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1.
Medicine (Baltimore) ; 100(3): e23963, 2021 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-33545979

RESUMO

INTRODUCTION: Exercise has been believed to have positive effects on blood glucose control in patients with type 2 diabetes mellitus. However, few medical evidences have been found to ascertain which type of exercise has the best effect on blood glucose control in diabetes and which type of exercise is more acceptable. The purpose of this study is to compare the effects and acceptability of different exercise modes on glycemic control in type 2 diabetes patients by using systematic review and network meta-analysis. METHODS AND ANALYSIS: Relevant randomized controlled trial studies will be searched from PubMed, EMbase, CochraneCENTRAL, CNKI, VIP, and Chinese medical paper libraries. Primary outcome indicators: glycosylated hemoglobin and dropout rate of the research (number of dropouts/numbers of initially enrolled subjects). Secondary outcome measures: fasting blood glucose, body weight, total cholesterol (TC), low-density lipoprotein cholesterol (LDL), high-density lipoprotein cholesterol, triglycerides (TG), diastolic pressure, systolic pressure (SBP). Two reviewers are arranged to screen Title, Abstract, and then review full text to further extract data. Standard meta-analysis and network meta-analysis of the data are performed afterward. Methodological quality assessment is planned to be conducted using Cochrane risk of bias tool. The outcome will be analyzed statistically according to Bayesian analysis methods. After that, subgroup analysis is conducted on the duration of intervention, whether there is supervision of intervention, frequency of intervention per week, age, gender, and medication use. TRIAL REGISTRATION NUMBER: PROSPERO CRD42020175181. DISCUSSION: The systematic review and network meta-analysis include evidence of the impact of different exercise modes on blood glucose control in type 2 diabetes mellitus. There are 2 innovative points in this study. One is to conduct a classified study on exercise in as much detail as possible, and the other is to study the acceptability of different exercise modes. The network meta-analysis will reduce the uncertainty of intervention and enable clinicians, sports practitioners, and patients to choose more effective and suitable exercise methods. ETHICS AND DISSEMINATION: The findings of the study will be disseminated through publications in peer-reviewed journals and scientific conferences and symposia. Further, no ethical approval is required in this study.


Assuntos
Protocolos Clínicos , Diabetes Mellitus Tipo 2/terapia , Terapia por Exercício/métodos , /métodos , Diabetes Mellitus Tipo 2/fisiopatologia , Terapia por Exercício/normas , Humanos , Metanálise como Assunto , Revisões Sistemáticas como Assunto
2.
Medicine (Baltimore) ; 100(3): e24351, 2021 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-33546067

RESUMO

PURPOSE: Although several types of occupational therapy for motor recovery of the upper limb in patients with chronic stroke have been investigated, most treatments are performed in a hospital or clinic setting. We investigated the effect of graded motor imagery (GMI) training, as a home exercise program, on upper limb motor recovery and activities of daily living (ADL) in patients with stroke. METHODS: This prospective randomized controlled trial recruited 42 subjects with chronic stroke. The intervention group received instruction regarding the GMI program and performed it at home over 8 weeks (30 minutes a day). The primary outcome measure was the change in motor function between baseline and 8 weeks, assessed the Manual Function Test (MFT) and Fugl-Meyer Assessment (FMA). The secondary outcome measure was the change in ADL, assessed with the Modified Barthel Index (MBI). RESULTS: Of the 42 subjects, 37 completed the 8-week program (17 in the GMI group and 20 controls). All subjects showed significant improvements in the MFT, FMA, and MBI over time (P < .05). However, the improvements in the total scores for the MFT, FMA, and MBI did not differ between the GMI and control groups. The MFT arm motion score for the GMI group was significantly better than that of the controls (P < .05). CONCLUSIONS: The GMI program may be useful for improving upper extremity function as an adjunct to conventional rehabilitation for patients with chronic stroke.


