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PubMed2002

Adherence to exercise prescriptions: effects of prescribing moderate versus higher levels of intensity and frequency.

Sedentary adults (N = 379) were randomly assigned in a 2 x 2 design to walk 30 min per day at a frequency of either 3-4 or 5-7 days per week, at an intensity of either 45%-55% or 65%-75% of maximum heart rate reserve. Analyses of exercise accumulated over 6 months showed greater amounts completed in the higher frequency (p = .0001) and moderate intensity (p = .021) conditions. Analyses of percentage of prescribed exercise completed showed greater adherence in the moderate intensity(p = .02) condition. Prescribing a higher frequency increased the accumulation of exercise without a decline in adherence, whereas prescribing a higher intensity decreased adherence and resulted in the completion of less exercise.

Adult↗
PubMed1992

Is aerobic dance an effective alternative to walk-jog exercise training?

In order to compare the physiological effects of an 8 week aerobic dance program to those of a walk-jog exercise training program, 60 male and female University employees ages 24-48 years were randomly assigned to an aerobic dance program (N = 22), a walk-jog program (N = 24), or a sedentary control group (N = 15). Subjects who had an exercise compliance rate less than or equal to 85% were dropped from the study, as were control subjects who had scheduling conflicts or illnesses precluding post-treatment testing. Thirty-five subjects completed the 8 week period with a compliance rate greater than or equal to 85%, leaving 14 in the aerobics group, 11 in the walk-jog group and 10 in the control group. Significant increases (p less than 0.001) in maximal oxygen uptake occurred in both the aerobics (+3.9 ml/kg-1/min-1) and walk-jog group (+3.4 ml/kg-1/min-1), while no significant change was observed in the control group. Peak heart rate decreased significantly (p less than 0.05) in the aerobics (-4 b/min-1) and walk-jog groups (-3 b/min-1 but was unchanged in the control group (-1 b/min-1) following the treatment period. Body weight, peak respiratory exchange ratio and peak minute ventilation remained the same in the aerobics, walk-jog and control groups throughout the treatment period. It is concluded that aerobic dance programs can result in similar improvements in aerobic power as a walk-jog program. Thus, an aerobic dance program is an effective alternative to a traditional walk-jog training regime.

Adult↗
PubMed2006

Prevention of disability by exercise among the elderly: a population-based, randomized, controlled trial.

OBJECTIVE: To assess the effectiveness of an intervention planned and implemented by regional geriatric care teams in order to prevent disability in an elderly population. DESIGN: Randomized, controlled trial with intention-to-treat and subgroup analyses. Subjects and setting. All home-dwelling persons aged 85 years or older in the City of Oulu (n = 555, 67%), including 486 persons with a history of recurrent falls or at least one risk factor for disability in the activities of daily living (ADL) or mobility. INTERVENTIONS: Programme consisting of home exercise, walking exercise, group exercise, and self-care exercise. MAIN OUTCOME MEASURES: Change in ADL and mobility during the intervention. RESULTS: Change in ADL performance did not differ (p = 0.462) but a positive change was found in mobility performance (p = 0.013) in the intervention subjects (n = 243) compared with the controls (n = 243). At the end of the intervention period, severe mobility restrictions existed similarly in intervention and control subjects: 48 (34%) and 46 (31%) (p = 0.650) respectively. Frequency of admissions into long-term institutional care were similar in intervention and control groups: 15 (7%) and 13 (6%) (p = 0.669). Impaired balance existed in fewer intervention subjects (64, 45%) than controls (89, 59%) (p = 0.015). Frequency and times of home exercise activity reduced in control subjects (p < 0.001) but did not change in subjects assigned to home exercise intervention (p > 0.05). CONCLUSION: A pragmatic intervention slowed down the reduction of movement performance but positive effects could not be found in subjects with severe movement and any ADL dysfunction. Positive effects were also found in balance performance.

Activities of Daily Living↗
PubMedDate not supplied

Pedometers as a means to increase ambulatory activity for patients seen at a family medicine clinic.

