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PubMed2003

Effects of age-related gait changes on the biomechanics of slips and falls.

A laboratory study was conducted to examine gait changes associated with aging and the effect of these changes on initiation of slips and frequency of falls utilizing newly defined biomechanical parameters of slips and falls. Twenty-eight participants from two age groups (young and old) walked around a circular track at a comfortable pace wearing a safety harness. A slippery floor surface was placed on the walking track over the force plate at random time intervals without the participants' awareness. Synchronized kinetic and kinematic measurements were obtained on both slippery and non-slippery walking surfaces. The results indicated that older participants' horizontal heel contact velocity was significantly faster, step length was significantly shorter, and transitional acceleration of the whole body centre-of-mass (COM) was significantly slower than younger participants. Older participants' initial friction demand, as measured by required coefficient of friction (RCOF), was not significantly different than their younger counterparts. Additionally, older participants slipped longer and faster, and fell more often than younger participants. A comparison of horizontal heel contact velocity for participants who fell with participants who did not fall indicated that, in general, fallers' horizontal heel contact velocity was faster than non-fallers. However, a comparison of RCOF for participants who fell with participants who did not fall suggested that RCOF was not a totally deterministic factor influencing actual fall events. These findings suggest that gait changes associated with aging (especially higher horizontal heel contact velocity and slower transition of the whole body COM) affect initiation of slip-induced falls.

Accidental Falls↗

PubMed1991

Perceived exertion and physiological economy of competition walking, ordinary walking and running.

Four competition walkers performed competition walking, ordinary walking and running on a treadmill on two different occasions. During the two walking modes, the subjects performed maximal tests. During running, the session was terminated at a heart rate of 150 beats min-1 or an exertion rating--for either chest or leg--of 5 or higher. The tests commenced at 2.5 km h-1 and the velocity was increased by 2.5 km h-1 every 4 min. Measures of chest exertion and breathlessness, leg exertion, heart rate and blood lactate were taken every 4 min just prior to the velocity changes. The measured psychological and physiological variables were described by monotonously accelerating power functions with exponents around 2 for the perceptual variables at both walking modes. The heart rate growth for competition walking accelerated according to a function with an exponent of 1.7, which is lower than that for ordinary walking (2.0), but higher than that for running which is linear. No significant difference was found between maximal oxygen uptake when competition walking and running were compared. A second test was carried out so as to confirm the cross-over point for the heart rate curves in the two walking modes. The cross-over point for the two walking curves were determined to be at 8.6 km h-1.

Adolescent↗

PubMed2005

Long-term evaluation of motor function following intraneural injection of ropivacaine using walking track analysis in rats.

BACKGROUND: There is a paucity of data regarding neurologic function following nerve injury. Our objective was the long-term evaluation of motor function following intraneural injection of ropivacaine in rats using the sciatic function index (SFI), derived from walking track analysis. METHODS: Rats were randomly assigned to one of four groups of 13 animals each. A needle was inserted under magnification into the left sciatic nerve and 0.2 ml of normal saline, formalin 15%, ropivacaine 0.2 or 0.75% were injected intraneurally. The right side was sham operated. Walking track analysis was performed the day before and on days 1, 4, 7, 11, 15, 18, 21, and 67 following intraneural injection. At the end of the experiment (day 67) a semi-quantitative evaluation of neuropathologic changes was performed by three independent observers. RESULTS: Animals treated with saline and ropivacaine (0.2 and 0.75%) had no detectable impairment of motor function at any time point. In contrast, rats treated with formalin had a complete loss of motor function immediately after the intraneural injection, which persisted until day 21 and returned to normal by day 67. Important histopathologic changes (score=2) with excellent inter-observer agreement were seen only in the group treated with formalin. This applied to both axonal degeneration and Schwann cell density evaluations. CONCLUSIONS: These findings suggest that intraneural injections of ropivacaine at concentrations routinely used in clinical practice appear to have no deleterious effect on sciatic nerve motor function in this experimental rat model.

Amides↗

PubMed1990

Electromyographic versus rhythmic positional biofeedback in computerized gait retraining with stroke patients.

