Effects of non-supervised aerobic exercise on sleep quality and maternal-fetal attachment in pregnant women: A randomized controlled trial

ObjectivesThis study was designed to evaluate the effect in pregnant women of a non-supervised aerobic exercise intervention on sleep quality and maternal-fetal attachment.DesignPretest-posttest randomized controlled trial.SettingPrenatal clinic of a medical center in southern Taiwan.ParticipantsOne hundred and forty eligible, pregnant women were assigned systematically, at a random starting point, to either the experimental group (n = 70) or the control group (n = 70).InterventionParticipants in the experimental group received a 20-minute, low-impact aerobic exercise video on DVD and were instructed to exercise at home at least three times per week for a period of three months. Participants in the control group received routine prenatal care only.Main outcome measuresThe Pittsburgh Sleep Quality Index and Modified Maternal-Fetal Attachment Scale were used to assess outcome measures before the intervention and at four and 12-weeks post-intervention.ResultsThe paired-sample t-tests revealed a significant improvement in sleep quality in the experimental group at 4-weeks posttest, which persisted through 12-weeks posttest. In addition, the experimental group reported a significantly higher mean score for maternal-fetal attachment at 4-weeks posttest than the control group.ConclusionThe results of this study indicate that performing aerobic exercise ameliorates the decline in sleep quality and improves maternal-fetal attachment in women who are pregnant. These findings may be used to encourage pregnant women to regularly perform low-impact aerobic exercise.     

Step aerobic vs. cycle ergometer training: effects on aerobic capacity,coordinative tasks,and pleasure in untrained adults--a randomized controlled trial

The purpose of the study was to evaluate the impact of step aerobic (StA) and cycle ergometer training (CET) on physical performance, coordination, and pleasure, during workout. Forty untrained persons (40-70 years) were randomly assigned to either of the two regimens. Prior to and after three months of training, we investigated the participants' physical performance with a cycle ergometer test and by testing coordinative tasks (upper extremities: tapping test; lower extremities: one-leg stance). After the training period, visual analog scales were used to evaluate personal assessment (pleasure, wellbeing, team spirit, interest in prolongation of training). StA increased the relative oxygen uptake at the anaerobic threshold (RVO2AT) while CET increased the relative maximal oxygen uptake (RVO2max) to a statistically significant extent. However, intergroup comparison failed to show group-specific differences. Concerning coordinative tasks, the members of the StA group achieved a significant time reduction for both hands' tapping test. However, only the improvement in left-handed tapping was significantly higher than that achieved by members of the CET group. Despite the absence of group-specific differences, CET members showed a statistically significant change when comparing the duration of pre- with post-training time for one-leg stance under proprioceptive conditions. Team spirit was significantly higher in the StA group than in the CET group. Except for the time reduction in left-handed tapping, the present study found no group-specific differences in physical performance and coordination. Participating in a StA class has a more cohesive effect on the individual members than attending a CET group.     

A randomized controlled trial of relaxation training to reduce hot flashes in women with primary breast cancer

Hot flashes are experienced by about 52% of perimenopausal women. After breast cancer, this may increase to 70%. The use of hormone replacement therapy is not recommended in women who have had breast cancer; therefore, alternatives are required to help relieve hot flashes. This study was conducted to assess the efficacy of relaxation training in reducing the incidence of hot flashes in women with primary breast cancer. This was a randomized controlled trial of 150 women with primary breast cancer who experienced hot flashes. The intervention group received a single relaxation training session and was instructed to use practice tapes on a daily basis at home for one month; the control group received no intervention. Outcomes were incidence and severity of flashes using a diary and validated measures of anxiety and quality of life. The incidence and severity of hot flashes, as recorded by diaries, each significantly declined over one month (P<0.001 and P=0.01, respectively), compared with the control group. Distress caused by flashes also significantly declined in the treatment group over one month (P=0.01), compared with the control group. There were no significant differences between the treatment group and the control group at three months and no changes in anxiety or quality-of-life measures. Relaxation may be a useful component of a program of measures to relieve hot flashes in women with primary breast cancer.     

