Objectives:
To identify effective aerobic exercise programs and provide clinicians and patients with updated, high-quality recommendations concerning traditional land-based exercises for knee ...osteoarthritis.
Methods:
A systematic search and adapted selection criteria included comparative controlled trials with strengthening exercise programs for patients with knee osteoarthritis. A panel of experts reached consensus on the recommendations using a Delphi survey. A hierarchical alphabetical grading system (A, B, C+, C, D, D+, or D-) was used, based on statistical significance (P < 0.5) and clinical importance (⩾15% improvement).
Results:
The five high-quality studies included demonstrated that various aerobic training exercises are generally effective for improving knee osteoarthritis within a 12-week period. An aerobic exercise program demonstrated significant improvement for pain relief (Grade B), physical function (Grade B) and quality of life (Grade C+). Aerobic exercise in combination with strengthening exercises showed significant improvement for pain relief (3 Grade A) and physical function (2 Grade A, 2 Grade B).
Conclusion:
A short-term aerobic exercise program with/without muscle strengthening exercises is promising for reducing pain, improving physical function and quality of life for individuals with knee osteoarthritis.
Localized exercises are employed to activate, train, or restore the function of particular muscles and they are usually considered as part of treating individuals suffering low back pain. So, this ...systematic review and meta-analysis aimed to assess the efficacy of specific exercises in general population with non-specific low back pain (LBP).
We conducted electronic searches in MEDLINE/PubMed, Scopus, Web of Science (WoS), and Google scholar from January 1990 to June 2021. Initially, 47,740 records were identified. Following the removal of duplicates, 32,138 records were left. After reviewing titles and abstracts, 262 papers were chosen for thorough assessment. Among these, 208 studies were excluded, resulting in 54 trials meeting the inclusion criteria for this study. Additionally, 46 of these trials were randomized controlled trials and were further evaluated for the meta-analysis. We included trials investigating the effectiveness of exercise therapy, including isometric activation of deep trunk muscles, strengthening exercises, stabilization exercises, stretching exercises, and proprioceptive neuromuscular facilitation exercises (PNF) in LBP patients. The primary outcome was pain intensity, measured using tools such as the visual analogue scale (VAS) and numeric pain rating scale (NPRS). The secondary outcome was disability, assessed through instruments such as the Roland Morris Disability Questionnaire (RMDQ) and Oswestry Disability Index (ODI). The quality of the eligible studies was assessed using the Verhagen tool, and the level of evidence was evaluated using the GRADE approach.
Based on the Verhagen tool, 46 trials (85.2%) were categorized as having low methodological quality, while 8 studies (14.8%) were considered to have medium methodological quality. The meta-analysis indicated a small efficacy in favor of isometric activation of deep trunk muscles (−0.37, 95% CI: −0.88 to 0.13), a moderate efficacy in favor of stabilization exercises (−0.53, 95% CI: −1.13 to 0.08), and a large efficacy in favor of PNF exercises (−0.91, 95% CI: −1.62 to −0.2) for reducing pain intensity as assessed by VAS or NPRS tools. Moreover, the meta-analysis revealed a moderate efficacy for isometric activation of deep trunk muscles (−0.61, CI: −1.02 to −0.19), and a large efficacy for PNF exercises (−1.26, 95% CI: −1.81 to −0.72) in improving disability, assessed using RMDQ or ODI questionnaires.
The level of certainty in the evidence, as determined by the GRADE approach, was very low to low.
These findings emphasize the importance of incorporating localized therapeutic exercises as a fundamental aspect of managing non-specific LBP. Clinicians should consider utilizing localized therapeutic exercise tailored to individual patient needs. Furthermore, further research investigating optimal exercise therapy, optimal dose of the exercises, durations, and long-term adherence is warranted to enhance the precision and efficacy of exercise-based interventions for non-specific LBP.
•This study aimed to investigate the effectiveness of localized exercises among individuals suffering from LBP.•The evidence level for localized exercise interventions ranged from very low to low.•Among these exercises, PNF exercises demonstrated the most effectiveness in improving pain and disability.
