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Danicic JM, Inder WJ, Kotowicz MA. The impact of subclinical hypothyroidism on health-related quality of life: a narrative review. Intern Med J 2021; 51:1380-1387. [PMID: 34139046 DOI: 10.1111/imj.15431] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 06/08/2021] [Accepted: 06/14/2021] [Indexed: 11/28/2022]
Abstract
A biochemical diagnosis of subclinical hypothyroidism is defined by an elevated serum thyroid-stimulating hormone (TSH) with a normal serum free thyroxine (FT4). This paper discusses SCH in the Australian population, the impact of SCH on health-related quality of life (HRQoL), and the evidence for thyroid hormone therapy as well as exercise therapy to improve HRQoL in SCH. The prevalence of SCH in Australia is approximately 4-5% and is higher in females and the elderly. Current evidence suggests thyroid hormone therapy is not associated with an improvement in HRQoL. However, there does appear to be a subgroup of those with SCH that experience an impairment in HRQoL who may potentially benefit from treatment. Because the majority of research to date has been done in elderly, largely asymptomatic individuals, this may not be representative of the entire SCH population. Additionally, alternative treatments such as exercise therapy have not been well explored in the literature, despite exercise therapy's effects on HRQoL in other populations. Further research is required to clearly define which individuals with SCH are likely to experience an impaired HRQoL, as well as explore the effects of thyroid hormone therapy and exercise therapy in these individuals. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Joseph M Danicic
- Department of Diabetes and Endocrinology, Princess Alexandra Hospital, Brisbane, Australia
| | - Warrick J Inder
- Department of Diabetes and Endocrinology, Princess Alexandra Hospital, Brisbane, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Mark A Kotowicz
- School of Medicine, Deakin University, Geelong, Australia.,Department of Endocrinology and Diabetes, Barwon Health.,Department of Medicine, University of Melbourne, Melbourne
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Feasibility of an Intradialytic Combined Exercise Program Targeting Older Adults With End-Stage Renal Disease. J Aging Phys Act 2021; 29:905-914. [PMID: 34111843 DOI: 10.1123/japa.2020-0359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 11/10/2020] [Accepted: 12/01/2020] [Indexed: 11/18/2022]
Abstract
Intradialytic exercise is feasible and yields substantial clinical benefits in middle-aged patients. However, evidence is scarce in older hemodialysis patients. OBJECTIVE To assess the feasibility and clinical benefits of supervised, intradialytic exercise in older patients. METHODS Multicenter one-arm feasibility study. The main outcome was feasibility (ease of recruitment, dropout rate, adherence, affective valence, and adverse events). The secondary outcomes were physical capacity (five-repetition sit-to-stand, 60-s sit-to-stand tests, and grip strength), quality of life (36-Item Short-Form Health Survey), quality of sleep (Pittsburgh Sleep Quality Index), depressive symptoms (Beck Depression Inventory), and dialysis efficacy (Kt/V and urea reduction ratio). RESULTS About 79% of the screened patients agreed to participate (n = 25, 73 [66-77] years). The dropout rate was high (32%), but adherence remained high among the participants who completed the study (94%). Improvements were found in the five-repetition sit-to-stand (p < .001), 60-s sit-to-stand tests (p = .028), 36-Item Short-Form Health Survey mental component score (p = .008), depressive symptoms (p = .006), and quality of sleep (p = .035). CONCLUSION Supervised intradialytic exercise seems safe and beneficial in older patients.
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53
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Nickerson GY, Shade K. Effect of Increasing Physical Activity on Cognitive Function in Individuals With Mild Cognitive Impairment: A Knowledge Translation to Practice Pilot Project. J Gerontol Nurs 2021; 47:14-18. [PMID: 34039095 DOI: 10.3928/00989134-20210401-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The purpose of the current pilot study was to determine if 12 weeks of increased physical activity improved cognitive function in individuals with mild cognitive impairment (MCI). Participants used commercial wearable technology to objectively measure daily steps. Participants wore an activity tracker for approximately 12 hours per day and received telephone support every 2 weeks. The Montreal Cognitive Assessment (MoCA) was used to measure pre/posttest cognitive function. Increased step count was positively correlated with improvement in cognitive function with a moderate effect size (Pearson's r = 0.55; p = 0.04); 5,396 steps per day was the decision boundary for MoCA score improvement. Increased physical activity over 12 weeks improved cognitive function in individuals with MCI. It is feasible for individuals with MCI to wear an activity tracker on a daily basis. [Journal of Gerontological Nursing, 47(5), 14-18.].
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El Masri A, Kolt GS, George ES. Feasibility and acceptability of a culturally tailored physical activity intervention for Arab-Australian women. BMC Womens Health 2021; 21:131. [PMID: 33784997 PMCID: PMC8008684 DOI: 10.1186/s12905-021-01250-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 03/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite being one of the largest migrant groups in Australia, few physical activity interventions exist for Arab-Australians. The primary aim of this study was to test the feasibility and acceptability of a 12-week culturally tailored physical activity intervention for Arab-Australian women. METHODS This study used a single-group pretest-posttest design, and was informed by extensive formative research and consultation involving the Arab-Australian community. Participants were insufficiently active Arab-Australian women aged 35-64 with no current illness or injury that would limit physical activity participation. The intervention comprised 6 face-to-face physical activity and education sessions over 12 weeks. The intervention was conducted at 2 separate intervention sites in Western Sydney, Australia. Feasibility outcomes included recruitment, session attendance, and retention. The acceptability of the intervention was assessed through a process evaluation questionnaire completed post-intervention. Accelerometers and the short-form International Physical Activity Questionnaire were used to measure physical activity at baseline and post-intervention. Descriptive statistics were used for feasibility and acceptability outcomes, and changes in physical activity were examined using Wilcoxon signed-rank tests. RESULTS Of the 53 women who were contacted or expressed interest, 22 were eligible and enrolled in the study. Participants were primarily recruited through direct contact by Arab-Australian community workers and by word-of-mouth. Average session attendance was 63% and the retention rate post-intervention was 68%. The culturally-related intervention components, such as the appropriateness of content, and women-only setting, were rated highly favourably (4.33 to 4.87/5). General intervention elements, such as the face-to-face delivery, knowledge and approachability of facilitators, and session structure, were also rated favourably (4.33 to 4.93/5), and the lowest scored item was the intervention session frequency (3.2/5). There were no statistically significant changes in physical activity post-intervention. CONCLUSIONS The findings from this study highlighted factors related to recruitment and delivery that need to be considered when developing physical activity interventions for Arab-Australian women. Further research is required using a larger sample and a randomised controlled trial design to examine the longer-term impact on physical activity, and to also examine ways of increasing intervention engagement and retention among Arab-Australian women. TRIAL REGISTRATION ANZCTR, ACTRN12618001392257. Registered 20 August 2018, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375636 .
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Affiliation(s)
- Aymen El Masri
- School of Health Sciences, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Gregory S Kolt
- School of Health Sciences, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Emma S George
- School of Health Sciences, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia.
- Translational Health Research Institute, Western Sydney University, Penrith, Australia.
