A Randomized Study of Exercise and Fitness Trackers in Obese Patients After Total Knee Arthroplasty.
The Orthopedic clinics of North America. 2019;(1):35-45
Functional limitations persist in obese patients after total knee arthroplasty (TKA). This study assessed the effect of an exercise program (EP) and fitness trackers (FT) in obese patients with TKA. Sixty patients 1 year after orthopedic surgery were recruited and received a 16-week tailored EP; half were randomized to receive an FT. FT had no measurable effect compared with EP alone. EP improved knee range of motion, strength, and quality-of-life scores. This study provides preliminary evidence that a 16-week EP in obese individuals 1 year post TKA is feasible and effective in improving function and quality of life.
Differences in pulmonary and extra-pulmonary characteristics in severely versus non-severely fatigued recipients of allogeneic hematopoietic stem cell transplantation: a cross-sectional, comparative study.
Hematology (Amsterdam, Netherlands). 2019;(1):112-122
OBJECTIVES Fatigue is a common symptom in allogeneic-hematopoietic stem cell transplantation (allogeneic-HSCT) recipients. However, effects of severe fatigue on pulmonary functions, blood cells, dyspnea, muscle strength, exercise capacity, depression and quality of life (QOL) in allogeneic-HSCT recipients are still unknown. Therefore, to compare pulmonary functions, blood levels, dyspnea, muscle strength, exercise capacity, depression, and QOL between allogeneic-HSCT recipients according to fatigue severity and to determine predictors of severe fatigue were aimed in the current study. METHODS Twenty-four severe-fatigued (Fatigue Severity Scale score ≥36) (40.08 ± 12.44years) and 25 non-severe-fatigued (36.20 ± 13.73years) allogeneic-HSCT recipients were compared. Blood levels, pulmonary functions (spirometer), dyspnea (Modified Medical Research Council Dyspnea scale), exercise capacity (6-minute walk test), depression (Beck Depression Inventory-II), QOL (European Organization for Research and Treatment of Cancer QOL Questionnaire), respiratory (mouth pressure device) and peripheral muscle strength (dynamometer) were evaluated. RESULTS Symptom QOL-subscale and depression scores were significantly higher; peripheral muscle strength, global health status, and functional QOL-subscales scores were lower in severe-fatigued recipients (p < 0.05) whose exercise capacity was clinically (28.85 m) decreased. Blood levels, pulmonary functions, dyspnea, and respiratory muscle strength were similar in groups (p > 0.05). 42.4% of the variance in severe fatigue was explained by symptom QOL-subscale score and corticosteroid use after HSCT (p < 0.001). CONCLUSIONS Impairments in peripheral muscle strength, QOL, exercise capacity, and depression are more prevalent among severe-fatigued recipients. Moreover, poorer QOL and corticosteroid use after HSCT are most important predictors of severe fatigue. Effects of comprehensive exercise programs and psychosocial support for severe-fatigued recipients in late post-engraftment period should be investigated.
Effect of aerobic exercise intervention on markers of insulin resistance in breast cancer women.
European journal of cancer care. 2018;(2):e12617
Insulin may affect breast cancer (BC) risk and prognosis. Exercise reduces insulin in obese BC survivors. We designed a randomised controlled trial to test the effect of an aerobic exercise intervention (AEI) on insulin parameters and body composition in non-obese BC women without insulin resistance. Thirty-eight BC women were randomised into an intervention group (IG = 18) or control group (CG = 20). IG participated in a structured AEI for 3 months, while CG received only the Word Cancer Research Fund/American Institute Cancer Research (WCRF/AICR) recommendation to be physically active. Fasting insulin, homeostasis model assessment of insulin resistance (HOMA-IR) index, metabolic parameters and body composition were collected at baseline and after the AEI. IG reduced insulin and HOMA-IR index by 15% and 14%, while CG increased these parameters (+12% and +16%). Insulin changed differently over time in the two randomised groups (pinteraction = .04). The between-group differences in the change of insulin (IG = -1.2 μU/ml versus CG = +0.8 μU/ml) and HOMA-IR index (IG = -0.26 versus CG = +0.25) were respectively significant (p = .04) and non-significant (p = .06). IG significantly improved lower limb muscle mass in comparison with CG (p = .03). A structured AEI may improve insulin, HOMA-IR index and body composition in non-obese BC survivors without insulin resistance.
