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Objectives: The aims of the study are to systematically evaluate the effect of body weight support training on lower extremity motor function(s) in patients with spinal cord injury and to compare the effect differences among three body weight support training methods. Design: PubMed, Web of Science, Cochrane Library, Embase, CNKI, CBM, China Scientific Journal, and Wan Fang databases were searched until December 31, 2022. Meta-analysis and network meta-analysis were conducted using RevMan 5.4 and ADDIS 1.16.8. Results: Nineteen randomized controlled trials involving 864 patients were included. The meta-analysis showed that body weight support training could improve lower extremity motor scores according to the International Standards for Neurological Classification of Spinal Cord Injury standard (mean difference = 6.38, 95% confidence interval = 3.96–8.80, P < 0.05), walking speed (standard mean difference = 0.77, 95% confidence interval = 0.52–1.02, P < 0.05), and modified Barthel Index scores (mean difference = 9.85, 95% confidence interval = 8.39–11.30, P < 0.05). The network meta-analysis showed no significant difference among the three body weight support training methods for improving lower extremity motor scores in patients with spinal cord injury. The best probability ranking of the body weight support training methods for improving lower extremity motor scores in patients with spinal cord injury was robot-assisted gait training (P = 0.60), followed by aquatic exercise (P = 0.21) and body weight support training (P = 0.19). Conclusions: Body weight support training can improve lower extremity motor score in patients with spinal cord injury. No significant difference was observed among the three body weight support training methods, but robot-assisted gait training may produce the best effect. [ABSTRACT FROM AUTHOR]

This study showed that job crafting and work performance could be efficiently improved by the job crafting intervention program composed of task, relational, and cognitive crafting among younger workers. The current job crafting intervention program could be used as a new strategy to increase work performance of younger workers. Objective: This study reports a randomized controlled trial of the effect of a job crafting intervention program on work performance and job crafting (as secondary outcomes) among Japanese employees. Methods: Participants who satisfied the inclusion criteria were randomly allocated to an intervention (n  = 138) or a control group (n  = 143). Outcomes were measured at baseline and at 3-month and 6-month follow-up in both groups. Results: For the whole sample, the job crafting intervention program showed a nonsignificant effect on work performance and job crafting. However, the program showed a significant effect on these outcomes among younger participants (under 36years old). Conclusions: The job crafting intervention program may not be sufficiently effective to improve work performance and job crafting for the whole sample of participants. However, it may be efficacious for younger workers. [ABSTRACT FROM AUTHOR]

Introduction: Exercise usually results in less weight loss than expected. This suggests increased energy intake and/or deceased expenditure counteract the energy deficit induced by exercise. The aim of this study was to evaluate changes in components of daily energy expenditure (doubly labeled water and room calorimetry) after 24 wk of exercise training with two doses of aerobic exercise. Methods: This was an ancillary study in 42 (29 women, 13 men) sedentary, middle-age (47.8 ± 12.5 yr) individuals with obesity (35 ± 3.7 kg⋅m-2) enrolled in the Examination of Mechanisms of Exercise-induced Weight Compensation study. Subjects were randomized to three groups: healthy living control group (n = 13), aerobic exercise that expended 8 kcal⋅kg-1 of body weight per week (8 KKW, n = 14), or aerobic exercise that expended 20 kcal per kilogram of weight per week (20 KKW, n =15). Total daily energy expenditure (TDEE) was measured in free-living condition by doubly labeled water and in sedentary conditions in a metabolic chamber over 24 h (24EE). Energy intake was calculated over 14 d from TDEE before and after the intervention using the intake-balance method. Results: Significant weight loss occurred with 20 KKW (-2.1 ± 0.7 kg, P = 0.04) but was only half of expected. In the 20 KKW group free-living TDEE increased by ~4% (P = 0.03), which is attributed to the increased exercise energy expenditure (P = 0.001), while 24EE in the chamber decreased by ~4% (P = 0.04). Aerobic exercise at 8 KKW did not induce weight change, and there was no significant change in any component of EE. There was no significant change in energy intake for any group (P = 0.53). Conclusions: Structured aerobic exercise at a dose of 20 KKW produced less weight loss than expected possibly due to behavioral adaptations leading to reduced 24EE in a metabolic chamber without any change in energy intake. [ABSTRACT FROM AUTHOR]

