (LVEF) (MD 4.97%, 95% CI 1.44-8.49; P = .006, I2 = 59%), and health related quality of life (HRQoL) (the change in Minnesota living with heart failure questionnaire [MLHFQ]: MD -19.96, 95% CI -21.57 to -18.34; P < .00001, I2 = 0%) were significantly improved in the light to moderate intensity training (non-HIT) group, while there seemed no statistical difference of above endpoints in the high intensity training (HIT) group. CONCLUSION: During the short term (up to 6 months), non-HIT could improve exercise capacity, cardiac function, and HRQoL in CHF patients with CRT. However, due to the small number of participants, a high-quality large-sample multicenter trial is demanded.


Asunto(s)
Rehabilitación Cardiaca/métodos , Terapia de Resincronización Cardíaca/métodos , Terapia por Ejercicio/métodos , Ejercicio Físico/fisiología , Insuficiencia Cardíaca/rehabilitación , Anciano , Enfermedad Crónica , Tolerancia al Ejercicio , Femenino , Insuficiencia Cardíaca/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Calidad de Vida , Ensayos Clínicos Controlados Aleatorios como Asunto , Volumen Sistólico/fisiología , Resultado del Tratamiento , Función Ventricular Izquierda/fisiología
19.
Heart Fail Clin ; 17(2): 263-271, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33673950

RESUMEN

Exercise training is recommended for patients with heart failure by major societies' guidelines. It improves exercise capacity and quality of life, reduces symptoms of depression, can improve survival, and reduce the risk for hospitalizations. Exercise-based cardiac rehabilitation can be offered with different modalities, such as continuous or interval aerobic training, resistance, and inspiratory muscle training. The intervention must follow an accurate evaluation of the patient's cardiovascular conditions and functional capacity. Despite the multiple benefits of exercise training, there is a lack of adherence to exercise-based programs, due to socioeconomic factors, patients' characteristics, and lack of referral.


Asunto(s)
Rehabilitación Cardiaca/métodos , Terapia por Ejercicio/métodos , Tolerancia al Ejercicio/fisiología , Insuficiencia Cardíaca/rehabilitación , Calidad de Vida , Insuficiencia Cardíaca/fisiopatología , Humanos
20.
Medicine (Baltimore) ; 100(9): e25042, 2021 Mar 05.
Artículo en Inglés | MEDLINE | ID: mdl-33655981

RESUMEN

BACKGROUND: Coronary heart disease (CHD) is one of the highest mortality diseases in the world, which seriously threatens human health and quality of life (QOL). The purpose of this study is to systematically analyze the effects of mind-body exercise on cardiopulmonary function, blood pressure and QOL in CHD patients, and to provide scientific evidence-based exercise prescription for patients with coronary heart disease. METHODS: This research review will include the following electronic databases from its establishment to December 2020: PubMed, EMBASE, Web of Science, Cochrane Library, the Chinese National Knowledge Infrastructure, the Chinese Science and Technology Periodical Database, and Wanfang. Objective to search randomized controlled trials (RCTs) about the effects of mind-body exercise on cardiopulmonary function, blood pressure and QOL in patients with coronary heart disease. CONCLUSION: This systematic review and meta-analysis will provide strong evidence for the efficacy and safety of mind-body exercise in patients with coronary heart disease. SYSTEMATIC REVIEW REGISTRATION: INPLASY202120016. ETHICS AND DISSEMINATION: Ethical approval will not be necessary since this systematic review and meta-analysis will not contain any private information of participants or violate their human rights.


Asunto(s)
Presión Sanguínea/fisiología , Enfermedad Coronaria/terapia , Terapias Mente-Cuerpo/métodos , Calidad de Vida , Enfermedad Coronaria/fisiopatología , Terapia por Ejercicio/métodos , Humanos
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