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Cruvinel Júnior RH, Ferreira JSSP, Beteli RI, Silva ÉQ, Veríssimo JL, Monteiro RL, Suda EY, Sacco ICN. Foot-ankle functional outcomes of using the Diabetic Foot Guidance System (SOPeD) for people with diabetic neuropathy: a feasibility study for the single-blind randomized controlled FOotCAre (FOCA) trial I. Pilot Feasibility Stud 2021; 7:87. [PMID: 33766146 PMCID: PMC7995736 DOI: 10.1186/s40814-021-00826-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 01/18/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Diabetic neuropathy dramatically affects musculoskeletal structure and function of the lower limbs by impairing their muscle strength and mobility. Specific muscle strengthening through physiotherapy strategies appears to be promising; however, adherence to physiotherapy treatment is low in people with chronic diseases. Thus, an internet-based foot-ankle exercise program was created as a potential telerehabilitation alternative for people with diabetes to improve their self-monitoring and self-care management. This study assessed the feasibility, safety, acceptability, and changes in foot health and neuropathy symptoms in people with diabetes after 12 weeks of the intervention program with the Sistema de Orientação ao Pé diabético - Diabetic Foot Guidance System (SOPeD). METHODS Fourteen individuals were recruited and randomized to either the usual care (control group) or usual care plus an internet-based foot-ankle exercise program through SOPeD (intervention group) three times per week for 12 weeks. For feasibility, we assessed contact and recruitment rates per week; program adherence, determined as completing over 70% of the 36 sessions; and participant satisfaction and safety assessed through a questionnaire and scored on a 5-point Likert scale. We assessed changes in neuropathy symptoms and foot health and functionality from baseline to 12 weeks estimating differences or median of differences and 95% confidence intervals in the intervention group. RESULTS In 24 weeks, of the 822 patients in the database, 192 were contacted, 65 were assessed for eligibility, and 20 were considered eligible. The recruitment rate was 0.83 participants per week. Fourteen out of the 20 eligible participants agreed to participate, resulting in recruitment success of 70%. Adherence to the program was 66.7%, and there was no dropout. Participants' median level of satisfaction was 5.0 (IQR: 4.5-5.0) and perceived safety was 5.0 (IQR: 5.0-5.0). CONCLUSION The internet-based foot-ankle exercise program using SOPeD is feasible, satisfactory, and safe. Although this study had moderate adherence and a zero-dropout rate, recruitment needs to be improved in the larger trial. TRIAL REGISTRATION ClinicalTrials.gov, NCT04011267 . Registered on 8 July 2019.
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Affiliation(s)
- Ronaldo H Cruvinel Júnior
- Department of Physical Therapy, Speech, and Occupational Therapy, School of Medicine, University of São Paulo, Rua Cipotânea, 51 - Cidade Universitária, São Paulo, São Paulo, 05360-160, Brazil
| | - Jane S S P Ferreira
- Department of Physical Therapy, Speech, and Occupational Therapy, School of Medicine, University of São Paulo, Rua Cipotânea, 51 - Cidade Universitária, São Paulo, São Paulo, 05360-160, Brazil
| | - Raquel I Beteli
- Department of Physical Therapy, Speech, and Occupational Therapy, School of Medicine, University of São Paulo, Rua Cipotânea, 51 - Cidade Universitária, São Paulo, São Paulo, 05360-160, Brazil
| | - Érica Q Silva
- Department of Physical Therapy, Speech, and Occupational Therapy, School of Medicine, University of São Paulo, Rua Cipotânea, 51 - Cidade Universitária, São Paulo, São Paulo, 05360-160, Brazil
| | - Jady L Veríssimo
- Department of Physical Therapy, Speech, and Occupational Therapy, School of Medicine, University of São Paulo, Rua Cipotânea, 51 - Cidade Universitária, São Paulo, São Paulo, 05360-160, Brazil
| | - Renan L Monteiro
- Department of Physical Therapy, Speech, and Occupational Therapy, School of Medicine, University of São Paulo, Rua Cipotânea, 51 - Cidade Universitária, São Paulo, São Paulo, 05360-160, Brazil
- Department of Physical Therapy, Federal University of Amapá, Amapá, Brazil
| | - Eneida Y Suda
- Department of Physical Therapy, Speech, and Occupational Therapy, School of Medicine, University of São Paulo, Rua Cipotânea, 51 - Cidade Universitária, São Paulo, São Paulo, 05360-160, Brazil
- Department of Physical Therapy, Ibirapuera University, São Paulo, SP, Brazil
| | - Isabel C N Sacco
- Department of Physical Therapy, Speech, and Occupational Therapy, School of Medicine, University of São Paulo, Rua Cipotânea, 51 - Cidade Universitária, São Paulo, São Paulo, 05360-160, Brazil.
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Adeline F, Hugo PR, René M, Tàmàs F, Eléonor R, Michel P. Effects of a mixed exercise program on cancer related-fatigue and health-related quality of life in oncogeriatric patients: A feasibility study. J Geriatr Oncol 2021; 12:915-921. [PMID: 33750673 DOI: 10.1016/j.jgo.2021.02.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 02/01/2021] [Accepted: 02/24/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Cancer-related fatigue (CRF) is the most debilitating side effect occurring with cancer treatment accumulation. Although combining aerobic and resistance exercise is an effective strategy to counteract this side effect, there is a paucity of studies performed with older patients even if this is the most affected population. Hence, the objective was to assess the feasibility and the impact of a twelve-week exercise program performed during cancer treatment on CRF, quality of life, and physical capacity in older adults diagnosed with early-stage cancer. MATERIAL AND METHODS Twenty patients with cancer (70 ± 4 years) beginning systemic cancer treatments were recruited and randomized into two groups: 1) aerobic and resistance training (MIX) and 2) stretching (CON). Both groups were supervised three times/week for a total of twelve weeks. The primary outcome was feasibility and secondary outcomes were CRF (FACIT-Fatigue questionnaire), health-related quality of life (HRQoL) (EORTC QLQ-C30 questionnaire) and physical capacity (6MWT and grip strength). RESULTS In Mix, both exercise adherence (88.2%) and completion rate (86.6%) were high, which suggests that exercise is feasible in an oncologic context. In the MIX group, HRQoL improved (p = 0.05) and CRF was clinically, ableit non-significantly (p = 0.09), decreased. Concerning physical capacity, MIX showed a clinical improvement in the 6MWT during the intervention (p = 0.002) compared to CON. CONCLUSION This study suggests that, in older patients with cancer undergoing adjuvant or neoadjuvant systemic treatments, a mixed exercise program is feasible, well tolerated and might help mitigate CRF and HRQoL decrements.
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Affiliation(s)
- Fontvieille Adeline
- Faculty of Physical Activity Sciences, University of Sherbrooke, 2500 boulevard de l'université, Sherbrooke, Quebec J1K 2R1, Canada; Research Centre on Aging, CIUSSS de l'Estrie - CHUS, 1036 rue Belvédère Sud, Sherbrooke, Quebec J1H 4C4, Canada
| | - Parent-Roberge Hugo
- Faculty of Physical Activity Sciences, University of Sherbrooke, 2500 boulevard de l'université, Sherbrooke, Quebec J1K 2R1, Canada; Research Centre on Aging, CIUSSS de l'Estrie - CHUS, 1036 rue Belvédère Sud, Sherbrooke, Quebec J1H 4C4, Canada
| | - Maréchal René
- Faculty of Physical Activity Sciences, University of Sherbrooke, 2500 boulevard de l'université, Sherbrooke, Quebec J1K 2R1, Canada; Research Centre on Aging, CIUSSS de l'Estrie - CHUS, 1036 rue Belvédère Sud, Sherbrooke, Quebec J1H 4C4, Canada
| | - Fülöp Tàmàs
- Research Centre on Aging, CIUSSS de l'Estrie - CHUS, 1036 rue Belvédère Sud, Sherbrooke, Quebec J1H 4C4, Canada; Faculty of Medicine and Health Sciences, University of Sherbrooke, 3001 12 Avenue Nord, Quebec J1H 5N4, Canada
| | - Riesco Eléonor
- Faculty of Physical Activity Sciences, University of Sherbrooke, 2500 boulevard de l'université, Sherbrooke, Quebec J1K 2R1, Canada; Research Centre on Aging, CIUSSS de l'Estrie - CHUS, 1036 rue Belvédère Sud, Sherbrooke, Quebec J1H 4C4, Canada.