We investigated the effect of moderate versus high-intensity interval exercise training on the heart rate variability (HRV) indices in physically inactive adults. Twenty inactive adults were randomly allocated to receive either moderate-intensity training (MCT group) or high-intensity interval training (HIT group). The MCT group performed aerobic training at an intensity of 55-75%, which consisted of walking on a treadmill at 60-80% of the maximum heart rate (HRmax) until the expenditure of 300 kcal. The HIT group ran on a treadmill for 4 minutes at 85-95% peak HRmax and had a recovery of 4 minutes at 65% peak HRmax until the expenditure of 300 kcal. Supine resting HRV indices (time domain: SDNN = SD of normal-to-normal intervals; rMSSD = root mean square successive difference of R-R intervals and frequency domain: HFLn = high-frequency spectral power; LF = low-frequency spectral power and HF/LF ratio) were measured at baseline and 12 weeks thereafter. The SDNN changes were 3.4 (8.9) milliseconds in the MCT group and 29.1 (7.6) milliseconds in the HIT group {difference between groups 32.6 (95% confidence interval, 24.9 to 40.4 [p = 0.01])}. The LF/HFLn ratio changes were 0.19 (0.03) milliseconds in the MCT group and 0.13 (0.01) milliseconds in the HIT group (p between groups = 0.016). No significant group differences were observed for the rMSSD, HF, and LF parameters. In inactive adults, this study showed that a 12-week HIT training program could increase short-term HRV, mostly in vagally mediated indices such as SDNN and HF/LFLn ratio power. [ABSTRACT FROM AUTHOR]

Introduction: The Diabetes Aerobic and Resistance Exercise trial found that aerobic training and resistance training alone each reduced hemoglobin A1c (HbA1c) compared with nonexercising controls, and combined aerobic and resistance training caused greater HbA1c reduction than either training type alone. Our objective was to determine whether a dose–response relationship existed between frequency of exercise training and HbA1c change, and whether this varied by exercise modality or participant characteristics. Methods: Post hoc analysis of data from 185 Diabetes Aerobic and Resistance Exercise trial participants with type 2 diabetes randomized to aerobic, resistance or combined training thrice weekly. Dose–response relationships between adherence (percent of prescribed training sessions completed) and HbA1c change were assessed with linear regression. Results: Median overall adherence was 84.9% (interquartile range, 74.4%–93.6%). Higher exercise adherence was associated with greater HbA1c reduction; a 20% increase in adherence (e.g., an additional two sessions per month) was associated with a 0.15% (2 mmol·mol−1) decrease in HbA1c (β = −0.0076, R = −0.170, P = 0.021). Significant dose–response relationships were identified for aerobic (β = −0.0142, R = −0.313, P = 0.016) and combined training (β = −0.0109, R = −0.259, P = 0.041), but not resistance training (β = 0.0068, R = 0.153, P = 0.233). Dose–response relationships in all training groups combined were significant in subgroups younger than 55 yr (β = −0.0113, R = −0.286, P = 0.005), males (β = −0.0123, R = −0.234, P = 0.010), and baseline HbA1c ≥7.5% (58 mmol·mol−1) (β = −0.013, R = −0.263, P = 0.011). Conclusions: There was a dose–response relationship between adherence to prescribed exercise and HbA1c reduction suggesting that glycemic control is improved more in individuals with type 2 diabetes with a higher training volume. Dose–response relationships existed for aerobic and combined training but not resistance training. These findings support aerobic and combined exercise prescriptions outlined in clinical practice guidelines. [ABSTRACT FROM AUTHOR]

Aim: Incomplete reporting of interventions in randomized controlled trials (RCTs) may hinder the replicability of studies and thus lead to adverse clinical outcomes for patients. Currently, little is known about the completeness of intervention reporting in neurology clinical trials. This study's primary objective was to determine the completeness of intervention reporting in neurology RCTs, as measured by the Template for Intervention Description and Replication (TIDieR) checklist. The secondary objectives of this study were to compare the completeness of intervention reporting before and after TIDieR publication and to evaluate factors associated with intervention reporting. Methods: We conducted a cross-sectional, pilot-tested, double-blind investigation of 141 neurology RCTs to determine the completeness of intervention reporting in neurology. Results: Overall, the average number of TIDieR checklist items that reached completion per study was 7.4 out of 12 (61.7%). We found no increase in intervention reporting following the publication of TIDieR (P=0.35). Our generalized estimating equation analysis found that poorer TIDieR adherence was associated with trials lacking a trial registration (P=0.03). Conclusion: Our findings showed that on average, authors reported only 61.7% of items on the TIDieR checklist. These findings have significant implications, because incomplete reporting may hinder the replicability of studies and thus negatively affect clinical outcomes for patients. [ABSTRACT FROM AUTHOR]

