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PubMed1994

Optimal treatment of venous (stasis) ulcers in elderly patients.

In elderly patients, even those with a typical venous (stasis) ulcer, coexisting conditions like peripheral arterial insufficiency and diabetes are very common. Therefore, all elderly patients with leg ulcers should have a complete medical assessment. The mainstay of treatment for venous ulcers is compression therapy, exercise and leg elevation at rest. Long term treatment with double bandages (zinc paste bandages and elastic compression), changed once weekly, is the recommended standard treatment in the elderly. Hydrocolloid dressings are also suitable for long term treatment in clean ulcers, and should be changed once or twice weekly and combined with compression. Sloughy, exudating ulcers might need redressing daily with a desloughing agent for a short period of time. The risk of sensitising patients with chronic leg ulcers is high and few topical preparations, with low antigenicity, should be used. Infection and ulcerated skin cancers should be ruled out in nonhealing ulcers if the patient complies with compression therapy. After healing, the patient should be advised to continue compression therapy with stockings to prevent recurrences. New noninvasive techniques for investigation of venous insufficiency can select patients suitable for venous surgery, but many elderly patients are not interested in surgery or have other ailments that prevent surgery.

Aged↗
PubMed2000

Physical therapy for migraine-related vestibulopathy and vestibular dysfunction with history of migraine.

OBJECTIVES/HYPOTHESIS: To assess the efficacy of physical therapy for patients with a diagnosis of migraine-related vestibulopathy (MRV) or vestibular dysfunction with a history of migraine headache. STUDY DESIGN: Retrospective case series METHODS: Thirty-nine patients were identified through a retrospective chart review, 14 with a diagnosis of MRV and 25 with migraine headache. The patients were treated with a custom-designed physical therapy exercise program for a mean of 4.9 visits over a mean duration of 4 months. Patients completed the Dizziness Handicap Inventory (DHI), the Activities-Specific Balance Confidence Scale (ABC), and the Dynamic Gait Index (DGI), reported the number of falls they had experienced in the past 4 weeks, and rated the severity of their dizziness on an analogue scale of 0 to 100 at initial evaluation and at discharge. RESULTS: Significant differences were seen before and after therapy in each of the outcome measures used. The average decrease in DHI score was 12 points (P < .01). ABC scores increased an average of 14 points (P < .01). Subjects increased their DGI scores an average of 4 points (P < .01). The number of patients reporting more than one fall decreased by 78% at discharge. (P < .05). Baseline symptoms of dizziness decreased an average of 11 points (P < .05). CONCLUSIONS: Patients with MRV and migraine headache demonstrated improvement in physical performance measures and self-perceived abilities after vestibular physical therapy.

Adult↗
PubMed1999

The long-term effects of pulmonary rehabilitation in patients with asthma and chronic obstructive pulmonary disease: a research synthesis.

OBJECTIVE: To present a critical review and meta-analysis of studies evaluating the long-term effects of pulmonary rehabilitation in patients with asthma and chronic obstructive pulmonary disease (COPD). DATA SOURCES: A database of articles published over the last 45 years, compiled by using medical subject heading key words pulmonary, obstructive, rehabilitation, and exercise. Articles not written in English, Dutch, or German and abstracts were excluded. STUDY SELECTION: Selected studies (1) evaluated the effects of pulmonary rehabilitation, (2) included patients with asthma or COPD older than 18 years, (3) evaluated outcome measures of exercise capacity or health related quality of life (HRQL), and (4) included a control condition lacking exercise training. DATA EXTRACTION: Independent extraction by two reviewers. DATA SYNTHESIS: For each outcome, summary effects were computed by pooling standardized mean differences as well as raw mean differences. Significant improvements were found for all outcomes (p < .001). Sensitivity analyses for methodological quality of the selected studies did not change summary effect sizes. Effect sizes were significantly heterogeneous for the outcome endurance time (p < .0001). Pooling raw mean differences revealed overall effects in 6-minute walking distance (49+/-26 m) and all 4 dimensions of the chronic respiratory questionnaire (range, 0.5+/-0.3 to 0.8+/-0.3 points), indicating substantial improvements in these outcomes. Significant summary effect sizes were found up to 9 months after finishing rehabilitation for maximal exercise capacity (p < .003) and 6-minute walking distance (p < .005). CONCLUSIONS: Patients with asthma and COPD benefit from pulmonary rehabilitation.