Exercise for improving balance in older people Howe, Tracey E; Rochester, Lynn; Neil, Fiona ...
Cochrane database of systematic reviews,
2011-Nov-09, Volume:
2012, Issue:
5
Journal Article
Peer reviewed
Open access
Background
In older adults, diminished balance is associated with reduced physical functioning and an increased risk of falling. This is an update of a Cochrane review first published in 2007.
...Objectives
To examine the effects of exercise interventions on balance in older people, aged 60 and over, living in the community or in institutional care.
Search methods
We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, CENTRAL (The Cochrane Library 2011, Issue 1), MEDLINE and EMBASE (to February 2011).
Selection criteria
Randomised controlled studies testing the effects of exercise interventions on balance in older people. The primary outcomes of the review were clinical measures of balance.
Data collection and analysis
Pairs of review authors independently assessed risk of bias and extracted data from studies. Data were pooled where appropriate.
Main results
This update included 94 studies (62 new) with 9,821 participants. Most participants were women living in their own home.
Most trials were judged at unclear risk of selection bias, generally reflecting inadequate reporting of the randomisation methods, but at high risk of performance bias relating to lack of participant blinding, which is largely unavoidable for these trials. Most studies only reported outcome up to the end of the exercise programme.
There were eight categories of exercise programmes. These are listed below together with primary measures of balance for which there was some evidence of a statistically significant effect at the end of the exercise programme. Some trials tested more than one type of exercise. Crucially, the evidence for each outcome was generally from only a few of the trials for each exercise category.
1. Gait, balance, co‐ordination and functional tasks (19 studies of which 10 provided primary outcome data): Timed Up & Go test (mean difference (MD) ‐0.82 s; 95% CI ‐1.56 to ‐0.08 s, 114 participants, 4 studies); walking speed (standardised mean difference (SMD) 0.43; 95% CI 0.11 to 0.75, 156 participants, 4 studies), and the Berg Balance Scale (MD 3.48 points; 95% CI 2.01 to 4.95 points, 145 participants, 4 studies).
2. Strengthening exercise (including resistance or power training) (21 studies of which 11 provided primary outcome data): Timed Up & Go Test (MD ‐4.30 s; 95% CI ‐7.60 to ‐1.00 s, 71 participants, 3 studies); standing on one leg for as long as possible with eyes closed (MD 1.64 s; 95% CI 0.97 to 2.31 s, 120 participants, 3 studies); and walking speed (SMD 0.25; 95% CI 0.05 to 0.46, 375 participants, 8 studies).
3. 3D (3 dimensional) exercise (including Tai Chi, qi gong, dance, yoga) (15 studies of which seven provided primary outcome data): Timed Up & Go Test (MD ‐1.30 s; 95% CI ‐2.40 to ‐0.20 s, 44 participants, 1 study); standing on one leg for as long as possible with eyes open (MD 9.60 s; 95% CI 6.64 to 12.56 s, 47 participants, 1 study), and with eyes closed (MD 2.21 s; 95% CI 0.69 to 3.73 s, 48 participants, 1 study); and the Berg Balance Scale (MD 1.06 points; 95% CI 0.37 to 1.76 points, 150 participants, 2 studies).
4. General physical activity (walking) (seven studies of which five provided primary outcome data).
5. General physical activity (cycling) (one study which provided data for walking speed).
6. Computerised balance training using visual feedback (two studies, neither of which provided primary outcome data).
7. Vibration platform used as intervention (three studies of which one provided primary outcome data).
8. Multiple exercise types (combinations of the above) (43 studies of which 29 provided data for one or more primary outcomes): Timed Up & Go Test (MD ‐1.63 s; 95% CI ‐2.28 to ‐0.98 s, 635 participants, 12 studies); standing on one leg for as long as possible with eyes open (MD 5.03 s; 95% CI 1.19 to 8.87 s, 545 participants, 9 studies), and with eyes closed ((MD 1.60 s; 95% CI ‐0.01 to 3.20 s, 176 participants, 2 studies); and the Berg Balance Scale ((MD 1.84 points; 95% CI 0.71 to 2.97 points, 80 participants, 2 studies).
