-
1.
Therapists' experiences with a new treatment combining physical exercise and dietary therapy (the PED-t) for eating disorders: an interview study in a randomised controlled trial at the Norwegian School of Sport Sciences.
Bakland, M, Sundgot-Borgen, J, Wynn, R, Rosenvinge, JH, Stornæs, AV, Pettersen, G
BMJ open. 2018;8(1):e019386
-
-
-
Free full text
Plain language summary
Research has found that physical exercise and diet therapy (PED-t) can significantly reduce the symptoms experienced by patients with eating disorders. While many studies exist on overall knowledge about treating eating disorders, there is a gap around the therapist’s perspective in delivering a treatment programme. The aim of this study is to explore the therapists’ experiences while delivering PED-t treatments for patients with eating disorders. Interviews from ten therapists delivering the PED-t program were transcribed and analysed. Overall these therapists felt their professional knowledge and ability to maintain a good group dynamic was an important source of patients’ trust in the program. Based on these results, the authors conclude that professionals of various clinical backgrounds may have a significant role in treating patients with eating disorders.
Abstract
OBJECTIVES The aim of the current study is to explore how therapists running a guided physical exercise and dietary therapy programme (PED-t) experience their contribution to the treatment of patients with bulimia nervosa and binge eating disorder. METHODS Ten therapists running the PED-t were semistructurally interviewed and the transcribed interviews were analysed using a systematic text condensation approach. SETTING The study was run within the context of a randomised controlled trial at the Norwegian School of Sport Sciences. RESULTS The therapists experienced their knowledge about physical exercise and nutrition as important and useful, and that they could share their knowledge with the patients in different ways and with confidence in their own role. They also believed that their knowledge could serve as tools for the patients' post-treatment recovery and management of their daily lives. Moreover, the therapists put much effort in adjusting their teaching to fit each individual participant. Finally, they reported their personal qualities as important to build trust and therapeutic alliance. CONCLUSIONS The terms 'clinical confidence' and 'alliance' may stand out as the overarching 'metacategories' covering the experiences revealed in this study. The clinical implication is that new groups of professionals may have an important role in the treatment of eating disorders. TRIAL REGISTRATION NUMBER NCTO2079935; Results.
-
2.
The effects of yoga and quiet rest on subjective levels of anxiety and physiological correlates: a 2-way crossover randomized trial.
Albracht-Schulte, K, Robert-McComb, J
BMC complementary and alternative medicine. 2018;18(1):280
-
-
-
Free full text
Plain language summary
Increased stress and anxiety levels can lead to elevated cardiovascular responses and reduced capacity for stress recovery. Recent studies have found both an acute period of rest and bout of acute aerobic exercise to be effective in reducing stress, suggesting time away from stressors is what alters anxiety levels. Yoga has been reported to improve both physiological and psychological coping response to stressors, however yoga has not been studied in this context. The aim of this randomised, crossover study was to determine the effects of 30 minutes of yoga and seated rest on anxiety measures, namely heart rate variability (HRV), in forty healthy female university students. Participants were randomised to either begin with seated rest or vinyasa yoga, and after each session were shown 90 emotionally stimulating photos. Post-exposure stress and anxiety responses were measured. This study found both rest and yoga were effective for acutely reducing anxiety levels, however these positive effects did not persist after exposure to emotional stimuli. Based on these results, the authors support the theory that time away from stressors is important for reducing anxiety.