Assuntos
Terapia por Exercício/normas , Imagens, Psicoterapia/normas , Acidente Vascular Cerebral/complicações , Extremidade Superior/inervação , Adulto , Idoso , Distribuição de Qui-Quadrado , Terapia por Exercício/instrumentação , Terapia por Exercício/métodos , Feminino , Humanos , Imagens, Psicoterapia/métodos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Recuperação de Função Fisiológica , Estatísticas não Paramétricas , Acidente Vascular Cerebral/fisiopatologia , Extremidade Superior/fisiopatologia
4.
Artigo em Inglês | MEDLINE | ID: mdl-33327571

RESUMO

Attempts to classify the mobility levels of people with stroke (PWS) for a tailored exercise program in community settings have been few. We developed and evaluated a classified and tailored community-based (CTC) exercise program according to the mobility level of PWS. Forty-two PWS were classified into the Supine and Sitting, Sitting and Standing, and Standing and Gait groups, based on a newly developed classification model and participated in a group-based CTC exercise program for 1 h/day twice/week for 10 weeks. The health outcome measures were blood pressure, lipid profile, glucose control, body composition, ventilatory capacity, and physical and psychological function. The rate of agreement on classification results among the physiotherapists was analysed. For all participants, significant improvements were noted in the blood pressure, lipid profile, body composition, ventilatory capacity, and physical and psychological function. The lower mobility groups showed significant improvements in a greater number of health outcomes than the higher mobility group. The physiotherapists' agreement regarding the classification results was 91.16 ± 5.14%, verifying the model's possible high relevance to the community. The effective improvement in participant health implied that the CTC exercise program was well tailored to the participants' mobility levels, particularly the lower mobility groups.


Assuntos
Terapia por Exercício , Limitação da Mobilidade , Reabilitação do Acidente Vascular Cerebral , Terapia por Exercício/métodos , Terapia por Exercício/normas , Feminino , Marcha , Humanos , Masculino
6.
Medicine (Baltimore) ; 99(32): e21577, 2020 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-32769904

RESUMO

OBJECTIVES: To analyze the influence of Baduanjin exercise on blood pressure in patients with essential hypertension. METHODS: Randomized controlled trials were identified in Chinese and English databases to study the impact of Baduanjin exercise on essential hypertension. Qualified trials were selected and methodologic quality was critically evaluated. Two reviewers selected studies independently of each other. RESULTS: Twelve trials were included. There was a significant difference between the Baduanjin exercise intervention and control groups with regard to the change in systolic blood pressure (SBP) [SMD = - 1.80, 95% CI (- 2.86, - 0.73), P = .0009] and diastolic blood pressure (DBP) [SMD = -0.22, 95% CI (-2.00, -0.57), P = .0004]. Taking into account the subgroup analyses, the combined results showed that Baduanjin plus Antihypertensive drugs significantly reduced both SBP and DBP over a period > 12 weeks in all studies. CONCLUSIONS: Compared with control interventions, Baduanjin exercise seems to be an effective physical exercise in treating essential hypertension. Different training durations can lead to different effects.


Assuntos
Hipertensão Essencial/terapia , Terapia por Exercício/normas , Exercício Físico/fisiologia , Terapia por Exercício/métodos , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos
8.
Adv Exp Med Biol ; 1257: 193-207, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32483741

RESUMO

Exercise has the potential to positively affect patients with osteosarcoma by improvement of function, mitigation of disability, and maintenance of independence and quality of life. Exercise may also directly impact cancer treatment efficacy. This chapter examines the feasibility and use of exercise or physical activity as therapy in the treatment of osteosarcoma and its survivors. It additionally presents the benefits of physical activity as treatment and rehabilitation both preoperatively (prehabilitation) and postoperatively. This chapter will also discuss barriers to exercise and physical activity for patients with osteosarcoma and its survivors, emphasizing the need for a comprehensive and cohesive support system to promote its incorporation into patient treatment plans and ensure compliance.


