Water- versus land-based treatment for postural control in postmenopausal osteoporotic women: a randomized, controlled trial

The effect of pre-operative exercise training on post-operative cognitive function: a systematic review

BACKGROUND

With population aging and advances in surgical and anesthetic procedures, the incidence of surgery in patients over the age of 65 years is increasing. One post-operative complication often encountered by older surgical patients is post-operative cognitive dysfunction (POCD). Preoperative exercise training can improve the overall physiological resilience of older surgical patients, yet its impact on post-operative cognition is less well-established.

METHODS

Six databases (Medline (OVID); EMBASE (OVID); EMCARE (OVID); CINAHL (EBSCOHost), the Cochrane Library, and PubMed) were searched for studies reporting the effect of pre-operative physical training on post-operative cognition. The quality of evidence was assessed using the Mixed Methods Assessment Tool.

RESULTS

A total of 3983 studies were initially identified, three of which met the inclusion criteria for this review. Two studies were pilot randomized trials, and one was a prospective randomized trial. Two of the studies were high-quality. Each study used a different type of physical exercise and cognition assessment tool. Across the studies, post-operative cognition (p = 0.005) and attention (p = 0.04) were found to be better in the intervention groups compared to control, with one study reporting no difference between the groups.

CONCLUSION

Preoperative physical training may improve post-operative cognitive function, although more research with a consistent endpoint is required. Future studies should focus on patients at high risk of POCD, such as older adults, and explore the impact of different exercise regimes, including frequency, intensity, time, and type.

Self-management strategies and multicomponent training to mitigate the effects of the interruption of physical exercise programmes in the pandemic context on functionality, sedentary behaviour, physical capacity, mental health, body composition and quality of life in older adults: a blinded randomized controlled study protocol

Background

Considering the confinement recommended by the World Health Organization due to the pandemic caused by COVID-19, many community physical exercise programmes for older adults have had their activities cancelled. In this context, proposing strategies to recover the possible adverse effects of the confinement period is pertinent. The use of self-management strategies associated with regular physical activity reduces sedentary behaviour and improves physical capacity in older adults. Thus, the purpose of this study was to describe a multicomponent training programme combined with a self-management strategy protocol to mitigate the effects of interruptions in physical exercise programmes on functionality, physical capacity, mental health, body composition and quality of life in older adults.

Methods

This will be a blinded, randomized and controlled clinical trial performed in São Carlos, SP, Brazil. Eighty older adults will be divided into two groups: multicomponent training (Multi) and multicomponent training + self-management strategies (Multi+SM). The intervention will be performed over 16 weeks on three alternate days of every week, with 50-min sessions. The assessment of physical capacity will be performed before the interruption of physical exercise programmes (T0: initial assessment, March 2020), preintervention (T1: immediately after the return of the exercise programme) and postintervention (T2). The assessments of physical activity level, quality of life, mental health, functionality and body composition will be performed at T1 and T2.

Discussion

The results from this MC+SM protocol will allow us to contribute clinical support to evaluate the variables analysed and to guide future public health policies with the aim of minimizing the possible deleterious effects arising from the physical exercise interruption periods caused by epidemics and pandemics.

Trial registration

RBR-10zs97gk. Prospectively registered in Brazilian Registry of Clinical Trials (ReBEC) on 17 June 2021. Registry name: Use of self-management strategies combined with multicomponent training to mitigate the effects of social distancing due to COVID-19 on capacity, physical capacity, mental health and quality of life in older adults - A blind, randomized and controlled clinical trial.

Effects of water-based exercises on functioning of postmenopausal women: A systematic review with meta-analysis

OBJECTIVE

The aim of the present study was to compare the efficacy of Water-Based Exercise (WBE) versus Land-Based Exercise (LBE) and of WBE versus Non-Exercise in postmenopausal women on muscle strength, agility, flexibility, bone mineral density and aerobic capacity.

METHODS

We systematically searched in MEDLINE, PEDro, SciELO and the Cochrane Library RCT published until May 2022. Only randomized controlled trials were included. We analyzed the pooled results using weighted mean differences, standardized mean difference, and 95%CI were calculated.

