The Role of Exercise in the Treatment of Obesity

The United States is in the midst of a significant public health problem that relates to obesity and inactivity. This epidemic has far-ranging consequences for our workforce and our children and shows no signs of slowing in the near future. Significant research has been performed on the effects of exercise for the reduction of body weight; results of most studies indicate that exercise alone has a small effect on body-weight reduction independent of caloric restriction. However, when combined with dietary restriction, exercise has a synergistic effect and enhances weight loss beyond the effect of diet alone. In addition, exercise has been shown to have significant beneficial effects on cardiovascular and metabolic risk factors independent of actual weight loss, and losing just a small amount of weight can have a significant beneficial effect on these parameters. Genetic factors related to obesity have been found to be positively modified when persons incorporate physical activity into their lifestyle. Sitting time appears to be an independent risk factor for the development of metabolic risk factors; persons who spend more time sitting and watching television have worse metabolic profiles, even if they achieve the recommended amount of physical activity per week, than do those who move about throughout the day. Exercise also is essential for the prevention of weight gain over a life span, although the amount required to prevent weight gain may be closer to twice the amount of exercise recommended by the current Physical Activity Guidelines for Americans (www.health.gov/paguidelines). In many ways, the physiatrist is the most well prepared of all the specialists to address the complex, multidimensional problems of obesity and inactivity.     

The Role and Efficacy of Exercise in Persons With Cancer

Improvements in cancer screening, diagnosis, and treatment have resulted in an increasing population of cancer survivors with impairments in physical function, cancer-related symptoms, and reduced quality of life. Exercise and physical activity have therapeutic value at multiple points along the cancer disease continuum, spanning disease prevention, treatment, survivorship, prognostic outcomes, and end-of-life issues. Molecular mechanisms for the influence of exercise in persons with cancer include altering tumor initiation pathways and affecting hormonal, inflammatory, immune, and insulin pathways. Physical activity has been found to play a role in the prevention of certain malignancies, including breast, colon, and other cancers. An increasing amount of evidence indicates that physical activity may affect prognostic outcomes in certain cancer diagnoses, especially breast cancer. Structured exercise and physical activity interventions can be helpful in addressing specific survivorship issues, including overall quality of life, cardiorespiratory impairment, cancer-related fatigue, and lymphedema. Exercise also may be helpful during the palliative care phase to alleviate symptoms and increase physical well-being. This article will familiarize physiatrists with the current state of evidence regarding the role and efficacy of exercise in persons with cancer.     

Lung Function and Exercise Performance in Hyperthyroidism Before and After Treatment

In order to investigate the mechanism of dyspnoea in hyperthyroidismmeasurements of spirometry, lung volume, transfer factor forcarbon monoxide and its subdivisions, maximal respiratory pressures,methacholine challenge, arterial blood gases were made and exercisestudies performed on 16 patients before treatment for hyperthyroidism.Methacholine challenge showed that only three of 14 patientsincreased airway reactivity, which was mild. Maximal pressureswhich could be generated by the respiratory muscles were reducedin some patients, as was functional residual capacity. Exerciseventilation and breathing frequency were increased and the respiratoryexchange ratio was abnormally high. Anaerobic threshold wasmeasured in nine of 15 subjects and was below normal in eachcase. All but two subjects stopped exercise because of dyspnoea,and the maximum oxygen uptake achieved by the group was 53 percent (n=15, range 26–66 per cent) of predicted maximumoxygen consumption. The maximum ventilation averaged only 43per cent (n=15, range 16–96 per cent) of the maximal breathingcapacity predicted from spirometric tests. Nine patients were studied shortly after being rendered euthyroidby treatment. At rest, only maximal respiratory pressures increasedsignificantly. On exercise, the maximal workload attained andthe ventilation achieved increased significantly. Breathingpatterns, maximal oxygen consumption, ventilation, anaerobicthreshold and cardiac frequency remained unchanged. We conclude that: patients with hyperthyroidism do not generallyhave increased airway reactivity; when hyperthyroid, respiratorymuscles are weak, and improve following treatment; exercisecapacity is impaired in hyperthyroid patients probably becauseof a combination of an inefficiently rapid and shallow breathingpattern, an increase of anaerobic metabolism and discomfortassociated with the act of breathing. Although exercise capacityincreases and the sensation of dyspnoea may decrease after treatmentthe pattern of breathing does not immediately return to normal.     