| | - Pavic Michel
- Faculty of Medicine and Health Sciences, University of Sherbrooke, 3001 12 Avenue Nord, Quebec J1H 5N4, Canada; Centre de recherche du CHUS, 12 Avenue Nord, Quebec J1H 5N4, Canada
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Postigo-Martin P, Peñafiel-Burkhardt R, Gallart-Aragón T, Alcaide-Lucena M, Artacho-Cordón F, Galiano-Castillo N, Fernández-Lao C, Martín-Martín L, Lozano-Lozano M, Ruíz-Vozmediano J, Moreno-Gutiérrez S, Illescas-Montes R, Arroyo-Morales M, Cantarero-Villanueva I. Attenuating Treatment-Related Cardiotoxicity in Women Recently Diagnosed With Breast Cancer via a Tailored Therapeutic Exercise Program: Protocol of the ATOPE Trial. Phys Ther 2021; 101:6124131. [PMID: 33528004 DOI: 10.1093/ptj/pzab014] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 08/09/2020] [Accepted: 12/01/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Therapeutic exercise is already used to ameliorate some of the side effects of cancer treatment. Recent studies examined its preventive potential regarding treatment-related toxicity, which can increase the risk of functional decline and lead to disease recurrence and death. This trial will examine whether the Tailored Therapeutic Exercise and Recovery Strategies (ATOPE) program, performed before treatment, can mitigate the onset and extent of cardiotoxicity beyond that achieved when the program is followed during treatment in recently diagnosed breast cancer patients. METHODS The intervention has a preparatory phase plus 12 to 18 sessions of tailored, high-intensity exercise, and post-exercise recovery strategies. A total of 120 women recently diagnosed with breast cancer, at risk of cardiotoxicity due to anticancer treatment awaiting surgery followed by chemotherapy and/or radiotherapy, will be randomized to either group. In a feasibility study, measurements related to recruitment rate, satisfaction with the program, adherence to them, the retention of participants, safety, and adverse effects will be explored. In the main trial, the efficacy of these interventions will be examined. The major outcome will be cardiotoxicity, assessed echocardiographically via the left ventricular ejection fraction. Other clinical, physical, and anthropometric outcomes and biological and hormonal variables will also be assessed after diagnosis, after treatment, 1 year after treatment ends, and 3 years after treatment ends. CONCLUSION Given its potential effect on patient survival, the mitigation of cardiotoxicity is a priority, and physical therapists have an important role in this mitigation. If the ATOPE intervention performed before treatment returns better cardioprotection results, it may be recommendable that patients recently diagnosed follow this program. IMPACT The ATOPE program will highlight the need for a physical therapist intervention from the moment of diagnosis, in the prevention or mitigation of cardiotoxicity, in women with breast cancer. It could help physical therapists to establish an adequate therapeutic exercise dose adapted to breast cancer patients and to propose correct therapeutic exercise prescription according to the assimilation of the sessions.
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Affiliation(s)
- Paula Postigo-Martin
- Health Sciences Faculty, University of Granada, Spain.,Sport and Health Research Center (IMUDs), Granada, Spain.,Institute for Biomedical Research (ibs.GRANADA), University Hospital Complex of Granada, University of Granada, Granada, Spain
| | | | | | | | - Francisco Artacho-Cordón
- Institute for Biomedical Research (ibs.GRANADA), University Hospital Complex of Granada, University of Granada, Granada, Spain.,Department of Radiology and Physical Medicine, University of Granada, Granada, Spain
| | - Noelia Galiano-Castillo
- Health Sciences Faculty, University of Granada, Spain.,Sport and Health Research Center (IMUDs), Granada, Spain.,Institute for Biomedical Research (ibs.GRANADA), University Hospital Complex of Granada, University of Granada, Granada, Spain.,Unit of Excellence on Exercise and Health (UCEES), University of Granada, Granada, Spain
| | - Carolina Fernández-Lao
- Health Sciences Faculty, University of Granada, Spain.,Sport and Health Research Center (IMUDs), Granada, Spain.,Institute for Biomedical Research (ibs.GRANADA), University Hospital Complex of Granada, University of Granada, Granada, Spain.,Unit of Excellence on Exercise and Health (UCEES), University of Granada, Granada, Spain
| | - Lydia Martín-Martín
- Health Sciences Faculty, University of Granada, Spain.,Sport and Health Research Center (IMUDs), Granada, Spain.,Institute for Biomedical Research (ibs.GRANADA), University Hospital Complex of Granada, University of Granada, Granada, Spain.,Unit of Excellence on Exercise and Health (UCEES), University of Granada, Granada, Spain
| | - Mario Lozano-Lozano
- Health Sciences Faculty, University of Granada, Spain.,Sport and Health Research Center (IMUDs), Granada, Spain.,Institute for Biomedical Research (ibs.GRANADA), University Hospital Complex of Granada, University of Granada, Granada, Spain.,Unit of Excellence on Exercise and Health (UCEES), University of Granada, Granada, Spain
| | | | - Salvador Moreno-Gutiérrez
- Department of Computer Architecture and Technology, Information and Communication Technologies Research Center (CITIC), University of Granada, Spain
| | | | - Manuel Arroyo-Morales
- Health Sciences Faculty, University of Granada, Spain.,Sport and Health Research Center (IMUDs), Granada, Spain.,Institute for Biomedical Research (ibs.GRANADA), University Hospital Complex of Granada, University of Granada, Granada, Spain.,Unit of Excellence on Exercise and Health (UCEES), University of Granada, Granada, Spain
| | - Irene Cantarero-Villanueva
- Health Sciences Faculty, University of Granada, Spain.,Sport and Health Research Center (IMUDs), Granada, Spain.,Institute for Biomedical Research (ibs.GRANADA), University Hospital Complex of Granada, University of Granada, Granada, Spain.,Unit of Excellence on Exercise and Health (UCEES), University of Granada, Granada, Spain
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Skiadopoulos A, Stergiou N. Risk-of-falling related outcomes improved in community-dwelling older adults after a 6-week sideways walking intervention: a feasibility and pilot study. BMC Geriatr 2021; 21:60. [PMID: 33446112 PMCID: PMC7809866 DOI: 10.1186/s12877-021-02010-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 01/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Aging increases fall risk and alters gait mechanics and control. Our previous work has identified sideways walking as a potential training regimen to decrease fall risk by improving frontal plane control in older adults' gait. The purposes of this pilot study were to test the feasibility of sideways walking as an exercise intervention and to explore its preliminary effects on risk-of-falling related outcomes. METHODS We conducted a 6-week single-arm intervention pilot study. Participants were community-dwelling older adults ≥ 65 years old with walking ability. Key exclusion criteria were neuromusculoskeletal and cardiovascular disorders that affect gait. Because initial recruitment rate through University of Nebraska at Omaha and Omaha community was slower than expected (3 participants∙week- 1), we expanded the recruitment pool through the Mind & Brain Health Labs registry of the University of Nebraska Medical Center. Individualized sideways walking intervention carried out under close supervision in a 200 m indoor walking track (3 days∙week- 1). Recruitment and retention capability, safety, and fidelity of intervention delivery were recorded. We also collected (open-label) walking speed, gait variability, self-reported and performance-based functional measures to assess participants' risk-of-falling at baseline and post-intervention: immediate, and 6 weeks after the completion of the intervention. RESULTS Over a 7-month period, 42 individuals expressed interest, 21 assessed for eligibility (21/42), and 15 consented to participate (15/21). Most of the potential participants were reluctant to commit to a 6-week intervention. Desired recruitment rate was achieved after revising the recruitment strategy. One participant dropped out (1/15). Remaining participants demonstrated excellent adherence to the protocol. Participants improved on most outcomes and the effects remained at follow-up. No serious adverse events were recorded during the intervention. CONCLUSIONS Our 6-week sideways walking training was feasible to deliver and demonstrated strong potential as an exercise intervention to improve risk-of-falling outcomes in community-dwelling older adults. In a future trial, alternative clinical tools should be considered to minimize the presence of ceiling/floor effects. A future large trial is needed to confirm sideways walking as a fall prevention intervention. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT04505527 . Retrospectively registered 10 August 2020.
