Effects of long-term exercise rehabilitation on claudication distances in patients with peripheral arterial disease: a randomized controlled trial

PURPOSE: To determine if improvements in physical function and peripheral circulation after 6 months of exercise rehabilitation could be sustained over a subsequent 12-month maintenance exercise program in older patients with intermittent claudication. METHODS: Seventeen patients randomized to exercise rehabilitation and 14 patients randomized to usual care control completed this 18-month study. Patients exercised three times per week during the first 6 months of a progressive exercise program, followed by two times per week during the final 12 months of a maintenance program. Patients were studied at baseline, 6 months, and 18 months during the study. RESULTS: Eighteen months of exercise rehabilitation increased the initial claudication distance by 373 meters (189%) (P <.001), the absolute claudication distance by 358 meters (80%) (P <.001), walking economy by 11% (P <.001), 6-minute walk distance by 10% (P <.001), daily physical activity by 31%, and maximal calf blood flow by 18% (P <.001). These changes were similar to those found after 6 months of exercise rehabilitation (P = NS), and were significantly greater than the changes in the control group throughout the study (P <.05). CONCLUSION: Improvements in claudication distances, walking economy, 6-minute walk distance, physical activity level, and peripheral circulation after 6 months of exercise rehabilitation are sustained for an additional 12 months in older patients with intermittent claudication using a less frequent exercise maintenance program.     

Exercise and weight loss in obese older adults with knee osteoarthritis: a preliminary study

OBJECTIVE: The purposes of this pilot study were to determine if a combined dietary and exercise intervention would result in significant weight loss in older obese adults with knee osteoarthritis, and to compare the effects of exercise plus dietary therapy with exercise alone on gait, strength, knee pain, biomarkers of cartilage degradation, and physical function. DESIGN: Single-blind, two-arm, randomized clinical trial conducted for 24 weeks. SETTING: A university health and exercise science center. PARTICIPANTS: Twenty-four community-dwelling obese older adults aged > or = 60 years, body mass index > or = 28, knee pain, radiographic evidence of knee osteoarthritis, and self-reported physical disability. INTERVENTION: Randomization into two groups: exercise and diet (E&D) and exercise alone (E). Exercise consisted of a combined weight training and walking program for 1 hour three times per week. The dietary intervention included weekly sessions with a nutritionist utilizing cognitive-behavior modification to change dietary habits to reach a group goal of an average weight loss of 15 lb (6.8 kg) over 6 months. MEASUREMENTS: All measurements were conducted at baseline and 3 and 6 months, except for synovial fluid analysis, which was obtained only at baseline and 6 months. In addition, weight was measured weekly in the E&D group. Physical disability and knee pain were measured by self-report and physical performance was measured using the 6-minute walk and stair climb tasks. Biomechanical testing included kinetic and kinematic analysis of gait and isokinetic strength testing. Synovial fluid was analyzed for levels of total proteoglycan, keratan sulfate, and interleukin-1 beta. RESULTS: Twenty-one of the 24 participants completed the study, with one dropout in the E&D group and two in the E group. The E&D group lost a mean of 18.8 lb (8.5 kg) at 6 months compared with 4.0 lb (1.8 kg) in the E group (P = .01). Significant improvements were noted in both groups in self-reported disability and knee pain intensity and frequency as well as in physical performance measures. However, no statistical differences were found between the two groups at 6 months in knee pain scores or self-reported performance measures of physical function. There was no difference in knee strength between the groups, with both groups showing modest improvements from baseline to 6 months. At 6 months, the E&D group had a significantly greater loading rate (P = .03) and maximum braking force (P = .01) during gait. There were no significant between-group differences in the other biomechanical measures. Synovial fluid samples were obtainable at both baseline and 6 months in eight participants (four per group). The level of keratan sulfate decreased similarly in both groups from an average baseline of 96.8 +/- 37.1 to 71.5 +/- 23 ng/microg total proteoglycan. The level of IL-1 decreased from 25.3 +/- 9.8 at baseline to 8.3 +/- 6.1 pg/mL. The decrease in IL-1 correlated with the change in pain frequency (r = -0.77, P = .043). CONCLUSIONS: Weight loss can be achieved and sustained over a 6-month period in a cohort of older obese persons with osteoarthritis of the knee through a dietary and exercise intervention. Both exercise and combined weight loss and exercise regimens lead to improvements in pain, disability, and performance. Moreover, the trends in the biomechanical data suggest that exercise combined with diet may have an additional benefit in improved gait compared with exercise alone. A larger study is indicated to determine if weight loss provides additional benefits to exercise alone in this patient population.     