Abstract
BACKGROUND Rest or acute exercise can decrease state anxiety, with some evidence showing exercise to prevent laboratory-induced elevations in anxiety. No study has examined whether yoga provides short-term protection against laboratory-induced anxiety. The aim of this study was to examine the effectiveness of an acute YogaFit session on state anxiety and measures of heart rate variability (HRV) to determine whether yoga provides short-term protection against emotional picture stimuli. METHODS A randomized repeated-measures crossover clinical trial was performed. Forty healthy, female college students completed a 30 min session of YogaFit and a time-matched seated rest condition on separate days. After each condition, participants viewed 30 min of emotional picture stimuli. State anxiety, heart rate and time-domain and frequency-domain measures of HRV were assessed baseline, post- condition, and post-exposure to emotional stimuli. Data were analysed using a condition x time (2 × 3) repeated-measures ANOVA. RESULTS Post-hoc comparisons indicate the following: (1) state anxiety significantly decreased from baseline to post-condition for both yoga and rest (p = 0.001) but returned to baseline values following exposure to emotional stimuli (p < 0.001) for both conditions; (2) heart rate decreased post-condition to post-exposure (p = 0.020) and baseline to post-exposure (p = 0.033) for both conditions; (3) time-domain measure of HRV showed a significant increase in HRV between baseline and post-condition (p = 0 .019), post-condition and post-exposure (p = 0 .007), and between baseline and post-exposure (p < 0.001). CONCLUSIONS Both YogaFit and seated rest were effective at acutely reducing state anxiety post-condition, but not at preventing an induced anxiety response post-exposure. Following exposure to the emotionally stimulating pictures, there was a shift from the high frequency-domain to the low frequency-domain and an increase in the time-domain measure of HRV for both the YogaFit and the quiet rest condition. TRIAL REGISTRATION Retrospectively registered 2/16/2018, clinicaltrials.gov, Identifier: NCT03458702 .
-
3.
Effect of tai chi versus aerobic exercise for fibromyalgia: comparative effectiveness randomized controlled trial.
Wang, C, Schmid, CH, Fielding, RA, Harvey, WF, Reid, KF, Price, LL, Driban, JB, Kalish, R, Rones, R, McAlindon, T
BMJ (Clinical research ed.). 2018;360:k851
-
-
-
Free full text
-
Plain language summary
Fibromyalgia is a complex disorder, characterised by chronic widespread musculoskeletal pain, fatigue, sleep problems and depression. Conventional treatment is multidisciplinary, including medication, exercise and CBT. This randomised, single-blinded trial aimed to determine the effectiveness of regular Tai Chi practice when compared to the standard recommended exercise, aerobic training. 226 adults diagnosed with fibromyalgia were randomly assigned to either 24 weeks of supervised aerobic exercise or 12 or 24 weeks of Tai Chi classes. A standard fibromyalgia impact questionnaire was used to assess changes in pain and quality of life measures, along with patient perception of various aspects of their condition. The study found that Fibromyalgia Impact Questionnaire scores improved across all treatment groups, however the 24-week Tai Chi group saw a statistically significant greater improvement than the aerobic group. In addition, those patients on the 24-week Tai Chi programme experienced greater improvement than those on the 12-week Tai Chi programme. There was also higher attendance and fewer drop-outs in the Tai Chi groups in comparison to the aerobic exercise group. Tai Chi could therefore be considered as an alternative to aerobic exercise in a multi-disciplinary approach to fibromyalgia treatment.
Abstract
OBJECTIVES To determine the effectiveness of tai chi interventions compared with aerobic exercise, a current core standard treatment in patients with fibromyalgia, and to test whether the effectiveness of tai chi depends on its dosage or duration. DESIGN Prospective, randomized, 52 week, single blind comparative effectiveness trial. SETTING Urban tertiary care academic hospital in the United States between March 2012 and September 2016. PARTICIPANTS 226 adults with fibromyalgia (as defined by the American College of Rheumatology 1990 and 2010 criteria) were included in the intention to treat analyses: 151 were assigned to one of four tai chi groups and 75 to an aerobic exercise group. INTERVENTIONS Participants were randomly assigned to either supervised aerobic exercise (24 weeks, twice weekly) or one of four classic Yang style supervised