Few adverse events were reported but most studies did not monitor or report adverse events.
In general, the more effective programmes ran three times a week for three months and involved dynamic exercise in standing.
Authors' conclusions
There is weak evidence that some types of exercise (gait, balance, co‐ordination and functional tasks; strengthening exercise; 3D exercise and multiple exercise types) are moderately effective, immediately post intervention, in improving clinical balance outcomes in older people. Such interventions are probably safe. There is either no or insufficient evidence to draw any conclusions for general physical activity (walking or cycling) and exercise involving computerised balance programmes or vibration plates. Further high methodological quality research using core outcome measures and adequate surveillance is required.
This book proposes that health care is not just about physical abilities but mental and spiritual beliefs as well. The author argues for a more complex understanding of the psycho-physiological ...connection and advocates for a more holistic approach that may presently be perceived as a radical way to think about the practice of exercise and exercise physiology as a profession.
Objectives
In chronic obstructive pulmonary disease (COPD), quality of life and exercise capacity are altered in relationship to dyspnea. Benefits of inspiratory muscle training (IMT) on quality of ...life, dyspnea, and exercise capacity were demonstrated, but when it is associated to pulmonary rehabilitation (PR), its efficacy on dyspnea is not demonstrated. The aim of this systematic review with meta‐analysis was to verify the effect of IMT using threshold devices in COPD patients on dyspnea, quality of life, exercise capacity, and inspiratory muscles strength, and the added effect on dyspnea of IMT associated with PR (vs. PR alone).
Study selection
This systematic review and meta‐analysis was conducted on the databases from PubMed, Science direct, Cochrane library, Web of science, and Pascal. Following key words were used: inspiratory, respiratory, ventilatory, muscle, and training. The searching period extended to December 2017. Two reviewers independently assessed studies quality.
Results
Forty‐three studies were included in the systematic review and thirty‐seven studies in the meta‐analysis. Overall treatment group consisted of six hundred forty two patients. Dyspnea (Baseline Dyspnea Index) is decreased after IMT. Quality of life (Saint George's Respiratory Questionnaire), exercise capacity (6 min walk test) and Maximal inspiratory pressure were increased after IMT. During PR, no added effect of IMT on dyspnea was found.
Conclusion
IMT using threshold devices improves inspiratory muscle strength, exercise capacity and quality of life, decreases dyspnea. However, there is no added effect of IMT on dyspnea during PR (compared with PR alone).
OBJECTIVE: To compare the effects of neck exercises (McKenzie extension and isometric exercises) in the management of non-specific neck pain and range of motion in patients with neck pain. METHODS: ...This randomized controlled trial was conducted in physiotherapy departments of Dr. Akbar Niazi Teaching Hospital, Islamabad. Forty consecutive patients with acute to sub-acute cases of neck pain (<3 month) were enrolled. Based on lottery method two groups (n=20 in each group) were differentiated, Group-I (control) received isometric neck exercises and Group-II (treatment) received McKenzie extension exercises for 4-weeks along with hot packs therapy. Neck pain was measured using numeric pain rating scale (NPRS). All patients were tested on baseline, at 2nd and 4th week. RESULTS: Mean age of the sample was 33.85±4.80 and 33.50±5.20 years in group-I and group-II respectively. Male to female ratio was 4:1 in both groups. Mean body mass index was 24.54±1.50kg/m2. NPRS at baseline was 5.80±0.41 in group-I while 6.10±0.64 in group-II (p-value=0.001). NPRS decreased to 3.75±0.72 in group-I and 3.00±0.73 in group-II after 4-weeks (p-value=0.001). Neck flexion (degrees) at baseline was 31±2.05 in group-I and 35.75±1.83 in group-II (p-value=0.001) while after 4weeks increased to 35.50±4.26 in group-I and 40±4.29 in group-II (p-value=0.002). Neck extension (degrees) at baseline was 44±2.05 in group-I and 40.75±1.83 in group-II (p-value=0.001) while after 4-weeks increased to 48.5±4.01 in group-I and 45±4.29 in group-II (p-value=0.011). CONCLUSION: McKenzie exercises are more significant and show more improvement in reduction of pain and associated symptoms of neck and increased movements quicker than isometric exercises.