Supplemental digital content is available in the text. Introduction: Exercise therapy (ET) is advocated as a treatment for chronic nonspecific low back pain (CNSLBP). However, therapy effect sizes remain low. In other chronic disorders, training at higher intensity has resulted in greater improvements on both general health related and disease specific outcomes compared to lower-intensity ET. Possibly, high-intensity training also improves effect sizes in CNSLBP. Objective: To compare the effects of a high-intensity ET program with a similar moderate-intensity ET program on disability, pain, function, exercise capacity, and abdominal/back muscle strength in persons with CNSLBP. Methods: In a randomized controlled trial, persons with CNSLBP performed a 12-wk ET program (24 sessions, 1.5 h per session, twice per week) at high-intensity training (HIT) or moderate-intensity training (MIT). Questionnaires to assess disability (Modified Oswestry Index [MODI]), pain intensity (Numeric Pain Rating Scale), and function (Patient Specific Functioning Scale), a cardiopulmonary exercise test to assess exercise capacity (V˙O2max, cycling time), and a maximum isometric muscle strength test to assess abdominal/back muscle strength (maximum muscle torque) were administered at baseline and after the training program. Results: Thirty-eight participants (HIT: n = 19, MIT: n = 19) were included (mean age, 44.1 yr, SD = 9.8, 12 males). Groups did not differ at baseline. Between group differences (P < 0.01) in favor of HIT were found for MODI, V˙O2max, and cycling time. Within group improvements (P < 0.01) were found in both groups on MODI (HIT:−64%, MIT:−33%), Numeric Pain Rating Scale (HIT, −56%; MIT, −39%), Patient-Specific Functioning Scale (HIT:+37%, MIT:+39%), V˙O2max (HIT:+14, MIT:+4%), cycling time (HIT:+18%, MIT:+13%), and back muscle strength (HIT:+10%, MIT:+14%). Conclusions: High-intensity training proved to be a feasible, well tolerated, and effective therapy modality in CNSLBP. Moreover, it shows greater improvements on disability and exercise capacity than a similar ET performed at moderate intensity. [ABSTRACT FROM AUTHOR]

Supplemental digital content is available in the text. Identifying promoters of cerebral small vein integrity is important to counter vascular contributions to cognitive impairment and dementia. Purpose: In this preliminary investigation, the effects of a randomized 24-month physical activity (PA) intervention on changes in cerebral small vein integrity were compared to those of a health education (HE) control. Methods: Cerebral small vein integrity was measured in 24 older adults (n = 8, PA; n = 16, HE) using ultra-high field MRI before and at the end of the 24-month intervention. Deep medullary veins were defined as straight or tortuous; percent change in straight length, tortuous length, and tortuosity ratio were computed. Microbleed count and white matter hyperintensities were also rated. Results: Accelerometry-based values of PA increased by 17.2% in the PA group but declined by 28.0% in the HE group. The PA group, but not the HE group, had a significant increase in straight vein length from baseline to 24-month follow-up (P = 0.02 and P = 0.21, respectively); the between-group difference in percent change in straight length was significant (increase: median, 93.6%; interquartile range, 112.9 for PA; median, 28.4%; interquartile range, 90.6 for HE; P = 0.07). Between group differences in other markers were nonsignificant. Conclusions: Increasing PA in late-life may promote cerebral small vein integrity. This should be confirmed in larger studies. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study was to evaluate the rate of publication of randomized controlled trials, systematic reviews, and meta-analysis in physical and rehabilitation medicine and its variation over time. Design: We performed a bibliometric study and searched PubMed from inception to 2017, using National Library of Medicine 3rd level MeSH terms ("rehabilitation," "physical therapy modalities," and "drug therapy") and filters ("randomized controlled trial," "systematic reviews," and "meta-analysis"). We used descriptive statistics, and we calculated the best-fitting regression model for all data considered. Results: The absolute number of articles is growing in rehabilitation as much as in other treatment fields such as drug therapy. Whereas the rate of growth of publications for all studies relative to PubMed is bigger for drug therapies than for rehabilitation and physical therapy, the rate of growth of randomized controlled trials, systematic reviews, and meta-analysis is significantly greater for rehabilitation and physical therapy (P < 0.001). In 2017, 19.3% and 28.2% of the total production of scientific articles for rehabilitation and physical therapy (respectively) were for randomized controlled trials and systematic reviews versus 11.3% for drug therapy. Conclusions: Production of the highest form of research evidence (randomized controlled trials, systematic reviews, and meta-analysis) is continuously increasing in physical and rehabilitation medicine at a higher rate than in other treatment fields such as drug therapy. The quality and results of this evidence should be evaluated in future studies. [ABSTRACT FROM AUTHOR]

Purpose: The presence of bone metastases has excluded participation of cancer patients in exercise interventions and is a relative contraindication to supervised exercise in the community setting because of concerns of fragility fracture. We examined the efficacy and safety of a modular multimodal exercise program in prostate cancer patients with bone metastases. Methods: Between 2012 and 2015, 57 prostate cancer patients (70.0 ± 8.4 yr; body mass index, 28.7 ± 4.0 kg⋅m-2) with bone metastases (pelvis, 75.4%; femur, 40.4%; rib/thoracic spine, 66.7%; lumbar spine, 43.9%; humerus, 24.6%; other sites, 70.2%) were randomized to multimodal supervised aerobic, resistance, and flexibility exercises undertaken thrice weekly (EX; n = 28) or usual care (CON; n = 29) for 3 months. Physical function subscale of the Medical Outcomes Study Short-Form 36 was the primary end point as an indicator of patient-rated physical functioning. Secondary end points included objective measures of physical function, lower body muscle strength, body composition, and fatigue. Safety was assessed by recording the incidence and severity of any adverse events, skeletal complications, and bone pain throughout the intervention. Results: There was a significant difference between groups for self-reported physical functioning (3.2 points; 95% confidence interval, 0.4-6.0 points; P = 0.028) and lower body muscle strength (6.6 kg; 95% confidence interval, 0.6-12.7; P = 0.033) at 3 months favoring EX. However, there was no difference between groups for lean mass (P = 0.584), fat mass (P = 0.598), or fatigue (P = 0.964). There were no exercise-related adverse events or skeletal fractures and no differences in bone pain between EX and CON (P = 0.507). Conclusions: Multimodal modular exercise in prostate cancer patients with bone metastases led to self-reported improvements in physical function and objectively measured lower body muscle strength with no skeletal complications or increased bone pain. Trial Registration: ACTRN12611001158954. [ABSTRACT FROM AUTHOR]

