Rehabilitation combined with dietary intervention improve urinary incontinence in women with obesity: A proof-of-principle study.

Objectives: This study aimed to assess the impact of add-on pelvic floor exercises on a weight management rehabilitation program. Patients and methods: This proof of principle study was conducted between July 2019 and December 2019. Ninety-three adult female inpatients with obesity and diagnosis of urinary incontinence (UI) were assessed for inclusion, and the suitable patients were randomly assigned to the experimental group and the control group. Both groups underwent a weight management rehabilitation program, while the experimental group also performed pelvic floor exercises. The primary outcome was UI severity, assessed by the 1-h pad test. Secondary outcomes were urinary symptoms, assessed by the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF), Patient Global Impression of Improvement (PGI-I), and Incontinence Quality of Life Questionnaire (I-QOL). Results: Sixty female inpatients were randomly assigned to the experimental group [n=30; median age: 64.50 (51.25 to 70.50) years] or the control group [n=30; median age: 67.50 (58.50 to 74.75) years]. The experimental group showed a statistically significant reduction in UI severity [pad test: 2.08 (1.21 to 8.85) g vs. 0.54 (0.24 to 1.13) g, p<0.01; ICIQ-SF: 14.00 (10.25 to 17.00) vs. 8.00 (6.25 to 11.75), p<0.01; I-QOL: 56.37 (42.28 to 73.64) vs. 78.64 (64.32 to 90.68), p<0.01]. Statistically significant differences were found in the between-groups analysis [pad test: 0.54 (0.24 to 1.13) g vs. 1.08 (0.83 to 3.86) g, p<0.01; ICIQ-SF: 8.00 (6.25 to 11.75) vs. 12.00 (10.00 to 16.00), p<0.01; I-QOL: 78.64 (64.32 to 90.68) vs. 68.18 (60.00 to 84.32), p<0.01]. Conclusion: Including pelvic floor exercises might provide additional benefits compared to standard rehabilitation in reducing UI symptoms in obese women.

Skeletal Muscle Mass, Sarcopenia and Rehabilitation Outcomes in Post-Acute COVID-19 Patients.

The relationship between skeletal muscle mass at the beginning of the post-acute rehabilitation phase and rehabilitation outcomes has been scarcely investigated. The aim of this study was to investigate the impact of the existence of sarcopenia upon admission to a post-acute COVID-19 patient rehabilitation unit on body composition and functional and respiratory capacity at discharge. Thirty-four post-acute COVID-19 patients were referred to our Rehabilitation Unit from different COVID Hospitals in northern Italy. Body weight loss, body composition, handgrip strength, functional parameters, oxygen saturation and related perception of dyspnea in several positions were measured before and after a 28-day multidisciplinary rehabilitation program. Spirometry was performed only upon admission. The intervention included psychiatric support, cognitive behavioral therapy, nutritional therapy and physiotherapy, including aerobic and resistance training. Training volume was 45 min/session, 6 sessions/week. Upon admission, the prevalence of sarcopenia among our patients was 58%. In all of the 34 patients, we observed a trend of improvement in all of the respiratory, body composition, muscle strength and functional parameters considered. Monitoring muscle mass and strength in post-acute COVID-19 patients appears to be a key predictor of rehabilitation outcomes. Early diagnosis of sarcopenia therefore appears to be of paramount importance in the management of post-acute COVID-19 patients.

Slow versus traditional strength training in obese female participants: preliminary results.

The aim of this study was to provide comparative data on a slow versus a traditional supervised resistance training in an obese female population. Forty obese female patients admitted to our rehabilitation hospital were assigned randomly to a slow training group (ST group; mean age: 47.44 years, mean BMI: 38.53 kg/m) and a traditional training group (TT group; mean age: 54.34 years, mean BMI: 39.37 kg/m). The ST protocol included five repetitions for five consecutive bouts on the leg press and extension machine. The duration of each repetition (concentric+eccentric phases) was 6 s for leg press and 5 s for leg extension. The initial load was 50% of the one repetition maximum and then gradually reduced by 20% for each bout. The TT protocol included six consecutive repetitions for five bouts on the leg press and leg extension with 80% of the one repetition maximum load. Both groups performed 10 sessions. All of the patients were assessed by a visual analogue scale for pain, a Borg scale for subjective fatigue, and an isokinetic strength test. Statistically significant strength improvements were observed in both groups. In ST group statistically significant improvements in visual analogue scale scores for knee pain were found at post, larger than that observed in TT group. Subjectively perceived fatigue on the Borg scale decreased more at post in ST group in comparison with TT group. Our preliminary data suggest that ST may represent a preferential strengthening method in obese patients as it can lead to significant strength gains with a relatively lower loading effect on the knee, and hence reduced perception of pain.

Do wearable sensors add meaningful information to the Timed Up and Go test? A study on obese women.