Assuntos
Neoplasias Ósseas , Exercício Físico , Osteossarcoma , Qualidade de Vida , Neoplasias Ósseas/patologia , Neoplasias Ósseas/terapia , Terapia por Exercício/normas , Humanos , Osteossarcoma/patologia , Osteossarcoma/terapia , Sobreviventes/estatística & dados numéricos
9.
PLoS One ; 15(6): e0234511, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32520970

RESUMO

BACKGROUND: Clinical guidelines make vague recommendations as to exercise training (ET) type and dosage to manage chronic non-specific neck pain (CNSNP). OBJECTIVE: To synthesise evidence on the effectiveness of different ET programmes to reduce CNSNP and associated disability, and whether dosage affects outcomes. METHODS: A systematic review and data synthesis was conducted according to a published registered protocol (PROSPERO CRD42018096187). A sensitive topic-based search was conducted of CINAHL, MEDLINE, EMBASE, PEDro, grey literature sources and key journals from inception to 6th January 2020 for randomised controlled trials, investigating ET for CNSNP or disability. Two reviewers independently completed eligibility screening, data extraction, risk of bias assessment (Cochrane Risk of Bias Tool) and rated the overall strength of evidence using Grading of Recommendations Assessment, Development and Evaluation. Data was tabulated for narrative synthesis and grouped by intervention, outcome and time point to compare across studies. RESULTS: Twenty-six trials from 3990 citations (n = 2288 participants) investigated fifteen ET programmes. High RoB and low sample sizes reduced evidence quality. Clinical heterogeneity prevented meta-analyses. A range of ET programmes reduce pain/disability in the short term (low to moderate evidence). Pillar exercises reduce pain/disability in the intermediate term (low level evidence). Moderate to very large pain reduction is found with ET packages that include motor control + segmental exercises (low to moderate evidence). No high-quality trials investigated long term outcomes. Increased frequency of motor control exercises and progressively increased load of pillar exercise may improve effectiveness. CONCLUSIONS: Motor control + segmental exercises are the most effective ET to reduce short term pain/disability, but long-term outcomes have not been investigated. Optimal motor control + segmental exercise variables and dosage is unknown and requires clarification. An adequately powered, low RoB trial is needed to evaluate the effectiveness and optimal dosage of motor control + segmental on long term outcomes. TRIAL REGISTRATION: PROSPERO CRD42018096187.


Assuntos
Terapia por Exercício/métodos , Cervicalgia/terapia , Guias de Prática Clínica como Assunto , Ensaios Clínicos como Assunto , Terapia por Exercício/efeitos adversos , Terapia por Exercício/normas , Humanos
10.
Medicine (Baltimore) ; 99(26): e20846, 2020 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-32590780

RESUMO

BACKGROUND: Among all types of cervical spondylitis, cervical spondylitis radiculopathy (CSR) has the highest incidence. The incidence of CSR increases year by year and is generally younger, which has seriously threatened people's quality of life and affected their work and life. This study proposes to improve the recovery rate of patients with CSR, delay the recurrence, improve the symptoms of patients, and improve the quality of life of patients through the rehabilitation and exercise of five-step cervical vertebra exercises. METHODS: For 90 patients with CSR that met the inclusion criteria, SPSS 23.0 software random number generator was used to randomly divide the patients into an experimental group and control group, with 45 cases in each group. The control group took basic nursing measures, and the experimental group took five steps of cervical vertebra rehabilitation exercises on the basis of elementary nursing measures. The rehabilitation effect of five-step exercises on CSR patients was evaluated by Neck Disability Index (NDI), Visual Analogue Scale (VAS), and Cervical range of motion measured (CROM) before and after intervention. RESULTS: The results of this trial will be published on the website of China Clinical Trial Registration Center (http://www.chictr.org.cn/searchproj.aspx) and in peer-reviewed journals or academic conferences. CONCLUSIONS: This study will examine the feasibility and preliminary effects of five-step exercises for the treatment of patients with CSR. TRIAL REGISTRATION: This protocol was registered in Clinical Trials platform with the number ChiCTR1900027299.