tai chi interventions (12 or 24 weeks, once or twice weekly). Participants were followed for 52 weeks. Adherence was rigorously encouraged in person and by telephone. MAIN OUTCOME MEASURES The primary outcome was change in the revised fibromyalgia impact questionnaire (FIQR) scores at 24 weeks compared with baseline. Secondary outcomes included changes of scores in patient's global assessment, anxiety, depression, self efficacy, coping strategies, physical functional performance, functional limitation, sleep, and health related quality of life. RESULTS FIQR scores improved in all five treatment groups, but the combined tai chi groups improved statistically significantly more than the aerobic exercise group in FIQR scores at 24 weeks (difference between groups=5.5 points, 95% confidence interval 0.6 to 10.4, P=0.03) and several secondary outcomes (patient's global assessment=0.9 points, 0.3 to 1.4, P=0.005; anxiety=1.2 points, 0.3 to 2.1, P=0.006; self efficacy=1.0 points, 0.5 to 1.6, P=0.0004; and coping strategies, 2.6 points, 0.8 to 4.3, P=0.005). Tai chi treatment compared with aerobic exercise administered with the same intensity and duration (24 weeks, twice weekly) had greater benefit (between group difference in FIQR scores=16.2 points, 8.7 to 23.6, P<0.001). The groups who received tai chi for 24 weeks showed greater improvements than those who received it for 12 weeks (difference in FIQR scores=9.6 points, 2.6 to 16.6, P=0.007). There was no significant increase in benefit for groups who received tai chi twice weekly compared with once weekly. Participants attended the tai chi training sessions more often than participants attended aerobic exercise. The effects of tai chi were consistent across all instructors. No serious adverse events related to the interventions were reported. CONCLUSION Tai chi mind-body treatment results in similar or greater improvement in symptoms than aerobic exercise, the current most commonly prescribed non-drug treatment, for a variety of outcomes for patients with fibromyalgia. Longer duration of tai chi showed greater improvement. This mind-body approach may be considered a therapeutic option in the multidisciplinary management of fibromyalgia. TRIAL REGISTRATION ClinicalTrials.gov NCT01420640.
-
4.
"I've made this my lifestyle now": a prospective qualitative study of motivation for lifestyle change among people with newly diagnosed type two diabetes mellitus.
Sebire, SJ, Toumpakari, Z, Turner, KM, Cooper, AR, Page, AS, Malpass, A, Andrews, RC
BMC public health. 2018;18(1):204
-
-
-
Free full text
Plain language summary
The point of diagnosis with T2DM is an opportunity for clinicians to help patients initiate changes in lifestyle behaviours such as physical activity and diet. Diagnosis with T2DM provokes a range of emotional responses, close scrutiny of patients’ lifestyle, threats to people’s social and personal identity and the need to construct a new identity representation. The aim of the study is to qualitatively explore how people newly diagnosed with T2DM articulate and experience motivation for lifestyle change as proposed in self-determination theory, and to examine qualitative evidence for patients’ motivational internalisation over time (i.e., transition from controlled to autonomous motivation). The study is a secondary analysis of semi-structured interview data collected with individuals who had been newly diagnosed with T2DM and were participants in the Early ACTID (Early ACTivity In Diabetes) trail. The ACTID was a lifestyle RCT involving 593 adults aged between 30 and 80 years who had received a diagnosis of T2DM within the previous 6 months. The results are presented as six themes reflecting the motivation types in self-determination theory with narratives reflecting internalisation (or the lack of) integrated alongside each motivation type. Some participants were reluctant to change and articulated a passivity towards any changes reported. Whereas for some participants, health-based reasons for change, prompted by their T2DM diagnosis, were more motivating than their previous extrinsic appearance-based weight loss goals. The findings suggest that if T2DM patients can be supported to internalise their motivation to the point of identifying a personal benefit or integrate changes as part of an enjoyable way of life, such changes may be more sustainable and resilient to common challenges to behaviour change (such as lack of time, periods of holidays and changes in routine). It is important to consider not only the quantity of a patient’s motivation but also the quality based on the extent to which it is self-directed.
