Over de effectiviteit van stretching wordt in de praktijk veel gespeculeerd en beweerd. De een gelooft er heilig in, de ander vindt het maar onzin. Tijd om de wetenschappelijke bewijzen eens op een rijtje te zetten. Stretching blijkt soms zinnig, en soms onzinnig.
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Last year we published a randomised trial demonstrating that stretching before sleep reduces the frequency and severity of nocturnal leg cramps in older adults (Hallegraeff et al 2012). The results of that study align perfectly with the uncontrolled study of Daniell (1979). In a recent letter to this journal, Daniell and Pentrack (2013) proposed an alternative stretching procedure for preventing nocturnal leg cramps. Some major differences can be identified between their new stretching procedure and the procedure used in our study.
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QUESTION: In adults who experience nocturnal leg cramps, does stretching of the calf and hamstring muscles each day just before sleep reduce the frequency and severity of the cramps?DESIGN: A randomised trial with concealed allocation and intention-to-treat analysis.PARTICIPANTS: Eighty adults aged over 55 years with nocturnal leg cramps who were not being treated with quinine.INTERVENTION: The experimental group performed stretches of the calf and hamstring muscles nightly, immediately before going to sleep, for six weeks. The control group performed no specific stretching exercises. Both groups continued other usual activities.OUTCOME MEASURES: Participants recorded the frequency of nocturnal leg cramps in a daily diary. Participants also recorded the severity of the pain associated with nocturnal leg cramps on a 10-cm visual analogue scale. Adverse events were also recorded.RESULTS: All participants completed the study. At six weeks, the frequency of nocturnal leg cramps decreased significantly more in the experimental group, mean difference 1.2 cramps per night (95% CI 0.6 to 1.8). The severity of the nocturnal leg cramps had also decreased significantly more in the experimental group than in the control group, mean difference 1.3 cm (95% CI 0.9 to 1.7) on the 10-cm visual analogue scale.CONCLUSION: Nightly stretching before going to sleep reduces the frequency and severity of nocturnal leg cramps in older adults.
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BACKGROUND: Burn survivors are frequently faced with disfiguring scars. Various techniques exist to improve scar appearance, such as laser treatment and dermabrasion. Next to that, surgical reconstruction, such as scar excision is an option. This randomized controlled trial investigates whether a larger burn scar can be excised using a skin-stretching device for wound closure, thereby optimizing use of adjacent healthy skin. This technique may allow scar excision in a one-step procedure instead of two or more steps, which is necessary for serial excision and tissue expansion.METHODS: Two arms were compared: scar excision and closure by skin stretch and scar excision without additional techniques. The primary outcome measure was scar surface area reduction. In addition, complications were registered.RESULTS: Fifteen patients were randomized for skin stretch and 15 patients were randomized for scar excision only. In the skin stretch group, 10 of 15 scars were completely excised compared with three of 15 in the scar excision-only group (p = 0.025). In the skin stretch group, a significantly larger reduction in scar area was achieved: 95 ± 11 percent of the scar was excised versus 78 ± 17 percent in the scar excision-only group (p = 0.003). One patient in the skin stretch group and three patients in the scar excision-only group experienced partial wound dehiscence (p = 0.598).CONCLUSIONS: In burn scar reconstructions, a significantly larger reduction in scar area can be achieved using a skin-stretching device compared with scar excision with no additional techniques, without an increased risk of complications. It was shown that skin stretching is of added value for scars that cannot be excised in a one-step procedure.
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In 2012, our randomised trial demonstrated that stretching before sleep reduces the frequency and severity of nocturnal leg cramps in older adults.1 These episodic cramp attacks are characteristic: painful, sustained, involuntary muscle contractions of the calf muscles, hamstrings or feet. The sharp and intense pain may last from seconds to several minutes, accompanied by firm and tender muscles, and in some cases, with plantar flexion of feet and toes.2–5 In his letter, Garrison argues that prophylactic stretching is unlikely to prevent nocturnal leg cramps.
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Ascertaining the contribution of research is complex; this is not a conclusion but a starting point for the preliminary thoughts in this inaugural lecture. The guiding question is: where does this complexity lie? The dominant answer that has taken root in many practices flattens this complexity into a line. As a handle, or a rule of thumb. The concept of continuous effects serves as a crowbar to break open this one-dimensionality, not least to do more justice to practice-based research at universities of applied sciences. This allows for a different way of looking at how practice-based research contributes to change: from continuous effects ‘stretching each moment to the fullest’ and indicators of the effects of direct interactions, to multiple action perspectives beyond merely generating new knowledge to bring about change.
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De dissertatie "Probing Futures, Acting Today" van Caroline Maessen onderzoekt hoe organisaties alternatieve toekomsten kunnen verbeelden om dagelijkse toekomstvormende praktijken te veranderen teneinde complexe maatschappelijke uitdagingen aan te pakken. Organisaties hebben de neiging door lineair denken hun verbeeldingsvermogen te beperken tot conventionele toekomsten, wat effectieve reacties op problemen zoals klimaatverandering en sociale ongelijkheid belemmert. Het gevolg is dat na de zoveelste heisessie voor visieontwikkeling, er nog steeds niets fundamenteel verandert. Hoe de toekomst zich ontvouwt, tegen de achtergrond van maatschappelijke complexe problemen, gaat vaak voorbij onze collectieve verbeeldingskracht. Organisaties hebben moeite om zich te verbinden met onconventionele toekomsten en acties in het heden daarop af te stemmen. Voor betekenisvolle verandering moeten organisaties navigeren tussen de aantrekkingskracht van inspirerende onconventionele toekomsten en de behoefte aan stabiliteit en controle. Maessen heeft in twee (semi) publieke organisaties onderzocht waarom dit zo lastig is en hoe organisaties daarin ondersteund kunnen worden.
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The sports club is seen as a new relevant setting to promote health-enhancing physical activity (HEPA) among inactive population groups. Little is known about the effectiveness of strategies and activities implemented in the sports club setting on increasing HEPA levels. This study investigated the effects of Start2Bike, a six-week training program for inactive adults and adult novice cyclers, on HEPA levels of participants in the Netherlands. To measure physical activity, the Short QUestionnaire to ASsess Health-enhancing physical activity was used (SQUASH). Start2Bike participants were measured at baseline, six weeks and six months. A matched control group was measured at baseline and six months. The main outcome measure was whether participants met the Dutch Norm for Health-enhancing Physical Activity (DNHPA: 30 min of moderate-intensity activity on five days a week); Fit-norm (20 min of vigorous-intensity activity on three days a week); and Combi-norm (meeting the DNHPA and/or Fit-norm). Other outcome measures included: total minutes of physical activity per week; and minutes of physical activity per week per domain and intensity category. Statistical analyses consisted of McNemar tests and paired t-tests (within-group changes); and multiple logistic and linear regression analyses (between-group changes).
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We need mental and physical reference points. We need physical reference points such as signposts to show us which way to go, for example to the airport or the hospital, and we need reference points to show us where we are. Why? If you don’t know where you are, it’s quite a difficult job to find your way, thus landmarks and “lieux de memoire” play an important role in our lives.
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We need educators to be constantly updating their skills and knowledge, and evidenced-informed practice is central to this; yet it is far from universal in our schools. Kristin Vanlommel and Chris Brown draw on their international research to show how EIP can be achieved based on three core principles. With this article, we consider the engagement by teachers and school leaders in educational practices that are ‘evidence-informed’ - across school systems and world-wide. There is a growing consensus that effective teaching and leadership is based on evidence-informed practice (or EIP), and that EIP results in improving student learning and achievement.
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