Because of their frequent encounters with sedentary patients, family physicians are poised to be on the forefront of the medical community's response to physical inactivity. The purpose of this pilot study was to examine whether the addition of a pedometer to brief physician counseling could help patients increase their ambulatory activity. Ninety four participants recruited from a family medicine clinic were randomly assigned to 2 groups. Both groups received a brief physician endorsement of regular physical activity, a handout on the benefits of an active lifestyle, and 3 follow-up phone calls from a health educator. In addition, the intervention group received a pedometer and was instructed to record their steps daily over the 9-week study period. Measurements were taken for self-reported walking, walking stage-of-change, walking self-efficacy, and pedometer steps (intervention group only). Among completers, mean daily step counts in the pedometer group rose from 6779 at baseline to 8855 at study end. Average individual improvement was 41% over the study period. Both groups significantly increased blocks walked per day, stair climbing versus using the elevator, days per week walking > or = 30 minutes, and walking for fun/leisure. The frequency of walking short trips improved significantly more in the pedometer group relative to the comparison group. The results of this pilot study highlight the need for further research on the use of pedometers as a motivational tool in the context of medical encounters with inactive patients.

Adult↗
PubMed2006

Neural mechanisms underlying balance improvement with short term Tai Chi training.

BACKGROUND AND AIMS: Though previous research has shown that Tai Chi reduces falls risk in older adults, no studies have examined underlying neural mechanisms responsible for balance improvement. We aimed to determine the efficacy of Tai Chi training in improving neuromuscular response characteristics underlying balance control in balance-impaired older adults. METHODS: Twenty-two balance-impaired older adults were randomly divided into Tai Chi (TC) or control groups. Nineteen subjects (age 68-92, BERG 44 or less) completed the study. TC training included repetitive exercises using TC motor and biomechanical strategies, techniques, and postural elements. Control training included axial mobility exercises, balance/awareness education and stress reduction. Groups trained 1.5 hours/day, 5 days/week for 3 weeks. After post-testing the control group received TC training. Subjects walked across a force plate triggered to move forward 15 cm at 40 cm/sec at heel strike. Tibialis anterior (TA) and medial gastrocnemius (GA) responses during balance recovery were measured with electromyograms (EMGs). Four clinical measures of balance were also recorded. RESULTS: TC subjects, but not controls, significantly reduced both TA response time from 148.92 +/- 45.11 ms to 98.67 +/- 17.22 ms (p < or = 0.004) and occurrence of co-contraction of antagonist muscles (p < or = 0.003) of the perturbed leg. Clinical balance measures also significantly improved after TC. CONCLUSIONS: TC enhanced neuromuscular responses controlling the ankle joint of the perturbed leg. Fast, accurate neuromuscular activation is crucial for efficacious response to slips or trips.

Aged↗
PubMed2005

Exercise and functional tasks among adults who are functionally limited.

This study compared the efficacy of 16 weeks of either resistance training, aerobic walking, or combined resistance training and aerobic walking on the performance of functional tasks among adults age 65 years and older with limited functional ability. One hundred thirty-one older adult individuals were randomized into four groups: resistance training, aerobic walking, combined resistance and aerobic walking groups, or a nonexercise control group. Each of the exercise groups documented 70% compliance with their respective exercise intervention, which included three weekly exercise sessions. At baseline, and 8 and 16 weeks following baseline, all participants completed six assessments of their functional ability. Analysis of covariance indicated that all three exercise intervention groups significantly improved measures of functional ability, with the resistance group demonstrating the most consistent gains over the six measures. These findings indicate that older adults who are functionally limited can improve their functional ability through a variety of types of exercise.

Activities of Daily Living↗
PubMed2003

Muscle activity reduces soft-tissue resonance at heel-strike during walking.