The effects of multidimensional home-based exercise on functional performance in elderly people

BACKGROUND: This study tested the hypothesis that a home-based exercise program would improve functional performance in elderly people. METHODS: We conducted a 6-month, single-blinded, randomized controlled trial. 72 community dwelling men and women (aged >/=70 years) with self-reported and laboratory-based functional impairment were recruited for the study. Participants were randomly assigned to either a home-based progressive strength, balance, and general physical activity intervention or an attention-control group that received home-based nutrition education. Functional performance was measured in the laboratory using the Physical Performance Test (PPT) and the Established Populations for Epidemiologic Studies of the Elderly (EPESE) short physical performance battery. Physiologic capacity was measured by strength (one repetition maximum), dynamic balance (tandem walk), gait speed (2-meter walk), and cardiovascular endurance (6-minute walk). RESULTS: 70 participants (97%) completed the 6-month trial. Compliance with study interventions within each group ranged from 75% in controls to 82% in exercisers. PPT increased by 6.1 +/- 13.4% in exercisers and decreased by 2.8 +/- 13.6% in controls (p =.02). EPESE improved by 26.2 +/- 37.5% in exercisers and decreased by 1.2 +/- 22.1% in controls (p =.001). Dynamic balance improved by 33.8 +/- 14.4% in exercisers versus 11.5 +/- 23.7% in controls (p =.0002). There were no differences between groups in the change in strength, gait speed, or cardiovascular endurance. CONCLUSIONS: Minimally supervised exercise is safe and can improve functional performance in elderly individuals. The improvements in functional performance occurred along with improvements in balance but without a significant change in muscle strength or endurance.     

Inflammatory biomarkers and physical function in older, obese adults with knee pain and self-reported osteoarthritis after intensive weight-loss therapy

OBJECTIVES: To describe the relationships between proinflammatory biomarkers and self-reported and performance-based physical function and to examine the effect of weight loss on these markers of inflammation.
DESIGN: Randomized, longitudinal, clinical study comparing subjects eating an energy-restricted diet and participating in exercise training with a control group.
SETTING: Community-base participants for the Physical Activity, Inflamation and Body Composition Trial.
PARTICIPANTS: Eighty-seven obese (body mass index (BMI) >30.0 kg/m²) adults aged 60 and older with knee pain and self-report of osteoarthritis.
MEASUREMENTS: Inflammatory biomarkers (interleukin 6 (IL-6), tumor necrosis factor alpha (TNFα), C-reactive protein, and soluble receptors for TNFα (sTNFR1 and sTNFR2)) and self-reported (Western Ontario and McMaster University Osteoarthritis Index questionnaire) and performance-based (6-minute walk distance and stair climb time) measures of physical function at baseline and 6 months.
RESULTS: Mean (standard error of the mean) weight loss was 8.7% (0.8%) in the intervention group, compared with 0.0% (0.7%) in the control group. sTNFR1 was significantly less in the intervention group than in the control group at 6 months. sTNFR1 and sTNFR2 predicted stair climb time at baseline. Change across the 6-month intervention for sTNFR2 was an independent predictor for change in 6-minute walk distance.
CONCLUSION: These results indicate that an intensive weight-loss intervention in older obese adults with knee pain can help improve inflammatory biomarkers and that changes in these concentrations showed associations with physical function.     