Assuntos
Terapia por Exercício/normas , Radiculopatia/terapia , Adulto , China , Exercício Físico/psicologia , Terapia por Exercício/métodos , Terapia por Exercício/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Radiculopatia/psicologia , Resultado do Tratamento
11.
Rev. andal. med. deporte ; 13(2): 106-109, jun. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-194373

RESUMO

El presente artículo describe el proceso sistemático seguido para desarrollar unas directrices científicas de ejercicio para personas con lesión medular, así como sus resultados. Para mejorar la condición física, las personas adultas con lesión medular deben realizar al menos 20 minutos de ejercicio aeróbico de intensidad moderada-vigorosa, dos veces por semana, combinados con tres series de ejercicios de fuerza de intensidad moderada-vigorosa por cada grupo muscular con funcionalidad, dos veces por semana. Para mejorar la salud cardiometabólica, se sugiere que las personas adultas con lesión medular realicen al menos 30 minutos de ejercicio aeróbico de intensidad moderada-vigorosa tres veces por semana. Dado que la falta de información sobre el tipo y la cantidad de actividad física necesaria para obtener beneficios saludables es una barrera importante para las personas con lesión medular, este conocimiento puede ser de gran relevancia para la promoción de estilos de vida activos entre este colectivo


The present paper describes the systematic process adopted to develop scientific exercise guidelines for adults with spinal cord injury and its results. To improve fitness, adults with spinal cord injury should engage in at least 20 minutes of moderate-to-vigorous intensity aerobic exercise twice a week, combined with three sets of strength-training exercises for each major functioning muscle group, at a moderate to vigorous intensity, twice a week. To improve cardiometabolic health, adults with spinal cord injury are suggested to engage in at least 30 minutes of moderate-to-vigorous intensity aerobic exercise three times a week. Since lack of information on the type and the amount of physical activity needed to obtain health benefits is an important barrier for people with spinal cord injury, this knowledge could be of great relevance in order to promote physically active lifestyles in this population


Este artigo descreve o processo sistemático seguido para desenvolver diretrizes científicas de exercício para pessoas com lesão medular e seus resultados. Para melhorar o condicionamento físico, as pessoas adultas com lesão medular devem realizar pelo menos 20 minutos de exercício aeróbico de intensidade moderada-vigorosa duas vezes por semana, combinados com tres séries de exercícios de força de intensidade moderada-vigorosa para cada grupo muscular com funcionalidade, duas vezes por semana. Para melhorar a saúde cardiometabólica, sugere-se que as pessoas adultas com lesão medular realizem pelo menos 30 minutos de exercício aeróbico de intensidade moderada-vigorosa três vezes por semana. Dado que a falta de informações sobre o tipo e a quantidade de atividade física necessária para obter benefícios saudáveis é uma barreira importante para as pessoas com lesão medular, esse conhecimento pode ser de grande relevância para a promoção de estilos de vida ativos nesse grupo


Assuntos
Humanos , Adulto , Traumatismos da Medula Espinal , Guias de Prática Clínica como Assunto , Terapia por Exercício/normas , Terapia por Exercício/educação , Treinamento de Resistência/métodos , Exercício Físico , Terapia por Exercício/métodos , Estilo de Vida , Doenças Cardiovasculares/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde
12.
Geriatr Gerontol Int ; 20(6): 595-601, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32304159