The Role of Radical Surgery in the Treatment of Prostatic Cancer

At present, prostatic cancer is the most common malignancy in men in many Western countries and its incidence is continuously increasing. Radical prostatectomy has been used for over 80 years, but there is still controversy about its role in the treatment of localized prostatic cancer. Because of insufficient knowledge of the natural history of prostatic cancer and a lack of accurate prognostic factors there are possibilities for both over-and undertreatment. Better staging methods are also required to discriminate between intra-and extracapsular tumours, which is essential for curative treatment. On the basis of the facts mentioned above and because of the poor sensitivity and specificity of transrectal palpation, ultrasound examination and prostate-specific antigen, which are used in screening, diagnosing and staging of prostatic cancer, screening is not yet recommended for the detection of early prostatic cancer.     

The Role of Corticosteroids in the Treatment of Pain in Cancer Patients

Pain is one of the most frequent and most distressing symptoms in the course of cancer. The management of pain in cancer patients is based on the concept of the World Health Organization (WHO) analgesic ladder and was recently updated with the EAPC (European Association for Palliative Care) recommendations. Cancer pain may be relieved effectively with opioids administered alone or in combination with adjuvant analgesics. Corticosteroids are commonly used adjuvant analgesics and play an important role in neuropathic and bone pain treatment. However, in spite of the common use of corticosteroids, there is limited scientific evidence demonstrating their efficacy in cancer patients with pain. The use of corticosteroids in spinal cord compression, superior vena cava obstruction, raised intracranial pressure, and bowel obstruction is better established than in other nonspecific indications. This review aims to present the role of steroids in pain and management of other symptoms in cancer patients according to the available data, and discusses practical aspects of steroid use.     

造血生长因子在癌症治疗中的作用

造血生长因子在癌症治疗中的作用鄢践（江西南昌市中西医结合医院南昌３３０００３）ＲｏｌｅｏｆＨａｅｍｏｐｏｉｅｔｉｃＧｒｏｗｔｈＦａｃｔｏｒｓｉｎＣａｎｃｅｒＴｒｅａｔｍｅｎｔＹａｎＪｉａｎ（ＮａｎｃｈａｎｇＨｏｓｐｉｔａｌｏｆＣｏｍｂｉｎａｔｉｏｎｏ...     

锻炼能够缓解癌性疲乏

许多癌症患者都会感到极度疲乏。这可能是癌症本身直接导致的，也可能是因治疗所致。这种疲乏可以让人变得非常虚弱，并且难以缓解。一篇新的Cochrane系统评价收集了有关锻炼可以缓解癌性疲乏的证据，结果令人鼓舞。     

癌症患者的运动疗法

本文介绍了各种常见肿瘤病人的康复方法和常见并发症及其危险度。提出了运动疗法中应注意事项,并探讨了并发症的处理方法。     

青春期前阴茎发育不良治疗探讨

[目的]探讨儿童阴茎发育不良的治疗方法.[方法]398例性激素水平正常,阴茎睾丸低于当地儿童青少年阴茎、睾丸正常标准1～2.5标准差的青春期阴茎发育不良患者,采用绒毛膜促性腺激素(HCG)治疗.测量其治疗前、后和治疗后1个月的阴茎长度、阴茎直径、睾丸纵径和睾丸横径进行比较.[结果]384例患儿经1疗程治疗达到正常值,2...     