Abstract
BACKGROUND Diagnosis with Type 2 Diabetes is an opportunity for individuals to change their physical activity and dietary behaviours. Diabetes treatment guidelines recommend theory-based, patient-centred care and advocate the provision of support for patient motivation but the motivational experiences of people newly diagnosed with diabetes have not been well studied. Framed in self-determination theory, this study aimed to qualitatively explore how this patient group articulate and experience different types of motivation when attempting lifestyle change. METHODS A secondary analysis of semi-structured interview data collected with 30 (n female = 18, n male = 12) adults who had been newly diagnosed with type two diabetes and were participants in the Early ACTID trial was undertaken. Deductive directed content analysis was performed using NVivo V10 and researcher triangulation to identify and describe patient experiences and narratives that reflected the motivation types outlined in self-determination theory and if/how these changed over time. RESULTS The findings revealed the diversity in motivation quality both between and within individuals over time and that patients with newly-diagnosed diabetes have multifaceted often competing motivations for lifestyle behaviour change. Applying self-determination theory, we identified that many participants reported relatively dominant controlled motivation to comply with lifestyle recommendations, avoid their non-compliance being "found out" or supress guilt following lapses in behaviour change attempts. Such narratives were accompanied by experiences of frustrating slow behaviour change progress. More autonomous motivation was expressed as something often achieved over time and reflected goals to improve health, quality of life or family time. Motivational internalisation was evident and some participants had integrated their behaviour change to a new way of life which they found resilient to common barriers. CONCLUSIONS Motivation for lifestyle change following diagnosis with type two diabetes is complex and can be relatively low in self-determination. To achieve the patient empowerment aspirations of current national health care plans, intervention developers, and clinicians would do well to consider the quality not just quantity of their patients' motivation. TRIAL REGISTRATION ISRCTN ISRCTN92162869 . Retrospectively registered.
-
5.
Swimming pool exposure is associated with autonomic changes and increased airway reactivity to a beta-2 agonist in school aged children: A cross-sectional survey.
Cavaleiro Rufo, J, Paciência, I, Silva, D, Martins, C, Madureira, J, Oliveira Fernandes, E, Padrão, P, Moreira, P, Delgado, L, Moreira, A
PloS one. 2018;13(3):e0193848
-
-
-
Free full text
Plain language summary
Studies have shown an association between swimming in chemically-treated pools and a higher risk of asthma in children, although the mechanism is not fully understood. This study aimed to investigate how swimming pool attendance influences lung and nervous system function in school-aged children. Around 800 children were classified as current swimmers (CS), past swimmers (PS) or non-swimmers (NS). The children underwent several tests to determine their lung function and allergic response to common allergens. Parasympathetic nervous system function was tested by measuring the speed at which their pupils constricted in response to light. The current swimmers group had significantly lower pupil constriction speeds compared to PS and NS, suggesting a poorer functioning of the autonomic nervous system, possibly due to inflammation resulting from swimming pool chemical exposure. CS experienced greater constriction of the airways compared to NS. A non-significant trend for a higher risk of asthma, atopic eczema and rhinitis, was observed in swimmers. The authors concluded that swimming pool attendance appears to be associated with autonomic nervous system changes and increased baseline airway smooth muscle constriction even in children without asthma.
Abstract
BACKGROUND Endurance swimming exercises coupled to disinfection by-products exposure has been associated with increased airways dysfunction and neurogenic inflammation in elite swimmers. However, the impact of swimming pool exposure at a recreational level on autonomic activity has never been explored. Therefore, this study aimed to investigate how swimming pool attendance is influencing lung and autonomic function in school-aged children. METHODS A total of 858 children enrolled a cross sectional survey. Spirometry and airway reversibility to beta-2 agonist, skin-prick-tests and exhaled nitric oxide measurements were performed. Pupillometry was used to evaluate autonomic nervous function. Children were classified as current swimmers (CS), past swimmers (PS) and non-swimmers (NS), according to the amount of swimming practice. RESULTS Current swimmers group had significantly lower maximum and average pupil constriction velocities when compared to both PS and NS groups (3.8 and 5.1 vs 3.9 and 5.3 vs 4.0 and 5.4 mm/s, p = 0.03 and p = 0.01, respectively). Moreover, affinity to the beta-2 agonist and levels of exhaled nitric oxide were significantly higher in CS when compared to NS (70 vs 60 mL and 12 vs 10 ppb, p<0.01 and p = 0.03, respectively). A non-significant trend for a higher risk of asthma, atopic eczema and allergic rhinitis was found with more years of swimming practice, particularly in atopic individuals (β = 1.12, 1.40 and 1.31, respectively). After case-case analysis, it was possible to observe that results were not influenced by the inclusion of individuals with asthma. CONCLUSIONS Concluding, swimming pool attendance appears to be associated with autonomic changes and increased baseline airway smooth muscle constriction even in children without asthma.