The effect of group exercise on physical functioning and falls in frail older people living in retirement villages: a randomized, controlled trial

OBJECTIVES: To determine whether a 12-month program of group exercise can improve physical functioning and reduce the rate of falling in frail older people. DESIGN: Cluster randomized, controlled trial of 12 months duration. SETTING: Retirement villages in Sydney and Wollongong, Australia. PARTICIPANTS: Five hundred fifty-one people aged 62 to 95 (mean+/-standard deviation=79.5+/-6.4) who were living in self- and intermediate-care retirement villages. MEASUREMENTS: Accidental falls, choice stepping reaction time, 6-minute walk distance postural sway, leaning balance, simple reaction time, and lower-limb muscle strength. RESULTS: Two hundred eighty subjects were randomized to the weight-bearing group exercise (GE) intervention that was designed to improve the ability of subjects to undertake activities for daily living. Subjects randomized to the control arm (n=271) attended flexibility and relaxation (FR) classes (n=90) or did not participate in a group activity (n=181). In spite of the reduced precision of cluster randomization, there were few differences in the baseline characteristics of the GE and combined control (CC) subjects, although the mean age of the GE group was higher than that of the CC group, and there were fewer men in the GE group. The mean number of classes attended was 39.4+/-28.7 for the GE subjects and 31.5+/-25.2 for the FR subjects. After adjusting for age and sex, there were 22% fewer falls during the trial in the GE group than in the CC group (incident rate ratio=0.78, 95% confidence interval (CI)=0.62-0.99), and 31% fewer falls in the 173 subjects who had fallen in the past year (incident rate ratio=0.69, 95% CI=0.48-0.99). At 6-month retest, the GE group performed significantly better than the CC group in tests of choice stepping reaction time, 6-minute walking distance, and simple reaction time requiring a hand press. The groups did not differ at retest in tests of strength, sway, or leaning balance. CONCLUSION: These findings show that group exercise can prevent falls and maintain physical functioning in frail older people.     

Measuring fitness in healthy older adults: the Health ABC Long Distance Corridor Walk

OBJECTIVES: The Health ABC Long Distance Corridor Walk (LDCW) was designed to extend the testing range of self-paced walking tests of fitness for older adults by including a warm-up and timing performance over 400 meters. This study compares performance on the LDCW and 6-minute walk to determine whether the LDCW encourages greater participant effort. DESIGN: Subjects were administered the LDCW and 6-minute walk during a single visit. Test order alternated between subjects, and a 15-minute rest was given between tests. SETTING: The Baltimore Veterans Affairs Medical Center. PARTICIPANTS: Twenty volunteers age 70 to 78. MEASUREMENTS: The LDCW, consisting of a 2-minute warm-up walk followed by a 400-meter walk and a 6-minute walk test were administered using a 20-meter long course in an unobstructed hallway. Heart rate (HR) and blood pressure (BP) were recorded at rest and before and after all walks. RESULTS: All 20 subjects walked a faster pace over 400 meters than for 6 minutes, in which the mean distance covered was 402 meters. From paired t-tests, walking speed was faster (mean difference = 0.23 m/sec; P < .001), and ending HR (mean difference = 7.6 bpm; P < .001) and systolic BP (mean difference = 8.3 mmHg; P = .024) were greater for the 400-meter walk than for the 6-minute walk. Results were independent of test order and subject fitness level. CONCLUSIONS: Providing a warm-up walk and using a target distance instead of time encouraged subjects to work closer to their maximum capacity. This low-cost alternative to treadmill testing can be used in research and clinical settings to assess fitness and help identify early functional decline in older adults.     

Physical exercise and comorbidity. Results from the Fitness and Arthritis in Seniors Trial (FAST)

BACKGROUND AND AIMS: Physical exercise is associated with a lower risk of disability. The impact of comorbidity on the benefits from physical exercise has not been clearly investigated. Elders with comorbidity may benefit from physical exercise to preserve physical function. METHODS: Data are from 435 participants with knee osteoarthritis aged > or = 60 years enrolled in the Fitness and Arthritis in Seniors Trial (FAST), who were randomly assigned to 18-month health educational (HE), weight training (WT), or aerobic exercise (AE) interventions. Comorbidity was defined as the presence of osteoarthritis and > or = 2 clinical conditions. Percent changes in the 6-minute walk test, self-reported disability and knee pain from baseline to 3-, 9-, and 18-month follow-up visits were analyzed according to comorbidity, using analysis of variance. Significances were adjusted using the Bonferroni method. RESULTS: Mean age of the sample was 68.7 years. In participants with comorbidity (n=197), those in the AE intervention showed significant improvement in walking speed, compared to WT and HE groups, since the beginning of follow-up. Subjects with comorbidity in AE and WT groups showed improvement of the disability score at the 3-month follow-up visit compared to those in the HE group. This improvement was maintained at the end of the follow-up by the only AE group compared to the HE one (p=0.06). In participants with comorbidity, the pain score was improved by the AE intervention. CONCLUSIONS: AE and WT interventions improve physical function in individuals with comorbidity. AE improves physical function and knee pain independently of the presence of comorbidity.     