Study Design: Randomized controlled trial.Objective: The present study investigated the effectiveness of chewing gum on promoting faster bowel function and its ability to hasten recovery for patients with adolescent idiopathic scoliosis (AIS) after posterior spinal fusion (PSF) surgery.Summary Of Background Data: Sham feeding with chewing gum had been reported to reduce the incidence of postoperative ileus by accelerating recovery of bowel function.Methods: We prospectively recruited and randomized 60 patients with AIS scheduled for PSF surgery into treatment (chewing gum) and control group. The patient-controlled anesthesia usage, wound pain score, abdominal pain score, nausea score, and abdominal girth were assessed and recorded at 12, 24, 36, 48, and 60 hours postoperatively. The timing for the first fluid intake, first oral intake, sitting up, walking, first flatus after surgery, first bowel opening after surgery, and duration of hospital stay were also assessed and recorded.Results: We found that there were no significant differences (P > 0.05) in patient-controlled anesthesia usage, wound pain score, abdominal pain score, nausea score, and abdominal girth between treatment (chewing gum) and control groups. We also found that there were no significant difference (P > 0.05) in postoperative recovery parameters, which were the first fluid intake, first oral intake, sitting up after surgery, walking after surgery, first flatus after surgery, first bowel opening after surgery, and duration of hospital stay between both groups. The wound pain was the worst at 12 hours postoperatively, which progressively improved in both groups. The abdominal pain progressively worsened to the highest score at 48 hours in the treatment group and 36 hours in the control group before improving after that. The pattern of severity and recovery of wound pain and abdominal pain was different.Conclusion: We found that chewing gum did not significantly reduce the abdominal pain, promote faster bowel function, or hasten patient recovery.Level Of Evidence: 1. [ABSTRACT FROM AUTHOR]

Objective: The aims of this work were to evaluate the effects of home-based telesupervising rehabilitation on physical function for stroke survivors with hemiplegia and to determine if the rehabilitation therapy can relieve the burden on caregivers. Design: This study is a randomized, controlled, assessor-blinded trial. Stroke survivors were randomly assigned to either home-based telesupervising rehabilitation group or conventional rehabilitation group to receive physical exercise and electromyography-triggered neuro-muscular stimulation. Modified Barthel Index, Berg Balance Scale, modified Rankin Scale, Caregiver Strain Index, root mean square of extensor carpi radialis longus and tibialis anterior muscle were measured at 3 time points: baseline, postintervention (12 weeks), and 12-week follow-up (24 weeks). Results: Both the home-based telerehabilitation and conventional rehabilitation groups demonstrated significant effects within groups over the 3 time points in increasing Modified Barthel Index, Berg Balance Scale, and root mean square value of extensor carpi radialis longus and tibialis anterior, as well as decreasing Caregiver Strain Index (P < 0.001), but none of the between-group differences was significant. For modified Rankin Scale, the percentage of participants of grades 0 and 1 in 2 groups increased over time without significant difference between the groups. Conclusions: Home-based telesupervising rehabilitation is most likely as effective as the conventional outpatient rehabilitation for improving functional recovery in stroke survivors and could ease the burden of caregivers as conventional rehabilitation. [ABSTRACT FROM AUTHOR]

Background: Measurement of intervention fidelity is an essential component of any scientifically sound intervention trial. However, few papers have proposed ways to integrate intervention fidelity data into the execution of these trials. Objective: The purpose of this article is to describe the intervention fidelity process used in a randomized controlled trial of a human patient simulator intervention and how these data were used to monitor drift and provide feedback to improve the consistency of both intervention and control delivery overtime in a multisite education intervention for parents of children with newly diagnosed Type 1 diabetes. Methods: Intervention fidelity was measured for both the intervention and control condition by direct observation, self-report of interventionist delivery, and parent participant receipt of educational information. Intervention fidelity data were analyzed after 50%, 75%, and 100% of the participants had been recruited and compared by group (treatment and control) and research site. Results: The sample included 191 parents of young children newly diagnosed with Type 1 diabetes. Observations scores in both intervention and control groups indicated a high level of intervention fidelity. Treatment receipt was also high and did not differ by treatment group. The teaching session attendance rates by site and session were significantly different at Time Point 1 (50% enrollment); following study staff retraining and reinforcement, there were no significant differences at Time Point 3 (100% enrollment). Implications: Results demonstrate the importance of monitoring intervention fidelity in both the intervention and control condition over time and using these data to correct drift during the course of a multisite clinical trial. [ABSTRACT FROM AUTHOR]