This research provides a preliminary investigation of the relative efficacy of electromyographic (EMG) versus a novel biofeedback (BFB) approach to improve ankle control and functional gait in stroke patients. A computerized system was designed to provide audiovisual feedback of either muscle activity or ankle position during dorsiflexion and plantar flexion. The novel approach also included rhythmic pacing to emphasize the rapid timing of ankle motion necessary to switch from stance to swing during walking. Thirty-seven subjects were randomly assigned to one of the following groups: (1) no-treatment control, (2) EMG BFB, and (3) rhythmic positional BFB. Blind evaluations of ankle performance, gait, and perceived exertion were performed at regular intervals. Analyses of covariance revealed that subjects receiving rhythmic positional BFB significantly increased their walking speeds relative to other groups at posttest (p = .02) and at three-month follow-up (p = .035), without any increase in subjectively reported energy cost. The ability of positional BFB to emphasize the timing events during walking provided optimistic results for carry-over into gait functioning. The degree of sensorimotor recovery and time since onset of stroke were considered important factors in determining outcomes.

Adult↗

PubMed2003

Progressive resistance strengthening exercises after stroke: a single-blind randomized controlled trial.

OBJECTIVE: To determine the effectiveness of progressive resistance strengthening exercises to improve gross motor function and walking in patients receiving intensive rehabilitation after stroke. DESIGN: Randomized controlled trial. SETTING: Five inpatient rehabilitation programs affiliated with teaching hospitals. PARTICIPANTS: Inclusion criteria included less than 6 months poststroke and recovery of the leg stages 3 to 5 on the Chedoke-McMaster Stroke Assessment (CMSA). INTERVENTIONS: Both groups received conventional physical therapy programs. In addition, the experimental group performed 9 lower-extremity progressive resistance exercises 3 times a week for the duration of their stay, whereas the control group did the same exercises and for the same duration but without resistance. MAIN OUTCOME MEASURES: The Disability Inventory of the CMSA and the 2-minute walk test (2MWT) at baseline, 4 weeks, discharge, and 6 months after discharge. RESULTS: Over the length of stay, the rate of change in the Disability Inventory was.27 points per day in the experimental group and.29 points per day in the control group; the between-group difference was -.02 points per day (95% confidence interval [CI], -.10 to.06; P=.62). At discharge, the rate of change in the 2MWT was -.01 m in the experimental group and.15m in the control group; the between-group difference was -.16 m (95% CI, -.37 to.05; P=.14). CONCLUSIONS: Progressive resistance strengthening exercises as applied in our study were not effective when compared with the same exercises given without resistance.

Activities of Daily Living↗

PubMed2006

Effects of continuous positive airway pressure on pulmonary function and exercise tolerance in patients with congestive heart failure.

STUDY OBJECTIVES: Continuous positive airway pressure (CPAP) has been used to improve cardiopulmonary function and reduce pulmonary edema symptoms in patients with congestive heart failure (CHF). The objective of this study was to evaluate the efficacy of CPAP therapy on pulmonary function and exercise tolerance in patients with CHF. DESIGN: Prospective blind randomized clinical study. PARTICIPANTS: Twenty-four patients with class II or III CHF and dilated cardiomyopathy were randomly assigned to 30 min of CPAP therapy and respiratory exercises (CPAP group) or respiratory exercise only (control group) once a day for 14 days. MEASUREMENTS AND RESULTS: Evaluation of pulmonary function was performed measuring FEV1 and FVC. Exercise tolerance was assessed measuring the distance walked during the 6-min walking test (6MWT). These parameters were measured before treatment and 4 days, 9 days, and 14 days later. CPAP therapy caused a progressive increase (p < 0.05) in both FVC (maximum of 16% after 9 days) and FEV1 (maximum of 14% after 14 days) compared to basal values, without significant changes in the control group. The 6MWT showed a progressive improvement in the distance walked in the CPAP group, reaching approximately 28% above the basal values in the CPAP group and without significant changes in the control group. CONCLUSIONS: These data show that the use of CPAP therapy for 2 weeks on a daily basis is able to enhance pulmonary function and consequently improve the tolerance to physical activities in patients with CHF. The clinical implication of this finding is that CPAP therapy could potentially be used as an adjunct to the treatment of CHF patients.

Analysis of Variance↗

PubMed2000

Long-term exercise and its effect on balance in older, osteoarthritic adults: results from the Fitness, Arthritis, and Seniors Trial (FAST).

