Treatment for chronic fatigue syndrome.
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Combined Modality Therapy↗
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The conservative management of patients with symptoms of stress incontinence: a randomized, prospective study comparing weighted vaginal cones and interferential therapy.
Sixty-nine female patients with symptoms of stress urinary incontinence were randomized to treatment with either interferential therapy or weighted vaginal cones. Fifty-four patients completed treatment (interferential therapy, 30 patients; weighted vaginal cones, 24 patients). Patients were assessed by subjective response, pad testing, continence charts, and the maximum weight of cone that could be held actively and passively. Forty-seven patients were reassessed at 6 months (19 cones; 28 interferential), five patients (9.26%) required surgery, and two patients (3.7%) could not be reassessed. Subjective response to treatment was good, with 80% to 90% of patients cured or improved after treatment. After 6 months, 41.67% in the cone group and 40% in the interferential group were subjectively cured, with improvement in 50% and 30%, respectively. Of those patients initially referred for treatment, greater than 30% in each group were cured of symptoms. There was an objective improvement in both groups. In the cone group 50% had improved after treatment and greater than 60% had improved at 6 months as assessed by pad testing, while in the interferential group 76% had improved after treatment and 73% had improved at 6 months. There was no significant difference in improvement between the two groups in any of the methods of assessment. However, the cones require less supervision by trained staff and can be used at home by the patient. Their use results in a savings in time for the physiotherapy department. The use of the cones is recommended as a cost-effective method of treatment that can be added to the present therapy options available to the physiotherapist.
Electric Stimulation Therapy↗
Intensive rehabilitative approach to eosinophilia myalgia syndrome associated with severe polyneuropathy.
We report a case of the eosinophilia myalgia syndrome (EMS) with incapacitating myalgias, weakness secondary to a severe polyneuropathy, and contractures in all four extremities requiring aggressive rehabilitation treatment. A 55-year-old woman was admitted to a rehabilitation hospital 11 months after the onset of EMS. At that time, she had severe weakness secondary to peripheral neuropathy and painful contractures in all extremities and required high doses of narcotics for pain control. A continuous passive range of motion machine was used in order to maintain range of motion obtained during active exercise therapy. The patient showed functional improvement in basic mobility and ADL skills. She was withdrawn from narcotics and successfully learned pain management techniques. An aggressive rehabilitation approach in the treatment of EMS associated with peripheral neuropathy may improve functional outcome even when instituted late in the clinical course.
Eosinophilia-Myalgia Syndrome↗
Goal-setting and spouse involvement in the treatment of obesity.
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Behavior Therapy↗
Use of functional electrical stimulation in the rehabilitation of patients with incomplete spinal cord injuries.
When patients enter the Rehabilitation Centre a therapeutic electrical stimulation programme is immediately initiated. Three groups of patients were identified: (i) those in whom an improvement of both voluntary and stimulated muscle force was observed, (ii) those with an increase in stimulation response only, and (iii) patients in whom no effect of electrical stimulation training could be recorded. Isometric measurement of voluntary and stimulated knee joint torque revealed that in a great number of patients one leg was severely paralysed while the other leg was under sufficient voluntary control. Unilateral two-channel stimulation of knee extensors and the peroneal nerve was proposed as an orthotic aid for this group of patients. Exaggerated extensor tone was observed by assessment of spasticity around the knee joint. A two-channel peroneal stimulator was found to be a useful approach in order to inhibit this tone and thereby help the patients to initiate a step.
Adult↗
Response of patients with coronary artery disease stratified by ejection fraction following short-term training.