Effect of long-term neck muscle training on pressure pain threshold: A randomized controlled trial

Muscle tenderness has been measured in several studies to evaluate effectiveness of treatment methods, but only short-term results have been reported so far. The aim of the present study was to evaluate the long-term effects of two different muscle training methods on the pressure pain threshold of neck muscles in women with neck pain. Altogether 180 woman with chronic, non-specific neck pain were randomized into three groups: neck muscle endurance training, neck muscle strength training and control groups. The main outcome measures included pressure pain threshold measurement at six muscle sites and on the sternum. Neck pain was assessed by a visual analogue scale (VAS). At the 12-month follow-up statistically significantly higher pressure pain threshold values were obtained in both training groups at all muscle sites compared to the baseline, while no significant change occurred in the controls. Significantly higher changes in pressure pain threshold were detected at all six sites in the strength training group and at four out of six sites in the endurance training group compared to the control group. This is the first study to show an increase in pressure pain thresholds as a result of long-term muscle training. A decrease in neck pain was associated with reduced pressure pain sensitivity in neck muscles, showing that the pressure pain threshold may be a useful outcome measure of the effectiveness of neck muscle rehabilitation.     

Effectiveness of aerobic gymnastic exercise on stress,fatigue, and sleep quality during postpartum: A pilot randomized controlled trial

BackgroundGymnastics is a preferable safe exercise for postnatal women performing regularly.ObjectiveThe aim of this pilot randomized controlled trial was to determine whether the aerobic gymnastic exercise improves stress, fatigue, sleep quality and depression in postpartum women.DesignSingle-blinded, randomized controlled trial held from December 2014 until September 2015. Setting: Postnatal clinic of a medical center in southern Taiwan.Participants140 eligible postnatal women were systematically assigned, with a random start to experimental (n = 70) or a control (n = 70) group.InterventionsEngage in aerobic gymnastic exercise at least three times (15 min per section) a week for three months using compact disc in the home.Outcome measuresPerceived Stress Scale, Postpartum Fatigue Scale, Postpartum Sleep Quality Scale, and Edinburgh Postnatal Depression Scale.ResultsIn a two-way ANOVA with repeated measures, the aerobic gymnastic exercise group showed significant decrease in fatigue after practicing exercise 4 weeks and the positive effects extended to the 12-week posttests. Paired t-tests revealed that aerobic gymnastic exercise participants had improved significantly in perceived stress and fatigue after 4 weeks gymnastic exercise; these positive effects extended to the 12-week posttests. In addition, the changes in physical symptoms-related sleep inefficiency after 12 weeks gymnastic exercise were significantly decreased in the experimental group compared with the control group.Relevance to clinical practiceThe findings can be used to encourage postnatal women to perform moderate-intensity gymnastic exercise in their daily life to reduce their stress, fatigue and improve sleep quality.     

Metabolic effects of aerobic training and resistance training in type 2 diabetic subjects: a randomized controlled trial (the RAED2 study)

OBJECTIVE

To assess differences between the effects of aerobic and resistance training on HbA_1c (primary outcome) and several metabolic risk factors in subjects with type 2 diabetes, and to identify predictors of exercise-induced metabolic improvement.

RESEARCH DESIGN AND METHODS

Type 2 diabetic patients (n = 40) were randomly assigned to aerobic training or resistance training. Before and after 4 months of intervention, metabolic phenotypes (including HbA_1c, glucose clamp–measured insulin sensitivity, and oral glucose tolerance test–assessed β-cell function), body composition by dual-energy X-ray absorptiometry, visceral (VAT) and subcutaneous (SAT) adipose tissue by magnetic resonance imaging, cardiorespiratory fitness, and muscular strength were measured.

RESULTS

After training, increase in peak oxygen consumption (VO_2peak) was greater in the aerobic group (time-by-group interaction P = 0.045), whereas increase in strength was greater in the resistance group (time-by-group interaction P < 0.0001). HbA_1c was similarly reduced in both groups (−0.40% [95% CI −0.61 to −0.18] vs. −0.35% [−0.59 to −0.10], respectively). Total and truncal fat, VAT, and SAT were also similarly reduced in both groups, whereas insulin sensitivity and lean limb mass were similarly increased. β-Cell function showed no significant changes. In multivariate analyses, improvement in HbA_1c after training was independently predicted by baseline HbA_1c and by changes in VO_2peak and truncal fat.