OBJECTIVES: To examine the effects of 18-month aerobic walking and strength training programs on static postural stability among older adults with knee osteoarthritis. DESIGN: Randomized, single-blind, clinical trial of therapeutic exercise. SETTING: Both center-based (university) and home-based. PARTICIPANTS: A cohort of 103 older adults (age = 60 years) with knee osteoarthritis who were participants in a large (n = 439) clinical trial and who were randomly assigned to undergo biomechanical testing. INTERVENTION: An 18-month center- (3 months) and home-based (15 months) therapeutic exercise program. The subjects were randomized to one of three treatment arms: (1) aerobic walking; (2) health education control; or (3) weight training. MEASUREMENTS: Force platform static balance measures of average length (Rm) of the center of pressure (COP), average velocity (Vel) of the COP, elliptical area (Ae) of the COP, and balance time (T). Measures were made under four conditions: eyes open, double- and single-leg stances and eyes closed, double- and single-leg stances. RESULTS: In the eyes closed, double-leg stance condition, both the aerobic and weight training groups demonstrated significantly better sway measures relative to the health education group. The aerobic group also demonstrated better balance in the eyes open, single-leg stance condition. CONCLUSIONS: Our results suggest that long-term weight training and aerobic walking programs significantly improve postural sway in older, osteoarthritic adults, thereby decreasing the likelihood of larger postural sway disturbances relative to a control group.

Aged↗

PubMed1998

How readily will sheep walk for a preferred forage?

We studied how ewes chose between a poor-quality hay freely available and a good-quality one offered in limited quantities when they walked across an indoor test area. To determine what dictates a ewe's behavior, we varied the accessibility of the good hay by changing the quantity that rewarded the walk (2, 4, 8, 16, or 32 g) and the distance walked (23 or 46 m). Ewes were more reluctant to walk for the good hay as reward level decreased. For a given reward, average preference for good hay (P(GH)) also fell when ewes had to walk 46 m to be rewarded. In each comparison, for the same reward to distance (Rew/Dist) ratio, average P(GH) did not differ. We determined the correlation between P(GH) and Rew/Dist using data from three experiments with ewes offered a similar choice. The best model accounted for 85% of the corrected total sum of squares. Good hay procurement cost thus dictated a ewe's behavior. Choice was suboptimal only, either due to the test conditions, discrimination errors, or an animal's will to select a mixed diet. Our results suggest that, within its perceptive field, a ewe will equally walk to resources that have the same edible biomass relative to the distance to the patch.

Animal Feed↗

PubMed1993

Effects of a 12-week resistive training program in the home using the body bar on dynamic and absolute strength of middle-age women.

Guidelines published by the American College of Sports Medicine indicate that resistive training should be an integral part of an adult fitness program. Most adults will find it difficult to train resistively regularly unless they train in their own homes using simple, inexpensive equipment. The purpose of this study was to examine the extent to which participation in a 12-week resistive training program using the Body Bar, a simple, inexpensive resistive training device, in the home improves dynamic and absolute strength of middle-age women compared to similar women engaged in a walking program. A pretest-midtest-posttest design was employed with subjects randomly assigned to either a resistive (n = 30) or a walking (control) group (n = 30). All subjects were tested on measures of dynamic and absolute strength. Resistive trainers performed significantly better than the controls across the 12-week training period on all strength variables even with statistical control for potential confounders. Number of workouts performed and average intensity of each workout were both significant predictors of strength improvements among the resistive trainers.

Adult↗

PubMed1979

Walk-in patients' decisions about follow-up care.

This study examined the decisions patients made about obtaining follow-up care after an initial visit to a psychiatric walk-in clinic. Sixty-nine randomly selected patients who received a variety of ambulatory referrals were questioned by means of structured and ured to, and 70 per cent of the patients given medication took it substantially as prescribed. Completion of the referral was associated with being employed, not abusing drugs and alcohol, having a positive view of the walk-in clinic, and adherence to the medication regimen. Referral success was unrelated to sociodemographic characteristics, social integration, the nature of the intended disposition, or prior medical or psychiatric care. Patients who adhered to the disposition did not necessarily adhere to the medication regimen, and vice versa. Referrals were more successful when the patient had preceded the clinical encounter with an active appraisal of his situation. The decision to adhere was a complex and prolonged one in which the patient weighed many factors, of which the physician's suggested disposition was only one.