The purpose of this study was to investigate the response of patients with ischemic heart disease and varied left ventricular function following 6 weeks of exercise training. We studied the oxygen consumption (VO2), and central hemodynamic and metabolic responses of 14 patients with coronary artery disease (CAD) stratified by left ventricular ejection fraction (EF). There were two groups of patients: normal EF (NEF), EF = 64 +/- 9.9 (mean +/- S.E.M.); n = 7, and diminished EF (DEF), EF = 36 +/- 11.6; n = 7. The patients ranged in age from 42 to 72 years (54.9 +/- 2.2), and were evaluated prior to and then following training. Measures of VO2, cardiac output (Qt) stroke volume (SV), heart rate (HR), exercise duration (XTIME) and intensity (XI), as well as plasma lactate (LA), and the catecholamines epinephrine (E) and norepinephrine (NE) were obtained in response to maximal cycle ergometry. Subjects trained three times per week, 30 min per session, at an intensity equal to 70% of their peak oxygen consumption. Repeated measures analysis of variance (ANOVA) revealed no interaction between groups suggesting a similar training response. Significant post-training changes (P < 0.05) were observed in peak VO2 (VO2peak) NEF, 11.8% increase, (16.0 +/- 1.3 to 17.9 +/- 1.1 ml/kg/min) and DEF, 9.3% increase (15.1 +/- 1.6 to 16.5 +/- 1.2 ml/kg/min); submaximal HR, 4% decrease in the NEF (95.57 +/- 4.58 to 92 +/- 4.43 beats/min) and a 6% decrease in the DEF (107.29 +/- 7.44 to 101.43 +/- 6.77 beats/min); XTIME NEF, 11.2% increase (7.8 +/- 0.57 to 8.67 +/- 0.61 min) and DEF, 16.6% increase (7.3 +/- 0.91 to 8.51 +/- 0.69 min); and XI NEF, 19.2% increase (104.3 +/- 11.3 to 124.3 +/- 12.9 W) DEF, 21.2% increase (94.3 +/- 18.5 to 114.3 +/- 16.9 W), and a 15% decrease in resting NE (350 +/- 26 to 296.9 +/- 19 pg/ml). There were no changes in Qt, SV, LA, E, peak NE or peak HR for either group. These findings suggest short-term endurance training at 70% VO2peak provide the necessary stimulus for individuals with CAD and NEF or DEF to display an improvement in XI, XTIME, and VO2peak. The lack of a significant enhancement in Qt with short-term training may indicate that the mechanism by which both study groups were able to attain significantly higher levels of VO2peak may have been attributable to peripheral mechanisms rather than any alterations in Qt, a central mechanism.
Coronary Disease↗
Early active short arc motion for the repaired central slip.
This study compared the functional results in patients with open and repaired central slip injuries treated by two different postoperative management methods. The groups were similar in number of patients and amount of complex injuries. The comparisons made were proximal interphalangeal joint extensor lag, flexion at distal interphalangeal and proximal interphalangeal joints, total active motion, and length of treatment required. Patients in group 1 were treated with 3-6 weeks of continuous immobilization followed by a vigorous standard rehabilitation program. Patients in group 2 were treated by early active short arc motion initiated between the second day and the eleventh day after repair. By all criteria evaluated, patients in group 2 demonstrated better results at discharge compared to patients in group 1.
Adult↗
Physical training improves skeletal muscle metabolism in patients with chronic heart failure.
OBJECTIVES: This study investigated the effects of physical training on skeletal muscle metabolism in patients with chronic heart failure. BACKGROUND: Skeletal muscle metabolic abnormalities in patients with chronic heart failure have been associated with exercise intolerance. Muscle deconditioning is a possible mechanism for the intrinsic skeletal muscle metabolic changes seen in chronic heart failure. METHODS: We used phosphorus-31 nuclear magnetic resonance spectroscopy to study muscle metabolism during exercise in 12 patients with stable ischemic chronic heart failure undergoing 8 weeks of home-based bicycle exercise training in a randomized crossover controlled trial. Changes in muscle pH and concentrations of phosphocreatine and adenosine diphosphate (ADP) were measured in phosphorus-31 spectra of calf muscle obtained at rest, throughout incremental work load plantar flexion until exhaustion and during recovery from exercise. Results were compared with those in 15 age-matched control subjects who performed a single study only. RESULTS: Before training, phosphocreatine depletion, muscle acidification and the increase in ADP during the 1st 4 min of plantar flexion exercise were all increased (p < 0.04) compared with values in control subjects. Training produced an increase (p < 0.002) in incremental plantar flexion exercise tolerance. After training, phosphocreatine depletion and the increase in ADP during exercise were reduced significantly (p < 0.003) at all matched submaximal work loads and at peak exercise, although there was no significant change in the response of muscle pH to exercise. After training, changes in ADP were not significantly different from those in control subjects, although phosphocreatine depletion was still greater (p < 0.05) in trained patients than in control subjects. The phosphocreatine recovery half-time was significantly (p < 0.05) shorter after training, although there was no significant change in the half-time of adenosine diphosphate recovery. In untrained subjects, the initial rate of phosphocreatine resynthesis after exercise (a measure of the rate of oxidative adenosine triphosphate [ATP] synthesis) and the inferred maximal rate of mitochondrial ATP synthesis were reduced compared with rates in control subjects (p < 0.003) and both were significantly increased (p < 0.05) by training, so that they were not significantly different from values in control subjects. CONCLUSIONS: The reduction in phosphocreatine depletion and in the increase in ADP during exercise, and the enhanced rate of phosphocreatine resynthesis in recovery (which is independent of muscle mass) indicate that a substantial correction of the impaired oxidative capacity of skeletal muscle in chronic heart failure can be achieved by exercise training.