CONCLUSIONS

Resistance training, similarly to aerobic training, improves metabolic features and insulin sensitivity and reduces abdominal fat in type 2 diabetic patients. Changes after training in VO_2peak and truncal fat may be primary determinants of exercise-induced metabolic improvement.Recent data suggest that both aerobic and resistance training may exert beneficial effects on glucose control in subjects with type 2 diabetes (1,2). However, it remains unclear if the extent of improvement and the mechanisms underlying the metabolic effects of these exercise protocols are similar.Two recent comparison studies reported similar HbA_1c reductions after aerobic or resistance training (3,4). However, the extent of HbA_1c changes in other studies using either type of exercise varied considerably (2), and therefore the results cannot be considered conclusive.The most direct determinants of glucose control are β-cell function and insulin sensitivity. In particular, most of the benefit of regular exercise on glucose control in these subjects is attributed to attenuation of insulin resistance. However, only a few studies have accurately assessed, by the gold-standard glucose clamp technique, the effects of aerobic training on insulin sensitivity in diabetic patients (5–8), and only one small study assessed the effects of resistance training (9). In contrast, little attention has been devoted to the potential effects of physical training on insulin secretion, with controversial results (10,11).The amelioration of insulin resistance brought about by physical training may be due to changes in a number of potential factors, including, but not limited to, body fat mass, fat distribution, lean mass, and maximal aerobic performance. The role played by these factors is still unsettled. Answering this question is of great interest and could help in programming more appropriate exercise training protocols in diabetic subjects.We carried out the RAED2 (Resistance Versus Aerobic Exercise in Type 2 Diabetes) trial to assess what differences and similarities exist between the effects of aerobic and resistance training in diabetic subjects, and which of these are the main determinants of the exercise-induced improvement of glucose control. To answer these questions, the effects of these exercise protocols on body fat, body composition, insulin sensitivity, β-cell function, aerobic performance, and strength measures were carefully assessed.     

Effects of Pilates training VS. Suspension training on quality of life in women with knee osteoarthritis: A randomized controlled trial

IntroductionOsteoarthritis is the most common synovial joint disease and is characterized by progressive destruction of the articular cartilage. This study aimed to compare the effect of Pilates and suspension training in patients with knee Osteoarthritis.MethodsThe participants in this randomized trial study were patients with knee Osteoarthritis. In this study, 30 females (61.40 ± 4.85 years) were divided into three groups of suspension training, Pilates, and control group. Participants were randomly assigned to 8-week (3x/week, 1 h/session) Pilates and suspension training program groups. The static and dynamic balance, range of motion, and knee function were respectively measured by The Stork stand balance test, Y balance test, Goniometers, and The WOMAC performance disability questionnaire. To analyze the findings, a dependent sample t-test, covariance test, and Bonferroni's post hoc test were used (P ≤ 0.05).ResultsDynamic and static balance in the suspension training and Pilates training caused a significant increase (P ≤ 0.05) compared to the control group. Also, the range of motion and motor performance in the suspension training and Pilates training showed a significant decrease (P ≤ 0.05) compared to the control group. The suspension training compared to the Pilates training was more effective on dynamic and static balance (P ≤ 0.05). Also, the suspension training compared to the Pilates training had more effect on Range of motion and Motor performance (P ≤ 0.05).ConclusionIt seems that Pilates and suspension training can be used in medical centers as a complementary rehabilitation method among female patients with knee Osteoarthritis to improve the dynamic and static balance, range of motion, and performance.     

Medroxyprogesterone and conjugated oestrogen are equivalent for hot flushes: a 1-year randomized double-blind trial following premenopausal ovariectomy