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Affiliation(s)
- Andreas Skiadopoulos
- Department of Biomechanics and Center for Research in Human Movement Variability, University of Nebraska at Omaha, Biomechanics Research Building 214, 6160 University Drive South, 68182-0860, NE, Omaha, USA
| | - Nick Stergiou
- Department of Biomechanics and Center for Research in Human Movement Variability, University of Nebraska at Omaha, Biomechanics Research Building 214, 6160 University Drive South, 68182-0860, NE, Omaha, USA.
- College of Public Health, University of Nebraska Medical Center, 68198-4355, Omaha, NE, USA.
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59
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Brown MC, Araújo-Soares V, Skinner R, Glaser AW, Sarwar N, Saxton JM, Montague K, Hall J, Burns O, Sharp L. Using qualitative and co-design methods to inform the development of an intervention to support and improve physical activity in childhood cancer survivors: a study protocol for BEing Active after ChildhOod caNcer (BEACON). BMJ Open 2020; 10:e041073. [PMID: 33371034 PMCID: PMC7754664 DOI: 10.1136/bmjopen-2020-041073] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 11/02/2020] [Accepted: 11/14/2020] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Childhood cancer survivors (CCSs) treated with cardiotoxic cancer treatments are at increased risk of developing cardiometabolic complications. This risk is further exacerbated by poor health behaviours. In particular, CCSs are less active than non-cancer comparators. Existing interventions aiming to improve physical activity (PA) levels in CCSs are methodologically weak. The aim of this study is to rigorously and systematically develop an evidence-based and theoretically-informed intervention to promote, support, improve and sustain PA levels in CCSs, with the long-term goal of reducing CCSs' cardiovascular morbidity and mortality. METHODS AND ANALYSIS The BEing Active after ChildhOod caNcer (BEACON) study involves two workpackages at two National Health Service sites in England, UK.Participants will be CCSs and their parents, and healthcare professionals (HCPs) involved in their care.Workpackage one (WP1) will use qualitative methods to explore and understand the barriers and facilitators to PA in CCSs. Two sets of semistructured interviews will be conducted with (1) CCSs (aged 10-24 years) and (2) parents of CCSs. WP2 will use co-design methods to bring together stakeholders (CCSs; their parents; HCPs; researchers) to develop a prototype intervention. Where possible, all data will be audio recorded and transcribed.Data from WP1 will be analysed using a thematic approach. Analysis of WP2 data will involve content analysis, and analysis of formative output and procedures. ETHICS AND DISSEMINATION The study was approved by North East-Tyne & Wear South Research Ethics Committee (REC ref: 18/NE/0274). Research findings will be disseminated primarily via national and international conferences and publication in peer-reviewed journals. Patient and public involvement will inform further dissemination activities.
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Affiliation(s)
- Morven C Brown
- Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Vera Araújo-Soares
- Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Roderick Skinner
- Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne, UK
- Department of Paediatric and Adolescent Haematology and Oncology, Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Adam W Glaser
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
- Department of Paediatric Oncology, Leeds Children's Hospital, Leeds, UK
| | - Naseem Sarwar
- Department of Paediatric Oncology, Leeds Children's Hospital, Leeds, UK
| | - John M Saxton
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Kyle Montague
- OpenLab, Newcastle University, Newcastle upon Tyne, UK
| | | | | | - Linda Sharp
- Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Auliffe SM, Korakakis V, Hilfiker R, Whiteley R, O'Sullivan K. Participant characteristics are poorly reported in exercise trials in tendinopathy: A systematic review. Phys Ther Sport 2020; 48:43-53. [PMID: 33360409 DOI: 10.1016/j.ptsp.2020.12.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 12/11/2020] [Accepted: 12/13/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To evaluate the reporting of eligibility criteria and baseline participant characteristics in randomised controlled trials investigating the effects of exercise interventions in tendinopathy. METHODS Randomised controlled trials investigating the effects of exercise therapy compared to a non-exercising intervention in upper and lower limb tendinopathy were included. Data extraction was categorised into the following domains: participant demographics, tendinopathy descriptors, general health, participant recruitment and eligibility criteria. RESULTS The review included the following tendinopathies: Achilles (n = 9), gluteal (n = 2), lateral elbow tendinopathy (n = 15), patellar (n = 3) plantar (n = 3), and rotator cuff (n = 13). Age, sex, duration of symptoms and symptom severity were commonly reported across the review, while prior history of tendinopathy was poorly reported (6/45). Variables such as physical activity level (17/45), sleep (0/45), psychological factors (2/45), medication at baseline (8/45), co morbid health complaints (10/45) and sociodemographic factors (11/45) were poorly reported across the included studies. Substantial variation existed between studies in the specific eligibility criteria used. CONCLUSION The findings of this systematic review demonstrate that participant characteristics are poorly reported in exercise trials in tendinopathy. To improve effectiveness of exercise interventions in tendinopathy, improved reporting of participant characteristics may allow better comparisons and targeted interventions for specific subgroups.
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Affiliation(s)
- Seán Mc Auliffe
- Department of Physical Therapy & Rehabilitation Science, College of Health Sciences, Qatar University, Doha, Qatar.
| | | | - Roger Hilfiker
- School of Health Sciences, HES-SO Valais-Wallis, University of Applied Sciences and Arts Western Switzerland Valais, Leukerbad, Switzerland
| | - Rodney Whiteley
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Kieran O'Sullivan
- School of Allied Health, University of Limerick, Limerick, Ireland; Ageing Research Centre, University of Limerick, Limerick, Ireland
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Boniface G, Gandhi V, Norris M, Williamson E, Kirtley S, O’Connell NE. A systematic review exploring the evidence reported to underpin exercise dose in clinical trials of rheumatoid arthritis. Rheumatology (Oxford) 2020; 59:3147-3157. [PMID: 32780816 PMCID: PMC7590408 DOI: 10.1093/rheumatology/keaa150] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 02/06/2020] [Accepted: 03/09/2020] [Indexed: 02/07/2023] Open
Abstract
We aimed to evaluate the evidence reported to underpin exercise dose in randomised controlled trials (RCTs) using strengthening exercise in RA. We searched six different databases between 1 January 2000 and 3 April 2019. We included RCTs, where a main component of the intervention and/or control used strengthening exercise. Evidence sources cited to underpin dose were judged for their quality, consistency and applicability. Thirty-two RCTs were reviewed. Four (12.5%) piloted the intervention without using dose-escalation designs to determine optimal dose-response. Twenty (62.5%) reported no evidence underpinning dose. Where reported, quality, consistency and applicability of the underpinning evidence was a cause for methodological concern. The majority of RCTs did not report the evidence underpinning dose. When reported, the evidence was often not applicable to the clinical population. Frequently, the dose used differed to the dose reported/recommended by the underpinning evidence. Our findings illustrate exercise dose may not be optimised for use with clinical populations prior to evaluation by RCT.
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Affiliation(s)
- Graham Boniface
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences (NDORMS), Centre for Rehabilitation Research in Oxford (RRIO), University of Oxford, Oxford
| | - Varsha Gandhi
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences (NDORMS), Centre for Rehabilitation Research in Oxford (RRIO), University of Oxford, Oxford
| | - Meriel Norris
- Department of Clinical Sciences, Brunel University London, Uxbridge, UK
| | - Esther Williamson
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences (NDORMS), Centre for Rehabilitation Research in Oxford (RRIO), University of Oxford, Oxford
| | - Shona Kirtley
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences (NDORMS), Centre for Rehabilitation Research in Oxford (RRIO), University of Oxford, Oxford
| | - Neil E O’Connell
- Department of Clinical Sciences, Brunel University London, Uxbridge, UK
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Hashem F, Stephensen D, Bates A, Pellatt-Higgins T, Hobbs RNP, Hopkins M, Woodward H, Stavropoulou C, Swaine IL, Ali H. Acceptability and Feasibility of an Isometric Resistance Exercise Program for Abdominal Cancer Surgery: An Embedded Qualitative Study. Cancer Control 2020; 27:1073274820950855. [PMID: 33035075 PMCID: PMC7791474 DOI: 10.1177/1073274820950855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Although it is recognized in the early stages of cancer recovery that changes in
lifestyle including increases in physical activity improves physical function,
there are no clear findings whether low versus moderate intensity activity or
home or gym exercise offer optimal benefit. Isometric-resistance exercises can
be carried out with very little equipment and space and can be performed while
patients are bed-bound in hospital or at home. This embedded qualitative study,
based in an English hospital trust providing specialist cancer care, was
undertaken as a component of a feasibility trial to evaluate the acceptability
and feasibility of an isometric-resistance exercise program and explore the
suitability of functional assessments by drawing from the experiences of
abdominal cancer patients following surgery. Telephone interviews were
undertaken with 7 participants in the intervention group, and 8 interviews with
the usual care group (n = 15). The gender composition consisted of 11 females
and 4 males. Participants’ ages ranged from 27 to 84 (M = 60.07, SD = 15.40).