RESUMO

AIM: It is important for older adults to maintain the ability to be physically active, and to experience the benefits that physical activity brings. This study evaluates a 12-week Accredited Exercise Physiologist-led exercise program for vulnerable older adults living with dementia, delivered in a residential aged care facility in South Australia. The value of the program was also evaluated from the perspective of partners-in-care (family members and care staff). METHODS: Participants (n = 59) were randomized to either an intervention or control group, based on their functional and cognitive status. Physical function, cognitive function and habitual physical activity were assessed at baseline and post-intervention. In total, 51 family members and 44 care staff completed surveys or participated to understand their perspectives of residents' capacity to exercise, as well as their perceptions of the impact of the program. RESULTS: Repeated measures ANOVA identified evidence for maintenance of physical function (timed-up-and-go [ɳ2 = 0.19], handgrip strength [ɳ2 = 0.13]); however, there were no differences for objectively measured habitual activity or cognitive function. Evidence for a dose effect was demonstrated for the 2-min walk and timed-up-and-go associated with the number of individual sessions attended by a participant. Partners-in-care perceived greater improvement compared with deterioration across all measured factors [(P < 0.01, partial eta2 (ɳ2 ) =0.19] ranged from 0.35 to 0.78) post-intervention. Perceptions and expectations of who could benefit from participation were changed (P < 0.05) and indicated that all but the most severely declined residents would be likely to benefit. CONCLUSIONS: Data supporting the maintenance for some physical functions suggest that this type of program should be considered for older adults living with dementia in residential aged care facilities. Geriatr Gerontol Int 2020; ••: ••-••.


Assuntos
Demência/terapia , Terapia por Exercício/normas , Avaliação de Programas e Projetos de Saúde , Idoso , Idoso de 80 Anos ou mais , Cognição , Família , Feminino , Força da Mão , Humanos , Masculino , Pessoa de Meia-Idade , Distribuição Aleatória , Instituições Residenciais , Austrália do Sul
13.
J Fam Pract ; 69(3): 127-134, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32289126

RESUMO

Tendinopathy, tendinitis, tendinosis, paratenonitis-they are not synonymous. Here you'll find a review of their pathophysiology and best approaches to treatment.


Assuntos
Corticosteroides/normas , Corticosteroides/uso terapêutico , Terapia por Exercício/normas , Tendinopatia/classificação , Tendinopatia/diagnóstico , Tendinopatia/terapia , Terminologia como Assunto , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Tendinopatia/fisiopatologia
15.
Medicina (Kaunas) ; 56(2)2020 Feb 14.
Artigo em Inglês | MEDLINE | ID: mdl-32075185

RESUMO

Performing physical exercise after a colorectal cancer diagnosis is associated with lower mortality related to the tumor itself. In order to improve physical recovery after elective surgery, there are no specific exercise protocols after discharge from the hospital. The purpose of this study is to show the preliminary results of an exercise program after colorectal cancer surgery. Six patients with non-metastatic colorectal adenocarcinoma addressed to respective laparoscopic were randomly assigned to a mixed supervised/home-based exercise program for six months and compared to a control group without exercise. To assess the effectiveness of the program, functional and body composition parameters were evaluated. Three months after surgery, the exercise group increased flexibility (p < 0.01, ES = 0.33), strength of lower limbs (p < 0.01, ES = 0.42) and aerobic capacity (p < 0.01, ES = 0.28). After surgery, the six patients experienced a significant reduction in body mass index (BMI) and free fat mass. More specifically, fat mass reached the lowest values, with a concomitant increase in cell mass after six months (p < 0.01, ES = 0.33). This did not occur in the control group. Colorectal cancer treatment induces a reduction in physical function, particularly during the first six months after treatment. A mixed exercise approach appears promising in countering this process after colorectal cancer surgery.


Assuntos
Neoplasias Colorretais/terapia , Procedimentos Cirúrgicos do Sistema Digestório/reabilitação , Terapia por Exercício/normas , Exercício Físico/psicologia , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Neoplasias Colorretais/psicologia , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Exercício Físico/fisiologia , Terapia por Exercício/métodos , Terapia por Exercício/estatística & dados numéricos , Feminino , Humanos , Laparoscopia/métodos , Laparoscopia/reabilitação , Laparoscopia/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Projetos Piloto
16.
Arch Osteoporos ; 15(1): 14, 2020 02 20.
Artigo em Inglês | MEDLINE | ID: mdl-32078057