Objective: To examine a school-based high-intensity neuromuscular training (NMT) program in reducing sport injury risk and improving fitness in youth. Participants: Students (ages 11-15) (n = 725) in physical education (PE) classes were randomized by school to intervention or control groups. Intervention: A 12-week high-intensity NMT program (including aerobic, strength, balance, and agility components) was designed to reduce sport injury risk and improve measures of fitness. The control program was a standard of practice warm-up (including running and stretching). Results: A Poisson regression model using an intent-to-treat analysis demonstrated a reduced risk of sport injury: incidence rate ratio (IRR)all injury = 0.30 (95% CI, 0.19-0.49), IRRlower extremity injury = 0.31 (95% CI, 0.19-0.51), IRRankle sprain injury = 0.27 (95% CI, 0.15-0.50), and IRRknee sprain injury = 0.36 (95% CI, 0.13-0.98). A change in waist circumference: 20.99 centimeters (95% CI, 21.84 to 20.14) and an increase in indirect measures of aerobic fitness: 1.28 mL⋅kg-1 ⋅min-1 (95% CI, 0.66-1.90) in the intervention school compared with the control school also occurred. Conclusions: A NMT program in junior high school PE class was efficacious in reducing sport-related injury and improving measures of adiposity and fitness in the intervention group. [ABSTRACT FROM AUTHOR]

Purpose: Fatigue is a common problem among colon cancer patients and typically increases during chemotherapy. Exercise during chemotherapy might have beneficial effects on fatigue. To investigate the short- and long-term effects of an exercise program in colon cancer patients during adjuvant treatment, the Physical Activity During Cancer Treatment study was conducted. Methods: In this multicenter randomized controlled trial, 33 colon cancer patients under-going chemotherapy (21 men and 12 women) were randomly assigned to either a group receiving an 18-wk supervised exercise program (n = 17) or to usual care (n = 16). The primary outcome was fatigue as measured by the Multidimensional Fatigue Inventory and the Fatigue Quality List. Secondary outcomes were quality of life, physical fitness, anxiety, depression, body weight, and chemotherapy completion rate. Outcome assessment took place at baseline, postintervention (18 wk) and at 36 wk. Results: Intention-to-treat mixed linear model analyses showed that patients in the intervention group experienced significantly less physical fatigue at 18 wk and general fatigue at 36 wk (mean between group differences, -3.2; 95% confidence interval [CI], -6.2 to -0.2; effect size [ES], -0.9 and -2.7; 95% CI, -5.2 to -0.1; ES, -0.8, respectively), and reported higher physical functioning (12.3; 95% CI, 3.3-21.4; ES, 1.0) compared with patients in the usual care group. Conclusion: The Physical Activity During Cancer Treatment trial shows that an 18-wk supervised exercise program in colon cancer patients during chemotherapy is safe and feasible. The intervention significantly reduced physical fatigue at 18 wk and general fatigue at 36 wk. Considering the number of patients included in the present study, replication in a larger study population is required. [ABSTRACT FROM AUTHOR]

Objective: To assess the efficacy of autologous blood injections (ABIs) against saline in patients with chronic recalcitrant patella tendinopathy (PT). Design: Double-blind randomized controlled study. Setting: Homerton Hospital Sports Medicine department. Patients: Those with a diagnosis of refractory patellar tendinopathy were recruited between March 2010 and March 2012. Interventions: Using 2 practitioners, patients were randomized to either receive ABIs or saline injections. Main Outcome Measures: All patients completed the Short-Form McGill Pain Questionnaire (MPQ), a visual analog scale (VAS), and a Victoria Institute of Sport Assessment for Patella Tendinopathy scale over a 12-month period. Results: Twenty-two patients completed the final review at 12 months and were included in the study. Subjects ranged in age from 22 and 61 years and were randomized to 11 in each ABI and saline groups. Autologous blood injection group had a mean duration of symptoms of 16.7 months, whereas that of the saline group was 19.2 months. The saline group mean VAS score was reduced from 7.9 to 4.5 at 1 month (P = 0.003) and 3.3 (P = 0.005) at 1 year. With ABI, the score was reduced from 7.5 to 4.5 (P = 0.005) at 1 month and 3.1 (P = 0.003) at 1 year. Victoria Institute of Sport Assessment for Patella Tendinopathy, MPQ, and VAS scores improved significantly in both groups. Conclusions: This study demonstrated that both the ABI and saline groups experienced a significant improvement in symptoms. However, when the results were compared, there was no statistical difference between the 2 groups. Clinical Relevance: This research showed that tendon fenestra-tion is an alternative cost-effective treatment for recalcitrant PT. [ABSTRACT FROM AUTHOR]

