A predominantly home-based progressive resistance exercise program increases knee extensor strength in the short-term in people with chronic obstructive pulmonary disease: a randomised controlled trial

QUESTIONS: Does a 12-week, predominantly home-based program of progressive resistance exercises reduce impairments, activity limitations, and participation restrictions in people with chronic obstructive pulmonary disease? Are any gains maintained 12 weeks after the cessation of the program? DESIGN: Randomised controlled trial with concealed allocation, assessor blinding, and intention-to-treat analysis. PARTICIPANTS: 54 people with moderately severe chronic obstructive pulmonary disease not undergoing pulmonary rehabilitation. INTERVENTION: The experimental group performed six progressive resistance exercises three times per week (once a week hospital-based, twice a week home-based) for 12 weeks. Exercise intensity was three sets of 8 to 12 repetition maximum progressed against elasticised bands of increasing resistance. The control group received no intervention. OUTCOME MEASURES: Primary outcomes were strength (knee extensor, hip abductor, shoulder horizontal flexor, shoulder flexor) measured using hand-held dynamometry, and walking capacity measured by the 6-minute Walk Test performed before and after intervention and again at 12 weeks after the cessation of intervention. RESULTS: The experimental group increased their knee extensor strength by 4.9 kg (95% CI 1.1 to 8.7) more than the control group by Week 12. However, this gain was not maintained at Week 24. No difference between the groups was found for any of the other primary outcomes. CONCLUSIONS: A predominantly home-based progressive resistance exercise program led to modest improvements in knee extensor strength in people with chronic obstructive pulmonary disease. However, 44% of the experimental group were unable to complete the exercise program, highlighting the need to understand factors influencing adherence to exercise in this population.     

Efficacy of electrical stimulation to increase muscle strength in people with neurological conditions: a systematic review

Background and Purpose. Weakness in partially paralysed muscles is a disabling impairment for people with neurological conditions. Strength training programmes are widely administered to address this impairment. There is a common belief that the effectiveness of strength training programmes can be enhanced by the addition of electrical stimulation. The purpose of this systematic review was to assess the efficacy of electrical stimulation for increasing voluntary strength in people with neurological conditions. Method. Eligible randomized trials of electrical stimulation were identified by searches of computerized databases. The search yielded 11 267 abstracts, of which 60 were retrieved. Two assessors independently reviewed full text versions of these articles. Results. Eighteen studies satisfied the inclusion criteria. These studies involved participants with spina bifida (n = 1), cerebral palsy (n = 1), peripheral nerve lesion (n = 1), multiple sclerosis (n = 1), spinal cord injury (n = 3) and stroke (n = 11). The mean (SD) PEDro score for trial quality was 4.9 (1.0) out of 10. Meta‐analyses of studies involving similar patients were not done because of insufficient data or lack of homogeneity. The results of all studies were analysed individually. Conclusion. Several studies suggest a modest beneficial effect of electrical stimulation in patients with stroke. It is not clear whether patients with other types of neurological disabilities benefit from electrical stimulation in the same way. Copyright © 2007 John Wiley & Sons, Ltd.     

Short-term progressive resistance exercise may not be effective at increasing wrist strength in people with tetraplegia: a randomised controlled trial