RESULTS

Twenty studies met the inclusion criteria; although, sixteen studies were included in the meta-analyses. The studies presented low methodological quality. WBE was more effective than NE for improving muscle strength of knee extension (3.34), knee flexion (2.51), arm curl (6.78 repetitions), VO2Max (4.12 ml/kg), and flexibility (6.38 cm) When comparing WBE with LBE, no significant statistical difference was found regarding muscular strength of lower limbs (1.00), muscular strength of upper limbs (0.47), flexibility (1.95 cm), aerobic capacity (0.82 ml/kg) and lumbar bone mineral density (0.04 g/cm²).

CONCLUSIONS

WBE promotes significant benefits in muscle strength, aerobic capacity, and flexibility, when compared to no intervention. However, WBE was similar to the LBE for improving muscle strength, aerobic capacity, flexibility, agility, and bone mineral density - lumbar in postmenopausal women.

Comparing durability of water- and land-based exercise benefits among older adults in South Korea: A randomized controlled trial with 1-year follow-up

BACKGROUND

Aquatic exercise can improve strength, flexibility, and aerobic function while safely providing partial weight-bearing support through viscosity and buoyancy.

OBJECTIVE

The aim of the present study was to compare the effects of water-based exercise with land-based exercise before and after a 10-week exercise intervention and again at one-year follow-up.

METHODS

Eighty participants aged 65 years and older were randomly assigned to either a water- or a land-based 10-week exercise program. Assessment included the Senior Fitness Test (SFT), the Modified Falls-Efficacy Scale, and the 36-Item Short-Form Health Survey (SF-36). Hip and knee strength was also measured. All assessments were completed at three time points: pre- (T1), post- (T2), and at 1-year follow-up (T3).

RESULTS

Significant differences were observed between the two groups on three parameters: the SFT timed up-and-go test; lower hip muscle strength in extension, adduction, and external rotation; and quality of life (QoL) measured by the SF-36 (p< 0.05). No significant differences were observed in the SFT chair stand test, dominant arm curl test, two-minute step test, chair sit-and-reach test, back scratch test, and Modified Falls-Efficacy Scale.

CONCLUSION

Aquatic exercise provided greater improvement of physical health and QoL among older people than land-based exercise.

Effects of aquatic physical exercise on neuropsychological factors in older people: A systematic review

BACKGROUND

. There is a lack of standardized protocols and clinical trials for older adults involving neuropsychological factors in the literature. Furthermore, no systematic review has been published investigating this theme.

PURPOSE

. The purpose of this systematic review was to analyze the effects of aquatic physical exercise on neuropsychological factors in older adults.

METHODS

. A systematic review (CRD42020176899) was conducted, using articles from Pubmed, Web of Science, Scopus, Cochrane Library, Science Direct and Medline published until March 2020 (without limit of previous year). Eligibility criteria for selecting studies were: clinical trials; samples with a mean age of 65 years old and over; articles involving aquatic physical exercise; and presenting neuropsychological outcomes (behavior, cognition, psychological, mental health).

RESULTS AND DISCUSSION

. The search yielded 801 records and 16 studies were included, totaling: 1707 older adults, with a mean age of 71.3 years old (range of mean ages in the studies: 65.3 to 88.4 years old) and a predominance of women. Aquatic physical exercise showed positive results in the mental component of quality of life, fear of falling, mood, anxiety and internal health locus of control in healthy sedentary older adults. Only one study out of 5 carried out with older adults with osteoarthritis showed improvements in psychological well-being after aquatic intervention. Older women with osteopenia or osteoporosis showed improvements in the mental component of quality of life. Studies on dementia showed a significant improvement in behavioral and psychological symptoms after aquatic intervention and no effect on depressive symptoms.

CONCLUSION

. Based on the results of this systematic review, aquatic physical exercise has positive effects on quality of life, fear of falling, cognitive functions, mood, anxiety and internal health locus of control in sedentary community-dwelling older people. It can be a great resource for carrying out physical activities in this population.

Characteristics of Physical Exercise Programs for Older Adults in Latin America: A Systematic Review of Randomized Controlled Trials

AIM

To characterize physical exercise programs for older adults in Latin America.

METHODS

This review was conducted in accordance with the PRISMA statement. A search for randomized controlled trials (RCTs) published between the years 2015 and 2020 was performed in the Scopus, MedLine and SciELO databases.