-
6.
Metabolic stress-dependent regulation of the mitochondrial biogenic molecular response to high-intensity exercise in human skeletal muscle.
Fiorenza, M, Gunnarsson, TP, Hostrup, M, Iaia, FM, Schena, F, Pilegaard, H, Bangsbo, J
The Journal of physiology. 2018;596(14):2823-2840
-
-
-
Free full text
-
Plain language summary
Endurance exercise stimulates mitochondrial biogenesis in skeletal muscles, a crucial adaptive protective mechanism against various metabolic disorders. Mitochondrial biogenesis is a process that involves the expansion of mitochondrial volume and changes in mitochondrial composition. Continuous moderate‐intensity exercise (CM) may lead to mild but prolonged metabolic disturbances, and low‐volume intense intermittent exercise regimes such as repeated‐sprint (RE) and speed endurance (SE) exercises may lead to a distinct degree of metabolic stress. This randomised counter-balanced crossover trial included 12 healthy trained men to investigate the effect of RE and SE exercise and high‐volume CM on metabolic perturbations and its impact on the regulation of molecular response stimulating mitochondrial biogenesis in human skeletal muscle. Compared to CM, PGC‐1α mRNA (Peroxisome proliferator‐activated receptor gamma coactivator 1‐alpha (PGC‐1α) mRNA) showed elevation in response to RS and SE exercises in well-trained subjects, and this was associated with high accumulation of muscle lactate, greater decline in muscle pH and elevated plasma adrenaline levels. Elevated metabolic perturbations lead to enhanced mitochondrial biogenesis-related mRNA responses. SE was associated with a greater increase in the PGC‐1α mRNA and severe metabolic stress. SE and CM elevated exercise-induced signalling and mRNA content of genes controlling mtDNA. Further robust research is required to elucidate the role of metabolic stress in initiating mitochondrial biogenesis in skeletal muscles in response to acute exercise, regulating genes modulating mtDNA transcription and mitochondrial remodelling dynamics. However, healthcare professionals can use the results of this study to understand that low-volume high-intensity exercise programmes can promote mitochondrial biogenesis in skeletal muscles in healthy trained men and have a similar effect to that of high-volume moderate-intensity exercise programmes.
Abstract
KEY POINTS Low-volume high-intensity exercise training promotes muscle mitochondrial adaptations that resemble those associated with high-volume moderate-intensity exercise training. These training-induced mitochondrial adaptations stem from the cumulative effects of transient transcriptional responses to each acute exercise bout. However, whether metabolic stress is a key mediator of the acute molecular responses to high-intensity exercise is still incompletely understood. Here we show that, by comparing different work-matched low-volume high-intensity exercise protocols, more marked metabolic perturbations were associated with enhanced mitochondrial biogenesis-related muscle mRNA responses. Furthermore, when compared with high-volume moderate-intensity exercise, only the low-volume high-intensity exercise eliciting severe metabolic stress compensated for reduced exercise volume in the induction of mitochondrial biogenic mRNA responses. The present results, besides improving our understanding of the mechanisms mediating exercise-induced mitochondrial biogenesis, may have implications for applied and clinical research that adopts exercise as a means to increase muscle mitochondrial content and function in healthy or diseased individuals. ABSTRACT The aim of the present study was to examine the impact of exercise-induced metabolic stress on regulation of the molecular responses promoting skeletal muscle mitochondrial biogenesis. Twelve endurance-trained men performed three cycling exercise protocols characterized by different metabolic profiles in a randomized, counter-balanced order. Specifically, two work-matched low-volume supramaximal-intensity intermittent regimes, consisting of repeated-sprint (RS) and speed endurance (SE) exercise, were employed and compared with a high-volume continuous moderate-intensity exercise (CM) protocol. Vastus lateralis muscle samples were obtained before, immediately after, and 3 h after exercise. SE produced the most marked metabolic perturbations as evidenced by the greatest changes in muscle lactate and pH, concomitantly with higher post-exercise plasma adrenaline levels in comparison with RS and CM. Exercise-induced phosphorylation of CaMKII and p38 MAPK was greater in SE than in RS and CM. The exercise-induced PGC-1α mRNA response was higher in SE and CM than in RS, with no difference between SE and CM. Muscle NRF-2, TFAM, MFN2, DRP1 and SOD2 mRNA content was elevated to the same extent by SE and CM, while RS had no effect on these mRNAs. The exercise-induced HSP72 mRNA response was larger in SE than in RS and CM. Thus, the present results suggest that, for a given exercise volume, the initial events associated with mitochondrial biogenesis are modulated by metabolic stress. In addition, high-intensity exercise seems to compensate for reduced exercise volume in the induction of mitochondrial biogenic molecular responses only when the intense exercise elicits marked metabolic perturbations.