Effect of vitamin D supplementation as adjunctive therapy to methylphenidate on ADHD symptoms: A randomized, double blind, placebo-controlled trial.
Nutritional neuroscience. 2018;(3):202-209
OBJECTIVES Previous studies have shown that serum levels of vitamin D were lower in attention deficit hyperactivity disorder (ADHD) children compared to healthy controls. The aim of the study was to determine the effect of vitamin D supplementation as adjunctive therapy to methylphenidate on symptoms of children with ADHD. METHODS Sixty-two children aged 5-12 years with a diagnosis of ADHD based on DSM-IV criteria were randomly assigned into two groups to receive either 2000IU vitamin D or placebo in addition to methylphenidate for 8 weeks. Symptoms severity was assessed by Conner's Parent Rating Scale-Revised[S] (CPRS), ADHD rating scale-IV (ADHD-RS), and Weekly Parent Ratings of Evening and Morning Behavior (WPREMB) at weeks 0, 4, and 8. Serum levels of 25(OH)D were measured at baseline and after 8 weeks. Anthropometric variables, dietary intake, physical activity, sun exposure, and side effects were assessed. RESULTS Fifty-four participants completed the trial. After 8 weeks of supplementation, serum levels of 25(OH)D significantly increased in the vitamin D group. ADHD symptoms decreased significantly in both groups (P < 0.05). Evening symptoms and total score of WPREMB scale were significantly different at weeks 4 and 8 between the two groups (P = 0.013, 0.016, respectively), but no differences were found in symptoms by CPRS and ADHD-RS scales. DISCUSSION Vitamin D supplementation as adjunctive therapy to methylphenidate improved ADHD evening symptoms. Future research is needed to clarify vitamin D effects as monotherapy in ADHD and its mechanism. The trial was registered in www.irct.ir is (IRCT201404222394N10).
Efficacy of pulsed high-intensity laser therapy on pain, functional capacity, and gait in children with haemophilic arthropathy.
Disability and rehabilitation. 2018;(4):462-468
AIM: The aim of this study was to evaluate the effects of pulsed high-intensity laser therapy (HILT) on pain, functional capacity, and gait in children with haemophilia. METHODS Thirty children with haemophilia type A with ages ranging from 9 to 13 years were selected for this study. They were assigned randomly, into two equal treatment groups. The laser group received the traditional physical therapy programme plus active laser (total energy of 1500 J through three phases/3 sessions/week), whereas the placebo group received the same physical therapy programme plus placebo laser over three consecutive months. Baseline and post-treatment assessments used the visual analogue scale (VAS) to evaluate pain, a 6-min walk test (6MWT) to evaluate functional capacity, and the GAITRite® system to evaluate gait parameters. RESULTS Children in the laser group showed significant improvement in pain, functional capacity, and gait parameters compared to those in the placebo group (p < 0.05). Post-treatment functional capacity for the laser and placebo groups were 316.6 ± 35.27 and 288 ± 43.3 m, respectively. CONCLUSIONS HILT is an effective modality in reducing pain, increasing functional capacity, and improving gait performance in children with haemophilic arthropathy. Implications for Rehabilitation Haemophilic arthropathy due to recurrent joint bleeding leads to physical, psychological, and socioeconomic problems in children with haemophilia and reduces their quality of life. Early physiotherapeutic interventions help to prevent and treat the sequelae of recurrent haemarthrosis. High-intensity laser therapy has been introduced as non-invasive and an effective physiotherapy modality for rapid pain control, with consequent improvement in children's quality of life. High-intensity laser therapy should be used as an adjunct to exercise programme in the rehabilitation of children with haemophilic arthropathy.
A specific brushing sequence and plaque removal efficacy: a randomized split-mouth design.