Muscle activity has previously been suggested to minimize soft-tissue resonance which occurs at heel-strike during walking and running. If this concept were true then the greatest vibration damping would occur when the input force was closest to the resonant frequency of the soft-tissues at heel-strike. However, this idea has not been tested. The purpose of this study was to test whether muscle activity in the lower extremity is used to damp soft-tissue resonance which occurs at heel-strike during walking. Hard and soft shoe conditions were tested in a randomized block design. Ground reaction forces, soft-tissue accelerations and myoelectric activity were measured during walking for 40 subjects. Soft-tissue mass was estimated from anthropologic measurements, allowing inertial forces in the soft-tissues to be calculated. The force transfer from the ground to the tissues was compared with changes in the muscle activity. The soft condition resulted in relative frequencies (input/tissue) to be closer to resonance for the main soft-tissue groups. However, no increase in force transmission was observed. Therefore, the vibration damping in the tissues must have increased. This increase concurred with increases in the muscle activity for the biceps femoris and lateral gastrocnemius. The evidence supports the proposal that muscle activity damps soft-tissue resonance at heel-strike. Muscles generate forces which act across the joints and, therefore, shoe design may be used to modify muscle activity and thus joint loading during walking and running.

Acceleration↗
PubMed2000

"Special steps": an effective visiting/walking program for persons with cognitive impairment.

A program for elderly persons with cognitive impairment and their caregivers was evaluated for its effectiveness and efficiency with regard to caregiver burden, sense of coherence, satisfaction, and cost to the health-care system. The program consisted of a weekly 2-hour visit and walk by volunteers. During a 9-month period in 1997, all eligible referrals were randomly assigned to receive the service immediately (experimental group) or be placed on a waiting list to receive it 6 weeks later (control group). Eleven caregivers/recipients formed the experimental group; 10 caregivers/recipients formed the control group. All completed questionnaires at randomization and at 6-week follow-up. Perceived burden decreased by 8% only for the caregivers in the experimental group (F = 6.8, p = .02). They indicated that they appreciated the respite and support and that the care recipient enjoyed the visit/walk. Although this study was short in duration and small in sample size, improvements were noted in perceived caregiver burden and caregivers expressed satisfaction with the program. The program did not result in additional health and social-service expenditures.

Adult↗
PubMed2001

Ligation-mediated suppression-PCR as a powerful tool to analyse nuclear gene sequences in the green alga Chlamydomonas reinhardtii.

To improve the analysis of unknown flanking DNA sequences adjacent to known sequences in nuclear genomes of photoautotrophic eukaryotic organisms, we established the technique of ligation-mediated suppression-PCR (LMS-PCR) in the green alga Chlamydomonas reinhardtii for (1) walking from a specific nuclear insertion fragment of random knockout mutants into the unknown flanking DNA sequence to identify and analyse disrupted genomic DNA regions and for (2) walking from highly conserved DNA regions derived from known gene iso-forms into flanking DNA sequences to identify new members of protein families. The feasibility of LMS-PCR for these applications was successfully demonstrated in two different approaches. The first resulted in the identification of a genomic DNA fragment flanking a nuclear insertion vector in a random knockout mutant whose phenotype was characterised by its inability to perform functional LHC state transitions. The second approach targeted the cab gene family. An oligonucleotide of a cabII gene, derived from a highly conserved region, was used to identify potential cab gene regions in the nuclear genome of Chlamydomonas. LMS-PCR combined with 3' rapid amplification of cDNA ends (3' RACE) and a PCR-based screening of a cDNA library resulted in the identification of the new cabII gene lhcb4. Both results clearly indicate that LMS-PCR is a powerful tool for the identification of flanking DNA sequences in the nuclear genome of Chlamydomonas reinhardtii.

Journal Article↗
PubMed2000

Oral Beraprost sodium, a prostaglandin I(2) analogue, for intermittent claudication: a double-blind, randomized, multicenter controlled trial. Beraprost et Claudication Intermittente (BERCI) Research Group.