-
7.
Prevalence and determinants of physical activity in a mixed sample of psychiatric patients in Saudi Arabia.
Alosaimi, FD, Abalhasan, MF, Alhabbad, AA, Fallata, EO, Haddad, BA, AlQattan, NI, Alassiry, MZ
Saudi medical journal. 2018;39(4):401-411
-
-
-
Free full text
Plain language summary
Physical activity has been shown to considerably reduce the burden of several non-communicable disorders (are diseases of long duration and generally slow progression), such as heart disease, stroke, diabetes, and breast and colon cancers. The aim of the study is to estimate the prevalence of physical activity among a mixed group of patients with psychiatric illnesses in Saudi Arabia. Furthermore, the study sought to evaluate the associations between physical activity, patients with different psychiatric diagnoses and the use of psychotropic medications. The study is a cross-sectional observational study that recruited 1185 patients seeking psychiatric advice, with an average age of 38.0±13.0 years. Results indicate a low prevalence of physical activity in a large, mixed sample of patients with psychiatric illnesses in both inpatient and outpatient settings in Saudi Arabia. Authors conclude that physical activity levels vary according to the type of psychiatric disease and the medications used. They outline that it is important to assess the physical activity status in patients with psychiatric illnesses and promote physical activity programs among psychiatric patients.
Abstract
OBJECTIVES To estimate prevalence of physical activity and its associations with various psychiatric disorders and the use of psychotropic medications. METHODS A cross-sectional observational study was carried out between July 2012 and June 2014. Patients were enrolled from a number of hospitals located in 5 regions of the Kingdom of Saudi Arabia. RESULTS A total of 1185 patients were included in current analysis: 796 were outpatients, and 389 were inpatients. Out of 1,185 patients, 153 (12.9%) were physically active. Much higher rates of physical activity were reported among males than females (15.9% versus 9.6%, p less than 0.001). According to the univariate analysis, higher rates of physical activity were positively correlated with primary bipolar disorders, the use of antianxiety medications and, to a lesser extent, use of antipsychotic medications, but they were negatively correlated with primary anxiety disorders, use of antidepressant medications, and use of multiple psychotropic medications. The associations between physical activity and primary bipolar disorders (odds ratio [OR]=2.47, p=0.002), use of antianxiety medications (OR=3.58, p=0.003), and use of multiple psychotropic medications (OR=0.33, p less than 0.001) remained significant after adjusting for demographic and clinical characteristics. CONCLUSION We report a variable but generally low prevalence of physical activity among a large, mixed sample of psychiatric patients in Saudi Arabia. These findings may highlight the importance of assessing physical activity status of psychiatric patients and the critical need for physical activity promotion programs among this group of disadvantaged patients.
-
8.
Impact of implementation intentions on physical activity practice in adults: A systematic review and meta-analysis of randomized clinical trials.