Adult↗

PubMed1995

Adult accompaniment and the risk of pedestrian injury on the school-home journey.

STUDY OBJECTIVE: To quantify the effect of adult accompaniment on the risk of pedestrian injury on the school-home journey. DESIGN: A community based case-control study. SETTING: The Auckland region of New Zealand. PARTICIPANTS: Cases (n = 54) were all children killed or hospitalized as a result of a pedestrian injury occurring on the school-home journey between 1 January 1992 and 1 March 1994. The response rate for the case group was 98%. Controls (n = 157) were a random sample of all children who walk to and from school in the study region. The response rate for the control group was 100%. MAIN RESULTS: Adult accompaniment on the school-home journey was associated with a reduced risk of injury (odds ratio (OR) 0.36, 95% confidence interval (CI) 0.04 to 1.66). This effect persisted after controlling for age, sex, and socioeconomic status (OR 0.31, 95% CI 0.07 to 1.49). CONCLUSIONS: Adult accompaniment on the school-home journey may have the potential to significantly reduce child pedestrian injury rates. The effect of adult accompaniment may have important implications for the interpretation of child pedestrian exposure studies.

Accidents, Traffic↗

PubMed2005

Gait and step training to reduce falls in Parkinson's disease.

INTRODUCTION: Frequent falls and risk of injury are evident in individuals with Parkinson's disease (PD) as the disease progresses. There have been no reports of any interventions that reduce the incidence of falls in idiopathic PD. PURPOSE: Assess the benefit of gait and step perturbation training in individuals with PD. DESIGN: Randomized, controlled trial. SETTING: Outpatient research, education and clinical center in a tertiary care Veterans Affairs Medical Center. OUTCOME MEASURES: Gait parameters, 5-step test, report of falls. SUBJECTS: Eighteen men with idiopathic PD in stage 2 or 3 of the Hoehn and Yahr staging. METHODS: Subjects were randomly assigned to a trained or control group. They were asked about any falls 2 weeks prior to and after an 8 week period. Gait speed, cadence, and step length were tested on an instrumented walkway. Subjects were timed while stepping onto and back down from an 8.8 cm step for 5 consecutive steps. Gait training consisted of walking on a treadmill at a speed greater than over ground walking speed while walking in 4 directions and while supported in a harness for safety. Step training consisted of suddenly turning the treadmill on and off while the subject stood in the safety harness facing either forwards, backwards, or sideways. Training occurred 1 hour per day, three times per week for 8 weeks. A two-factor (time and group) analysis of variance with repeated measures was used to compare the groups. RESULTS: Substantial reduction occurred in falls in the trained group, but not in the control group. Gait speed increased in the trained group from 1.28+/-0.33 meters/sec to 1.45+/-0.37 meters/sec, but not in the control group (from 1.26 to 1.27 m/s). The cadence increased for both groups: from 112.8 to 120.3 steps/min for the trained group and 117.7 to 124.3 steps/min for the control group. Stride lengths increased for the trained group, but not the control group. The 5-step test speed increased in the trained group from 0.40+/-0.08 steps/sec to 0.51+/-0.12 steps/sec, and in the control group (0.36+/-0.11 steps/sec to 0.42+/-0.11 steps/sec). CONCLUSION: Gait and step perturbation training resulted in a reduction in falls and improvements in gait and dynamic balance. This is a promising approach to reduce falls for patients with PD.

Accidental Falls↗

PubMed2006

Functional and neuromotor performance in older adults: effect of 12 wks of aerobic exercise.

OBJECTIVE: There is little information regarding the effect of aerobic exercise on physical and neuromotor performance in older adults. The aim of this randomized, controlled trial was to determine the effects of a 12-wk aerobic exercise program on functional and neuromotor performance in inactive healthy older adults. DESIGN: A total of 22 inactive healthy older adults, aged 60-75 yrs, voluntarily participated in the study and were randomly assigned to a progressively increased high-intensity aerobic exercise group (n = 12) or to a control group (n = 10). The aerobic exercise group exercised three times per week for 12 wks on nonconsecutive days. Both groups were evaluated before and after the exercise period in the one-repetition maximum of knee extensors and flexors, 6-min walk distance, chair-rising time, and whole-body reaction time. RESULTS: Multivariate analysis of variance repeated measures (2 x 2) revealed significant (P < 0.05) time by group interaction for one-repetition maximum knee extension and flexion strength, 6-min walk distance, chair-rising time, and whole-body reaction time. For the aerobic exercise group, the following variables improved significantly (P < 0.05) after the exercise period: the one-repetition maximum knee extensors (12%) and flexors (19%) muscle strength, 6-min walk distance (17%), chair-rising time (8%), and whole-body reaction time (20%). No significant differences were observed in the control group. CONCLUSIONS: The results of the present study show that short-term progressively increased high-intensity aerobic exercise improved the physical and neuromotor performance in inactive healthy older adults. These findings suggest that the participation in a progressively increased high-intensity aerobic exercise program may improve mobility and ability to carry out activities of daily living in older adults.