Adenosine Diphosphate↗
Long-term physical training and left ventricular remodeling after anterior myocardial infarction: results of the Exercise in Anterior Myocardial Infarction (EAMI) trial. EAMI Study Group.
OBJECTIVES: The aim of this multicenter randomized study was to investigate whether long-term physical training would influence left ventricular remodeling after anterior myocardial infarction. BACKGROUND: Exercise is currently recommended for patients after myocardial infarction; however, the effects of long-term physical training on ventricular size and remodeling still have to be defined. METHODS: Patients with no contraindications to exercise were studied 4 to 8 weeks after anterior Q wave myocardial infarction and 6 months later by echocardiography at rest and bicycle ergometric testing. After the initial study, patients were randomly allocated to a 6-month exercise training program (n = 49) or a control group (n = 46). A computerized system was used to derive echocardiographic variables of ventricular size, function and topography. RESULTS: After 6 months, a significant (p < 0.01) increase in work capacity (from 4,596 +/- 1,246 to 5,508 +/- 1,335 kp-m) was observed only in the training group, whereas global ventricular size, regional dilation and shape distortion did not change in either the control or the training group. However, compared with patients with an ejection fraction > 40%, patients with an ejection fraction < or = 40% had more significant (p < 0.001) ventricular enlargement at entry and demonstrated further (p < 0.01) global and regional dilation after 6 months, in both the control and the training group (end-diastolic volume from 77 +/- 14 to 85 +/- 17 ml/m2 in the control group and from 74 +/- 11 to 77 +/- 15 ml/m2 in the training group; regional dilation from 46 +/- 18% to 57 +/- 21% in the control group and from 42 +/- 18% to 44 +/- 26% in the training group). Ventricular size and topography did not change in patients with an ejection fraction > 40%. CONCLUSIONS: Patients with poor left ventricular function 1 to 2 months after anterior myocardial infarction are prone to further global and regional dilation. Exercise training does not appear to influence this spontaneous deterioration. Thus, postinfarction patients without clinical complications, even those with a large anterior infarction, may benefit from long-term physical training without any additional negative effect on ventricular size and topography.
Electrocardiography↗
Physical training in patients with stable chronic heart failure: effects on cardiorespiratory fitness and ultrastructural abnormalities of leg muscles.
