[Physiological studies of the question of functional limits in active physical therapy (exercise therapy of handicapped)].
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STUDY DESIGN: A multicenter, randomized, controlled trial with 1-year follow-up. OBJECTIVES: To compare the effect of manual therapy to exercise therapy in sick-listed patients with chronic low back pain (>8 wks). SUMMARY AND BACKGROUND DATA: The effect of exercise therapy and manual therapy on chronic low back pain with respect to pain, function, and sick leave have been investigated in a number of studies. The results are, however, conflicting. METHODS: Patients with chronic low back pain or radicular pain sick-listed for more than 8 weeks and less than 6 months were included. A total of 49 patients were randomized to either manual therapy (n = 27) or to exercise therapy (n = 22). Sixteen treatments were given over the course of 2 months. Pain intensity, functional disability (Oswestry disability index), general health (Dartmouth COOP function charts), and return to work were recorded before, immediately after, at 4 weeks, 6 months, and 12 months after the treatment period. Spinal range of motion (Schober test) was measured before and immediately after the treatment period only. RESULTS: Although significant improvements were observed in both groups, the manual therapy group showed significantly larger improvements than the exercise therapy group on all outcome variables throughout the entire experimental period. Immediately after the 2-month treatment period, 67% in the manual therapy and 27% in the exercise therapy group had returned to work (P < 0.01), a relative difference that was maintained throughout the follow-up period. CONCLUSIONS: Improvements were found in both intervention groups, but manual therapy showed significantly greater improvement than exercise therapy in patients with chronic low back pain. The effects were reflected on all outcome measures, both on short and long-term follow-up.
OBJECTIVE: To determine the effectiveness of a manual therapy program compared with an exercise therapy program in patients with osteoarthritis (OA) of the hip. METHODS: A single-blind, randomized clinical trial of 109 hip OA patients was carried out in the outpatient clinic for physical therapy of a large hospital. The manual therapy program focused on specific manipulations and mobilization of the hip joint. The exercise therapy program focused on active exercises to improve muscle function and joint motion. The treatment period was 5 weeks (9 sessions). The primary outcome was general perceived improvement after treatment. Secondary outcomes included pain, hip function, walking speed, range of motion, and quality of life. RESULTS: Of 109 patients included in the study, 56 were allocated to manual therapy and 53 to exercise therapy. No major differences were found on baseline characteristics between groups. Success rates (primary outcome) after 5 weeks were 81% in the manual therapy group and 50% in the exercise group (odds ratio 1.92, 95% confidence interval 1.30, 2.60). Furthermore, patients in the manual therapy group had significantly better outcomes on pain, stiffness, hip function, and range of motion. Effects of manual therapy on the improvement of pain, hip function, and range of motion endured after 29 weeks. CONCLUSION: The effect of the manual therapy program on hip function is superior to the exercise therapy program in patients with OA of the hip.
BACKGROUND: Evidence is needed for the effectiveness of interventions given with reducing diets for obese adults: drug therapy, exercise, or behaviour therapy. METHODS: We systematically reviewed randomized controlled trials in any language. We searched 13 databases and handsearched journals. Trials lasted 1 year or more. One investigator extracted data and a second checked data extraction. Trial quality was assessed. RESULTS: Adding orlistat to diet was associated with weight change for up to 24 months (-3.26 kg, 95% CI, -4.15 to -2.37 kg), and statistically significant beneficial changes were found for total and LDL cholesterol, blood pressure and glycaemic control. Adding sibutramine to diet was associated with a 12 month weight change of -4.18 kg (95% CI, -5.14 to -3.21 kg), and statistically significant beneficial effects on high density lipoprotein cholesterol (HDL) and triglycerides (TGs), but an increase in diastolic blood pressure. Adding exercise to diet, or to diet and behaviour therapy, was associated with improved weight loss for up to 36 months and improvements in HDL, TGs and blood pressure. Adding behaviour therapy to diet, or to diet and sibutramine together, was associated with improved weight loss for up to 18 months. Adding drugs, exercise or behaviour therapy to dietary advice was each associated with similar weight change. CONCLUSIONS: Adding orlistat, sibutramine, exercise, or behaviour modification to dietary advice can improve long-term weight loss.