Physical performance effects of low-intensity exercise among clinically defined high-risk elders

BACKGROUND: Falls are among the leading causes of injuries and deaths. Results from a number of studies have suggested that a community-based exercise program may be effective in improving lower body strength, although some have shown only limited improvements. However, the impact of these programs on gait and balance are equivocal. Further, studies that have specifically targeted deconditioned elderly individuals, rather than individuals drawn from the general community, either showed limited or no improvements in gait and balance. OBJECTIVE: This study examined the effectiveness of a community-based, short-term, low-intensity exercise intervention strategy on measures of mobility skills, gait and balance, and muscle strength for a clinically targeted group of elderly individuals at high risk of falls. METHODS: 245 men and women aged 60 years or older were randomized into either an intervention or control group and received a baseline (T1) assessment. Subjects in the intervention group received up to 24 sessions (45 min long) of low-intensity standard exercise modalities tailored to the individual patient over an 8- to 10-week period. At the conclusion of the program, the participants in the intervention group were instructed to continue performing the exercises at home until 1 year after T1. Measures of physical function and performance were collected for all subjects at three different points of study enrollment. RESULTS: Of the subjects assessed at baseline, 138 (56%) also had a postintervention assessment (T2), 128 (52%) had a 6-month follow-up assessment (T3), and 105 subjects had assessments at all time points. Primary analyses were based on the 105 subjects who had assessments at all time points. Intervention and control subjects did not differ in any of the physical function or performance measures at baseline. Between T1 and T2, the intervention subjects showed significantly greater improvement than the control subjects on all outcomes, with improvements plateauing for most measures between T2 and T3. Gait and balance scores continued to improve throughout the study period for both groups of subjects. CONCLUSIONS: This easily implemented, low-intensity exercise program may lead to improvements in physical functioning that are retained over the long term and effectively targets a clinically defined population of deconditioned elders at high risk of falling and sustaining serious injury.     

Six-month and one-year followup of 23 weeks of aerobic exercise for individuals with fibromyalgia

OBJECTIVE: To measure mood and physical function of individuals with fibromyalgia, 6 and 12 months following 23 weeks of supervised aerobic exercise. METHODS: This is a followup report of individuals who were previously enrolled in 23 weeks of land-based and water-based aerobic exercise classes. Outcomes included the 6-minute walk test, Beck Depression Inventory (BDI), State-Trait Anxiety Inventory, Arthritis Self-Efficacy Scale (ASES), Fibromyalgia Impact Questionnaire (FIQ), tender point count, patient global assessment score, and exercise compliance. Outcomes were measured at the start and end of the exercise classes and 6 and 12 months later. RESULTS: Analyses were conducted on 29 (intent-to-treat) or 18 (efficacy) subjects. Six-minute walk distances and BDI total scores were improved at followup (all analyses). BDI cognitive/affective scores were improved at the end of 23 weeks of exercise (both analyses) and at the 12-month followup (efficacy analysis only). BDI somatic scores were improved at 6-month (both analyses) and 12-month followup (intent-to-treat only). FIQ and ASES function were improved at all followup points. ASES pain was improved in efficacy analyses only (all followup points). Tender points were unchanged after 23 weeks of exercise and at followup. Exercise duration at followup (total minutes of aerobic plus anaerobic exercise in the preceding week) was related to gains in physical function (6- and 12-month followup) and mood (6-month followup). CONCLUSION: Exercise can improve physical function, mood, symptom severity, and aspects of self efficacy for at least 12 months. Exercising at followup was related to improvements in physical function and perhaps mood.     