International journal of dental hygiene. 2018;(1):85-91
AIM: It has been propagated by the dental care professionals to start toothbrushing the lingual aspect of teeth first. In general, it is assumed that these surfaces of teeth are more difficult to clean. The evidence to support this recommendation is sparse. METHOD In this randomized controlled clinical trial using a split-mouth design, 46 students were included. Before the visit, the participants were requested to refrain from any oral hygiene procedure for 48 h. First, the plaque index (PI) score was assessed full mouth. Two randomly chosen contra-lateral quadrants were used to start brushing from the lingual aspect first. The opposing two quadrants were used to start brushing from the buccal aspect. After the brushing exercise was completed, full-mouth PI was scored again. Subanalyses were performed for the buccal, lingual and approximal surfaces. RESULTS At baseline, there was no statistically significant difference between the two sets of contra-lateral quadrants (P = 0.770). Starting at the lingual aspect of the lower jaw resulted in a 55% reduction of plaque scores in comparison with 58% when the brushing exercise was started buccally. [Correction added on 16 January 2017, after first online publication: In the preceding sentence, the percentage reduction of plaque scores when the brushing exercise was started buccally, was previously wrong and has been corrected to 58% throughout this article.] The difference in mean plaque scores between brushing orders was 0.04, which was not significant (P = 0.219). None of the subanalyses revealed any significant differences for the isolated surfaces. CONCLUSION Using a manual toothbrush reduced the plaque scores between 55 and 58% with no difference between brushing from either the lingual or buccal aspect first. Within the limitations of this study, a recommendation to start toothbrushing the lingual aspect is not supported by the outcome in this young student population.
Improvement of Elite Female Athletes' Physical Performance With a 3-Week Unexpected Disturbance Program.
Journal of sport rehabilitation. 2018;(1):1-7
CONTEXT Sensorimotor training is commonly used in a rehabilitative setting; however, the effectiveness of an unexpected disturbance program (UDP) to enhance performance measures in uninjured elite athletes is unknown. OBJECTIVE To assess the impact of a 3-wk UDP program on strength, power, and proprioceptive measures. DESIGN Matched-group, pre-post design. SETTING National sport institute. PARTICIPANTS 21 international-level female field hockey athletes. INTERVENTION Two 45-min UDP sessions were incorporated into each week of a 3-wk training program (total 6 sessions). MAIN OUTCOME MEASURES 1-repetition-maximum strength, lower-limb power, 20-m running speed, and proprioception tests were performed before and after the experimental period. RESULTS Substantial improvements in running sprint speed at 5-m (4.4 ± 2.6%; effect size [ES]: 0.88), 10-m (2.1 ± 1.9%; ES: 0.51), and 20-m (1.0 ± 1.6%; ES: 0.23) were observed in the UDP group. Squat-jump performance was also clearly enhanced when compared to the control group (3.1 ± 6.1%; ES: 0.23). Small but clear improvements in maximal strength were observed in both groups. CONCLUSIONS A 3-wk UDP can elicit clear enhancements in running sprint speed and concentric-only jump performance. These improvements are suggestive of enhanced explosive strength and are particularly notable given the elite training status of the cohort and relatively short duration of the intervention. Thus, the authors would reiterate the statement by Gruber et al (2004) that sensorimotor training is a "highly efficient" modality for improving explosive strength.
Effect of dapagliflozin administration on metabolic syndrome, insulin sensitivity, and insulin secretion.
Minerva endocrinologica. 2018;(3):229-235
BACKGROUND The aim of this paper was to evaluate the effect of dapagliflozin on metabolic syndrome (MetS), insulin sensitivity and insulin secretion. METHODS A randomized, double blind, placebo-controlled clinical trial was carried out in 24 patients with MetS. Glucose and insulin levels were measured every 30 minutes for 2 hours after a 75-g dextrose load. Metabolic profile was also evaluated before and after the pharmacological intervention. Twelve patients received dapagliflozin (10 mg) before breakfast for 90 days. The remaining 12 patients received placebo. Area under the curve (AUC) of glucose and insulin, total insulin secretion, first-phase of insulin secretion and insulin sensitivity were calculated. Data were tested using the Wilcoxon signed-rank, Mann-Whitney U and χ2 tests. The Ethics Committee approved the study protocol. RESULTS After dapagliflozin, there were significant decreases in body weight (82.8±12.9 vs. 81.2±12.9 kg, P<0.001), BMI (33.4±3.6 vs. 32.7±3.7 kg/m2, P<0.001), waist circumference (102±10 vs. 98±9 cm, P<0.001), total cholesterol (5.4±0.7 vs. 5.2±0.7 mmol/L, P=0.049), triglycerides (2.7±1.4 vs. 1.7±0.8 mmol/L, P=0.003), AUC of insulin (103,914±55,170 vs. 45,018±22,146 pmol/L, P<0.001) and total insulin secretion (0.84±0.64 vs. 0.35±0.11, P<0.001). Seven patients (58.3%) in the dapagliflozin group showed remission of MetS (P=0.027). CONCLUSIONS Dapagliflozin decreased body weight, BMI, waist circumference, total cholesterol, triglycerides, AUC of insulin and total insulin secretion, with a remission of MetS in 58.3%.