BACKGROUND: Beraprost sodium (BPS) is a new stable, orally active prostaglandin I(2) analogue with antiplatelet and vasodilating properties. We report the results of a phase III clinical trial of BPS in patients with intermittent claudication. METHODS AND RESULTS: Patients (n=549) with a pain-free walking distance of between 50 and 300 m were entered into a 4-week single-blind placebo run-in phase. Patients whose pain-free walking distance had changed by <25% were then randomized to receive either BPS (40 microg TID, n=209) or placebo (n=213) in a double-blind manner for 6 months. Pain-free and maximum walking distances were measured on the occasion of treadmill exercise tests performed at baseline and 1.5, 3, 4.5, and 6 months after randomization. Success was defined as an improvement of >50% in pain-free walking distance at month 6 and in > or =1 earlier treadmill exercise test in the absence of critical cardiovascular events. Success was observed more frequently in the BPS group (43.5%) than in the placebo group (33.3%, P=0.036). Pain-free walking distances increased by 81.5% and 52.5%, respectively, in the BPS and placebo groups (P=0.001) and maximum walking distances by 60.1% and 35.0%, respectively (P=0.004). The incidence of critical cardiovascular events was 4.8% in the BPS group and 8.9% in the placebo group. CONCLUSIONS: These results show that BPS is an effective symptomatic treatment of patients with intermittent claudication. The beneficial effects of BPS on critical cardiovascular events should be confirmed in appropriate clinical trials.

Administration, Oral↗
PubMed2003

Treadmill training with partial body-weight support after total hip arthroplasty: a randomized controlled trial.

OBJECTIVE: To compare treadmill training with partial body-weight support (TT-BWS) and conventional physical therapy (PT) in ambulatory patients with hip arthroplasty. DESIGN: Randomized controlled trial. SETTING: Rehabilitation center. PARTICIPANTS: Eighty patients with a fully loadable implant who could walk independently with crutches after unilateral total hip arthroplasty were randomized to receive either TT-BWS (treatment group) or conventional PT (controls), for 10 working days. INTERVENTIONS: Each patient received 45 minutes of individualized PT, either treadmill training plus PT in the experimental or PT alone in the control group. MAIN OUTCOME MEASURES: The Harris score, recorded by blind assessors, served as the primary outcome measure. Secondary outcome measures were the hip extension deficit, gait velocity, gait symmetry, affected hip abductor power; hip abductor amplitude of electromyographic activation; and the interval from surgery to abandoning crutches. RESULTS: At the end of training, the treatment group's Harris score was 13.6 points higher (P<.0001) than the control group's score. Further, hip extension deficit was 6.8 degrees less (P<.0001), gait symmetry was 10% greater (P=.001), affected hip abductor was stronger (Medical Research Council grades 4.24 vs 3.73; P<.0001), and the amplitude of gluteus medius activity was 41.5% greater (P=.001) than those measures for controls. Gait velocity did not differ in the 2 groups. These significant differences in favor of the treatment group persisted at 3 and 12 months. The treatment group abandoned crutches sooner than the control group (3 vs 8wk). In the treatment group, 39 patients finished treatment, 35 appeared at 3, and 26 at 12 months for follow-up. In the control group, the corresponding numbers were 40, 35, and 24 patients, respectively. CONCLUSION: TT-BWS is more effective than conventional PT at restoring symmetrical independent walking after hip replacement.

Aged↗
PubMed2004

Trial of print and telephone delivered interventions to influence walking.

BACKGROUND: Both self-help print materials and telephone-assisted counseling have generally proved useful strategies to increase physical activity. This study examined their effectiveness in an intervention aimed specifically at promoting walking for specific purposes. METHODS: Participants (n = 399) were randomly allocated to one of two 3-week intervention programs. The Print program comprised multiple mailing of brochures that emphasized walking within the local community environments. The Print plus Telephone program received the same brochures plus three telephone calls. Data collected via mailed self-completed surveys were analyzed by exploring outcomes related to walking for specific purposes. RESULTS: There were no significant differences between the two programs in any of the walking measures. Both groups significantly increased time reported walking for exercise per week [Print: t(1,277) = -3.50, P < 0.001; Print plus telephone: t(1,106) = -2.44, P < 0.016]. Significantly, more participants in the Print plus Telephone group reported receiving and reading the materials (chi2 = 20.11, P < 0.0001). CONCLUSIONS: The intervention programs were more successful at increasing walking for exercise than for any other purpose. The addition of brief telephone support was successful in focusing participants' attention on the print materials, but did not result in any additional increase in walking.

