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This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the effects of skeletal muscle training on functional performance in people with spinal muscular atrophy (SMA) type 3 and to identify any adverse effects
Background: Many international clinical guidelines recommend therapeutic exercise as a core treatment for knee and hip osteoarthritis. We aimed to identify individual patient-level moderators of the effect of therapeutic exercise for reducing pain and improving physical function in people with knee osteoarthritis, hip osteoarthritis, or both. Methods: We did a systematic review and individual participant data (IPD) meta-analysis of randomised controlled trials comparing therapeutic exercise with non-exercise controls in people with knee osteoathritis, hip osteoarthritis, or both. We searched ten databases from March 1, 2012, to Feb 25, 2019, for randomised controlled trials comparing the effects of exercise with non-exercise or other exercise controls on pain and physical function outcomes among people with knee osteoarthritis, hip osteoarthritis, or both. IPD were requested from leads of all eligible randomised controlled trials. 12 potential moderators of interest were explored to ascertain whether they were associated with short-term (12 weeks), medium-term (6 months), and long-term (12 months) effects of exercise on self-reported pain and physical function, in comparison with non-exercise controls. Overall intervention effects were also summarised. This study is prospectively registered on PROSPERO (CRD42017054049). Findings: Of 91 eligible randomised controlled trials that compared exercise with non-exercise controls, IPD from 31 randomised controlled trials (n=4241 participants) were included in the meta-analysis. Randomised controlled trials included participants with knee osteoarthritis (18 [58%] of 31 trials), hip osteoarthritis (six [19%]), or both (seven [23%]) and tested heterogeneous exercise interventions versus heterogeneous non-exercise controls, with variable risk of bias. Summary meta-analysis results showed that, on average, compared with non-exercise controls, therapeutic exercise reduced pain on a standardised 0–100 scale (with 100 corresponding to worst pain), with a difference of –6·36 points (95% CI –8·45 to –4·27, borrowing of strength [BoS] 10·3%, between-study variance [τ2] 21·6) in the short term, –3·77 points (–5·97 to –1·57, BoS 30·0%, τ2 14·4) in the medium term, and –3·43 points (–5·18 to –1·69, BoS 31·7%, τ2 4·5) in the long term. Therapeutic exercise also improved physical function on a standardised 0–100 scale (with 100 corresponding to worst physical function), with a difference of –4·46 points in the short term (95% CI –5·95 to –2·98, BoS 10·5%, τ2 10·1), –2·71 points in the medium term (–4·63 to –0·78, BoS 33·6%, τ2 11·9), and –3·39 points in the long term (–4·97 to –1·81, BoS 34·1%, τ2 6·4). Baseline pain and physical function moderated the effect of exercise on pain and physical function outcomes. Those with higher self-reported pain and physical function scores at baseline (ie, poorer physical function) generally benefited more than those with lower self-reported pain and physical function scores at baseline, with the evidence most certain in the short term (12 weeks). Interpretation: There was evidence of a small, positive overall effect of therapeutic exercise on pain and physical function compared with non-exercise controls. However, this effect is of questionable clinical importance, particularly in the medium and long term. As individuals with higher pain severity and poorer physical function at baseline benefited more than those with lower pain severity and better physical function at baseline, targeting individuals with higher levels of osteoarthritis-related pain and disability for therapeutic exercise might be of merit. Funding: Chartered Society of Physiotherapy Charitable Trust and the National Institute for Health and Care Research.
The purpose of this study was to assess predictive value of a new submaximal rowing test (SmRT) on 2,000-m ergometer rowing time-trial performance in competitive rowers. In addition, the reliability of the SmRT was investigated. Twenty-four competitive male rowers participated in this study. After determining individual HRmax, all rowers performed an SmRT followed by a 2,000-m rowing ergometer time trial. In addition, the SmRT was performed 4 times (2 days in between) to determine the reliability. The SmRT consists of two 6-minute stages of rowing at 70 and 80% HRmax, followed by a 3-minute stage at 90% HRmax. Power was captured during the 3 stages, and 60 seconds of heart rate recovery (HRR60s) was measured directly after the third stage. Results showed that predictive value of power during the SmRT on 2,000-m rowing time also increased with stages. CVTEE% is 2.4, 1.9, and 1.3%. Pearson correlations (95% confidence interval [95% CI]) were −0.73 (−0.88 to −0.45), −0.80 (−0.94 to −0.67), and −0.93 (−0.97 to −0.84). 2,000-m rowing time and HRR60s showed no relationship. Reliability of power during the SmRT improved with the increasing intensity of the stages. The coefficient of variation (CVTEM%) was 9.2, 5.6, and 0.4%. Intraclass correlation coefficients (ICC) and 95% CI were 0.91 (0.78–0.97), 0.92 (0.81–0.97), and 0.99 (0.97–1.00). The CVTEM% and ICC of HRR60s were 8.1% and 0.93 (0.82–0.98). In conclusion, the data of this study shows that the SmRT is a reliable test that it is able to accurately predict 2,000-m rowing time on an ergometer. The SmRT is a practical and valuable submaximal test for rowers, which can potentially assist with monitoring, fine-tuning and optimizing training prescription in rowers.