The purpose of this study was to validate Time Up and Go test (TUG) as measured by a single Inertial Measurement Unit (IMU) placed on the lower back to that measured by a stopwatch in obese and normal weight women; in addition, the comparison of the performance of TUG test between obese and healthy women using the instrumented TUG (iTUG). Forty-four severely obese women and 14 age-matched healthy women were assessed simultaneously by IMU and stopwatch. The comparison between manual and instrumented assessment of total time duration showed no significant differences both in the healthy (8.32 ±â€¯0.96 s vs. 8.52 ±â€¯0.97 s, p > 0.05) and in the obese group (9.99 ±â€¯2.28 s vs. 9.81 ±â€¯2.52 s; p > 0.05). The comparison between obese and healthy group exhibited significant differences in terms of total time duration both during manual and iTUG, which is longer in obese women than normal weight women. The duration of the sub-phases in obese group is longer with the exception of sit-to-stand and stand-to-sit phase, with lower turning velocity both in mid- and final turning sub-phase. The results suggest that the iTUG is an objective and fast mobility test and it could add useful information to the manual TUG for clinical practice.

Effects of nanotechnology-based devices on postural control in healthy subjects.

BACKGROUND: The aim of the present preliminary randomized controlled study was to ascertain whether the use of newly developed nanotechnologies-based patches can influence posture control of healthy subjects. METHODS: Thirty healthy female subjects (age 39.4 years, BMI 22.74 kg/m2) were randomly assigned to two groups: one with active patches and a control group with sham patches. Two patches were applied with a tape: one on the subject's sternum and the other on the C7 apophysis. Body sway during quiet upright stance was recorded with a dynamometric platform. Each subject was tested under two visual conditions, eyes open and closed. We used a blocked stratified randomization procedure conducted by a third party. RESULTS: Subjects wearing the sham patches showed a significant increase of the center of pressure sway area after 4 hours when they performed the habitual moderate-intensity work activities. In the active patch group, a decrease of the sway path was evident, providing evidence of an enhanced balance control. CONCLUSIONS: Our preliminary findings on healthy subjects indicate that nanotechnological devices generating ultra-low electromagnetic fields can improve posture control.

Dizziness and Falls in Obese Inpatients Undergoing Metabolic Rehabilitation.

AIM: The relationship between dizziness and falls in the obese population is a relatively unexplored issue. The aims of the present study were to define the 1-year prevalence of dizziness in an obese inpatient population undergoing metabolic rehabilitation and to investigate possible correlations with fall events. MATERIALS AND METHODS: We recruited 329 obese subjects: 203 female (BMI 43,74 kg/m2 ± 0.5 SE; age 17-83 years, 58.33 ± 0.9 SE) and 126 male (BMI 44,27kg/m2 ± 0.7 DE age 27-79 years, 58.84 ± 1 SE). To assess dizziness we used the validated Italian version (38) of the Dizziness Handicap Inventory (DHI). RESULTS: Out of the experimental sample, 100 subjects did not complain of dizziness and felt confident about their balance control, while 69.6% reported some degree of dizziness. Their mean DHI score was 22.3, which corresponds to mild dizziness. Twenty-one percent reported more severe dizziness (DHI score > 40). The majority of our sample reported minor dizziness and its perception appears to be independent from BMI: DHI scores were consistent across classes of obesity. DISCUSSION: The rate of dizziness and falls (30.1%) in an this obese population was higher than that previously reported in a general matched population. However, obese subjects, in our sample, seem to underestimate their risk of fall and DHI score does not appear a reliable predictor of falls. Since complications associated with falls in obese persons generally require longer treatments than in lean individuals, our findings should be taken into account in order to identify other predictors, including cognitive and perceptual, of risk of fall and to implement fall prevention programs.

Spinal load in nurses during emergency lifting of obese patients: preliminary results.

BACKGROUND: Nurses are exposed to the risk of injury while handling patients. This is particularly true for obese patients. OBJECTIVE: The goal of this paper is to estimate the spinal loads and the related risk of injury to nurses while lifting obese patients from the floor with a bariatric sheet during a hospital emergency. METHODS: Six male nurses participated in this study. The biomechanical analysis focused on the lifting strategy. Thirty obese in-patients were enrolled to take part in the experimental study and divided into three groups according to their Body Mass Index (BMI). Three-dimensional motion analysis was conducted using an optoelectronic system. The trunk kinematics and the loading on the spines of the operating nurses were computed. RESULTS: Our data showed that when the nurse was operating from the central handle, his trunk was more flexed at the end of the lift with a reduced range of motion. The values were higher when the nurse lifted patients with higher BMIs. All kinetic parameters and tension in the lumbar muscles at the end of the movement were characterised by lower values for the nurse placed beside the patient's head or feet if compared to the operator positioned beside the central handle in all patient groups. CONCLUSIONS: Our preliminary data suggest that only the reaction load on the spine of the nurse holding the central handle, closest to the patient's centre of mass, seems to exceed the recommended safety limits.