Adult↗
PubMed2005

Exercise manages fatigue during breast cancer treatment: a randomized controlled trial.

Fatigue is the most prevalent and debilitating symptom experienced by breast cancer patients receiving adjuvant chemotherapy or radiation therapy and few evidence-based treatments are available to manage this distressing side-effect. The purpose of this multi-institutional randomized controlled trial was to determine the effects of exercise on fatigue levels during treatment for breast cancer. Sedentary women (N=119) with Stage 0-III breast cancer receiving outpatient adjuvant chemotherapy or radiation therapy were randomized to a home-based moderate-intensity walking exercise program or to usual care for the duration of their cancer treatment. Of participants randomized to exercise, 72% adhered to the exercise prescription; 61% of the usual care group adhered. The intention-to-treat analysis revealed no group differences in part because of a dilution of treatment effect as 39% of the usual care group exercised and 28% of the exercise group did not. When exercise participation was considered using the data analysis method of instrumental variables with principal stratification, a clinically important and statistically significant (p=0.03) effect of exercise on pretest-to-posttest change in fatigue levels was demonstrated. Adherence to a home-based moderate-intensity walking exercise program may effectively mitigate the high levels of fatigue prevalent during cancer treatment.

Adult↗
PubMed1998

Mental effort required for walking: effects of retinitis pigmentosa.

PURPOSE: To determine whether retinitis pigmentosa (RP) increases the mental effort required for walking. METHODS: A dual-task methodology was used; walking speed and reaction time (RT) to randomly emitted tones were measured in 13 persons with RP and 29 persons with normal vision. Measures of RT were used to estimate the mental effort required for walking. In a second experiment, 15 persons with RP and 17 persons with normal vision navigated a "simple" and a "complex" route. RESULTS: The RP subjects had longer RT compared with the normal-vision subjects when walking the complex but not the simple route. Normalized to each person's baseline, RT while walking the complex route was significantly correlated with log contrast sensitivity (r = -0.63) and log retinal area (r = -0.64) in the RP group. The amount of mental effort required for walking was shown to also depend on familiarity with the route. CONCLUSIONS: Route complexity is critical in determining whether walking requires more mental effort for persons with RP than for persons with normal vision. The magnitude of mental effort required for mobility covaries with the visual impairment measures which correlate with mobility performance in RP.

Adult↗
PubMed2005

Physical therapy treatment effectiveness for osteoarthritis of the knee: a randomized comparison of supervised clinical exercise and manual therapy procedures versus a home exercise program.

BACKGROUND AND PURPOSE: Manual therapy and exercise have not previously been compared with a home exercise program for patients with osteoarthritis (OA) of the knee. The purpose of this study was to compare outcomes between a home-based physical therapy program and a clinically based physical therapy program. SUBJECTS: One hundred thirty-four subjects with OA of the knee were randomly assigned to a clinic treatment group (n=66; 61% female, 39% male; mean age [+/-SD]=64+/-10 years) or a home exercise group (n=68, 71% female, 29% male; mean age [+/-SD]=62+/-9 years). METHODS: Subjects in the clinic treatment group received supervised exercise, individualized manual therapy, and a home exercise program over a 4-week period. Subjects in the home exercise group received the same home exercise program initially, reinforced at a clinic visit 2 weeks later. Measured outcomes were the distance walked in 6 minutes and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). RESULTS: Both groups showed clinically and statistically significant improvements in 6-minute walk distances and WOMAC scores at 4 weeks; improvements were still evident in both groups at 8 weeks. By 4 weeks, WOMAC scores had improved by 52% in the clinic treatment group and by 26% in the home exercise group. Average 6-minute walk distances had improved about 10% in both groups. At 1 year, both groups were substantially and about equally improved over baseline measurements. Subjects in the clinic treatment group were less likely to be taking medications for their arthritis and were more satisfied with the overall outcome of their rehabilitative treatment compared with subjects in the home exercise group. DISCUSSION AND CONCLUSION: Although both groups improved by 1 month, subjects in the clinic treatment group achieved about twice as much improvement in WOMAC scores than subjects who performed similar unsupervised exercises at home. Equivalent maintenance of improvements at 1 year was presumably due to both groups continuing the identical home exercise program. The results indicate that a home exercise program for patients with OA of the knee provides important benefit. Adding a small number of additional clinical visits for the application of manual therapy and supervised exercise adds greater symptomatic relief.