OBJECTIVES: The present study was designed to evaluate the effect of an ambulatory training program on ultrastructural morphology and the oxidative capacity of skeletal muscle and its relation to central and peripheral hemodynamic variables in patients with chronic heart failure. BACKGROUND: Clinical evidence supports the hypothesis that exercise intolerance in patients with chronic heart failure is not only a consequence of low cardiac output, but is also a result of alterations in oxidative metabolism of skeletal muscle. METHODS: Twenty-two patients were prospectively randomized either to a training group (mean [+/-SD] ejection fraction 26 +/- 9%, n = 12) participating in an ambulatory training program or to a physically inactive control group (ejection fraction 27 +/- 10%, n = 10). At baseline and after 6 months, patients underwent symptom-limited bicycle exercise testing, and central and peripheral hemodynamic variables were measured. Percutaneous needle biopsy samples of the vastus lateralis muscle were obtained at baseline and after 6 months. The ultrastructure of skeletal muscle was analyzed by ultrastructural morphometry. RESULTS: After 6 months, patients in the training group achieved an increase in oxygen uptake at the ventilatory threshold of 23% (from 0.86 +/- 0.2 to 1.07 +/- 0.2 liters/min, p < 0.01 vs. control group) and at peak exercise of 31% (from 1.49 +/- 0.4 to 1.95 +/- 0.4 liters/min, p < 0.01 vs. control group). There was no significant change in oxygen uptake at the ventilatory threshold and at peak exercise in the control group. The total volume density of mitochondria and volume density of cytochrome c oxidase-positive mitochondria increased significantly by 19% (from 4.7 +/- 1.5 to 5.6 +/- 1.5 vol%, p < 0.05 vs. control group) and by 41% (from 2.2 +/- 1.0 to 3.1 +/- 1.0 vol%, p < 0.05 vs. control group) after 6 months of regular physical exercise. Cardiac output at rest and at submaximal exercise remained unchanged but increased during maximal symptom-limited exercise from 11.9 +/- 4.0 to 14.1 +/- 3.3 liters/min in the training group (p < 0.05 vs. baseline; p = NS vs. control group). Peak leg oxygen consumption increased significantly by 45% (from 510 +/- 172 to 740 +/- 254 ml/min, p < 0.01 vs. control group). Changes in cytochrome c oxidase-positive mitochondria were significantly related to changes in oxygen uptake at the ventilatory threshold (r = 0.82, p < 0.0001) and at peak exercise (r = 0.87, p < 0.0001). CONCLUSIONS: Regular physical training increases maximal exercise tolerance and delays anaerobic metabolism during submaximal exercise in patients with stable chronic heart failure. Improved functional capacity is closely linked to an exercise-induced increase in the oxidative capacity of skeletal muscle.
Biopsy↗
Low intensity exercise training in patients with chronic heart failure.
OBJECTIVES: The present study was designed to evaluate whether a specific program of low intensity exercise training may be sufficient to improve the exercise tolerance of patients with chronic heart failure. BACKGROUND: Recent studies have shown that exercise training can improve exercise tolerance in patients with stable chronic heart failure, mainly through peripheral adaptations. These changes have been observed with exercise regimens at intensities of 70% to 80% of peak oxygen uptake and > 8 weeks. METHODS: We studied 27 patients (23 men, 4 women; mean [+/- SD] age 57 +/- 6 years) with mild chronic heart failure. We classified patients into two groups: trained group and untrained group. The trained group underwent a low intensity (40% of peak oxygen uptake) training program three times/week for 8 weeks. The untrained group performed no exercise. RESULTS: An increase in peak oxygen uptake (17%, p < 0.0001), lactic acidosis threshold (20%, p < 0.0002) and peak work load (21%, p < 0.0002) were obtained in the trained group only. Cardiac output and stroke volume were unchanged. A high correlation was found between the increases in peak oxygen uptake and volume density of mitochondria of vastus lateralis muscle (r = 0.77, p < 0.0002). CONCLUSIONS: Patients with stable chronic heart failure can achieve significant improvement in functional capacity from a low intensity exercise training regimen. The mechanism responsible for this favorable effect involves an increase in mitochondrial density, which reflects an improvement in oxidative capacity of trained skeletal muscles.
Anaerobic Threshold↗
Effects of mazindol in two patients with Prader-Willi syndrome.
Two patients with Prader-Willi syndrome, including gross obesity with food-related behavior and mild mental retardation, are presented. One patient was an 11-year-old girl with the diagnosis of development delay, hypoactivity, and waxy skin with normal female karyotype. The other patient was a 15-year-old girl with the diagnosis of abnormal chromosome 15. Obesity had been present since early childhood, and it was difficult for them to manage their weight control by means of diet and exercise therapy. With 24-week mazindol administration, they demonstrated marked improvement in weight control during the early period and improvement in pathologic behavior without side effects. Mazindol was given orally, 1.0-2.0 mg/day, in one or two daily doses. Mazindol may prove to be useful in the treatment of patients with Prader-Willi syndrome.