Comparison of the Therapeutic Effects of a Sling Exercise and a Traditional Stabilizing Exercise for Clinical Lumbar Spinal Instability.
Journal of sport rehabilitation. 2018;(1):47-54
CONTEXT Specific muscle-stabilization training can be relevant to patients with clinical spinal instability symptoms. The authors hypothesized that performing sling exercise using an elastic band in patients with clinical spinal instability would lead to pain reduction and improved lumbar spine stability. OBJECTIVE To compare supervised sling exercise with an elastic band with traditional stabilizing exercise in chronic lower back pain (LBP) patients with clinical spinal instability. DESIGN Randomized assessor-blind controlled trial. SETTING University rehabilitation hospital. MAIN OUTCOME MEASURES The participants were evaluated thrice at baseline, immediately after, and 3 mo after the last treatment session with the Numeric Pain Rating Scale (NPRS) and by the Oswestry Disability Index (ODI). INTERVENTIONS Participants were randomly assigned to 1 of 2 treatment groups: a traditional trunk-muscle-stabilizing exercise group or a sling-exercise with elastic bands group. The participants in all treatment groups attended treatment twice a week for 12 wk. RESULTS The NPRS at immediately and 3 mo after treatments showed significantly higher improvement in the sling-exercise with elastic bands group than in the traditional trunk-muscle-stabilizing exercise group, respectively (P < .05). The ODI at immediately and 3 mo after treatment showed a significantly higher improvement in the sling-exercise with elastic bands group than in the traditional trunk-muscle-stabilizing exercise group, respectively (P < .05). CONCLUSION A sling exercise with elastic bands leads to a reduction in pain and disability compared with a traditional stabilizing exercise, although traditional stabilizing exercise also shows good results in chronic LBP patients with clinical spinal instability. A sling exercise with an elastic band could be a useful treatment for chronic LBP with clinical spinal instability.
Acute effects of snus in never-tobacco users: a pilot study.
The American journal of drug and alcohol abuse. 2018;(1):113-119
BACKGROUND Snus tobacco characteristics may attract non-tobacco users, including relatively low, but pharmacologically active, doses of nicotine. Lower nicotine doses may limit adverse drug effects while also producing a physiologically active response. OBJECTIVES This pilot study is the first to profile the acute effects of snus on physiological and subjective assessments in a sample of never-tobacco users. METHODS Eleven never-tobacco users (five women; <100 uses/lifetime) were recruited from the community via university-approved advertisements. Using a within-subject design, participants consumed six pouches in ascending dose order (0, 1.6, 3.2, 4.8, 6.4, and 8.0 mg nicotine) within one session. The start of each snus bout was separated by 45 minutes, and pre- and post-pouch assessments included ratings of drug effects and physiological response. RESULTS The average heart rate and systolic blood pressure increased significantly from pre- to post-pouch use as a function of dose, though these increases were reliable for 8.0 mg nicotine only (p < .05). Collapsed across time, diastolic blood pressure was significantly higher for 8.0 mg nicotine than for all other doses (p < .05). Subjective ratings for "excessive salivation" and "satisfying" increased significantly from pre- to post-pouch use (p < .05), independent of dose. CONCLUSION Significant increases in physiological response at some doses suggest that users were exposed to pharmacologically active doses of nicotine. The lack of reliable subjective effects may be the product of the dosing regimen or the relatively small sample size. Findings highlight the need for identification of doses of snus that may promote abuse among naïve users.