BACKGROUND: Although exercise therapy is considered to be of significant benefit to people with leg pain (intermittent claudication), almost half of those affected do not undertake any exercise therapy. OBJECTIVES: To evaluate the effects of supervised versus non-supervised exercise therapy on the maximal walking time or distance for people with intermittent claudication. SEARCH STRATEGY: The Cochrane Peripheral Vascular Diseases Group searched their Specialized Register (last searched November 2005) and the Cochrane Central Register of Controlled Trials (CENTRAL) database in The Cochrane Library (last searched Issue 4, 2005). In addition, we handsearched the reference lists of relevant articles for additional trials. There was no restriction on language of publication. SELECTION CRITERIA: Randomized and controlled clinical trials comparing supervised exercise programs with non-supervised exercise programs for people with intermittent claudication. DATA COLLECTION AND ANALYSIS: Two authors (BB and EMW) independently selected trials and extracted data. One author (BB) assessed trial quality and this was confirmed by a second author (MP). For all continuous outcomes we extracted the number of participants, the mean differences, and the standard deviation. If data were available, the standardized mean difference was calculated using a fixed-effect model. MAIN RESULTS: We identified twenty-seven trials, of which 19 had to be excluded because the control group received no exercise therapy at all. The remaining eight trials involved a total of 319 male and female participants with intermittent claudication. The follow up ranged from 12 weeks to 12 months. In general, the supervised exercise regimens consisted of three exercise sessions per week. All trials used a treadmill walking test as one of the outcome measures. The overall quality of the included trials was good, though the trials were all small with respect to the number of participants, ranging from 20 to 59. Supervised exercise therapy showed statistically significant and clinically relevant differences in improvement of maximal treadmill walking distance compared with non-supervised exercise therapy regimens, with an overall effect size of 0.58 (95% confidence interval 0.31 to 0.85) at three months. This translates to a difference of approximately 150 meters increase in walking distance in favor of the supervised group. AUTHORS' CONCLUSIONS: Supervised exercise therapy is suggested to have clinically relevant benefits compared with non-supervised regimens, which is the main prescribed exercise therapy for people with intermittent claudication. However, the clinical relevance has not been demonstrated definitely and will require additional studies with a focus on the improvements in quality of life.
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Physical training enhances adaptibility in all organs, by this way the morbidity will be reduced. It is of value as well in prophylaxis as in clinical rehabilitation in combination with medical therapy. Indications, contra-indications and the effect of an adequate training in chronic pulmonary diseases and conditions after lung operations are discussed; examples are given. Volume and intensity of training are assessed and administered from the results of cardiopulmonary function testing including ergometry with measurements of pulmonary arterial pressure.
The exercise therapy is a therapy of physiological reactions. Moving impulses can lead to direct or indirect functional reactions in different systems (i.e. neuromotor, cardiovascular etc.). As an aim within the therapy, exercise is used either under adaptive substituting or compensatory relieving. In order to reach economic and effective functional results, many aspects have to be considered many aspects, such as executing-, planning- and control criteria. They are demonstrated by means of selected samples of diseases and injuries of the locomotor apparatus.
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Cognitive-behavioral therapy (CBT) was compared to a combination of aerobic/anaerobic exercise therapy (ET) for the treatment of elevated levels of body image disturbance in college females. CBT consisted of a modification of the 1987 Butters and Cash procedure that was tailored for group intervention; ET consisted of weightlifting and aerobic dancing. Using a counterbalancing procedure, the same therapists conducted both 6-week interventions, which were compared to a nontreated control group. Results revealed equivalent reductions for both treatment groups when compared to controls on measures of body image disturbance reflective of trait and state body weight anxiety, cognitive-behavioral aspects of appearance, and overall body dissatisfaction. Unfortunately, few subjects were available for follow-up analyses, preventing an evaluation of the stability of changes. The findings are discussed with regard to the potential role of fitness training as an adjunct to cognitive-behavioral interventions for body image disturbance.
OBJECTIVE: To investigate whether patients with chronic obstructive pulmonary disease on long-term oxygen therapy would benefit from an early 8-week rehabilitation programme in terms of exercise performance, health-related quality of life and activities of daily living. METHODS: Two weeks after onset of oxygen therapy, 20 patients were randomized to rehabilitation (group A) or not (group B). Exercise performance was measured using a 6-minute walking test. Health-related quality of life was measured with the Chronic Respiratory Disease Questionnaire. Activity of daily living ability was measured with the Stanford Health Assessment Questionnaire. RESULTS: The mean 6-minute walking distance increased by 35% (p < 0.01) in group A after rehabilitation. The mean increase in group B was only 8% (n.s.). Patients in group A reported less overall dyspnoea after rehabilitation (p < 0.05) and, compared with group B, reported better activity of daily living ability (p < 0.01). CONCLUSION: Patients with chronic obstructive pulmonary disease on long-term oxygen treatment may improve their walking distance, experience less dyspnoea and improve activity of daily living ability with an early rehabilitation programme.
Therapeutic exercise has a central role within physiatry and physiotherapy. Contrary to other forms of treatment, the patient does not passively absorb energy (i. e. electricity or heat) but has to supply the energy him/herself. Exercise therapy is the only causal therapy in physical medicine and it can be dosed such that it is almost always applicable. Particularly about the latter point there is much confusion: Measures of positioning like in Guthrie-Smith's apparatus equally belong to therapeutic exercise as sequential therapy with power machines. Thus many patients are not submitted to physiotherapy and therapeutic exercise in particular, which are admittedly based on empiricism rather than scientific evaluation. This review attempts to provide an overview of the various methods of exercise therapy--incomplete and prone to the authors own preferences.