RESUMO

Management of hospitalised osteoporotic vertebral fracture patients was explored across all major trauma orthopaedic hospitals in Ireland. Findings, based on a survey of orthopaedic doctors and physiotherapists, indicate a lack of standardised clinical care pathways. This study will inform development of clinical audit mechanisms and health service development for this large and growing fracture population in both Ireland and internationally. PURPOSE: To explore the management of hospitalised vertebral fragility fracture (VFF) patients in Ireland. METHODS: A cross-sectional survey of orthopaedic doctors (specialist registrar level) and physiotherapists was conducted across all hospitals with major orthopaedic trauma units in Ireland. Data were analysed using descriptive statistics in SPSS (V24). RESULTS: Responses were achieved from 100% (n = 16) of the hospitals (42 individual physiotherapists and 47 orthopaedic doctors). Conservative management was usual with both orthopaedic doctors (n = 37, 79%) and physiotherapists (n = 40, 96%) reporting prescription of bracing as common practice despite a lack of underpinning evidence. A majority (87%) of the doctors believed osteoporosis medications should commence prior to discharge from the acute setting, but 68% did not agree that responsibility for coordination and delivery of bone health assessment and fracture risk management rested with them. A majority (72%) of physiotherapists reported an absence or were unsure regarding existence of fracture liaison services. 73% of physiotherapists reported prescribing an inpatient or home (78%) exercise programme, including mobility, strength and balance exercise though detail on dose and adherence remain unknown. Wide variance in referral patterns to multi-disciplinary team (MDT) members existed although 79% of orthopaedic doctors supported an MDT approach. CONCLUSION: Clinical care pathways for the hospitalised VFF population lack standardisation in Ireland. Key challenges reported by orthopaedic doctors and physiotherapists relate to pain management, osteoporosis medication prescription, clarity on indications for bracing and a lack of fracture liaison services. Clinical guidelines, defined clinical care pathways and high-quality clinical research trials are required for VFF management.


Assuntos
Procedimentos Clínicos/estatística & dados numéricos , Cirurgiões Ortopédicos/estatística & dados numéricos , Fraturas por Osteoporose/terapia , Fisioterapeutas/estatística & dados numéricos , Fraturas da Coluna Vertebral/terapia , Idoso , Procedimentos Clínicos/normas , Estudos Transversais , Terapia por Exercício/normas , Terapia por Exercício/estatística & dados numéricos , Feminino , Pesquisas sobre Serviços de Saúde , Hospitalização/estatística & dados numéricos , Humanos , Irlanda , Masculino , Cirurgiões Ortopédicos/normas , Manejo da Dor/normas , Manejo da Dor/estatística & dados numéricos , Fisioterapeutas/normas , Encaminhamento e Consulta/normas , Encaminhamento e Consulta/estatística & dados numéricos
17.
BMC Endocr Disord ; 20(1): 28, 2020 Feb 21.
Artigo em Inglês | MEDLINE | ID: mdl-32085762

RESUMO

BACKGROUND: The number of patients with obesity continues to increase in our society. At the same time, digitalization defines our everyday life. Therefore, the question arises whether to use digital media for effective treatments against obesity. Aim of this review is a concise presentation of effects of media-assisted therapeutic approaches. METHODS: A systematic literature research in multiple scientific databases, PubMed, Web of Science and Cochrane Library, was performed for literature published in the last 10 years (cut-off date 12.07.2017). Only randomized controlled trials using digital support for treatment and/or aftercare of obese adults aged between 18 to 70 years were included into the analysis. RESULTS: Overall, 14 trials with data on a total of 4979 participants were included in this review. Generally, there are positive trends for increased moderate to vigorous physical activity by the use of digital media. A simultaneous usage of various digital media, which focus on important aspects of activity behavior, has proven to be effective. A combination of various digital media shows the greatest positive effect and could significantly increase physical activity. However, the biggest potential was found in mixed approaches combining digital devices and personal face-to-face support. CONCLUSIONS: Therapeutic approaches using digital media for supporting obesity treatment did not show superior benefit over traditional personal therapeutic methods. Nevertheless, using both methods together offered the greatest potential for successful obesity therapy. However, there is a backlog of transparency concerning information about the content of treatment. Furthermore, there is a lack of valid data about aftercare and follow-up.