Activities of Daily Living↗

PubMed2006

Small-scale randomized controlled trials need more powerful methods of mediational analysis than the Baron-Kenny method.

OBJECTIVE: To devise more-effective physical activity interventions, the mediating mechanisms yielding behavioral change need to be identified. The Baron-Kenny method is most commonly used, but has low statistical power and may not identify mechanisms of behavioral change in small-to-medium size studies. More powerful statistical tests are available. STUDY DESIGN AND SETTING: Inactive adults (N=52) were randomized to either a print or a print-plus-telephone intervention. Walking and exercise-related social support were assessed at baseline, after the intervention, and 4 weeks later. The Baron-Kenny and three alternative methods of mediational analysis (Freedman-Schatzkin; MacKinnon et al.; bootstrap method) were used to examine the effects of social support on initial behavior change and maintenance. RESULTS: A significant mediational effect of social support on initial behavior change was indicated by the MacKinnon et al., bootstrap, and, marginally, Freedman-Schatzkin methods, but not by the Baron-Kenny method. No significant mediational effect of social support on maintenance of walking was found. CONCLUSIONS: Methodologically rigorous intervention studies to identify mediators of change in physical activity are costly and labor intensive, and may not be feasible with large samples. The use of statistically powerful tests of mediational effects in small-scale studies can inform the development of more effective interventions.

Aged↗

PubMed2000

Short- and long-term effects of outpatient rehabilitation in patients with chronic obstructive pulmonary disease: a randomized trial.

PURPOSE: Pulmonary rehabilitation programs are effective in patients with severe chronic obstructive pulmonary disease (COPD) in the short term, but their long-term effects are not known. We investigated the short- and long-term effects of a 6-month outpatient rehabilitation program in patients with severe COPD. SUBJECTS AND METHODS: One hundred patients were randomly assigned to receive either an exercise training program that included cycling, walking, and strength training (n = 50) or usual medical care (n = 50). Thirty-four patients in the training group were evaluated after 6 months (end of training), and 26 were evaluated after 18 months of follow-up. In the control group, 28 patients were evaluated at 6 months and 23 after 18 months. We measured pulmonary function, 6-minute walking distance, maximal exercise capacity, peripheral and respiratory muscle strength, and quality of life (on a 20 to 140-point scale), and estimated the cost-effectiveness of the program. RESULTS: At 6 months, the training group showed improvement in 6-minute walking distance [mean difference (training - control) of 52 m; 95% confidence interval (CI), 15 to 89 m], maximal work load (12 W; 95% CI, 6 to 19 W), maximal oxygen uptake (0.26 liters/min; 95% CI, 0.07 to 0.45 liters/min), quadriceps force (18 Nm; 95% CI, 7 to 29 Nm), inspiratory muscle force (11 cm H(2)O; 95% CI, 3 to 20 cm H(2)O), and quality of life (14 points; 95% CI, 6 to 21 points; all P <0.05). At 18 months all these differences persisted (P <0.05), except for inspiratory muscle strength. For 6-minute walking distance and quality of life, the differences between the training group and controls at 18 months exceeded the minimal clinically-important difference. CONCLUSION: Among patients who completed the 6-month program, outpatient training resulted in significant and clinically relevant changes in 6-minute walking distance, maximal exercise performance, peripheral and respiratory muscle strength, and quality of life. Most of these effects persisted 18 months after starting the program.

Aged↗

PubMed2026

Effectiveness of passive vs. assistive robotic gait training on functional recovery and neuroplasticity post-stroke: A randomized controlled trial.