Exercise, self-efficacy, and mobility performance in overweight and obese older adults with knee osteoarthritis

OBJECTIVE: To examine changes in mobility-related self efficacy following exercise and dietary weight loss interventions in overweight and obese older adults with knee osteoarthritis (OA), and to determine if self efficacy and pain mediate the effects of the interventions on mobility task performance. METHODS: The Arthritis, Diet, and Activity Promotion Trial was an 18-month, single-blind, randomized, controlled trial comparing the effects of exercise alone, dietary weight loss alone, a combination of exercise plus dietary weight loss, and a healthy lifestyle control intervention in the treatment of 316 overweight or obese older adults with symptomatic knee OA. Participants completed measures of stair-climb time and 6-minute walk distance, self efficacy for completing each mobility task, and self-reported pain at baseline, 6 months, and 18 months during the trial. RESULTS: Mixed model analyses of covariance of baseline adjusted change in the outcomes demonstrated that the exercise + dietary weight loss intervention produced greater improvements in mobility-related self efficacy (P = 0.0035), stair climb (P = 0.0249) and 6-minute walk performance (P = 0.00031), and pain (P = 0.09) when compared with the healthy lifestyle control intervention. Mediation analyses revealed that self efficacy and pain served as partial mediators of the beneficial effect of exercise + dietary weight loss on stair-climb time. CONCLUSION: Exercise + dietary weight loss results in improved mobility-related self efficacy; changes in these task-specific control beliefs and self-reported pain serve as independent partial mediators of the beneficial effect of exercise + dietary weight loss on stair-climb performance.     

Effect of a randomized, controlled trial of exercise on mood and physical function in individuals with fibromyalgia.

OBJECTIVE: To evaluate the effect of exercise on mood and physical function in individuals with fibromyalgia. METHODS: Subjects were randomly assigned to an exercise (EX) or control (CTL) group. EX subjects participated in 3 30-minute exercise classes per week for 23 weeks. Subjects were tested at entry and at 6, 12, and 23 weeks. Tests included the Beck Depression Inventory (BDI), 6-minute walk, State-Trait Anxiety Inventory (STAI), Mental Health Inventory (MHI), Fibromyalgia Impact Questionnaire (FIQ), Arthritis Self-Efficacy Scale (ASES), and a measure of tender points and knee strength. RESULTS: Fifty subjects (27 EX, 23 CTL) completed the study, and 31 (15 EX, 16 CTL) met criteria for efficacy analyses. In efficacy analyses, significant improvements were seen for EX subjects in 6-minute walk distances, BDI (total, cognitive/ affective), STAI, FIQ, ASES, and MHI (3 of 5 subscales) scores. These effects were reduced but remained during intent-to-treat analyses. CONCLUSION: Exercise can improve the mood and physical function of individuals with fibromyalgia.     

Effectiveness of an intensive nutritional intervention in patients with type 2 diabetes mellitus: results from a pilot study

The aim of this pilot study was to compare the effects of an intensive nutritional intervention with usual care conditions on dropout rate, body weight, lifestyle changes and glycemic control in patients with type 2 diabetes mellitus (T2DM). Thirty outpatients with T2DM but without insulin treatment (mean age: 57 +/- 9 yr) were randomly assigned to one of the two intervention groups: intensive care (IC) or usual care (UC). Patients in the UC group were given advice about dietary and physical activity goals in one consultation session at baseline, while patients in the IC group attended five goal-oriented consultation sessions held approximately every two weeks from baseline onwards. Changes in body weight, T2DM knowledge, dietary intake, physical activity, HbA1c, and percentage of dropouts were evaluated at 1-year follow-up post-intervention. Fifty percent of patients quitted the program and were classified as "dropouts". Program completers were older and included a lower percentage of newly diagnosed T2DM compared with dropouts. A tendency to a negative association between attendance of the IC group and the likelihood of dropping out was found (p = 0.08). No difference was detected between UC and IC groups regarding changes in body weight, HbA1c or other outcome measures, at post-intervention or 1-year follow-up. This pilot study did not confirm advantages of intensive nutritional intervention in T2DM patients in terms of glycemic control, body weight, diet and physical activity. However, the high dropout rate may have hampered its effectiveness.     