Interviews were conducted between August 2017 and May 2018, with audio files
digitally recorded and data coded using thematic framework analysis. Our results
show that blinding to intervention or usual care was a challenge, participants
felt the intervention was safe and suitable aided by the assistance of a
research nurse, yet, found the self-completion questionnaire tools hard to
complete. Our study provides an insight of trial processes, participants’
adherence and completion of exercise interventions, and informs the design and
conduct of larger RCTs based on the experiences of abdominal cancer surgery
patients.
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Affiliation(s)
- Ferhana Hashem
- Centre for Health Service Studies, University of Kent, Canterbury, Kent, United Kingdom
| | - David Stephensen
- Physiotherapy Department, East Kent Hospitals University Foundation NHS Trust, Kent and Canterbury Hospital, Canterbury, Kent, United Kingdom.,Haemophilia Centre, Royal London Hospital, United Kingdom
| | - Amanda Bates
- Centre for Health Service Studies, University of Kent, Canterbury, Kent, United Kingdom
| | - Tracy Pellatt-Higgins
- Centre for Health Service Studies, University of Kent, Canterbury, Kent, United Kingdom
| | - Ralph Nobby Peter Hobbs
- Maidstone and Tunbridge Wells NHS Trust, Maidstone, Maidstone Hospital, Hermitage Lane, Maidstone, Kent, United Kingdom
| | - Malcolm Hopkins
- Maidstone and Tunbridge Wells NHS Trust, Maidstone, Maidstone Hospital, Hermitage Lane, Maidstone, Kent, United Kingdom
| | - Hazel Woodward
- Maidstone and Tunbridge Wells NHS Trust, Maidstone, Maidstone Hospital, Hermitage Lane, Maidstone, Kent, United Kingdom
| | | | - Ian L Swaine
- Centre for Science and Medicine in Sport and Exercise, University of Greenwich, Gillingham, Chatham, United Kingdom
| | - Haythem Ali
- Maidstone and Tunbridge Wells NHS Trust, Maidstone, Maidstone Hospital, Hermitage Lane, Maidstone, Kent, United Kingdom
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63
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Hashem F, Stephensen D, Drechsler WI, Bladen M, Carroll L, Tracy P, Saloniki E. Muscle strengthening intervention for boys with haemophilia: Developing and evaluating a best-practice exercise programme with boys, families and health-care professionals. Health Expect 2020; 23:1350-1361. [PMID: 33405345 PMCID: PMC7696141 DOI: 10.1111/hex.13119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 06/13/2020] [Accepted: 07/21/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Muscle strengthening exercises have the potential to improve outcomes for boys with haemophilia, but it is unclear what types of exercise might be of benefit. We elicited the views of health-care professionals, boys and their families to create and assess a home-based muscle strengthening programme. OBJECTIVE To design and develop a muscle strengthening programme with health-care professionals aimed at improving musculoskeletal health, and refine the intervention by engaging boys with haemophilia and their families (Study 1). Following delivery, qualitatively evaluate the feasibility and acceptability of the exercise programme with the boys and the study's physiotherapists (Study 2). DESIGN A person-based approach was used for planning and designing the exercise programme, and evaluating it post-delivery. The following methods were utilized: modified nominal group technique (NGT) with health-care professionals; focus group with families; exit interviews with boys; and interviews with the study's physiotherapists. RESULTS Themes identified to design and develop the intervention included exercises to lower limb and foot, dosage, age accommodating, location, supervision and monitoring and incentivization. Programme refinements were carried out following engagement with the boys and families who commented on: dosage, location, supervision and incentivization. Following delivery, the boys and physiotherapists commented on progression and adaptation, physiotherapist contact, goal-setting, creating routines and identifying suitable timeframes, and a repeated theme of incentivization. CONCLUSIONS An exercise intervention was designed and refined through engagement with boys and their families. Boys and physiotherapists involved in the intervention's delivery were consulted who found the exercises to be generally acceptable with some minor refinements necessary.
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Affiliation(s)
- Ferhana Hashem
- University of KentCentre for Health Service StudiesCanterburyUK
| | - David Stephensen
- East Kent Hospitals University NHS TrustHaemophilia and Thrombosis CentreCanterburyUK
- Royal London HospitalHaemophilia CentreLondonUK
| | - Wendy I. Drechsler
- Kings College LondonSchool of Population Health & Environmental SciencesLondonUK
| | - Melanie Bladen
- Great Ormond Street Hospital For Children NHS Foundation TrustHaemophilia CentreLondonUK
- Institute of Child HealthUniversity College LondonLondonUK
| | | | | | - Eirini‐Christina Saloniki
- University of KentCentre for Health Service StudiesCanterburyUK
- University of KentPersonal Social Services Research UnitCanterburyUK
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Sönnerfors P, Wadell K, Dohrn IM, Nyberg A, Runold M, Halvarsson A. Use of an eHealth tool for exercise training and online contact in people with severe chronic obstructive pulmonary disease on long-term oxygen treatment: A feasibility study. Health Informatics J 2020; 26:3184-3200. [PMID: 32880209 DOI: 10.1177/1460458220945429] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Technology developments and demand for flexibility in health care and in contact with the health care system are two factors leading to increased use of eHealth solutions. The use of eHealth has been shown to have positive effects in people with chronic obstructive pulmonary disease, but the full potential for this group needs to be explored. Therefore, the aim was to evaluate the feasibility of an eHealth tool used for exercise training and online contacts for people with severe chronic obstructive pulmonary disease. The 10-week intervention included an eHealth tool for exercise training in home environment and regular online contacts, as well as weekly e-rounds for health care professionals. Seven of the nine participants completed the study. The eHealth tool was found to be feasible for e-rounds, exercise training and online contacts. Participants could manage the tool and adhere to training; positive effects were shown, and no adverse events occurred. Technical functions need to be improved.
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Campbell MJ, Mansournia MA, Lancaster G. Methods matter: pilot and feasibility studies in sports medicine. Br J Sports Med 2020; 54:1309-1310. [PMID: 32665226 DOI: 10.1136/bjsports-2020-102631] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2020] [Indexed: 11/04/2022]
Affiliation(s)
| | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Gillian Lancaster
- School of Primary, Community and Social Care and Keele Clinical Trials Unit (CTU), Keele, UK
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66
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Videoconference-Delivered Group-Based Physical Activity Self-Regulatory Support for Adults With Spinal Cord Injury: A Feasibility Study. Adapt Phys Activ Q 2020; 37:270-288. [PMID: 32541083 DOI: 10.1123/apaq.2019-0103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 10/25/2019] [Accepted: 11/22/2019] [Indexed: 11/18/2022] Open
Abstract
Videoconferencing is a novel method for overcoming time and transportation barriers to leisure-time physical activity (LTPA) interventions. This study examined the feasibility of a group videoconference intervention on LTPA self-regulatory skills training in a sample of nine adults with spinal cord injury (SCI). Session implementation checklists and self-report surveys were administered during four weekly sessions to assess intervention management, group processes, intervention resources, and initial efficacy. Attendance rate was high (91.7%), and the average weekly session duration was 79.6 min. Participants reported high ratings of group cohesion, facilitator collaboration, session content comprehension, and ease in operating the videoconference platform. Knowledge sharing among the group ranged from 18 to 58 exchanges per session, demonstrating learning and group cohesion. LTPA frequency increased among 44% of participants, and 22% of participants achieved the SCI-specific aerobic guidelines. Overall, group videoconferencing holds promise for LTPA support among adults with SCI. Long-term research is warranted to test LTPA self-regulatory and behavioral effects.