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Background: Healthy development of children is under pressure. While governments, schools and organizations are trying to stimulate physical activity in children, reduce overweight and improve motor skills, they are facing challenges in finding effective strategies. The model proposed by Stodden et al. (2008) is an interesting framework for studying healthy development of children, as it encompasses the physical aspect (motor skill competence, physical fitness, weight status), the mental aspect (perceived competence) and a behavioral component (physical activity). Importantly, it acknowledges the developmental stages of children by including age. Therefore, this model serves as the basis for this study in which we are looking for insights to effectively influence healthy development of children. Methods and Results: We measured these five variables in a large sample (N > 1000) of children in the Netherlands (age: 4-12, 50% girls). Through structural equation modeling we searched for cross-sectional as well as 1-year longitudinal relationships. Our results showed concurrent relationships between all variables and a tipping point at which relationships emerged or strengthened. The results indicated that targeting motor competence at a young age might be a feasible way to ensure continued participation in physical activities. However, longitudinal analyses revealed no effect of motor skill competence (T1) on physical activity (T2). Physical fitness appeared to be more important as a potential mediator than perceived motor competence. As a follow-up study, the five variables will be analyzed via a person-centered approach (latent profile analyses). This will guide us towards tailoring future interventions to the specific needs of subgroups of children. Analyses of this study are ongoing and will be presented at the conference. Conclusions: Our multiple analyses have shed additional light on the complexity of healthy development of children. In the upcoming presentation we will unite our study findings and delineate implications for developing effective strategies.
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Aim and method: To examine in obese people the potential effectiveness of a six-week, two times weekly aquajogging program on body composition, fitness, health-related quality of life and exercise beliefs. Fifteen otherwise healthy obese persons participated in a pilot study. Results: Total fat mass and waist circumference decreased 1.4 kg (p = .03) and 3.1 cm (p = .005) respectively. The distance in the Six-Minute Walk Test increased 41 meters (p = .001). Three scales of the Impact of Weight on Quality of Life-Lite questionnaire improved: physical function (p = .008), self-esteem (p = .004), and public distress (p = .04). Increased perceived exercise benefits (p = .02) and decreased embarrassment (p = .03) were observed. Conclusions: Aquajogging was associated with reduced body fat and waist circumference, and improved aerobic fitness and quality of life. These findings suggest the usefulness of conducting a randomized controlled trial with long-term outcome assessments.
ObjectiveTo investigate whether duration of knee symptoms influenced the magnitude of the effect of exercise therapy compared to non-exercise control interventions on pain and physical function in people with knee osteoarthritis (OA).MethodWe undertook an individual participant data (IPD) meta-analysis utilising IPD stored within the OA Trial Bank from randomised controlled trials (RCTs) comparing exercise to non-exercise control interventions among people with knee OA. IPD from RCTs were analysed to determine the treatment effect by considering both study-level and individual-level covariates in the multilevel regression model. To estimate the interaction effect (i.e., treatment x duration of symptoms (dichotomised)), on self-reported pain or physical function (standardised to 0–100 scale), a one-stage multilevel regression model was applied.ResultsWe included IPD from 1767 participants with knee OA from 10 RCTs. Significant interaction effects between the study arm and symptom duration (≤1 year vs >1 year, and ≤2 years vs>2 years) were found for short- (∼3 months) (Mean Difference (MD) −3.57, 95%CI −6.76 to −0.38 and −4.12, 95% CI-6.58 to −1.66, respectively) and long-term (∼12 months) pain outcomes (MD −8.33, 95%CI −12.51 to −4.15 and −8.00, 95%CI −11.21 to −4.80, respectively), and long-term function outcomes (MD −5.46, 95%CI −9.22 to −1.70 and −4.56 95%CI −7.33 to-1.80, respectively).ConclusionsThis IPD meta-analysis demonstrated that people with a relatively short symptom duration benefit more from therapeutic exercise than those with a longer symptom duration. Therefore, there seems to be a window of opportunity to target therapeutic exercise in knee OA.
Background: As the assistive and resistive properties of water can facilitate the performance of exercise, aquatic exercise therapy might be a promising rehabilitation modality for burn patients. This study aimed to investigate the feasibility and acceptability of aquatic exercise therapy in adult burn patients with an indication for supervised exercise therapy. Methods: Eligible for this observational pilot study were all competent adult burn patients with an indication for supervised exercise therapy who had been admitted to the burn centre of the Maasstad Hospital between June 2016 and February 2017. Patients were asked to participate in an in-hospital aquatic exercise therapy program for a minimum of 2 weeks, 2 times per week, or otherwise serve as control by having land-based exercise therapy (regular care). Feasibility of aquatic exercise therapy was assessed by comparing the number of eligible patients to the number of patients that could actually participate, monitoring attendance rates, monitoring complications, and evaluating early experiences. Acceptability was assessed using the Water Exercise Acceptability Questionnaire. Results: Eleven patients were invited and ten of them agreed to participate. All chose aquatic instead of land-based exercise therapy. Participants were aged between 19 and 64 years and their burns affected 18–53% of total body surface area (TBSA). Aquatic exercise therapy appeared feasible in nine of 13 eligible patients (69%). Attendance rates were high (42–100%) and the majority of participants (n = 9) continued with aquatic exercise therapy beyond the initial two weeks. No serious complications (e.g. infections) occurred. Adverse symptoms (wound healing issues) were reported in five participants, but in four of them these were not likely to be due to the aquatic exercise therapy. Enjoyment was high and adherence to the aquatic exercise therapy was further facilitated by support from staff, a sense of achievement, noticeable improvements, personal motivation, and support from other participants. Peer support was reported as a positive side effect. Conclusions: These preliminary results indicate that aquatic exercise therapy is both feasible and acceptable for the majority of adult burn patients with an indication for supervised exercise therapy. No indications were found for an increased risk of infection or other serious complications.