Age, functional capacity, and health-related quality of life in patients with heart failure

BACKGROUND: Although heart failure disproportionately affects older persons and is associated with significant physical disability, existing data on physical limitations and health-related quality of life (HRQL) derive largely from studies of younger subjects. We compared the relationship between functional limitation and HRQL between older and younger patients with heart failure. METHODS AND RESULTS: We evaluated 546 outpatients with heart failure enrolled in a multicenter prospective cohort study. At baseline and 6 +/- 2 weeks later, functional status was assessed by New York Heart Association (NYHA) classification and 6-minute walk testing. HRQL was measured with the Kansas City Cardiomyopathy Questionnaire (KCCQ). Comparing older (age >65 years, n = 218) and younger patients (n = 328), we assessed baseline HRQL across strata of functional status. In the 484 patients who completed follow-up (194 older and 290 younger patients), we also assessed the changes in HRQL associated with changes in functional status over time. At baseline, older patients had better HRQL than younger patients (mean KCCQ score 60 +/- 25 versus 54 +/- 28, P = .005) in spite of worse NYHA class (mean 2.54 versus 2.35, P < .001) and lower 6-minute walk distances (824 +/- 378 versus 1064 +/- 371 feet, P < .001). After multivariable adjustment including baseline NYHA class, older age was independently correlated with better HRQL (beta = +7.9 points, P < .001). At follow-up, older patients with a deterioration in NYHA class experienced marked declines in HRQL compared with younger patients (mean HRQL change of -14.4 points versus +0.3 points, respectively, P < .001). Analyses using 6-minute walk distance as the functional measure yielded similar results. CONCLUSIONS: Although older patients with heart failure have relatively good HRQL in spite of significant functional limitations, they are at risk for worsening HRQL with further decline in functional status. These results underscore the importance of treatments aimed at maintaining functional status in older persons with heart failure, including those with significant baseline functional limitations.     

The effects of high-intensity and low-intensity cycle ergometry in older adults with knee osteoarthritis

BACKGROUND: People with osteoarthritis (OA) of the knee experience pain and deconditioning that lead to disability. This study challenged the clinical belief that repetitive lower extremity exercise is not indicated in persons with knee OA. The effects of high-intensity and low-intensity stationary cycling on functional status, gait, overall and acute pain, and aerobic capacity were examined. METHODS: Thirty-nine adults (71+/-6.9 years old) with complaints of knee pain and diagnosis of OA were randomized to either a high-intensity (70% heart rate reserve [HRR]) or low-intensity (40% HRR) exercise group for 10 weeks of stationary cycling. Participants cycled for 25 minutes, 3 times per week. Before and after the exercise intervention they completed the Arthritis Impact Measurement Scale 2 for overall pain assessment, underwent timed chair rise, 6-minute walk test, gait, and graded exercise treadmill tests. Acute pain was reported daily with a visual analog scale and the Western Ontario and McMaster Universities Osteoarthritis Index scale. RESULTS: Analysis of variance revealed that participants in both groups significantly improved in the timed chair rise, in the 6-minute walk test, in the range of walking speeds, in the amount of overall pain relief, and in aerobic capacity. No differences between groups were found. Daily pain reports suggested that cycling did not increase acute pain in either group. CONCLUSIONS: Cycling may be considered as an alternative exercise modality for patients with knee OA. Low-intensity cycling was as effective as high-intensity cycling in improving function and gait, decreasing pain, and increasing aerobic capacity.     

A pilot exercise intervention to improve lower extremity functioning in peripheral arterial disease unaccompanied by intermittent claudication