Asthma↗
PubMed2006

Reduction of hyperinflation by pharmacologic and other interventions.

Hyperinflation of the lungs is associated with activity limitation and reduced quality of life of patients with chronic obstructive pulmonary disease (COPD). Cardiopulmonary exercise testing has proven useful, not only in establishing this link, but also in determining which interventions modify exercise endurance and the mechanisms by which this is achieved. In COPD, dynamic hyperinflation is reduced during exercise by interventions that either increase the potential for expiratory flow or increase the time available for expiration. Two classes of intervention improve exercise tolerance by increasing expiratory flow. Bronchodilators reduce expiratory airflow resistance by increasing the diameter of the airways. An alternative intervention, though less practical, is to reduce the density of the gas exhaled through obstructed airways, such as occurs when breathing a mixture of helium and oxygen (heliox). In contrast, supplemental oxygen and exercise rehabilitation programs improve endurance by reducing respiratory ventilatory drive and, therefore, respiratory rate. The different mechanisms exploited by these interventions to reduce dynamic hyperinflation suggest that combination treatments should yield additive benefits. This has been proven in the case of combinations of rehabilitative exercise training with supplemental oxygen, or with the bronchodilator tiotropium, both of which have been found to yield additive effects. With such interventions, we already have options for improving the mobility of patients with COPD. With a firm understanding of the physiologic basis of exercise limitation, we can focus on defining new and better strategies to improve exercise tolerance.

Bronchodilator Agents↗
PubMed1996

Recruitment strategies for black women at risk for noninsulin-dependent diabetes mellitus into exercise protocols: a qualitative assessment.

The literature is devoid of any specific data describing exercise therapy in blacks at risk for diabetes. The increasing and striking prevalence of obesity and diabetes among several indigenous populations demonstrates the unfortunate interplay between genetic predisposition and a "modern" sedentary lifestyle. Any successful intervention to reduce the risk of acquiring or attenuating the severity of diabetes must focus on behavioral, cultural, psychosocial, and social factors that are amenable to change. Thus, the objective of this study is to present qualitative data that can be useful in the recruitment of blacks into exercise protocols that could prove to be beneficial in preventing diabetes. Focus groups were conducted on 57 black women residing in Washington, DC, Columbia, Maryland, and Hartford, Connecticut. Barriers to exercising included lack of child care, lack of transportation, neighborhood constraints, and family. Incentives that would increase black women's ability to participate in an exercise protocols include transportation, child care, and an exercise environment that includes blacks.

Adult↗
PubMed1990

Relationship between age-adjusted heart rate and anaerobic threshold in estimating exercise intensity in diabetics.

We compared heart rates at the anaerobic threshold (AT) with age-adjusted heart rates in two groups of diabetics (DMY, mean age 31; and DMO, mean age 48) to ascertain whether the AT is useful for evaluating the intensity of exercise therapy for diabetics. In both the DMY and DMO groups the AT was reached at lower heart rates than in control groups of healthy subjects, indicating that the metabolism of diabetics may become anaerobic if their age-adjusted heart rate is higher than their heart rate at the AT. In this study, 86% of the DMY and 50% of the DMO group had age-adjusted heart rates, at 70% of maximum, that were higher than the heart rates at the AT. Thus, exercise intensity with an age-adjusted heart rate at 70% of maximum may induce anaerobic metabolism in some diabetics. We also studied the relationship between exercise intensity and the glycosylated hemoglobin (HbA1c) level at the AT in order to understand why the heart rate at the AT in diabetics was less than in healthy subjects. Exercise intensity at the AT in both diabetic groups was less than in healthy groups, and so did not increase the heart rates. Both exercise intensity and the heart rate at the AT were inversely related to the HbA1c level, suggesting that HbA1c may be important for keeping low the exercise intensity and the heart rate at the AT. As far as possible, we excluded cardiovascular autonomic neuropathy, so that it could not explain the mechanism.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2005

Long-term effects of supervised physical training in secondary prevention of low back pain.