Adolescent↗
Effects of a home walking exercise program on functional status and symptoms in heart failure.
BACKGROUND: Hospital-based exercise programs using a bicycle ergometer or a combination of exercise modalities have shown positive benefits in heart failure, but may not be readily accessible to many patients. Thus, we sought to evaluate the effects of a 12-week home walking exercise program on functional status and symptoms in patients with heart failure. METHODS: A randomized controlled trial comparing a 12-week progressive home walking exercise program (n = 42) to a "usual activity" control group (n = 37) was conducted in patients with heart failure (78 [99%] male; mean age 62.6 +/- 10.6 years; ejection fraction 27% +/- 8.8%; 63 [80%] New York Heart Association class II; 15[20%] New York Heart Association class III-IV) from a Veterans Affairs medical center and a university-affiliated medical center. Functional status (peak oxygen consumption via cardiopulmonary exercise testing, 6-minute walk test, the Heart Failure Functional Status Inventory), and symptoms (Dyspnea-Fatigue Index score with a postglobal rating of symptoms) were measured at baseline and 12 weeks. RESULTS: No adverse events related to exercise training occurred. Overall mean compliance to training was 74 +/- 37%. Peak oxygen consumption and the Heart Failure Functional Status Inventory were unchanged with training. Compared to the usual activity group, the training group had significantly longer walking distances measured by the 6-minute walk test (1264 +/- 255 vs 1337 +/- 272 feet, P =.001), and improved postglobal rating of symptoms (P =.03). CONCLUSION: In patients with heart failure, a progressive home walking exercise program is acceptable, increases walking distance, and decreases global rating of symptoms.
Aged↗
An alternative approach for exercise prescription and efficacy testing in patients with chronic heart failure: a randomized controlled training study.
BACKGROUND: Prescription of endurance training and documentation of its efficacy in patients with chronic heart failure (CHF) is usually done with reference to maximal ergometric measurements which are subject to form on the day changes and motivational influences. However, the use of submaximal parameters might represent an alternative approach. METHODS: This was tested in 54 patients with CHF (57 +/- 10 years, NYHA II: n = 40; NYHA III: n = 14) who were randomized into training (T; n = 26) or control group (CO; n = 28). Training consisted of 45 minutes cycling at an intensity corresponding to the anaerobic threshold (AT) and was conducted for 12 weeks, 4 to 5 times per week. Cardiorespiratory exercise testing was done before and after the experimental phase. Changes in well-being were investigated using a 5-point Likert scale. RESULTS: A significant rightward shift in the heart rate curve was demonstrated in T compared with CO (P = .01; T: decrease in resting heart rate by 8 per minute, during exercise by 7 to 11/min; CO: -1 and -1 to -3 per minute, respectively). Anaerobic threshold increased significantly by 11.6% in T (+0.11 +/- 0.11 L min(-1) oxygen uptake) compared with CO (-0.02 +/- 0.10 L min(-1)). Positive changes in well-being were significantly larger in T (P < .01). CONCLUSIONS: In patients with CHF, training can be prescribed and its efficacy can be evaluated by the exclusive use of submaximal parameters. Anaerobic threshold represents an appropriate training intensity in this population.
Aged↗
Heart rate recovery in heart failure patients after a 12-week cardiac rehabilitation program.
Heart rate recovery (HRR) after maximal exercise is a predictor of all-cause mortality. It was hypothesized that aerobic exercise training would increase HRR in patients with heart failure (HF), because it has been shown to be accelerated in athletes and improved in patients with coronary artery disease after cardiac rehabilitation. To date, no study has examined the effects of exercise training on HRR in HF. This was a retrospective study of patients with HF who had completed a phase II aerobic cardiac rehabilitation program with entry and exit maximal stress tests (n = 46). Thirty-five patients exhibited a training effect, 18 had abnormal HRR of < or =12 beats/min and the lowest initial functional capacity (L12), and 17 had HRR of >12 beats/min before training (G12). A group of 11 other patients did not achieve a training effect. After training, the L12 and G12 groups improved their estimated peak oxygen uptake (by 6.7 +/- 3.1 and 8.6 ml/kg/min, respectively) and treadmill time (by 117 +/- 62 and 181 +/- 108 seconds, respectively) compared with the no-training effect group (p <0.05). Only the L12 group demonstrated improvement in HRR (7 +/- 1 to 12 +/- 2 beats/min). In conclusion, the results indicate that short-term aerobic training can favorably modify HRR in patients with HF with low exercise capacity.