Introduction: Maintenance of normal weight and higher levels of physical activity are associated with a reduced risk of several types of cancer. Because genomic instability is regarded as a hallmark of cancer development, one proposed mechanism is improvement of DNA repair function. We investigated links between dietary weight loss, exercise, and strand break rejoining in an ancillary study to a randomized-controlled trial. Methods: Overweight/obese postmenopausal women (n = 439) were randomized to the following: a) reduced calorie weight loss diet ("diet," n = 118), b) moderate- to vigorous-intensity aerobic exercise ("exercise," n = 117), c) a combination ("diet + exercise," n = 117), or d) control (n = 87). The reduced calorie diet had a 10% weight loss goal. The exercise intervention consisted of 45 min of moderate to vigorous aerobic activity 5 d⋅wk-1 for 12 months. DNA repair capacity was measured in a subset of 226 women at baseline and 12 months from cryopreserved peripheral mononuclear cells using the comet assay. Anthropometric and body composition measures were performed at baseline and 12 months. Results: DNA repair capacity did not change significantly with any of the 12-month interventions compared with control; there were also no significant changes when stratified by changes in body composition or aerobic fitness (...O2max). At baseline, DNA repair capacity was positively associated with weight, body mass index, and fat mass (r = 0.20, P= 0.003; r = 0.19, P = 0.004; r = 0.13, P = 0.04, respectively) and inversely with lean body mass (r = -0.14, P = 0.04). Conclusion: In conclusion, DNA repair capacity in cryopreserved PBMCs (Comet Assay) did not change with dietary weight loss or exercise interventions in postmenopausal women within a period of 12 months. Other assays that capture different facets of DNA repair function may be needed. [ABSTRACT FROM AUTHOR]

Observational studies suggest that physical activity after a breast cancer diagnosis is associated with improved cancer outcomes; however, no randomized data are available. Here, we report an exploratory follow-up of cancer outcomes from the Supervised Trial of Aerobic versus Resistance Training (START). Methods: The START was a Canadian multicenter trial that randomized 242 breast cancer patients between 2003 and 2005 to usual care (n = 82), supervised aerobic (n = 78), or resistance (n = 82) exercise during chemotherapy. The primary end point for this exploratory analysis was disease-free survival (DFS). Secondary end points were overall survival, distant DFS, and recurrence-free interval. The two exercise arms were combined for analysis (n = 160), and selected subgroups were explored. Results: After a median follow-up o f 89 months, there were 25/160 (15.6%) DFS events in the exercise groups and 18/82 (22.0%) in the control group. Eight-year DFS was 82.7% for the exercise groups compared with 75.6% for the control group (HR, 0.68; 95% confidence interval (Cl), 0.37-1.24; log-rank, P = 0.21). Slightly stronger effects were observed for overall survival (HR, 0.60; 95% Cl, 0.27-1.33; log-rank, P = 0.21), distant DFS (HR, 0.62; 95% Cl, 0.32—1.19; log-rank, P = 0.15), and recurrence-free interval (HR, 0.58; 95% Cl, 0.30-1.11; Gray test, P = 0.095). Subgroup analyses suggested potentially stronger exercise effects on DFS for women who were overweight/obese (HR, 0.59; 95% Cl, 0.27-1.27), had stage II/III cancer (HR, 0.61; 95% Cl, 0.31-1.20), estrogen receptor-positive tumors (HR, 0.58; 95% Cl, 0.26-1.29), human epidermal growth factor receptor 2-positive tumors (HR, 0.21; 95% Cl, 0.04-1.02), received taxane-based chemotherapies (HR, 0.46; 95% Cl, 0.19-1.15), and ≥85% o f their planned chemotherapy (HR, 0.50; 95% Cl, 0.25-1.01). Conclusions: This exploratory follow-up o f the START provides the first randomized data to suggest that adding exercise to standard chemotherapy may improve breast cancer outcomes. A definitive phase III trial is warranted. [ABSTRACT FROM AUTHOR]