Oestrogen therapy is the gold standard treatment for hot flushes/night sweats, but it and oestrogen/progestin are not suitable for all women. MPA (medroxyprogesterone acetate) reduces hot flushes, but its effectiveness compared with oestrogen is unknown. In the present study, oral oestrogen [CEE (conjugated equine oestrogen)] and MPA were compared for their effects on hot flushes in a planned analysis of a secondary outcome for a 1-year randomized double-blind parallel group controlled trial in an urban academic medical centre. Participants were healthy menstruating women prior to hysterectomy/ovariectomy for benign disease. A total of 41 women {age, 45 (5) years [value is mean (S.D.)]} were enrolled; 38 women were included in this analysis of daily identical capsules containing CEE (0.6 mg/day) or MPA (10 mg/day). Demographic variables did not differ at baseline. Daily data provided the number of night and day flushes compared by group. The vasomotor symptom day-to-day intensity change was assessed by therapy assignment. Hot flushes/night sweats were well controlled in both groups, one occurred on average every third day and every fourth night. Mean/day daytime occurrences were 0.363 and 0.187 with CEE and MPA respectively, but were not significantly different (P=0.156). Night sweats also did not differ significantly (P=0.766). Therapies were statistically equivalent (within one event/24 h) in the control of vasomotor symptoms. Day-to-day hot flush intensity decreased with MPA and tended to remain stable with CEE (P<0.001). In conclusion, this analysis demonstrates that MPA and CEE are equivalent and effective in the control of the number of hot flushes/night sweats immediately following premenopausal ovariectomy.     

Effect of local anesthesia on atypical odontalgia--a randomized controlled trial

The aim of the study was to evaluate the analgesic effect of lidocaine in a double-blind, controlled multi-center study on patients with atypical odontalgia (AO)--a possible orofacial neuropathic pain condition. Thirty-five consecutive AO patients (range 31-81 years) with a mean pain duration of 7.2 years (range 1-30 years) were recruited from four different orofacial pain clinics in Sweden. In a randomized cross-over design, 1.5 ml local anesthesia (20mg/ml lidocaine and 12.5 microg/ml adrenaline) or 1.5 ml saline (9 mg/ml NaCl solution) (placebo) was injected to block the painful area. The VAS pain scores showed an overall effect of time (ANOVA: P<0.001) and treatment (ANOVA: P=0.018) with a significant interaction between the factors (ANOVA: P<0.001). Overall, VAS pain relief was significantly greater at 15-120 min following the lidocaine injections compared to the placebo injections (Tukey: P<0.05). All patients demonstrated significant disturbances in somatosensory function on the painful side compared to the non-painful side as revealed by quantitative sensory tests, however, only one significant inverse correlation was found between percentage pain relief and the magnitude of brush-evoked allodynia (Spearman: P<0.01). In conclusion, AO patients experienced significant, but not complete, pain relief from administration of local anesthetics compared with placebo. The findings indicate that the spontaneous pain in AO patients only to some extent is dependent on peripheral afferent inputs and that sensitization of higher order neurons may be involved in the pathophysiology of AO.     

Effect of abdominal massage on constipation and quality of life in older adults: A randomized controlled trial

Background and study aimThis study aimed to examine the effects of abdominal massage on constipation management and quality of life.Material and methodsIn this study conducted in a nursing home, 220 older adults (over 65 years old) were identified with constipation based on the Rome II Diagnostic Criteria for Constipation. This controlled trial using blocked randomization was stratified by sex and age and was conducted with 35 elderly participants, of which 17 formed the experimental group and were applied abdominal massage and 18 formed the untrained control group. The experimental group underwent abdominal massage training for eight weeks, five days, for 30 min/day after the meal under a research team member. The control group received no intervention. Data were collected from both groups by using a personal information form, the Constipation Quality of Life Scale. After the practice, each group was re-subjected to the same scales.ResultsOur results showed that abdominal massage is effective in constipation management (p < 0.005). Moreover, the difference between the experimental and control groups was statistically significant (p < 0.001) in terms of Constipation Quality of Life Scale post-test scores.Constipation Quality of Life Scale subscales of the experiment and control group; the difference between the post-test scores of Physical Disability (p < 0.001), Psychosocial Discomfort (p < 0.001), Anxiety (p < 0.001) and Satisfaction (p < 0.001) was found statistically significant.ConclusionAbdominal massage, as one of the independent nursing initiatives, may be suggested to be used in constipation management.     