Aged↗
[Exercise training in cardiac patients: usefulness of the cardiopulmonary exercise test].
Exercise training is currently including in the treatment of coronary arterial disease patients, in patients with left ventricular dysfunction as well as in patients who underwent cardiac transplantation or cardiac surgery. However methods of prescribing exercise-training programs are difficult to determine and must be adapted for each patient Exercise test with gas analysis through the determination of anaerobic threshold may help to understand the physiopathological mechanism related to exercise limitation in these patients. Exercise test may help to precise exercise intensity during cardiac rehabilitation and may assess the benefits on exercise tolerance.
Exercise Test↗
[Relationship between walking capacity and maximal exercise capacity, strength and motor deficiency in adult hemiplegic stroke patients].
OBJECTIVE: To evaluate the relation between walking capacity and maximal exercise capacity, strength and motor deficiency in hemiplegic stroke patients. DESIGN: Uncontrolled observational study. SETTING: Physical medicine and rehabilitation unit in a teaching hospital. PARTICIPANTS: Twenty hemiplegic stroke patients (17 men and 3 women) aged 18-70 years, whose stroke occurred more than 3 months before the study and who could walk independently with or without walking aids. MAIN OUTCOME MEASURES: Peak oxygen uptake (VO(2peak)), maximal power output walking capacity (6-min walk test) and motor deficiency (Fugl-Meyer scale). RESULTS: Walking capacity was correlated with both VO(2peak) and maximal power output (Pmax) [r=0.609, P<0.003 and r=0.868, P<0.0001, respectively] but also with strength (from r=0.640 to r=0.734; P=0.0018 to P=0.0001) and motor deficiency (r=0.6; P=0.004). CONCLUSIONS: Aerobic capacity and walking capacity are correlated and decreased in hemiplegic stroke patients. These results underscore the need for future studies to confirm the role of fitness in relation to walking capacity and to evaluate the benefit of integrating aerobic training into more traditional rehabilitation programs after stroke.
Adolescent↗
Ultrasound imaging distinguishes between normal and weak muscle.
OBJECTIVE: To determine whether real-time ultrasound imaging can provide quantitative data that distinguish pathologic from healthy muscle and that correlate with strength measures. DESIGN: Nonrandomized matched-pair, repeated-measures design. SETTING: Ultrasound imaging laboratory, rehabilitation medicine department, government research hospital. PARTICIPANTS: Nine patients with stable active or inactive myositis, stratified into 3 groups based on their 10-point manual muscle test (MMT) scores, and 9 age- and gender-matched controls. INTERVENTIONS: Maximal isometric contraction of the rectus femoris muscle in 2 knee-flexion positions (60 degrees, 90 degrees ) during simultaneous ultrasound imaging and muscle force dynamometry. MAIN OUTCOME MEASURES: Changes of the rectus femoris muscle in horizontal (X) and vertical (Y) diameters between relaxed and contracted states, and muscle force measurements. RESULTS: The X diameters decreased and the Y diameters increased during isometric contraction in all participants. For each group, average changes in cross-sectional diameters were consistently higher in controls than in patients. Patients with MMT less than 8 differed significantly from controls in both X and Y dimensions. A moderately strong correlation was found between muscle force and the Y diameter during contraction at 60 degrees (r =.78) and 90 degrees (r =.67) knee-flexion angles. CONCLUSIONS: Ultrasonography provided a quantitative measure of change between relaxed and contracted state of muscle, which correlated with muscle force. Ultrasound identified significant differences in cross-sectional diameters between the myopathic and normal muscles sampled and may be useful for measuring muscle response to drug and exercise therapy.
Adult↗