Silva, MAVD, São-João, TM, Brizon, VC, Franco, DH, Mialhe, FL
PloS one. 2018;13(11):e0206294
-
-
-
Free full text
Plain language summary
Many behavioural interventions have been implemented in order to increase physical activity levels among adults. Despite these efforts, there is often a large gap between setting goals and attaining goals. The aim of this systematic review and meta-analysis was to evaluate the effectiveness of using theory-based strategies on goal attainment in promoting physical activity among adults (specifically implementation intentions or if-then planning). Particular interest was given to the impact of reinforcements during the intervention and follow-up period for coping with obstacles. A total of 13 randomised controlled trials were included. Implementation intentions consisted of two strategies. Firstly, action planning which was designed to increase awareness of possible future situations where behaviours could be achieved. Secondly, coping planning which focused on barriers that might impede the goal behaviour, and ways to overcome these possible barriers. According to the current literature, application of the theory-based goal setting promoted physical activity behaviours, and this was heightened among those who received reinforcement of plans to increase physical activity during the follow-up period.
Abstract
OBJECTIVE The aim of this study was to verify the efficacy of using theory-based strategies on implementation intentions in promoting physical activity (PA) among adults. METHODS This review was conducted in accordance with the PRISMA recommendations. The search was carried out in seven electronic databases (LILACS, PubMed, SciELO, Cochrane, Web of Science) and two searches of the "grey literature" were performed (Openthesis and OpenGrey). Randomized clinical trials (RCT), published up to September 2016, were considered eligible for this study. Two reviewers independently and systematically evaluated the eligibility criteria, and performed data extraction. A meta-analysis was performed for the purpose of comparing the effect between the intervention and control groups. The effect sizes were grouped in two subgroups with the purpose of more accurately verifying the effect caused by reinforcing the implementation intentions strategy, and using the inverse variance statistical method with random effects models to estimate the main effect of the implementation intention strategy on the PA behavior. Heterogeneity among the studies was evaluated by using I-square statistics, and the Jadad scale to evaluate the quality of included papers. RESULTS The search resulted in 12,147 records, of which 13 RCTs were considered eligible for this review. Sample age ranged from 18 to 76 years, and participants had conditions such as medullary lesion, coronary disease, obesity, diabetes mellitus, sedentarism or occupational stress. When the summary of the effect was analyzed in the meta-analysis, the result found in the subgroup with reinforcement of the implementation intentions strategy was 0.25 (IC 95% = 0.05-0.45) in favor of the intervention group. This demonstrated that application of the implementation intentions strategy was capable of increasing PA practice in the participants of these studies, in comparison with others that did not use this reinforcement. CONCLUSION The findings of this review indicated that application of the theory of implementation intentions promoted PA behavior among the adults who received reinforcement of this strategy. The systematic review protocol was registered in the PROSPERO database under the number CRD42018090482.
-
9.
Postural sensorimotor training versus sham exercise in physiotherapy of patients with chronic non-specific low back pain: An exploratory randomised controlled trial.
McCaskey, MA, Wirth, B, Schuster-Amft, C, de Bruin, ED
PloS one. 2018;13(3):e0193358
-
-
-
Free full text
Plain language summary
Chronic low back pain is a leading cause of years lived with disability. Sensorimotor training (SMT) involves exercises that retrain the musculo-skeletal system to reduce muscular imbalance and improve proprioception. SMT has become a popular method for low back pain rehabilitation, however no study has looked into its effectiveness when supplemented with physiotherapy. The aim of this exploratory randomised trial was to investigate the effects of SMT in rehabilitation of chronic low back pain in 22 patients. Two trial arms received 9x30 minute physiotherapy sessions supplemented with either 15 minutes SMT or 15 minutes low-intensity training as control. Pain level and functional status were assessed at baseline, pre-intervention, post-intervention and 4-week follow-up. This trial found that in patients with chronic low back pain, SMT provided no added benefit to pain reduction and functional improvement compared with control. Based on these findings the authors suggest potential benefits of SMT for long-term functional status but further larger trials with increased SMT sessions are needed to better understand this association.