BACKGROUND AND OBJECTIVES: In the last few years, several studies have focused on short-term treatment effects of exercise therapy. However, there is a lack of knowledge concerning the long-term treatment effects recorded after several years. Hence, this study was performed to investigate the short- and long-term effects of supervised physical training on functional ability, self-rated pain and disability in secondary prevention of low back pain. METHODS: One hundred and eighty-three hospital employees with chronic low back pain were randomly assigned either to back school (comparison group), or three-months supervised physical training including a back school (exercise group). Various measurements of functional ability were performed and subjects completed questionnaires on self-rated pain, disability, and general well-being before treatment, immediately after intervention, and at six-months follow-up. At one-year and at ten-years follow-up participants evaluated treatment effectiveness. RESULTS: Out of 183 employees, 148 completed the program. Participation at follow-ups ranged from 66 to 96%. Supervised physical training significantly improved muscular endurance and isokinetic strength during a six-months follow-up, and effectively decreased self-rated pain and disability during a one-year follow-up. At ten-years follow-up the subjects' assessment of the effectiveness of treatment was significantly better in the exercise group. CONCLUSIONS: Supervised physical training effectively improved functional capacity and decreased LBP and disability up to one-year follow-up. The subjects' positive evaluation of the treatment effect at ten-years follow-up suggests a long-term benefit of training.

Adult↗
PubMed2005

Task-oriented aerobic exercise in chronic hemiparetic stroke: training protocols and treatment effects.

Stroke is the leading cause of disability in older Americans. Each year 750,000 Americans suffer a stroke, two thirds of whom are left with neurological deficits that persistently impair function. Principal among them is hemiparetic gait that limits mobility and increases fall risk, promoting a sedentary lifestyle. These events propagate disability by physical deconditioning and "learned non-use," with further functional declines accelerated by the sarcopenia and fitness decrements of advancing age. Conventional rehabilitation care typically provides little or no structured therapeutic exercise beyond the subacute stroke recovery period, based on natural history studies showing little or no further functional motor recovery beyond 6 months after stroke. Emerging evidence suggests that new models of task-oriented exercise have the potential to improve motor function even years after stroke. This article presents treadmill as a task-oriented training paradigm to optimize locomotor relearning while eliciting cardiovascular conditioning in chronic stroke patients. Protocols for exercise testing and longitudinal aerobic training progression are presented that provide fundamental formulas that safely approach the complex task of customizing aerobic training to gait deficit severity in the high CVD risk stroke population. The beneficial effects of 6 months task-oriented treadmill exercise on cardiovascular-metabolic fitness, energy cost of hemiparetic gait, ADL mobility task performance, and leg strength are discussed with respect to the central and peripheral neuromuscular adaptations targeted by the training. Collectively, these findings constitute one initial experience in a much broader neuroscience and exercise rehabilitation development of task-oriented training paradigms that offer a multisystems approach to improving both neurological and cardiovascular health outcomes in the chronic stroke population.

Adaptation, Physiological↗
PubMed2003

Regular exercise, hormone replacement therapy and the age-related decline in carotid arterial compliance in healthy women.