PURPOSE: A pilot study was conducted to test the feasibility of supervised treadmill exercise training to improve functioning in study participants with peripheral arterial disease who did not have classical symptoms of intermittent claudication. METHODS: For this study, 32 men and women with peripheral arterial disease but no symptoms of claudication were randomized to exercise training or usual care. The intervention was a 12-week supervised treadmill walking program. Outcomes included 6-minute walk distance, maximum treadmill walking distance, and 4-meter walking velocity. Participant-reported community walking ability was measured with the Walking Impairment Questionnaire (WIQ). Inflammatory blood factor levels also were measured. RESULTS: Altogether, 25 participants who completed follow-up testing were included in intention-to-treat analyses. Of 24 participants (58%) randomized to exercise, 14 completed the entire exercise training program. The participants randomized to the intervention showed greater improvement in their WIQ walking speed score than the control subjects (P =.05). The participants randomized to the intervention showed improvements in their 6-minute walk distance (1134 +/- 347 vs 1266 +/- 295 feet; P =.03), maximal treadmill walking distance (389 +/- 248 vs 585 +/- 293 feet; P <.001), WIQ distance score (52.3 +/- 29.1 vs 63.1 +/- 25.1; P =.002), and WIQ speed score (48.7 +/- 26.8 vs 59.7 +/- 22.7; P =.008). The participants randomized to the control condition showed improvements in maximal treadmill walking distance (362 +/- 180 vs 513 +/- 237 feet; P =.014). There were no significant changes in the inflammatory blood factors after exercise. CONCLUSIONS: This pilot study demonstrated that a supervised treadmill walking program may be feasible and may improve functioning for individuals with peripheral arterial disease who do not have classical symptoms of intermittent claudication. Further study is needed with a larger sample to identify optimal exercise methods that improve lower extremity functioning in men and women with peripheral arterial disease who do not have intermittent claudication.     

Continuous care in the treatment of obesity: an observational multicentre study

OBJECTIVES: To investigate weight loss and reasons for attrition in obese patients on long-term continuous care. DESIGN: Observational study with 36 months of follow-up. Setting. Fifteen Italian obesity centres applying a continuous care model of medical treatment. SUBJECTS: One thousand treatment-seeking obese subjects (785 females, median age 45.1 years, median BMI 37.4 kg m(-2)). Weight loss expectations were systematically recorded at baseline. INTERVENTIONS: An initial intensive treatment period (3-6 months) was followed by a less intensive continuous care (a follow-up control every 2-4 months). Main outcome measures. Attrition, reasons for treatment interruption and BMI change. Data were recorded by telephone interview in dropouts. RESULTS: Only 157 patients (15.7%) were in continuous treatment at 36 months. The main reasons of attrition were logistics, unsatisfactory results and lack of motivation. The only basal predictor for continuous care was lower Expected One-Year BMI Loss (P = 0.016). The probability of dropout increased systematically for any 5% expected BMI loss (Hazard ratio, 1.05; 96% confidence interval, 1.01-1.09). The mean percentage weight loss was greater in continuers (5.2% vs. 3.0% in dropouts; P = 0.016). However, the dropouts satisfied with the results or confident to lose additional weight without professional help reported a mean weight loss of 9.6% and 6.5% respectively. DISCUSSION: Continuous care produces long-term weight loss only in a subgroup of obese patients seeking treatment in medical centres. The finding that subgroups of dropouts report long-term weight loss has implication for the treatment of obesity.     

Home-based leg-strengthening exercise improves function 1 year after hip fracture: a randomized controlled study

OBJECTIVES: To compare the effectiveness of a short‐term leg‐strengthening exercise program with that of attentional control on improving strength, walking abilities, and function 1 year after hip fracture. DESIGN: Randomized controlled pilot study. SETTING: Patients' homes. PARTICIPANTS: Community‐dwelling older adults (n=26) 6 months after hip fracture at baseline. INTERVENTION: Exercise and control participants received interventions from physical therapists twice a week for 10 weeks. The exercise group received high‐intensity leg‐strengthening exercises. The control group received transcutaneous electrical nerve stimulation and mental imagery. MEASUREMENTS: Isometric force production of lower extremity muscles, usual and fast gait speed, 6‐minute walk (6‐MW) distance, modified Physical Performance Test (mPPT), and Medical Outcomes Study 36‐item Short Form Survey (SF‐36) physical function. RESULTS: The primary endpoint was 1 year after fracture. Isometric force production (P=.006), usual (P=.02) and fast (P=.03) gait speed, 6‐MW distance (P=.005), and mPPT score (P<.001) were improved 1 year after fracture with exercise. Effect sizes were 0.79 for strength, 0.81 for mPPT score, 0.56 for gait speed, 0.49 for 6‐MW, and 0.30 for SF‐36 score. More patients in the exercise group made meaningful changes in gait speed and 6‐MW distance than control patients (chi‐square P=.004). CONCLUSION: A 10‐week home‐based progressive resistance exercise program was sufficient to achieve moderate to large effects on physical performance and quality of life and may offer an alternative intervention mode for patients with hip fracture who are unable to leave home by 6 months after the fracture. The effects were maintained at 3 months after completion of the training program.     