QUESTIONS: Is an 8-week progressive resistance exercise program effective for increasing strength in the wrist muscles of people with tetraplegia? Is it effective for improving muscle endurance and participants' perceptions about use of their hands for activities of daily living? DESIGN: Randomised controlled trial with concealed allocation, assessor blinding, and intention-to-treat analysis. PARTICIPANTS: Thirty-two people with tetraplegia and neurological weakness of their wrist flexor or extensor muscles. INTERVENTION: The wrist muscles of one randomly-chosen hand were trained 3 times a week for 8 weeks. The control group received no intervention. OUTCOME MEASURES: The primary outcome was strength measured as maximal voluntary isometric torque in Nm. The secondary outcomes were muscle endurance measured as fatigue resistance and participants' perceptions about use of their hands using the Canadian Occupational Performance Measure. RESULTS: The mean effect on maximal voluntary isometric torque was 0.2 Nm (95% CI -0.5 to 0.8). This represents an 8% increase of mean initial strength; less than the 20% deemed clinically worthwhile at the commencement of the study. The mean effect on fatigue resistance was 0.1 (95% CI 0.0 to 0.2). The mean effect on participants' perceptions of performance was -0.3 (95% CI -1.9 to 1.2) and satisfaction was -0.3 (95% CI -1.6 to 1.0). CONCLUSION: The results indicate that progressive resistance exercise has no effect on participants' perceptions about hand function. However, it is not yet clear whether progressive resistance exercise programs improve strength and endurance in muscles with neurologically-induced weakness following tetraplegia.     

A qualitative analysis of a progressive resistance exercise programme for people with Parkinson's disease

PURPOSE: This qualitative study explored the perceptions of adults with Parkinson's disease (PD) about the positive and negative aspects and outcomes of a community-based progressive resistance strengthening programme (PRST), motivators to begin and continue with the PRST program, and factors that might facilitate or create barriers to participation in and completion of a PRST programme. METHODS: Three women and 10 men with PD participated in a 10-week community-based strengthening programme. Participants were interviewed at the end of the programme. A phenomenological theoretical framework and a grounded theory methodology were used to underpin the analysis of these data. RESULTS: Four themes emerged about the participants' experiences of the programme. These were: (i) Motivators for participation in the PRST programme were broader than physical outcomes, (ii) the outcomes were broader than just physical outcomes, (iii) the indicators of success for participants varied, and (iv) the participants' experience of a disease-specific exercise programme was positive. CONCLUSIONS: The outcomes of this study provide insights, not identified through the quantitative results, into the experiences of people with PD, which have implications for clinicians running future strength training programmes for people with PD.     

A qualitative analysis of a progressive resistance exercise programme for people with multiple sclerosis

Purpose. This qualitative study explored the perceptions of adults with multiple sclerosis about the positive and negative effects of a progressive resistance strengthening programme; and identified factors that might facilitate or create barriers to participation.

Methods. Seven women and two men (mean age 45.6 years, SD 10.7) with multiple sclerosis participated in a 10-week gymnasium based progressive resistance strengthening programme held twice a week. Participants were interviewed at the end of the programme. The recorded interviews were transcribed and then independently coded by three researchers. From these codes, the main themes emerged.

Results. Reports about the programme were very positive with physical, psychological and social benefits noted. Most participants said that they had less fatigue as a result of the programme. Few negative outcomes were reported and these were minor such as aches and pains. Key extrinsic factors for programme completion were the leaders' encouragement and knowledge of exercise; and the group aspect of the programme. Key intrinsic factors were enjoyment, determination, seeing the signs of progress, and a previously held positive attitude about the benefits of exercise.

Conclusions. The results of this study suggest that progressive resistance strength training is a feasible fitness option for some people with multiple sclerosis. Factors perceived to be important for programme completion suggest that choosing encouraging leaders with knowledge of exercise, and exercising in a group may contribute to programme success.     

A qualitative analysis of a progressive resistance exercise programme for people with Parkinson's disease

Purpose. This qualitative study explored the perceptions of adults with Parkinson's disease (PD) about the positive and negative aspects and outcomes of a community-based progressive resistance strengthening programme (PRST), motivators to begin and continue with the PRST program, and factors that might facilitate or create barriers to participation in and completion of a PRST programme.

Methods. Three women and 10 men with PD participated in a 10-week community-based strengthening programme. Participants were interviewed at the end of the programme. A phenomenological theoretical framework and a grounded theory methodology were used to underpin the analysis of these data.