Effect of aerobic exercise and relaxation training on fatigue and physical performance of cancer patients after surgery. A randomised controlled trial

Fatigue is a frequent problem after surgical treatment of solid tumours. Aerobic exercise and psychosocial interventions have been shown to reduce the severity of this symptom in cancer patients. Therefore, we compared the effect of the two therapies on fatigue in a randomised controlled study. Seventy-two patients who underwent surgery for lung (n=27) or gastrointestinal tumours (n=42) were assigned to an aerobic exercise group (stationary biking 30 min five times weekly) or a progressive relaxation training group (45 min three times per week). Both interventions were carried out for 3 weeks. At the beginning and the end of the study, we evaluated physical, cognitive and emotional status and somatic complaints with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core Module (EORTC-QLQ-30) questionnaire, and maximal physical performance with an ergometric stress test. Physical performance of the training group improved significantly during the programme (9.4±20 watts, p=0.01) but remained unchanged in the relaxation group (1.5±14.8 watts, p=0.37). Fatigue and global health scores improved in both groups during the intervention (fatigue: training group 21%, relaxation group 19%; global health of both groups 19%, p for all 0.01); however, there was no significant difference between changes in the scores of both groups (p=0.67). We conclude that a structured aerobic training programme improves the physical performance of patients recovering from surgery for solid tumours. However, exercise is not better than progressive relaxation training for the treatment of fatigue in this setting.     

Effect of aerobic training on walking capacity and maximal exercise tolerance in patients with multiple sclerosis: a randomized crossover controlled study

BACKGROUND AND PURPOSE: Physical deconditioning is involved in the impaired exercise tolerance of patients with multiple sclerosis (MS), but data on the effects of aerobic training (AT) in this population are scanty. The purpose of this study was to compare the effects of an 8-week AT program on exercise capacity-in terms of walking capacity and maximum exercise tolerance, as well as its effects on fatigue and health-related quality of life-as compared with neurological rehabilitation (NR) in subjects with MS. SUBJECTS AND METHODS: Nineteen subjects (14 female, 5 male; mean age [X+/-SD]=41+/-8 years) with mild to moderate disability secondary to MS participated in a randomized crossover controlled study. Eleven subjects (8 female, 3 male; mean age [X+/-SD]=44+/-6 years) completed the study. RESULTS: After AT, but not NR, the subjects' walking distances and speeds during a self-paced walk were significantly improved, as were their maximum work rate, peak oxygen uptake, and oxygen pulse during cardiopulmonary exercise tests. The increases in peak oxygen uptake and maximum work rate, but not in walking capacity, were significantly higher after AT, as compared with after NR. Additionally, the subjects who were most disabled tended to benefit more from AT. There were no differences between AT and NR in effects on fatigue, and the results showed that AT may have partially affected health-related quality of life. DISCUSSION AND CONCLUSION: The results suggest that AT is more effective than NR in improving maximum exercise tolerance and walking capacity in people with mild to moderate disability secondary to MS.     

Menopausal hot flushes and vascular health

Abstract

Hot flushes are complained of by approximately 75% of all postmenopausal women, and hormone therapy (HT) is the most effective way to alleviate them. Hot flushes are characterized by altered vascular function and sympathetic nervous system activity. Hot flushes occurred more often in women attending large, non-randomized observational studies (e.g. Nurses’ Health Study), where HT use protected against cardiovascular disease (CVD). However, they were absent (or mild) in randomized HT trials where HT use was accompanied with an elevated risk for CVD. Hot flushes, if a factor for cardiovascular health, could partly explain the conflict between observational and randomized trials.

Several cross-sectional studies imply that hot flushes are detrimental to the cardiovascular system. However, the data are not uniform, and hot flushes were recalled retrospectively or during HT use. In our prospective study hot flushes were accompanied with a vasodilatory effect during endothelial testing, and this was related to the severity of hot flushes. Night-time hot flushes were followed with transient rises in ambulatory blood pressure (BP). However, no effect of hot flushes on diurnal BP was detected. The use of estradiol showed no harmful effects on endothelial function in women with hot flushes, but in non-flushing women oral, but not transdermal, estradiol led to vasoconstrictive changes. Estradiol complemented with medroxyprogesterone acetate eliminated the vasoconstrictive effect of sole oral estradiol. Thus, both oral and transdermal estradiol are applicable in flushing women, whereas a transdermal route should be favored in non-flushing women if used e.g. for bone protection.