Assuntos
Terapia por Exercício/normas , Internet/estatística & dados numéricos , Meios de Comunicação de Massa/estatística & dados numéricos , Obesidade/terapia , Adulto , Humanos , Qualidade de Vida
18.
Acta Diabetol ; 57(7): 765-777, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32025878

RESUMO

AIMS: We aim to systematically review the existing guidelines on physical activity for T2DM and assess the consistency of their recommendations, methodological quality, and reporting quality. METHODS: We performed a literature search on PubMed, China Biology Medicine disc, and four main guideline databases in order to identify existing T2DM guidelines. We then evaluated the methodological and reporting qualities of the guidelines using the AGREE II instrument and the RIGHT checklist. Fifteen guidelines were included in total, with eight of these (53.33%) assessed being "recommended" and five graded as having good reporting quality. RESULT: A total of 30 physical activity recommendations were extracted. Fifteen recommendations reported the levels of evidence, and of these, five were found to be based on a high quality of evidence. Aerobic exercise at least 3 days per week was recommended by most guidelines (10/15, 66.67%). Eight guidelines (53.33%) recommended resistance exercise, while combined aerobic and resistance exercise was recommended in three of the guidelines (20.0%). Only two guidelines recommended supervised exercise, and one recommended flexibility exercise. Four of the guidelines (26.67%) solely recommended physical activity or exercise, but with no added details. CONCLUSIONS: The quality of the guidelines concerning physical activity for T2DM was found to be moderate to low and varied substantially. Recommendations regarding physical activity for T2DM are not very specific or clear and remain incompletely consistent, while the level of evidence and the strength of the recommendations were seldom reported. Our findings suggest a need for guidelines for diabetes based on high levels of evidence.


Assuntos
Diabetes Mellitus Tipo 2/terapia , Exercício Físico , Guias como Assunto , Lista de Checagem , China/epidemiologia , Estudos Transversais , Bases de Dados Factuais/estatística & dados numéricos , Diabetes Mellitus Tipo 2/epidemiologia , Terapia por Exercício/métodos , Terapia por Exercício/normas , Humanos , Inquéritos e Questionários
19.
Arthritis Care Res (Hoboken) ; 72(2): 149-162, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31908149

RESUMO

OBJECTIVE: To develop an evidence-based guideline for the comprehensive management of osteoarthritis (OA) as a collaboration between the American College of Rheumatology (ACR) and the Arthritis Foundation, updating the 2012 ACR recommendations for the management of hand, hip, and knee OA. METHODS: We identified clinically relevant population, intervention, comparator, outcomes questions and critical outcomes in OA. A Literature Review Team performed a systematic literature review to summarize evidence supporting the benefits and harms of available educational, behavioral, psychosocial, physical, mind-body, and pharmacologic therapies for OA. Grading of Recommendations Assessment, Development and Evaluation methodology was used to rate the quality of the evidence. A Voting Panel, including rheumatologists, an internist, physical and occupational therapists, and patients, achieved consensus on the recommendations. RESULTS: Based on the available evidence, either strong or conditional recommendations were made for or against the approaches evaluated. Strong recommendations were made for exercise, weight loss in patients with knee and/or hip OA who are overweight or obese, self-efficacy and self-management programs, tai chi, cane use, hand orthoses for first carpometacarpal (CMC) joint OA, tibiofemoral bracing for tibiofemoral knee OA, topical nonsteroidal antiinflammatory drugs (NSAIDs) for knee OA, oral NSAIDs, and intraarticular glucocorticoid injections for knee OA. Conditional recommendations were made for balance exercises, yoga, cognitive behavioral therapy, kinesiotaping for first CMC OA, orthoses for hand joints other than the first CMC joint, patellofemoral bracing for patellofemoral knee OA, acupuncture, thermal modalities, radiofrequency ablation for knee OA, topical NSAIDs, intraarticular steroid injections and chondroitin sulfate for hand OA, topical capsaicin for knee OA, acetaminophen, duloxetine, and tramadol. CONCLUSION: This guideline provides direction for clinicians and patients making treatment decisions for the management of OA. Clinicians and patients should engage in shared decision-making that accounts for patients' values, preferences, and comorbidities. These recommendations should not be used to limit or deny access to therapies.