体外受精-胚胎移植前输卵管积水处理方式探讨

[目的]探讨输卵管积水不同处理方式对体外受精-胚胎移植(IVF-ET)结局的影响.[方法]因输卵管积水致不孕147例,共治疗155个周期,按输卵管积水的处理方法分为5组.A组:22个周期,输卵管积水未处理,直接行IVF-ET;B组:21个周期,术前切除积水输卵管;C组:22个周期,术前行输卵管伞端造口术;D组:19个周期,IVF-ET开始后口服强力霉素100 mg,每日两次10 d,取卵日抽吸输卵管积水,胚胎移植前一日发现宫腔有积液者立即行宫腔积液抽吸;E组:对照组,71个周期,输卵管阻塞无积水.[结果]各组间受精率、卵裂率、优质胚胎率、移植胚胎数比较差异均无显著性(P＞0.05).获卵数、种植率及临床妊娠率A组最低,与其余组比较差异有统计学意义(P＜0.05),而其余四组间差异无显著性(P＞0.05).异位妊娠率及流产率A组最高,其次为D组、C组;与B组、E组比较差异有显著性(P＜0.05).[结论]输卵管积水对IVF-ET的结局有负面影响,适当的处理有利于改善IVF-ET结局.     

The Effect of Resistance Exercise on All-Cause Mortality in Cancer Survivors

ObjectiveTo examine the independent associations of leisure-time aerobic physical activity (PA) and resistance exercise (RE) on all-cause mortality in cancer survivors.Patients and MethodsPatients included 2863 male and female cancer survivors, aged 18 to 81 years, who received a preventive medical examination between April 8, 1987, and December 27, 2002, while enrolled in the Aerobics Center Longitudinal Study in Dallas, Texas. Physical activity and RE were assessed by self-report at the baseline medical examination. Cox proportional hazards regression analysis was performed to determine the independent associations of PA and RE with all-cause mortality in participants who had a history of cancer.ResultsPhysical activity in cancer survivors was not associated with a lower risk of all-cause mortality. In contrast, RE was associated with a 33% lower risk of all-cause mortality (95% CI, 0.45-0.99) after adjusting for potential confounders, including PA.ConclusionIndividuals who participated in RE during cancer survival had a lower risk for all-cause mortality. The present findings provide preliminary evidence for benefits of RE during cancer survival. Future randomized controlled trials examining RE and its effect on lean body mass, muscular strength, and all-cause mortality in cancer survivors are warranted.     

The Role of Therapeutic Exercise in the Conflicting and Unstable Shoulder

Abstract

Context: The use of therapeutic exercise and manual therapy in rehabilitation of the unstable and conflicting shoulder (UCS) is widespread. In the literature, there are several electromyographical studies that have analysed the effect of specific physical exercises and clinical trials on the effectiveness of specific rehabilitative protocols. However, it has not been established yet what is the best intervention for these disorders.

Objective: In order to establish general recommendations for the treatment of UCS, we have reviewed the results of some electromyographical studies to identify the best exercises to recruit specifically the shoulder girdle muscles and some clinical trials that have proposed the utilisation of therapeutic exercise and manual therapy for UCS.

Methods: Review of the literature of the last 10 years. We have searched Pedro, Medline and the Cochrane Library for randomised clinical trials, systematic reviews and electromyographical studies on rehabilitative protocols based on therapeutic exercise and manual therapy.

Outcomes: It is common practice for clinicians to consider the involvement of patients with shoulder instability or impingement in a programme of exercises, before proceeding to a surgical intervention. Our analysis of the literature provides evidence of the efficacy of manual therapy associated with therapeutic exercises for decrease in pain, recovery of patient's strength and restoration of abilities.

Conclusions: While the analysed studies are inconclusive, on the basis of the available data, we suggest some general rehabilitative principles for the treatment of the unstable and conflicting shoulder.     

The Role of Exercise in Cardiac Rehabilitation: A Nursing Perspective

A crucial component of cardiac rehabilitation programs is exercise therapy. The purpose of this paper is to describe the benefits of exercise and the role of nursing within these programs. Rehabilitation programs must be individualized by identifying different patient populations and appropriate nursing diagnoses. Thereby, benefits of the program are maximized in order to improve the individual's quality of life.