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67
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Kim HS, Strickland KJ, Pinto D, Arroyo C, Courtney DM, McCarthy DM, Lambert BL. Evaluating the Feasibility of an Emergency Department Physical Therapy Intervention for Acute Low Back Pain. JOURNAL OF ACUTE CARE PHYSICAL THERAPY 2020. [DOI: 10.1097/jat.0000000000000126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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68
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Gibbs JC, McArthur C, Wark JD, Thabane L, Scherer SC, Prasad S, Papaioannou A, Mittmann N, Laprade J, Kim S, Khan A, Kendler DL, Hill KD, Cheung AM, Bleakney R, Ashe MC, Adachi JD, Giangregorio LM. The Effects of Home Exercise in Older Women With Vertebral Fractures: A Pilot Randomized Controlled Trial. Phys Ther 2020; 100:662-676. [PMID: 31899499 PMCID: PMC7439228 DOI: 10.1093/ptj/pzz188] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 04/29/2019] [Accepted: 08/21/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND Regular exercise is advocated in osteoporosis guidelines to prevent fractures. Few studies have evaluated the effect of exercise on functional performance, posture, and other outcomes that are important to patients after vertebral fractures. OBJECTIVE This pilot study will explore the effect of home exercise versus control on functional performance, posture, and patient-reported outcome measures. DESIGN This study was a parallel 2-arm pilot feasibility trial with 1:1 randomization to exercise or attentional control groups. SETTING This study took place in 5 Canadian and 2 Australian academic or community hospitals/centers. PARTICIPANTS This study included 141 women ≥65 years of age with radiographically confirmed vertebral fractures. INTERVENTION A physical therapist delivered exercise and behavioral counseling in 6 home visits over 8 months and monthly calls. Participants were to exercise ≥3 times weekly. Controls received equal attention. MEASUREMENTS Functional performance, posture, quality of life, pain, and behavior-change outcomes were assessed at baseline and after 6 (questionnaires only) and 12 months. Adherence to exercise was assessed by calendar diary. All t tests examined between-group mean differences (MD) in change from baseline in intention-to-treat and per-protocol analyses. RESULTS There was a small effect of exercise on 5 times sit-to-stand test versus control (MD = -1.58 [95% CI = -3.09 to -0.07], intention-to-treat; MD = -1.49 [95% CI = -3.12 to 0.16], per-protocol). There were no other major or statistically significant MDs for any other measured outcomes after follow-up. Adherence declined over time. LIMITATIONS Treatment effects on variables may have been underestimated due to multiple comparisons and underpowered analyses. CONCLUSIONS Our exploratory estimate of the effect of exercise on functional leg muscle strength was consistent in direction and magnitude with other trials in individuals with vertebral fractures. Declining adherence to home exercise suggests that strategies to enhance long-term adherence might be important in future confirmatory trials.
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Affiliation(s)
- Jenna C Gibbs
- Department of Kinesiology and Physical Education, McGill University, Montreal, Quebec, Canada
| | - Caitlin McArthur
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada; and GERAS Centre for Aging Research, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - John D Wark
- Department of Medicine, University of Melbourne, Parkville, Victoria, Australia; and Bone and Mineral Medicine, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University
| | - Samuel C Scherer
- Department of Medicine, University of Melbourne; Royal Melbourne Hospital; and Broadmeadows Health Services, Northern Health, Melbourne, Australia
| | | | - Alexandra Papaioannou
- Department of Medicine, McMaster University; GERAS Centre for Aging Research, Hamilton Health Sciences; and Department of Health Research Methods, Evidence, and Impact, McMaster University
| | - Nicole Mittmann
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Judi Laprade
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada; and Ontario Osteoporosis Strategy, Osteoporosis Canada, Toronto, Ontario, Canada
| | - Sandra Kim
- Department of Medicine, University of Toronto; and Centre for Osteoporosis and Bone Health, Women’s College Hospital, Toronto, Ontario, Canada
| | - Aliya Khan
- Department of Medicine, McMaster University
| | - David L Kendler
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Keith D Hill
- Grad Dip Physio, BAppSc (Physio), School of Primary and Allied Health Care, Peninsula Campus, Monash University, Frankston, Australia
| | - Angela M Cheung
- Department of Medicine, University of Toronto; and Osteoporosis Program and Centre of Excellence in Skeletal Health Assessment, University Health Network and Sinai Health System, Toronto, Ontario, Canada
| | - Robert Bleakney
- Department of Medical Imaging, University of Toronto; and Centre of Excellence in Skeletal Health Assessment, University Health Network and Sinai Health System
| | - Maureen C Ashe
- Department of Family Practice, University of British Columbia; and Centre for Hip Health and Mobility, Vancouver, British Columbia, Canada
| | | | - Lora M Giangregorio
- Department of Kinesiology, University of Waterloo; and Schlegel-University of Waterloo Research Institute for Aging, Waterloo, Ontario, Canada; and KITE, Toronto Rehab-University Health Network, Toronto, Ontario, Canada
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69
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Haines M. Feasibility of procedures for a randomised pilot study of reduced exertion, high-intensity interval training (REHIT) with non-diabetic hyperglycaemia patients. Pilot Feasibility Stud 2020; 6:28. [PMID: 32099663 PMCID: PMC7031996 DOI: 10.1186/s40814-020-00571-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 02/10/2020] [Indexed: 12/28/2022] Open
Abstract
Background Physical activity and exercise interventions to improve health frequently bring about intended effects under ideal circumstances but often fail to demonstrate benefits in real-world contexts. The aim of this study was to describe the feasibility of an exercise intervention (reduced-exertion, high-intensity interval training) in non-diabetic hyperglycaemia patients delivered in a National Health Service setting to assess whether it would be appropriate to progress to a future large-scale study. Methods The intention was to recruit 40 participants from a single centre (specialist diabesity centre). Patients were eligible to take part if they were diagnostically defined as non-diabetic hyperglycaemic based on a glycated haemoglobin (HbA1c) value of 42–46 mmol mol. Study procedures including recruitment, occurrence of adverse events, intervention acceptability, and intervention adherence were used to assess feasibility. Results Key criteria for progression to a larger study were not met. The study revealed several issues including patient eligibility, challenges to recruitment, patient consent, and poor clinician engagement. Furthermore, despite the simplicity and convenience of using HbA1c to screen for diabetes risk, the process of accurately screening and case finding eligible patients was problematic. The small sample recruited for this trial (n = 6) also limits the interpretation of data, thus it is not possible to estimate the variability of intended outcomes to use in a formal sample size calculation for a full-scale trial. Some aspects of the intervention worked well. The acceptability of the exercise intervention and outcome measures met progression criteria thresholds and adherence was very high, with 97% of exercise sessions completed for participants that finished the study. Conclusions Given the issues, the trial is not feasible in its current form. Yet, this preparatory stage of trial design pre-empted problems with the intervention that could be changed to optimise the design and conduct of future studies. Solutions to the issues identified in this study revolve around using a dedicated local recruiter with a strong relationship among the healthcare team and patients, using participant incentives to take part, and allowing for a longer recruitment period. Trial registration ClinicalTrials.gov, NCT04011397. Registered 07 July 2019—retrospectively registered.