Results. Four themes emerged about the participants' experiences of the programme. These were: (i) Motivators for participation in the PRST programme were broader than physical outcomes, (ii) the outcomes were broader than just physical outcomes, (iii) the indicators of success for participants varied, and (iv) the participants' experience of a disease-specific exercise programme was positive.

Conclusions. The outcomes of this study provide insights, not identified through the quantitative results, into the experiences of people with PD, which have implications for clinicians running future strength training programmes for people with PD.     

A qualitative analysis of a progressive resistance exercise programme for people with multiple sclerosis

Purpose. This qualitative study explored the perceptions of adults with multiple sclerosis about the positive and negative effects of a progressive resistance strengthening programme; and identified factors that might facilitate or create barriers to participation.

Methods. Seven women and two men (mean age 45.6 years, SD 10.7) with multiple sclerosis participated in a 10-week gymnasium based progressive resistance strengthening programme held twice a week. Participants were interviewed at the end of the programme. The recorded interviews were transcribed and then independently coded by three researchers. From these codes, the main themes emerged.

Results. Reports about the programme were very positive with physical, psychological and social benefits noted. Most participants said that they had less fatigue as a result of the programme. Few negative outcomes were reported and these were minor such as aches and pains. Key extrinsic factors for programme completion were the leaders' encouragement and knowledge of exercise; and the group aspect of the programme. Key intrinsic factors were enjoyment, determination, seeing the signs of progress, and a previously held positive attitude about the benefits of exercise.

Conclusions. The results of this study suggest that progressive resistance strength training is a feasible fitness option for some people with multiple sclerosis. Factors perceived to be important for programme completion suggest that choosing encouraging leaders with knowledge of exercise, and exercising in a group may contribute to programme success.     

Intrinsic foot muscle strengthening exercises with electromyographic biofeedback achieve increased toe flexor strength in older adults: A pilot randomized controlled trial

BackgroundToe flexor strength is important for preventing older adults from falling. Although intrinsic foot muscles are the main determinants of toe flexor strength, exercises for strengthening these muscles are difficult for older adults. This study therefore aimed to determine whether the use of electromyographic biofeedback helps older adults to perform intrinsic foot muscle strengthening exercises.MethodsThis randomized controlled trial had two parallel arms. Participants were randomly allocated to the control group or the electromyographic biofeedback group. Control participants performed two progressive intrinsic foot muscle strengthening exercises twice a week for 6 weeks. Participants in the other group performed these exercises assisted by electromyographic biofeedback. Primary outcome measures were changes in toe flexor strength and the timed up-and-go and functional reach tests (the latter two being balance tests).FindingsAltogether, 23 older adults were randomized to the control group (n = 12) or the electromyographic biofeedback group (n = 11). After the 6-week intervention, toe flexor strength on the dominant side increased in both groups (P < 0.017). However, toe flexor strength on the nondominant side increased only in the electromyographic biofeedback group (P < 0.017), with a large effect size of 1.5. There were no changes in the two balance tests. Three of the control group and two of the electromyographic biofeedback group were lost to follow- up.InterpretationOur results indicate that, the use of electromyographic biofeedback can enhance the effect of intrinsic foot muscle strengthening exercises on the nondominant side in older adults.Clinical trial registration number: UMIN000036521.     

低负荷小强度抗阻运动对卧床老年患者肌力和心肺功能的影响

目的制订适合高龄老年卧床患者的低负荷小强度抗阻运动方案,评价其对患者肌力和心肺功能的影响。方法便利选取北京市某三级甲等医院老年病房2020年3月—4月收治的80岁及以上疾病稳定期患者64例,随机分为试验组和对照组。试验组在常规治疗和护理的基础上,给予6个月的低负荷小强度抗阻训练,对照组给予常规治疗和护理,比较两组的肌力和心肺功能。结果共有59例患者完成研究,试验组29例,对照组30例。试验组握力在3个月和6个月时高于对照组(P<0.05),仰卧举腿和30 s反复坐起次数在6个月时多于对照组(P<0.05)。肺活量在6个月时高于对照组(P<0.05),两组血压、心率、左心室射血分数等比较,差异均无统计学意义(P>0.05)。结论低负荷小强度抗阻运动不仅能提高高龄卧床老年患者的肌力,还能有效改善患者的肺功能,但对改善心功能的效果不明显。     