Assuntos
Fundações/normas , Articulação da Mão , Osteoartrite do Quadril/terapia , Osteoartrite do Joelho/terapia , Guias de Prática Clínica como Assunto/normas , Reumatologia/normas , Analgésicos/administração & dosagem , Gerenciamento Clínico , Terapia por Exercício/métodos , Terapia por Exercício/normas , Articulação da Mão/patologia , Humanos , Osteoartrite do Quadril/diagnóstico , Osteoartrite do Quadril/epidemiologia , Osteoartrite do Joelho/diagnóstico , Osteoartrite do Joelho/epidemiologia , Estados Unidos/epidemiologia
20.
Obstet Gynecol ; 135(2): 341-351, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31923073

RESUMO

OBJECTIVE: To evaluate outcomes after pelvic floor muscle therapy, as compared with perineorrhaphy and distal posterior colporrhaphy, in the treatment of women with a poorly healed second-degree obstetric injury diagnosed at least 6 months postpartum. METHODS: We performed a single center, open-label, randomized controlled trial. After informed consent, patients with a poorly healed second-degree perineal tear at minimum 6 months postpartum were randomized to either surgery or physical therapy. The primary outcome was treatment success, as defined by Patient Global Impression of Improvement, at 6 months. Secondary outcomes included the Pelvic Floor Distress Inventory, the Pelvic Floor Impact Questionnaire, the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire, and the Hospital Anxiety and Depression Scale. Assuming a 60% treatment success in the surgery group and 20% in the physical therapy group, plus anticipating a 20% loss to follow-up, a total of 70 patients needed to be recruited. RESULTS: From October 2015 to June 2018, 70 of 109 eligible patients were randomized, half into surgery and half into tutored pelvic floor muscle therapy. The median age of the study group was 35 years, and the median duration postpartum at enrollment in the study was 10 months. There were three dropouts in the surgery group postrandomization. In an intention-to-treat analysis, with worst case imputation of missing outcomes, subjective global improvement was reported by 25 of 35 patients (71%) in the surgery group compared with 4 of 35 patients (11%) in the physical therapy group (treatment effect in percentage points 60% [95% CI 42-78%], odds ratio 19 [95% CI 5-69]). The surgery group was superior to physical therapy regarding all secondary endpoints. CONCLUSION: Surgical treatment is effective and superior to pelvic floor muscle training in relieving symptoms related to a poorly healed second-degree perineal tear in women presenting at least 6 months postpartum. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT02545218.


Assuntos
Parto Obstétrico/reabilitação , Terapia por Exercício/métodos , Lacerações/reabilitação , Diafragma da Pelve/lesões , Períneo/cirurgia , Cuidado Pós-Natal/métodos , Adulto , Terapia por Exercício/normas , Incontinência Fecal/prevenção & controle , Feminino , Humanos , Lacerações/cirurgia , Modelos Logísticos , Diafragma da Pelve/cirurgia , Prolapso de Órgão Pélvico/prevenção & controle , Cuidado Pós-Natal/normas , Período Pós-Parto/fisiologia , Gravidez , Inquéritos e Questionários , Suécia , Resultado do Tratamento , Incontinência Urinária/prevenção & controle
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