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Affiliation(s)
- Matthew Haines
- Department of Allied Health Professions, Sport and Exercise, University of Huddersfield, Huddersfield, HD1 3DH UK
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70
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Corr M, McMullen J, Morgan PJ, Barnes A, Murtagh EM. Supporting Our Lifelong Engagement: Mothers and Teens Exercising ( SOLE MATES); a feasibility trial. Women Health 2019; 60:618-635. [PMID: 31709910 DOI: 10.1080/03630242.2019.1688446] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This study aimed to examine the feasibility of the Supporting Our Lifelong Engagement; Mothers and Teens Exercising (SOLE MATES) program. SOLE MATES, a single-arm six-week feasibility trial, comprised six face-to-face sessions. Participants were mothers (n = 27) with daughters (n = 31) aged 12-16 years. Data were collected in Ireland between January 2018 and March 2018. Feasibility benchmarks examined recruitment, data collection, acceptability, resources and participant responses. The primary outcome was daughters' step counts, measured via sealed pedometer for seven consecutive days at baseline and six weeks. Secondary outcomes included mothers' step counts, measures of communication, co-participation in activity, health-related quality of life and parenting practices. Feasibility benchmarks were reached or exceeded, except for retention. Eligibility rates were 93.4%, and baseline activity levels were low. Program content, measures and facilitators were acceptable, demonstrated through a mean score of 4.14 (SD 0.3) on a 5-point Likert Scale. Daily steps increased in mothers (2,875 increase, p = .009) and daughters (1,393 increase, p = .007). Positive feasibility metrics demonstrated the program's appeal. Participant responses for outcome measures also indicated program success. However, the relatively homogenous sample and relatively poor initial participation rate were study limitations. The intervention should be evaluated in a randomized controlled trial.
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Affiliation(s)
- Méabh Corr
- Department of Arts Education and Physical Education, Mary Immaculate College, University of Limerick , Limerick, Ireland
| | - Jaimie McMullen
- School of Sport and Exercise Science, University of Northern Colorado , Greeley, Colorado, USA
| | - Philip J Morgan
- Priority Research Centre for Physical Activity and Nutrition, School of Education, University of Newcastle , Newcastle, Australia
| | - Alyce Barnes
- Priority Research Centre for Physical Activity and Nutrition, School of Education, University of Newcastle , Newcastle, Australia
| | - Elaine M Murtagh
- Department of Arts Education and Physical Education, Mary Immaculate College, University of Limerick , Limerick, Ireland
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Roberts LM, Jaeger BC, Baptista LC, Harper SA, Gardner AK, Jackson EA, Pekmezi D, Sandesara B, Manini TM, Anton SD, Buford TW. Wearable Technology To Reduce Sedentary Behavior And CVD Risk In Older Adults: A Pilot Randomized Clinical Trial. Clin Interv Aging 2019; 14:1817-1828. [PMID: 31695350 PMCID: PMC6815758 DOI: 10.2147/cia.s222655] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 09/26/2019] [Indexed: 12/15/2022] Open
Abstract
Background Physical exercise is associated with decreased cardiovascular disease (CVD) risk, but recent large-scale trials suggest that exercise alone is insufficient to reduce CVD events in high-risk older adults. Purpose This pilot randomized clinical trial aimed to collect critical data on feasibility, safety, and protocol integrity necessary to design a fully powered randomized controlled trial (RCT) and evaluate the impact of combining structured exercise with an intervention designed to enhance non-exercise physical activity (EX+NEPA) compared to EX alone. Methods Forty participants aged ≥60 years with moderate-to-high risk of coronary heart disease events were randomly assigned to either the EX+NEPA or EX groups and followed for 20 weeks. Both groups underwent a twice-weekly, 8-week center-based exercise intervention with aerobic and resistance exercises. EX+NEPA group also received a wearable activity tracking device along with behavioral monitoring and feedback throughout the study. Study outcomes were evaluated at 8 and 20 weeks. Results Data are presented as adjusted mean change of the differences over time with 95% confidence intervals at 20 weeks. Relative to EX, the change in steps/day at 20 weeks was 1994 (-40.27, 4028) higher for EX+NEPA. For sedentary time at close-out, the EX+NEPA group was -6.8 (-45.2, 31.6) min/day relative to EX. The between-group differences for systolic and diastolic blood pressure were -9.9 (-19.6, -0.3) and -1.8 (-6.9, 3.3) mmHg, respectively. Conclusion The addition of wearable technology intervention appeared to positively influence daily activity patterns and changes in blood pressure - potentially improving risk factors for CVD. A fully powered randomized trial is needed to ultimately test this hypothesis.
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Affiliation(s)
- Lisa M Roberts
- Department of Medicine, Division of Gerontology/Geriatrics/Palliative Care, University of Alabama at Birmingham, Birmingham, AL, USA.,Center for Exercise Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Byron C Jaeger
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Liliana C Baptista
- Department of Medicine, Division of Gerontology/Geriatrics/Palliative Care, University of Alabama at Birmingham, Birmingham, AL, USA.,Center for Exercise Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sara A Harper
- Department of Medicine, Division of Gerontology/Geriatrics/Palliative Care, University of Alabama at Birmingham, Birmingham, AL, USA.,Center for Exercise Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Anna K Gardner
- Department of Aging and Geriatric Research, University of Florida, Gainesville, FL, USA
| | - Elizabeth A Jackson
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Dorothy Pekmezi
- Department of Health Behavior, School of Public Health, the University of Alabama at Birmingham, Birmingham, AL, USA
| | - Bhanuprasad Sandesara
- Department of Aging and Geriatric Research, University of Florida, Gainesville, FL, USA
| | - Todd M Manini
- Department of Aging and Geriatric Research, University of Florida, Gainesville, FL, USA
| | - Stephen D Anton
- Department of Aging and Geriatric Research, University of Florida, Gainesville, FL, USA
| | - Thomas W Buford
- Department of Medicine, Division of Gerontology/Geriatrics/Palliative Care, University of Alabama at Birmingham, Birmingham, AL, USA.,Center for Exercise Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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Brown M, Murphy M, McDermott L, McAneney H, O’Sullivan JM, Jain S, Prue G. Exercise for advanced prostate cancer: a multicomponent, feasibility, trial protocol for men with metastatic castrate-resistant prostate cancer (EXACT). Pilot Feasibility Stud 2019; 5:102. [PMID: 31428443 PMCID: PMC6696674 DOI: 10.1186/s40814-019-0486-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 08/07/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Men with metastatic castrate-resistant prostate cancer can experience an array of treatment-related side effects. Accumulating evidence suggests exercise may alleviate some of these adversities and assist in disease management. However, empirical evidence in advanced prostate cancer patients remains limited. The purpose of this study is to determine whether men with metastatic prostate cancer, who are ineligible for high-intensity exercise, can partake in a home-based, moderate-intensity exercise program and the impact of doing so on quality of life and physical fitness parameters. METHODS Thirty men with adenocarcinoma of the prostate and progressive systemic, metastatic disease will be recruited. Clinicians will screen patients against inclusion criteria to determine eligibility. All men enrolled will be prescribed a tailored, home-based, moderate-intensity exercise intervention consisting of aerobic and strengthening components for 12 weeks. Patients will receive supplementary education materials and weekly behavioural change consultations throughout the intervention. The primary outcome will be the feasibility of delivering such an intervention in men with metastatic disease. Secondary endpoints including skeletal events will be monitored for safety, as will the feasibility of patient-reported outcome measures and the sampling time points, generating data pertaining to completion rates and potential effect in future trials. General physical fitness will be assessed during these visits, using timed sit-to-stand testing and a 6-min walking test. Prior to each visit, objective physical activity levels will be captured for 7 days using an accelerometer, to determine the feasibility of this technology and the quality of data obtained. In parallel with the feasibility aspects of the trial, changes compared to baseline will be reported. Direct regular contact will also serve as a feedback loop, should any issues arise. This study has received ethical approval from the Office for Research Ethics Committees Northern Ireland. CONCLUSIONS This study aims to determine the potential utility of a home-based exercise intervention in managing side effects associated with advanced prostate cancer and its treatment. This feasibility trial will inform the design and implementation of a larger randomised control trial to determine the efficacy of moderate aerobic and strengthening exercise as an adjuvant therapy in men with metastatic prostate cancer. Collecting such evidence provides further support for exercise in this paradigm and potential for its inclusion as a low-toxicity therapy in standard cancer care, in the longer term. TRIAL REGISTRATION ClinicalTrials.gov, NCT03658486Trial sponsor: Queen's University Belfast (Reference: B18/15). Contact: Dr. Paula Tighe, Research and Enterprise, Queen's University Belfast. Telephone: 02890 973,296. Email: p.tighe@qub.ac.uk. The sponsor reviewed the protocol and ethical application prior to submission.Protocol issue: Version 1 (18th May 2018). Authors: MB, MM, SJ and GP.