OBJECTIVE: Carotid arterial compliance is reduced with age in sedentary estrogen-deficient women, contributing to the development of cardiovascular disorders. We determined the effects of regular aerobic exercise, hormone replacement therapy (HRT), and their interaction on carotid arterial compliance using a combination of cross-sectional and intervention study designs. METHODS: Cross-sectionally, we studied three groups of healthy postmenopausal women (50-80 years): 20 sedentary not taking HRT; 24 sedentary taking HRT; and 14 endurance-trained not taking HRT; and 11 sedentary premenopausal controls (20-37 years). In the intervention study, 12 sedentary postmenopausal women (58+/-3 years) who were taking HRT were studied before and after participation in a 3-month aerobic exercise (walking) program. Carotid arterial compliance was measured via simultaneous common carotid artery ultrasound imaging and applanation tonometry. RESULTS: Cross-sectional study. Carotid arterial compliance was lower (P<0.001) in all three postmenopausal groups compared with premenopausal women. Among the postmenopausal groups, arterial compliance was 33-43% higher in the sedentary HRT and endurance-trained women than in their sedentary estrogen-deficient peers. Intervention study. Arterial compliance increased (P<0.05) by approximately 40% to levels that were no longer different than premenopausal women. CONCLUSIONS: HRT use and regular aerobic exercise are associated with augmented carotid arterial compliance in healthy postmenopausal women. Moderate, short-term aerobic exercise can restore carotid arterial compliance in previously sedentary postmenopausal women taking HRT.

Aged↗
PubMed2005

Determinants of health-related quality of life in women with vertebral fractures.

Health-related quality of life (HRQL) is an important consideration in the management of patients with vertebral fractures. The purpose of this study was to examine patient-related factors that contribute to HRQL after vertebral fractures, including co-morbidities, medications, fracture history, family disease history, demographics, exercise, education and living environment. A total of 1,129 post-menopausal women (mean age 67.2, SD 11.9 years) was studied from the Canadian Database of Osteoporosis and Osteopenia (CANDOO). HRQL was measured using the mini-osteoporosis quality of life questionnaire (mini-OQLQ). Separate multivariable linear regression analyses [parameter estimates and corresponding 95% confidence intervals (CI)] were performed for each of the five mini-OQLQ domains: symptoms, physical functioning, emotional functioning, activities of daily living and leisure domains. A strong positive association was found between HRQL and post-secondary education, a family history of osteoporosis, working and thiazide therapy. Exercise improved HRQL; however, several hours a week were required to be meaningful. Living in long-term care had the most marked negative effect on HRQL. Smoking, past surgery of the hip or spine, sedatives, anticonvulsants, atherosclerotic disease and hypertension were also associated with a substantially decreased HRQL across several domains. Calcium channel-blockers, chemotherapy, corticosteroids, diabetes, migraines, the number of non-vertebral fractures and falls had a negative impact on selected domains. We demonstrated that several modifiable factors influence HRQL in patients with vertebral fractures, and physicians should be aware of these and other markers of reduced HRQL to enhance patient care.

Activities of Daily Living↗
PubMed2006

Physical therapy management of low back pain has changed.

BACKGROUND: Since the 1990s, new insights in the physical therapy management of low back pain have been described in guidelines. Furthermore, insurance companies introduced a volume policy to control the costs for physical therapy. OBJECTIVE: This study aims to establish if developments in knowledge and health policy since the 1990s have resulted in changes in the physical therapy management of patients with low back pain (LBP) in the Netherlands. METHODS: Data from 3148 patients, referred because of LBP, were selected from the databases of two registration studies (1989-1992 and 2002-2003) of patients treated by physical therapists. Descriptive statistics were used to compare patient characteristics. A multi-level regression analysis was carried out to determine a change in the number of treatment sessions adjusting for patient and disease characteristics, and to control for different levels (patient and physical therapist). RESULTS: A small decline in the number of treatment sessions was observed. In 2002, exercise therapy was the most frequently applied intervention, while massage and physical modalities were the interventions of first choice in the early 1990s. CONCLUSION: Our results suggest that since 1990 the management of patients with LBP by physical therapists in the Netherlands has changed. Both quality management by the profession and volume policy by government and insurance companies seem to have been instrumental in bringing about a decline in the number of treatment visits and an increase in the use of evidence-based interventions.

Adolescent↗
PubMed2006

TTM-based counselling in physiotherapy does not contribute to an increase of adherence to activity recommendations in older adults with chronic low back pain--a randomised controlled trial.