Diabetes and insulin resistance in older people

Diabetes is a common condition in older people. Diabetes significantly lowers the chances of successful aging, and notably increases functional limitations and impairs quality of life. Diabetes in older persons represents significant medical, human, and socioeconomic burden. Multiple interventions are now available to treat patients with diabetes. Clinicians have to weigh the risks and benefits of the treatments available to prevent these complications. This article discusses the pathophysiology, diagnosis, and vascular complications of diabetes and summarizes the various risk factors that are the focus of clinical care.     

Functional tasks exercise versus resistance exercise to improve daily function in older women: a feasibility study

OBJECTIVE: To evaluate the feasibility of a new functional tasks exercise program, designed to improve functional performance of community-dwelling older women, by comparing it with a resistance exercise program. DESIGN: A 12-week, randomized, single-blind pilot study. SETTING: A community leisure center. PARTICIPANTS: Twenty-four community-dwelling, medically stable women (mean age, 74.6+/-4.8 y) were randomized to the functional tasks exercises (function group) or the resistance exercises (resistance group). Three participants withdrew from the study. INTERVENTIONS: Exercises were given 3 times weekly for 12 weeks. The functional tasks exercise program aimed to improve daily tasks in the domains first affected in older adults, whereas the resistance exercise program focused on strengthening the muscle groups that are important for functional performance. MAIN OUTCOME MEASURES: Participant satisfaction with the exercises, Assessment of Daily Activity Performance (ADAP), and, as a secondary outcome, muscle strength and power. RESULTS: Exercise adherence was 81% in the function group and 90% in the resistance group. Participants reported greater satisfaction with the resistance exercises than with the functional exercises. The ADAP total score improved with time (P =.001; mean change function group, 7.5 U; 95% confidence interval [CI], 2.1-12.8; resistance group, 2.8 U, 95% CI, -0.4 to 5.9), as did isometric knee extensor strength (P =.001; mean change function group, 6.4%; 95% CI, -1.6 to 14.5; resistance group, 14.4%; 95% CI, 6.4-22.2). Testing for differences in outcomes between the 2 groups showed no statistically significant differences. CONCLUSIONS: The functional tasks exercise program is feasible and shows promise of being more effective for functional performance than a resistance exercise program. A randomized controlled trial with a larger sample size is needed to test the difference between the 2 programs.     

Steps for targeting exercise towards the skeleton to increase bone strength

Osteoporosis is a disease of bone fragility resulting mostly from low bone mass and a concomitant increase in the risk for fracture. Exercise is a commonly prescribed intervention for osteoporosis because bone tissue is mechanosensitive. The ability of mechanical stimuli to influence bone biology has been known for over a century, but it has been only in the past several decades that great gains have been made in terms of understanding factors that influence this response. By understanding these factors, steps can be developed to maximize the osteogenic effects of exercise on the skeleton and potentially reduce the incidence of bone fractures. This paper outlines these steps. They include: 1) starting exercise when young while the skeleton is most responsive to mechanical stimuli; 2) selecting exercises that are dynamic and high-impact to maximize osteogenic responses, such as jumping for the lower extremity and racquet sports for the upper extremity; 3) exercising the specific skeletal regions you want to strengthen as the bone response to mechanical loading is highly site-specific; 4) exercising briefly, yet often to offset the desensitization of skeletal mechanotransduction pathways; and 5) continuing to exercise as you age to prevent bone loss and reduce the risk of falls. Following these steps will help to promote skeletal health at all ages and may reduce an individuals risk for fracture by augmenting bone mass and size during youth, while reducing age-related bone loss and the risk for falls in adulthood.