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Affiliation(s)
- Malcolm Brown
- School of Nursing & Midwifery, Medical Biology Centre, Queen’s University Belfast, Lisburn Road, Belfast, Northern Ireland BT9 7BL
| | - Marie Murphy
- Sport & Exercise Sciences Research Institute, Ulster University, Jordanstown, Northern Ireland BT37 0QB
| | - Lauri McDermott
- Insight Centre for Data Analytics, Dublin City University, Glasnevin, Dublin 9 Ireland
| | - Helen McAneney
- Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland BT12 6BA
| | - Joe M. O’Sullivan
- Centre for Cancer Research & Cell Biology, Queen’s University Belfast, Belfast, Northern Ireland BT9 7AE
| | - Suneil Jain
- Centre for Cancer Research & Cell Biology, Queen’s University Belfast, Belfast, Northern Ireland BT9 7AE
| | - Gillian Prue
- School of Nursing & Midwifery, Medical Biology Centre, Queen’s University Belfast, Lisburn Road, Belfast, Northern Ireland BT9 7BL
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Lunde P, Nilsson BB, Bergland A, Bye A. Feasibility of a Mobile Phone App to Promote Adherence to a Heart-Healthy Lifestyle: Single-Arm Study. JMIR Form Res 2019; 3:e12679. [PMID: 31066684 PMCID: PMC6528433 DOI: 10.2196/12679] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 03/05/2019] [Accepted: 03/24/2019] [Indexed: 01/22/2023] Open
Abstract
Background Long-term maintenance of preventive activities is fundamental for achieving improved outcomes in cardiac rehabilitation (CR). Despite this, it has been shown to be a major challenge for many patients to follow recommendations and thereby adhere to a heart-healthy lifestyle. Mobile phone apps have been emphasized as potential tools to promote preventive activities after attendance in a CR program. Before commencing a trial to assess the potential effect of using an app to promote long-term adherence to preventive activities after attendance in CR, a study to assess if it is feasible to use an app is warranted. Objective The goal of the research is to assess if it is feasible to use a mobile phone app for promoting and monitoring patients’ adherence to a heart-healthy lifestyle after CR. Methods The study included an experimental, pre-post single-arm trial lasting for 12 weeks. All patients received access to an app aimed to guide individuals to change or maintain a heart-healthy lifestyle. During the study period, patients received weekly, individualized monitoring through the app, based on their own goals. Feasibility outcomes assessed were recruitment rate, adherence to the app, resource requirements, and efficacy regarding capability to detect a change in quality of life, health status, and perceived goal achievement as well as evaluating ceiling and floor effect in these outcomes. Criteria for success were preset to be able to evaluate whether the app was feasible to use in a potential future RCT. Results In total, 71% (17/24) of the patients who completed CR were eligible for a potential RCT as well as for this study. All 14 patients included in the study used the app to promote preventive activities throughout the study. Satisfaction with the technology was high, and the patients found the technology-based follow-up intervention both useful and motivational. Ceiling effect was present in more than 20% of the patients in several domains of the questionnaires evaluating quality of life (36-Item Short Form Health Survey and COOP/WONCA functional health assessments) and health status (EQ-5D). Overall self-rated health status (EuroQol Visual Analog Scale) and perceived goal achievement were found to be outcomes able to detect a change. Conclusions Individual follow-up through an app after attendance in CR is feasible. All patients used the app for preventive activities and found the app both useful and motivating. Several points of guidance from the patients in the study have been adopted and incorporated into the final design of the RCT now in the field.
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Affiliation(s)
- Pernille Lunde
- Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Birgitta Blakstad Nilsson
- Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway.,Section for Physiotherapy, Division of Medicine, Oslo University Hospital, Oslo, Norway
| | - Astrid Bergland
- Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Asta Bye
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway.,European Palliative Care Research Centre, Department of Oncology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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74
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Multimodal Intervention to Improve Functional Status in Hypertensive Older Adults: A Pilot Randomized Controlled Trial. J Clin Med 2019; 8:jcm8020196. [PMID: 30736317 PMCID: PMC6406861 DOI: 10.3390/jcm8020196] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 01/30/2019] [Accepted: 01/31/2019] [Indexed: 02/07/2023] Open
Abstract
This pilot randomized controlled trial (RCT) was designed to provide the preliminary data necessary to conduct a full-scale trial to compare the efficacy of differing first-line antihypertensive medications in improving functional status in older adults, when combined with exercise. The primary objectives were to assess study feasibility, safety, and protocol integrity. Dependent outcomes included gait speed, exercise capacity, body composition, and systemic cardiometabolic biomarkers. Thirty-one physically inactive older adults (70.6 ± 6.1 years) with hypertension and functional limitations were randomly assigned to (1) Perindopril (8 mg/day n = 10), (2) Losartan (100 mg/day; n = 13), or (3) Hydrochlorothiazide (HCTZ: 25 mg/day; n = 8). Participants were also assigned to a 24-week multimodal exercise intervention, separated into an aerobic and concurrent (aerobic + resistance) phase to evaluate potential mode effects. Retention was 84% (26/31), and compliance was >90% and >79% with medication and exercise, respectively. A total of 29 adverse events (Perindopril = 5; Losartan = 12; HCTZ = 11) and one unrelated serious adverse event were observed throughout the trial. Overall, this pilot RCT provided critical data and identified several challenges to ultimately designing and implementing a fully powered trial.
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75
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Shvedko AV, Thompson JL, Greig CA, Whittaker AC. Physical Activity Intervention for Loneliness (PAIL) in community-dwelling older adults: protocol for a feasibility study. Pilot Feasibility Stud 2018; 4:187. [PMID: 30598833 PMCID: PMC6299531 DOI: 10.1186/s40814-018-0379-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 11/29/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Low-quality social relationships in older adults are strongly associated with feelings of loneliness. Physical activity interventions could reduce loneliness and improve psychological well-being, among other health benefits. The aim of this study is to examine the feasibility of a Physical Activity Intervention for Loneliness (PAIL) in community-dwelling older adults at risk for loneliness. METHODS/DESIGN This feasibility study is a two-arm randomised controlled trial (RCT) with a wait-list control group using a mixed-methods research design. The primary aim of the feasibility study is to estimate recruitment, retention and adherence rates; the appropriateness of the intervention design and its practicality; the acceptability of the intervention by participants; and the set of instruments and measures and primary outcome measures to inform a future large-scale randomised trial. After eligibility screening, randomisation will be conducted using computer-based random sequence generation. Baseline and post-intervention assessments for intervention and control groups will include height, weight, body mass index, resting blood pressure, physical activity using accelerometry, loneliness, social support, social networks, anxiety and depression, self-efficacy for exercise, satisfaction with social contacts, and expected outcomes and barriers for exercise using questionnaires. Focus groups will be conducted at the mid-point and post-intervention period using a phenomenological approach to analyse the participants' experiences of taking part in PAIL. DISCUSSION This trial will provide important information regarding the feasibility of PAIL in community-dwelling older adults at risk for loneliness using a mixed-methods approach combining quantitative and qualitative research methods. TRIAL REGISTRATION Clinicaltrials.gov NCT03458793.
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Affiliation(s)
- Anastasia V. Shvedko
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Janice L. Thompson
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Carolyn A. Greig
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
- MRC – Arthritis Research UK Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, UK
| | - Anna C. Whittaker
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
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