AIMS: The present study examines the outcome of counselling in physiotherapy based on the Transtheoretical Model (TTM) in a sample of elderly individuals with chronic low back pain. METHODS: In a prospective randomised trial with concealed assignment, elderly individuals with chronic low back pain were allocated to two treatment conditions. Both contained 10 sessions of physiotherapy, each of 20min duration. In addition, the experimental group (EG) received 10min counselling prior to every session based on the TTM, also provided by the physiotherapist, and the control group (CG) underwent a placebo ultrasound treatment with an inactivated device to control for the additional attention given to the EG. Assessments took place prior to the treatment (t1), immediately after termination of the treatment (t2), and at a 6-months follow-up. Outcome measures were physical activity calculated from one-week activity diaries, self-reported functional capacity, and range of motion measured by ultrasound topometry. RESULTS: A total of 170 individuals (64% female) with a mean age of 70.3 years (SD=4.4, range 65-84) participated in the study. The retention rate was 90%. At t3, both EG and CG showed increased physical activity and functional capacity, but no change in range of motion. Effect sizes were large. Contrary to our hypothesis, however, motivational training did not result in a better outcome compared with placebo treatment. CONCLUSION: The study does not provide evidence that a short TTM-based motivation programme is superior to placebo treatment regarding adherence to activity recommendations.

Activities of Daily Living↗
PubMed1995

Effect of short-term cardiovascular conditioning and low-fat diet on myocardial blood flow and flow reserve.

BACKGROUND: Cardiovascular conditioning reduces resting myocardial oxygen demand by lowering systolic blood pressure and heart rate. Lower myocardial oxygen demand at rest would be expected to be associated with a decrease in resting myocardial blood flow and, consequently, an increase in myocardial flow reserve as the ratio of hyperemic to resting blood flow. However, the effect of controlled exercise together with a low-lipid diet on myocardial blood flow and flow reserve has not been examined in humans. METHODS AND RESULTS: Myocardial blood flow at rest and after dipyridamole-induced hyperemia (0.56 mg/kg i.v.) was quantified with [13N]ammonia and positron emission tomography in 13 volunteers before and upon completion of a 6-week program of cardiovascular conditioning and a low-fat diet. Exercise capacity and serum lipid profiles were also assessed at the start and finish of the program. Eight normal volunteers of similar age not participating in the conditioning program served as a control group. Cardiovascular conditioning lowered the resting rate-pressure product (8859 +/- 2128 versus 7450 +/- 1496, P < .001), serum cholesterol (217 +/- 36 versus 181 +/- 26 mg/dL), LDL cholesterol (140 +/- 32 versus 114 +/- 24 mg/dL), and triglycerides (145 +/- 53 versus 116 +/- 33 mg/dL, all P < .05). Exercise tolerance (metabolic equivalent of the task, METs) improved significantly from 10.0 +/- 3.0 to 14.4 +/- 3.6 (P < .01). Resting blood flow decreased (0.78 +/- 0.18 versus 0.69 +/- 0.14 mL.g-1.min-1, P < .05), whereas hyperemic blood flow increased (2.06 +/- 0.35 versus 2.25 +/- 0.40 mL.g-1.min-1, P < .05), resulting in an improved myocardial flow reserve (2.82 +/- 1.07 versus 3.39 +/- 0.91, P < .05). Overall, the myocardial flow reserve was significantly related to exercise performance (METs). In the control group, no changes in resting rate-pressure product, serum cholesterol levels, exercise performance, resting or hyperemic myocardial blood flow, or flow reserve were observed. CONCLUSIONS: Short-term cardiovascular conditioning together with a low-fat diet results in an improved myocardial flow reserve by lowering resting blood flow and increasing coronary vasodilatory capacity. These changes are associated with an improved exercise capacity and may offer a protective effect in patients with coronary artery disease.

Ammonia↗
PubMedDate not supplied

[Role of modern diet therapy in the prevention of visceral complications in patients with dietary obesity].