RESULTS

A total of 101 RCTs were included. A large percentage of the studies had an unclear risk of bias in the items: selection, performance, detection and attribution. Furthermore, a heterogeneous level of compliance was observed in the CERT items. A total sample of 5013 older adults (79% women) was included. 97% of the studies included older adults between 60-70 years, presenting an adherence to the interventions of 86%. The studies were mainly carried out in older adults with cardiometabolic diseases. Only 44% of the studies detailed information regarding the place of intervention; of these studies, 61% developed their interventions in university facilities. The interventions were mainly based on therapeutic physical exercise (89% of the articles), with a duration of 2-6 months (95% of the articles) and a frequency of 2-3 times a week (95% of the articles) with sessions of 30-60 min (94% of the articles) led by sports science professionals (51% of the articles). The components of physical fitness that were exercised the most were muscular strength (77% of the articles) and cardiorespiratory fitness (47% of the articles). Furthermore, only 48% of the studies included a warm-up stage and 34% of the studies included a cool-down stage.

CONCLUSIONS

This systematic review characterized the physical exercise programs in older adults in Latin America, as well the most frequently used outcome measures and instruments, by summarizing available evidence derived from RCTs. The results will be useful for prescribing future physical exercise programs in older adults.

Impact of water therapy on pain management in patients with fibromyalgia: current perspectives

Exercise-related interventions have been recommended as one of the main components in the management of fibromyalgia syndrome (FMS). Water therapy, which combines water's physical properties and exercise benefits, has proven effective in improving the clinical symptoms of FMS, especially pain, considered the hallmark of this syndrome. However, to our knowledge, the mechanisms underlying water therapy effects on pain are still scarcely explored in the literature. Therefore, this narrative review aimed to present the current perspectives on water therapy and the physiological basis for the mechanisms supporting its use for pain management in patients with FMS. Furthermore, the effects of water therapy on the musculoskeletal, neuromuscular, cardiovascular, respiratory, and neuroendocrine systems and inflammation are also addressed. Taking into account the aspects reviewed herein, water therapy is recommended as a nonpharmacologic therapeutic approach in the management of FMS patients, improving pain, fatigue, and quality of life. Future studies should focus on clarifying whether mechanisms and long-lasting effects are superior to other types of nonpharmacological interventions, as well as the economic and societal impacts that this intervention may present.

Is the word "osteoporosis" a reason for kinesiophobia?

BACKGROUND

Osteoporosis is a systemic skeletal disease that causes weakening of the bones which increases the risk of fractures. Especially hip fractures lead to substantial physical, psychological, social and economic burden both for the patients and the governments. Exercises and physically active life style are essential preventive and therapeutic approaches for osteoporosis. Kinesiophobia is an irrational fear of movement due to the belief of susceptibility to injury. It is associated with lower levels of physical activity. Having a diagnosis of osteoporosis without an adequate education about the disease may lead to kinesiophobia in patients due to an illogical belief about increasing possibility of falls and related fractures during physical activity.

AIM

To evaluate relationship between the diagnosis of osteoporosis and kinesiophobia.

DESIGN

Case-control study.

SETTING

Division of Rheumatology, Department of Rehabilitation, University Hospital.

POPULATION

Fifty-four subjects with osteoporosis and fifty-four healthy subjects who were age- and gender-matched.

METHODS

Demographic data of subjects (age, gender, weight, height, body mass index, disease duration) were recorded. The Tampa Kinesiophobia Scale (TKS) was applied to determine the level of fear of movement. Hospital Anxiety and Depression Scale (HADS) was used to evaluate mood status. The Quality of Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO-41) was performed to assess health related quality of life. Scores were compared between groups by Mann Whitney U test. Correlation between kinesiophobia and QUALEFFO-41 scores was performed by Spearman rank correlation.

RESULTS

Subjects with osteoporosis had higher level of kinesiophobia than healthy control subjects. There was no significant difference in HADS scores between the groups. QUALEFFO-41 total score was worse in subjects with osteoporosis than those in healthy subjects. There was a significant correlation between QUALEFFO-41 total score and kinesiophobia score in subjects with osteoporosis.

CONCLUSIONS

Subjects with osteoporosis have higher levels of kinesiophobia compared to age and gender-matched healthy subjects. Kinesiophobia may affect the quality of life in subjects with osteoporosis.

CLINICAL REHABILITATION IMPACT

As physical activity is essential for bone and general health, individuals should be educated and counseled about osteoporosis and the importance of physical activity to overcome kinesiophobia.