String theory is one of the most exciting and challenging areas of modern theoretical physics. This book guides the reader from the basics of string theory to recent developments. It introduces the ...basics of perturbative string theory, world-sheet supersymmetry, space-time supersymmetry, conformal field theory and the heterotic string, before describing modern developments, including D-branes, string dualities and M-theory. It then covers string geometry and flux compactifications, applications to cosmology and particle physics, black holes in string theory and M-theory, and the microscopic origin of black-hole entropy. It concludes with Matrix theory, the AdS/CFT duality and its generalizations. This book is ideal for graduate students and researchers in modern string theory, and will make an excellent textbook for a one-year course on string theory. It contains over 120 exercises with solutions, and over 200 homework problems with solutions available on a password protected website for lecturers at www.cambridge.org/9780521860697.
An objective of a warm-up prior to an athletic event is to optimize performance. Warm-ups are typically composed of a submaximal aerobic activity, stretching and a sport-specific activity. The ...stretching portion traditionally incorporated static stretching. However, there are a myriad of studies demonstrating static stretch-induced performance impairments. More recently, there are a substantial number of articles with no detrimental effects associated with prior static stretching. The lack of impairment may be related to a number of factors. These include static stretching that is of short duration (<90 s total) with a stretch intensity less than the point of discomfort. Other factors include the type of performance test measured and implemented on an elite athletic or trained middle aged population. Static stretching may actually provide benefits in some cases such as slower velocity eccentric contractions, and contractions of a more prolonged duration or stretch-shortening cycle. Dynamic stretching has been shown to either have no effect or may augment subsequent performance, especially if the duration of the dynamic stretching is prolonged. Static stretching used in a separate training session can provide health related range of motion benefits. Generally, a warm-up to minimize impairments and enhance performance should be composed of a submaximal intensity aerobic activity followed by large amplitude dynamic stretching and then completed with sport-specific dynamic activities. Sports that necessitate a high degree of static flexibility should use short duration static stretches with lower intensity stretches in a trained population to minimize the possibilities of impairments.
BACKGROUND Respiratory therapy is an integral part of treatment of cardiac patients. The aim of this study was to evaluate the effect of addition of inspiratory muscle training (IMT) to second-stage ...cardiac rehabilitation on exercise tolerance and function of lower extremities in patients following myocardial infarction (MI). MATERIAL AND METHODS This study included 90 patients (mean age 65 years) with MI who took part in the second stage of an 8-week cycle of cardiac rehabilitation (CR). They were divided into 3 groups: group I underwent CR and IMT, group II only underwent CR, and group III only underwent IMT. Groups I and II were allocated randomly according sealed opaque envelopes. The third group consisted of patients who could not participate in standard rehabilitation for various reasons. Before and after the 8-week program, participants were assessed for maximal inspiratory and expiratory pressure (PImax and PEmax) values, exercise tolerance, and knee muscle strength. RESULTS In groups I and II, a significant increase in the PImax parameters and exercise tolerance parameters (MET) were observed. Group I had increased PEmax parameters. In group III, the same changes in the parameter values that reflect respiratory muscle function were observed. All of the examined strength parameters of the knee joint muscles demonstrated improvement in all of the investigated groups, but the biggest differences were observed in group I. CONCLUSIONS Use of IMT in the ambulatory rehabilitation program of MI patients resulted in improved rehabilitation efficacy, leading to a significant improvement in physical condition.
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