The examination and treatment of 547 patients with alimentary obesity revealed in them significant impairments of myocardial contractility, manifest hemodynamic disorders (in 65.5% of patients), marked changes in lipid metabolism (hypercholesterolemia, hypertriglyceridemia, hyperlipacidemia, hyperlipoproteinemia type IIa in 26,5%, type IIb in 14,5%, type IV in 32,5% of patients), as well as reduced activity of the T-immunity system, all these changes being prerequisites for the development of atherosclerosis, ischemic heart disease and essential hypertension. During examination of the patients' liver, fatty hepatosis was detected in 91.4%, chronic nonalcoholic steatohepatitis in 14% of patients, manifest shifts were found in their bile biochemical composition, leading to the development of cholelithiasis. The incretory dysfunction of the pancreas led to carbohydrate imbalance in 43%, and to diabetes mellitus in 7.5% of patients. Under the effect of the treatment (diet, exercise therapy, oxygenotherapy, hydrotherapy) conducted in the alimentary obesity patients, lessening of the pathologic process was observed in the heart, liver and pancreas, their functions being significantly improved. It has been concluded that normalization of the body weight in obese subjects is a measure preventing atherosclerosis, ischemic heart disease, essential hypertension, fatty hepatosis, steatohepatitis, cholelithiasis and diabetes mellitus.

Arteriosclerosis↗
PubMed1995

Aging, physical activity and sports injuries. An overview of common sports injuries in the elderly.

Illness and aging both cause many structural and functional alterations in the human body, rendering elderly people liable to overloading of the musculoskeletal and cardiovascular systems. It should, however, be kept in mind that immobilisation and inactivity have even more deleterious effects on structures and functions in the elderly than in younger adults. Most physically active elderly people are selected individuals with respect to their superior health and physical capacity compared with inactive persons of the same age, thus making it possible to further improve their physical capacity. They will, however, be affected by some of the drawbacks of physical overloading, mostly due to the diminished ability of aging body systems to adapt to high levels of loading. The safety margin of an exercise dose tends to decline with aging. Exertional injuries are common among the elderly, and are connected mostly with degenerative aging processes. Acute injuries are common in those elderly people participating in sport activities which demand high coordination, reaction time, and balance capabilities, such as ball games, down-hill skiing, and gymnastics. Muscle has been reported to be the most commonly acutely injured tissue among active elderly athletes. The lower extremities are the most susceptible to injury. A large proportion of injuries (acute and exertional) are mild and can be treated by brief cessation of training and competition activities. Some of the injuries are, however, long term and cause disability not only during training and competition, but also in the normal activities of daily living. It is important that these injuries are treated as soon as possible and in the most effective way, similarly to injuries suffered by younger people. In treating elderly people, it is most important to avoid the detrimental effects of immobilisation; this requires active treatment and rehabilitation with compensatory exercise therapy. The best 'treatment' for sports-related injuries is prevention. Good agility, technical skills, and cardiovascular and musculoskeletal fitness are important in injury prevention among the elderly. Appropriate training programmes, the use of safe and familiar equipment, careful warming up and cooling down, multiphasic training [including the training of neurophysiological functions (balance, coordination and reaction time)] and muscle strength are essential aspects of injury prevention.

Aged↗
PubMedDate not supplied

Flexor tendon repair in zone II with 6-strand techniques and early active mobilization.

PURPOSE: There are many biomechanic studies of 6-strand suture techniques for active mobilization, but few reports have described the clinical outcome in zone II flexor tendon lacerations. We discuss the clinical results of zone II flexor tendon repair using 2 of these techniques followed by controlled early active mobilization. METHODS: Six-strand sutures using the number 1 technique by Yoshizu or a triple-looped suture technique were used to repair flexor tendons in 27 fingers from 21 consecutive patients. Fingers were mobilized by combining active extension and passive or active flexion in a protective splint for the first 3 weeks after surgery. The follow-up period averaged 13 months. RESULTS: Based on the original Strickland criteria, the results were excellent in 17 fingers, good in 9, and fair in 1. The average flexion was 62 degrees for distal interphalangeal joints and 91 degrees for proximal interphalangeal joints. None of the repaired tendons ruptured. CONCLUSIONS: The 6-strand flexor tendon suture technique followed by controlled active mobilization protected with a dorsal splint is safe, produces no ruptures, and achieves very good results in zone II flexor tendon laceration repair. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic, Level II.

Adolescent↗