Purpose: Recent studies suggest that walking on a treadmill improves gait, mobility, and quality of life of patients with Parkinson's disease (PD). Still, there is a need for larger-scale randomized controlled studies that demonstrate the advantages of treadmill training (TT) with control groups that receive similar amounts of attention. Moreover, to date, no study has combined speed and incline as parameters of progression. The aim of the study was to evaluate the effects of 24 wk of TT, with and without the use of incline, on gait, mobility and quality of life in patients with PD. Methods: The sample comprised 34 patients with PD, at the Hoehn and Yahr stage 1.5 or 2. Participants were randomized to speed TT, mixed TT, and control groups. The intervention consisted of 72 one-hour exercise sessions for 24 wk. The main outcome measures are the Movement Disorder Society-Unified Parkinson's Disease Rating Scale, the 39-item Parkinson's Disease Questionnaire, spatiotemporal parameters of gait and 6-min walking distance. The measures were taken at baseline, mid-term and after 6 months. Results: Both TT groups improved in terms of speed, cadence, and stride length during self-selected walking conditions at the study end point. Both groups also showed improvements in distance traveled. Only the Mixed TT group improved their quality of life. The Control group showed no progress. Conclusions: Participants in this study showed significant improvements in walking speed and walking endurance after 6 months of TT. Improvements were observed after 3 months of intensive TT and persisted at 6 months. It appears that individuals with poorer baseline performance may benefit most from TT. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to investigate the effects of additional virtual reality training using Xbox Kinect on upper extremity function, including range of motion, motor function, and gross manual dexterity, in stroke survivors with hemiplegia. Design: This study is a randomized controlled trial. Forty participants were randomly allocated to either the experimental or control groups; the experimental group (n = 20) underwent virtual reality training using Xbox Kinect and conventional occupational therapy, and the control group (n = 20) underwent conventional occupational therapy alone. The mean time since the onset of stroke was 7.22 mos in the experimental group and 8.47 mos in the control group. At baseline and after 6 wks of intervention, range of motion of the upper extremity was measured, and the Fugl-Meyer Assessment and the Box and Block Test were performed. Results: After intervention, significant improvements from baseline values in range of motion of the upper extremity, Fugl-Meyer Assessment scores, and Box and Block Test scores were observed in the experimental and control groups (P < 0.05). At follow-up, there were significant differences between the two groups in range of motion (except for the wrist), Fugl-Meyer Assessment scores, and Box and Block Test scores (P < 0.05). Conclusions: The hemiplegic stroke survivors who received additional virtual reality training using Xbox Kinect showed significantly improved function of the upper extremity. However, the effects of the virtual reality training using Xbox Kinect may have been a result of the greater total intervention time in the training group compared with the control group. Thus, the potential efficacy of Xbox Kinect in the rehabilitation of post-stroke survivors needs to be investigated in greater depth. [ABSTRACT FROM AUTHOR]

Background: People with sickle cell disease (SCD) or sickle cell trait (SCT) may not have information about genetic inheritance needed for making informed reproductive health decisions. CHOICES is a Web-based, multimedia educational intervention that provides information about reproductive options and consequences to help those with SCD or SCT identify and implement an informed parenting plan. Efficacy of CHOICES compared with usual care must be evaluated. Objective: The purpose was to compare immediate posttest effects of CHOICES versus an attention-control usual care Intervention (e-Book) on SCD-/SCT-related reproductive health knowledge, intention, and behavior. Methods: In a randomized controlled study, we recruited subjects with SCD/SCT from clinics, community settings, and online networks with data collected at sites convenient to the 234 subjects with SCD (n = 136) or SCT (n = 98). Their ages ranged from 18 to 35 years; 65% were women, and 94% were African American. Subjects completed a measure of sickle cell reproductive knowledge, intention, and behavior before and immediately after the intervention. Results: Compared with the e-Book group, the CHOICES group had significantly higher average knowledge scores and probability of reporting a parenting plan to avoid SCD or SCD and SCT when pretest scores were controlled. Effects on intention and planned behavior were not significant. The CHOICES group showed significant change in their intention and planned behavior, whereas the e-Book group did not show significant change in their intention, but their planned behavior differed significantly. Discussion: Initial efficacy findings are encouraging but warrant planned booster sessions and outcome follow-ups to determine sustained intervention efficacy on reproductive health knowledge, intention, and actual behavior of persons with SCD/SCT. [ABSTRACT FROM AUTHOR]

The article presents a study which compares the antiswelling and analgesis impact of different ice pack therapy durations in patients with soft tissue injuries. The study uses pretest and posttests, convenient sampling, and randomized block assignment to assess skin temperature, swelling and pain in ice treated areas. Results show that the duration of ice pack therapy can lower skin temperature and reduce partial swelling and pain.

Objective: Chronic lateral epicondylosis is common, debilitating, and often refractory. Prolotherapy (PrT) is an injection therapy for tendinopathy. The efficacy of two PrT solutions for chronic lateral epicondylosis was evaluated. Design: This study is a three-arm randomized controlled trial. Twenty-six adults (32 elbows) with chronic lateral epicondylosis for 3 mos or longer were randomized to ultrasound-guided PrT with dextrose solution, ultrasound-guided PrT with dextrose-morrhuate sodium solution, or watchful waiting ("wait and see"). The primary outcome was the Patient-Rated Tennis Elbow Evaluation ( 100 points) at 4, 8, and 16 wks (all groups) and at 32 wks (PrT groups). The secondary outcomes included pain-free grip strength and magnetic resonance imaging severity score. Results: The participants receiving PrT with dextrose and PrT with dextrose- morrhuate reported improved Patient-Rated Tennis Elbow Evaluation composite and subscale scores at 4, 8, and/or 1 6 wks compared with those in the wait-and- see group (P< 0.05). At 16 wks, compared with baseline, the PrT with dextrose and PrT with dextrose-morrhuate groups reported improved composite Patient- Rated Tennis Elbow Evaluation scores by a mean (SE) of 18.7 (9.6; 41.1%) and 17.5 (1 1.6; 53.5%) points, respectively. The grip strength of the participants receiving PrT with dextrose exceeded that of the PrT with dextrose-morrhuate and the wait and see at 8 and 1 6 wks (P < 0.05). There were no differences in magnetic resonance imaging scores. Satisfaction was high; there were no adverse events. Conclusions: PrT resulted in safe, significant improvement of elbow pain and function compared with baseline status and follow-up data and the wait-and-see control group. This pilot study suggests the need for a definitive trial. [ABSTRACT FROM AUTHOR]