OBJECTIVE: This study seeks to compare the impacts of various robotic gait training (RAGT) modes on lower limb motor function recovery in stroke patients while exploring the corresponding neural mechanisms. DESIGN: A single-blind, randomized controlled trial. SETTING: Inpatient Rehabilitation Facility. PARTICIPANTS: Forty-eight patients aged 18-80 who had experienced their first unilateral subacute stroke accompanied by walking impairments were included. INTERVENTIONS: Participants were randomly assigned to: (1) assistive mode training, (2) passive mode training, or (3) control group receiving only traditional rehabilitation. Clinical and neurological outcomes were assessed at pre-intervention (T0), and post-2-week intervention (T1). MAIN OUTCOME MEASURES: Outcomes were evaluated using the Fugl-Meyer Assessment for Lower Extremity, Berg Balance Scale, Modified Barthel Index, the Functional Ambulatory Category, and functional near-infrared spectroscopy. RESULTS: Among the 48 patients recruited, significant time effects were observed across all groups in FMA-LE scores (p < 0.001). Notable improvements were detected in the conventional group (MD = 2.69, p＜0.01) and the passive group (MD = 3.67, p < 0.001), with the assistive mode also demonstrating a significant effect (MD = 1.79, p < 0.05). BBS scores improved across all groups; however, no significant differences were noted between the groups (p = 0.11). Similarly, MBI scores showed a significant time effect (p < 0.001), without notable group differences (p = 0.29). CONCLUSION: All training modalities effectively enhanced motor function, balance, and daily living skills in stroke patients. Distinct cortical activation and connectivity patterns were observed between training modalities, which may reflect different neuroplastic mechanisms. These preliminary neural differences may help inform personalized rehabilitation strategies, although no clinical superiority of one mode over another can be concluded from the present data.

Humans↗

PubMed2006

Inspiratory muscle training in patients with heart failure and inspiratory muscle weakness: a randomized trial.

OBJECTIVES: This study sought to evaluate the effects of inspiratory muscle training in inspiratory muscle strength, as well as in functional capacity, ventilatory responses to exercise, recovery oxygen uptake kinetics, and quality of life in patients with chronic heart failure (CHF) and inspiratory muscle weakness. BACKGROUND: Patients with CHF may have reduced strength and endurance in inspiratory muscles, which may contribute to exercise intolerance and is associated with a poor prognosis. METHODS: Thirty-two patients with CHF and weakness of inspiratory muscles (maximal inspiratory pressure [Pi(max)] <70% of predicted) were randomly assigned to a 12-week program of inspiratory muscle training (IMT, 16 patients) or to a placebo-inspiratory muscle training (P-IMT, 16 patients). The following measures were obtained before and after the program: Pi(max) at rest and 10 min after maximal exercise; peak oxygen uptake, circulatory power, ventilatory oscillations, and oxygen kinetics during early recovery (VO2/t-slope); 6-min walk test; and quality of life scores. RESULTS: The IMT resulted in a 115% increment Pi(max), 17% increase in peak oxygen uptake, and 19% increase in the 6-min walk distance. Likewise, circulatory power increased and ventilatory oscillations were reduced. The VO2/t-slope was improved during the recovery period, and quality of life scores improved. CONCLUSIONS: In patients with CHF and inspiratory muscle weakness, IMT results in marked improvement in inspiratory muscle strength, as well as improvement in functional capacity, ventilatory response to exercise, recovery oxygen uptake kinetics, and quality of life.

Breathing Exercises↗

PubMed1992

The effects of aerobic exercise on psychological adjustment: a randomized study of sedentary obese women attempting weight loss.

This study evaluated the psychological effects of aerobic conditioning in 40 moderately obese, sedentary women participating in a 12-week behavioral weight loss program. Participants were randomly assigned to a no-exercise or moderate walking condition. Emotional impact of the treatment was assessed in two ways: (1) Subjects reported subjective mood prior to each eating episode and (2) the SCL-90-R was administered before and after the program. Exercisers lost more weight and body fat than non-exercisers. Both groups of subjects showed numerous improvements in mood as a result of participating in the weight loss program. Exercise had no specific differential effect on emotions as measured by daily mood ratings or the SCL-90-R. Exercise did not appear to add appreciably to the psychological benefits of losing weight in this sedentary obese population. Future studies utilizing longer periods of aerobic exercise training, larger sample size, and exercise specific measures are recommended.

Adaptation, Psychological↗