Exercise Therapy↗
PubMed2002

[The effects of exercise training on plasma tumor necrosis factor-alpha, blood leucocyte and its components in congestive heart failure patients].

OBJECTIVE: To evaluate six-minute walking test (6-MWT) in treatment of CHF and to investigate the effect of exercise training on blood leucocyte and its components and plasma TNF alpha in CHF patients. METHODS: 60 cases with NYHA II-III CHF patients underwent 6-MWT within 24 hours after hospitalization. The walking distance, heartbeat, plasma TNF alpha, and blood leucocyte and its components were investigated before and after walking test. These patients were then randomized into two groups, a training group (32 cases) and a control group (28 cases). Besides routine medication, 6-MWT was performed in the training group twice a day for 8 weeks. The same parameters were redetermined after 8 weeks of follow-up. 23 cases with NYHA IV CHF patients were investigated with the same parameters in the first day after hospitalization. RESULTS: Blood leucocyte count and percentage of granulocytes and mononuclears in cases with NYHA III-IV were significantly higher than those with NYHA II. There were significant reduction of heartbeat and prolongation of walking distance in CHF patients after exercise training. Blood leucocyte count and the percentage of granulocytes and mononuclear and plasma TNFalpha level were reduced more in the training group than the control group after 8 weeks the treatment. CONCLUSIONS: There is significantly higher leucocyte count and percentage of granulocytes and mononuclears in CHF with NYHA III-IV than those with NYHA II. 6-MWT, as an exercise training, is simple, safe, and not harmful. It can not only evaluate the severity of CHF but also serve as a therapeutic measure for CHF. Moreover the excessive activation of cytokines as TNFalpha could be reduced by 6-MWT training in CHF patients.

Adult↗
PubMed2000

Walking with labor epidural analgesia: the impact of bupivacaine concentration and a lidocaine-epinephrine test dose.

BACKGROUND: Regional analgesia techniques for labor that permit ambulation are popular among parturients. This study evaluated the influence of bupivacaine bolus concentration and a 3-ml 1.5% lidocaine-epinephrine test dose, on analgesic effectiveness and the ability to walk after block placement. METHODS: Using a randomized double-blind study design, epidural analgesia was initiated in 60 parturients undergoing labor as follows: Group TD/B.0625 received a 3-ml lidocaine-epinephrine test dose + 12 ml bupivacaine, 0.0625%; group TD/B.125 received a 3-ml test dose + 12 ml bupivacaine, 0.125%; group B.0625 received 15 ml bupivacaine, 0.0625% (no test dose); and group B.125 received 15 ml bupivacaine, 0.125% (no test dose). Initial boluses in all groups contained 10 microg sufentanil. Bupivacaine, 0.0625%, with 0.33 microg/ml sufentanil was infused throughout labor at 13.5-15 ml/h. Analgesia balance, proprioception, motor block, and patient ability to stand and walk were evaluated at various intervals. RESULTS: A bolus of 0.125% bupivacaine containing sufentanil, without a previous test dose, proved to be optimal with respect to analgesia and early ambulation. When a test dose was given before bupivacaine, 0.125%, fewer women walked within 1 h of block placement. Bupivacaine, 0.0625%, with sufentanil, with or without a test dose, provided inadequate analgesia, necessitating additional bupivacaine, which impaired the ability to walk. A high percentage of women in all groups (73-93%) walked at some stage during labor. CONCLUSIONS: Omitting a lidocaine-epinephrine test dose and using 0.125% bupivacaine for the initial bolus should permit ambulation in the early postblock period for most parturients who elect this option.

Adult↗