The article discusses research investigating whether measurement error is altered by participation in a physical activity intervention. The researchers argue that some error is inherent in self-report and device-based measures for moderate to vigorous physical activity (MVPA). They add that few studies have been conducted examining agreement between self-report and device-based measures in the context of an intervention trial or whether measures are influenced by intervention participation. The study's experimental design and methodology, a discussion of the results, and researchers' conclusions regarding the effect of intervention on measurement error of self-report relative to an accelerometer are presented.

Introduction: Weight management is a new public health role for community pharmacists in many countries. Lack of expertise is one of the key barriers to counseling obese patients. We evaluated the comparative efficacy of three alternative continuing education (CE) meetings on weight management. Methods: We designed a randomized controlled trial comparing didactic lecture, lecture plus case discussion, and lecture plus small-group training. It was conducted in 2011 in Tehran. Pharmacists' knowledge, attitudes, and competence were evaluated immediately before, immediately after and one month after each meeting via standardized questionnaires and case vignettes. Participants' satisfaction was evaluated after each meeting. Data were analyzed using repeated measure analysis of variance and chi-squared tests. Results: Sixty pharmacists were randomly allocated to each study arm. There were no demographic differences between the arms at the baseline. The knowledge scores significantly improved for all interventions over time. At the follow-up, the small-group training arm obtained significantly higher knowledge scores ( p < 0.001, effect size = 0.54). The competence scores in lecture plus case discussion and lecture plus small-group training meetings improved over time (effect size 0.14 and 0.34; difference nonsignificant). Small-group training resulted in significantly higher satisfaction scores ( p = 0.005). The interventions' effects on attitudes were similar. Discussion: This is the first study on the implementation and efficacy of various types of CE meetings for community pharmacists to provide weight management services. Lecture plus small group training resulted in better learning retention over time and higher satisfaction. Future studies should evaluate the effects of various types of CE meetings on pharmacists' behavior and their cost-effectiveness. [ABSTRACT FROM AUTHOR]

The article reports on research which was conducted to investigate the effects supervised aerobic exercise had on the motivational outcomes and longer-term behavior of lymphoma patients. Researchers evaluated 60 patients. They found that supervised exercise has motivational effects in lymphoma patients and improves longer-term exercise behavior. They concluded that strategies to further enhance the motivational value of supervised exercise in lymphoma patients are warranted and should be developed.

Background: Family caregivers of patients with dementia (PWD) often experience depressive symptoms and use poor coping strategies. Cognitive behavioral interventions may enhance positive appraisals of caregiving-related issues and the utilization of active coping strategies among caregivers, which may help prevent caregiver depression. However, there is a shortage of primary, community-based mental health services in China, and little research has been conducted on the effect of nurse-led mental health programs in this population. Purpose: This study explored the effect of a nurse-led cognitive behavioral intervention on depressive symptoms and coping strategies among family caregivers of PWD in China. Methods: This randomized controlled trial used data from a sample of 112 caregivers screened from 276 potential participants in a city in southeastern China. The sample was randomly assigned to an intervention group (n = 56) and a control group (n = 56). The intervention group received five monthly in-home, nurse-led cognitive behavioral sessions and telephone consultations after each session. The control group received five monthly, short, general conversations with nurse interventionists at the participants' homes, in the hospital, or via telephone. Depressive symptoms, coping strategies, and the demographics of caregiving dyads were collected at Time 1 (baseline), Time 2 (the end of the 5-month intervention), and Time 3 (2-month follow-up). IBM SPSS Statistics Version 19.0 was used for data analysis. Results: Eighty-two participants (intervention group: n = 47, control group: n = 35) completed the three evaluations. No significant group differences were found in baseline characteristics between the two groups. The general linear model repeated-measures analysis of variance indicated a significant difference in depressive symptoms and active coping between groups over time, with p <.001 for the interaction between depressive symptoms and groups and p <.01 for the interaction between active coping and groups. A similar result did not occur for passive coping. The t tests further supported a significant interventional effect on participants' depressive symptoms and active coping. Conclusions/Implications for Practice: This nurse-led cognitive behavioral intervention was effective in decreasing depressive symptoms and improving active coping among study participants. The findings suggest the improvement of mental health services and social policies in China to support family caregivers of PWD. [ABSTRACT FROM AUTHOR]