Enhancing Caregiver Health: Findings from the Resources for Enhancing Alzheimer's Caregiver Health II Intervention

OBJECTIVES: To examine the relationships between changes from baseline to post-Resources for Enhancing Alzheimer's Caregiver Health (REACH) intervention in caregiver (CG) self-reported health, burden, and bother.
DESIGN: Randomized, multisite clinical trial.
SETTING: CG and care recipient (CR) homes in five U.S. cities.
PARTICIPANTS: Four hundred ninety-five dementia CG and CR dyads (169 Hispanic, 160 white, and 166 African American) receiving intervention and their controls.
INTERVENTION: CGs were assigned to the REACH intervention or a no-treatment control group. Intervention subjects received individual risk profiles and the REACH intervention through nine in-home and three telephone sessions over 6 months. Control subjects received two brief "check-in" telephone calls during this 6-month period.
MEASUREMENTS: The primary outcome was change in CG health status from baseline to after the intervention. Secondary outcomes were CG burden and bother after the intervention.
RESULTS: After the intervention, CGs reported better self-rated health, sleep quality, physical health, and emotional health, which was related to less burden and bother with their caregiving role than for CGs not receiving the intervention. Changes in depression appeared to mediate these relationships. Several racial and ethnic group differences existed in physical and emotional health, as well as in total frustration with caregiving, emotional burden, and CG-rated bother with CR's activities of daily living and instrumental activities of daily living at baseline and at follow-up, although differences between baseline and posttest did not vary according to race.
CONCLUSION: A structured, multicomponent skills training intervention that targeted CG self-care behaviors as one of five target areas, improved self-reported health status, and decreased burden and bother in racially and ethnically diverse CGs of people with dementia.     

Functional capacity after traditional Chinese medicine (qi gong) training in patients with chronic atrial fibrillation: a randomized controlled trial

Evidence indicates that low energy expenditure protocols derived from traditional Chinese medicine may benefit patients with cardiac impairment; therefore, the authors carried out a randomized controlled trial to test a 16-week medically assisted qi gong training program for the physical rehabilitation of patients with stable chronic atrial fibrillation and preserved left ventricular function. Functional capacity variation was evaluated using the 6-minute walk test, which was performed at baseline, at the end of the intervention, and after 16 weeks. Thirty men and 13 women (mean age, 68+/-8 years) were randomized to the intervention protocol or to a wait-list control group. Qi gong training was well tolerated and, compared with baseline, trained patients walked an average 114 meters more (27%) at the end of treatment (P<.001) and 57 meters more (13.7%) 16 weeks later (P=.008). Control subjects showed no variation in functional capacity. These results seem promising and deserve confirmation with further research.     

A randomized,controlled trial comparing long-term and short-term exercise in patients with chronic obstructive pulmonary disease

PURPOSE: To compare the effects of short-term (3 months) and long-term (18 months) involvement in an exercise program on self-reported disability and physical function in patients with chronic obstructive pulmonary disease (COPD). METHODS: A total of 140 patients with COPD were studied in a randomized, single-blinded clinical trial. Self-reported disability and physical function were assessed using a 21-item questionnaire, a 6-minute walk, timed stair climb, and an overhead task. RESULTS: At the completion of the trial, participants in the long-term intervention reported 12% less disability than those in the short-term intervention (adjusted mean with 95% confidence interval, 1.53 (1.43-1.63) versus 1.71 (1.61 to 1.81) units, respectively; P=.016), walked 6% farther during 6-minutes (1,815.0 [1,750.4-1,879.6] vs 1,711.5 [1,640.7-1,782.3] feet, respectively), climbed steps 11% faster (11.6 [11.0-12.2] vs 12.9 [12.3-13.5] seconds, respectively), and completed an overhead task 8% faster (46.8 [44.4-49.2] vs 50.4 [47.8-53.0] seconds, respectively) than those in the short-term intervention. CONCLUSION: An 18 month exercise program results in greater improvements in self-reported disability and physical function in patients with COPD when compared with a 3-month exercise program. As such, long-term exercise should be recommended for all patients with COPD.