Abstract
Sensorimotor training (SMT) is popularly applied as exercise in rehabilitation settings, particularly for musculoskeletal pain. With insufficient evidence on its effect on pain and function, this exploratory randomised controlled trial investigated the potential effects of SMT in rehabilitation of chronic non-specific low back pain. Two arms received 9x30 minutes physiotherapy with added interventions: The experimental arm received 15 minutes of postural SMT while the comparator arm performed 15 minutes of added sub-effective low-intensity training. A treatment blinded tester assessed outcomes at baseline 2-4 days prior to intervention, pre- and post-intervention, and at 4-week follow-up. Main outcomes were pain and functional status assessed with a 0-100mm visual analogue scale and the Oswestry Disability Questionnaire. Additionally, postural control was analysed using a video-based tracking system and a pressure plate during perturbed stance. Robust, nonparametric multivariate hypothesis testing was performed. 22 patients (11 females, aged 32 to 75 years) with mild to moderate chronic pain and functional limitations were included for analysis (11 per arm). At post-intervention, average values of primary outcomes improved slightly, but not to a clinically relevant or statistically significant extent. At 4-week follow-up, there was a significant improvement by 12 percentage points (pp) on the functional status questionnaire in the SMT-group (95% confidence intervall (CI) = 5.3pp to 17.7pp, p < 0.001) but not in the control group (4 pp improvement, CI = 11.8pp to 19.2pp). However, group-by-time interaction effects for functional status (Q = 3.3, 19 p = 0.07) and pain (Q = 0.84, p = 0.51) were non-significant. Secondary kinematic outcomes did not change over time in either of the groups. Despite significant improvement of functional status after SMT, overall findings of this exploratory study suggest that SMT provides no added benefit for pain reduction or functional improvement in patients with moderate chronic non-specific low back pain. TRIAL REGISTRATION ClinicalTrials.gov NCT02304120 and related study protocol, DOI: 10.1186/1471-2474-15-382.
-
10.
Combination of Exercise and Acupuncture Versus Acupuncture Alone for Treatment of Myofascial Pain Syndrome: A Randomized Clinical Trial.
Eftekharsadat, B, Porjafar, E, Eslamian, F, Shakouri, SK, Fadavi, HR, Raeissadat, SA, Babaei-Ghazani, A
Journal of acupuncture and meridian studies. 2018;11(5):315-322
-
-
-
Free full text
Plain language summary
Myofascial pain syndrome (MPS) is a chronic condition in which connective tissue is inflamed and trigger points along muscle bands are hyper-sensitive. Previous studies have demonstrated that both exercise and acupuncture are effective for managing MPS. The purpose of this study was to investigate whether physical activity produced an additive effect in 64 patients receiving acupuncture for MPS. Participants were randomised to receive ten sessions of acupuncture or physical activity in addition to acupuncture. Pain measurements and quality of life questionnaires were completed and assessed. This single blind randomised study found that both exercise and acupuncture led to similar reductions in pain. Contrary to the hypothesis, there was no significant difference between the two groups, suggesting physical activity did not produce additive beneficial effect. Based on these results, the authors conclude both exercise combined with acupuncture or acupuncture alone are effective in managing MPS.
Abstract
Myofascial pain syndrome (MPS) is a common musculoskeletal disorder. This study was designed to compare the effects of aerobic exercise plus acupuncture with acupuncture alone in treatment of patients with MPS. Sixty-four patients (55 female and 9 male) with MPS in their neck and shoulders participated in the study with mean age of 33.1 ± 6.4 years. Participants were randomly allocated to aerobic exercise plus acupuncture (n = 32) or acupuncture alone (n = 32) groups. Outcome measurements included visual analog scale, pressure pain threshold, neck disability index, and quality of life that was measured with QoL-SF36 scale. Each group received 10 sessions of acupuncture in combination with aerobic exercise or acupuncture alone. The outcome measures were evaluated at baseline, at the end of the last treatment session, and at 1-month follow-up visit. While participants were waiting for their 1-month follow-up visit, the patients who received combination therapy were asked to continue their aerobic exercise by jogging 40 minutes a day. Although mean visual analog scale, pressure pain threshold, neck disability index, and QoL-SF36 were significantly improved in both groups (p < 0.001), there was no statistically significant difference among the measures between the two groups throughout the evaluated sessions. The interaction effect of time and groups did not show any significant difference among the outcome measures (p > 0.29).