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To determine if eccentric exercise was effective, safe and feasible in increasing function and quality of life in people with heart failure compared to usual care and a waitlist control group. A prospective, three-armed, parallel-design, assessor-blind, pilot randomised controlled trial with 1:1:1 allocation. Forty-seven participants (16 female; mean age 66 years) with mild to moderate heart failure were randomly allocated to either eccentric exercise, concentric exercise or a waitlist control group. Participants in the exercise groups completed twice-weekly exercise for eight weeks. Primary outcome was walking capacity. Secondary outcomes were quality of life, leg strength and fatigue. Outcomes were assessed at baseline, post intervention and three-month follow-up. Attendance, tolerability and adverse events were used to determine safety and feasibility. Intention-to-treat analysis showed no differences between eccentric exercise and either concentric exercise or waitlist for any outcome. Per-protocol analysis found improvements identified by the Minnesota living with heart failure questionnaire were significantly greater post-intervention for eccentric exercise compared to concentric exercise (−17.99 units, 95% confidence interval −35.96 to −0.01). No major adverse events were reported. In this small trial, eccentric exercise did not demonstrate superior outcomes to concentric exercise or a waitlist control group. The protocol for this trial was registered at clinicaltrials.gov, registration number: NCT02223624, registration date: 22 August 2014. Regular physical activity and referral to rehabilitation is recommended for people with chronic heart failure, however exercise can be challenging for this group. Eccentric exercise was safe and tolerable for participants with heart failure. Documentation of exercise progression is important to demonstrate a dose–response relationship. In this study there were no differences between groups who received eccentric exercise, concentric exercise or no exercise. [ABSTRACT FROM AUTHOR]

Purpose: To determine the effects of sit-to-stand exercise programs on patient-related outcomes in people with physical impairments due to health conditions. Methods: This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered prospectively. Seven electronic databases were systematically searched for relevant articles. Inclusion and exclusion criteria were used to screen the titles and abstracts of articles identified using the key search terms of sit-to-stand and exercise. Only randomized controlled trials were included. The methodological quality of papers was assessed using the Cochrane risk of bias tool. Results: A total of eight trials were included. A meta-analysis was conducted using four of the trials that focused on patients with neurological conditions. There was moderate-quality evidence that sit-to-stand exercise programs improve sit-to-stand performance, but no evidence from another meta-analysis that sit-to-stand training improved balance for patients with neurological conditions. There was also no evidence from individual trials that positive changes occurred in the outcomes of gait speed and distance, lower limb muscle strength, falls, or participation. Conclusions: Sit-to-stand training could be a useful intervention when patients have limited sit-to-stand function and the aim of treatment is to improve this performance. Sit-to-stand training could be a useful intervention for patients when the aim is to improve sit-to-stand performance. Sit-to-stand training may not be a useful intervention when the aim is to improve other functions such as balance. [ABSTRACT FROM AUTHOR]

Purpose: To examine the validity and reliability of an activity monitor to estimate upper limb activity.Methods: Thirty-two adults after distal radial fracture were recruited. 15 adults performed five upper limb activities during two testing sessions, one week apart to investigate criterion validity against the criterion reference of three-dimensional motion analysis, convergent validity, and test-retest reliability. 17 adults in two therapy groups wore monitors for three consecutive days at baseline and six weeks post-intervention. Hypothesis testing (noninferiority) assessed comparison of group differences.Results: There were large, significant positive correlations between monitor counts and motion analysis for affected/unaffected wrists during the grocery shelving [r = 0.82, r = 0.73, respectively] and floor sweeping activities [r = 0.54, r = 0.59, respectively]. Large confidence intervals relative to means suggests the monitor could not accurately predict motion analysis distance or acceleration. Relative reliability was excellent in affected/unaffected wrists for crank ergometer [ICC(2,1) = 0.91, ICC(2,1) = 0.88, respectively], grocery shelving [ICC(2,1) = 0.83, ICC(2,1) = 0.89, respectively], and table dusting activities [ICC(2,1) = 0.77, ICC(2,1) = 0.83, respectively]. Correlations and reliability for typing were poor; hypothesis testing of group equivalence was not confirmed.Conclusions: There is preliminary evidence that an activity monitor is a valid and reliable tool to measure gross arm activity after distal radial fracture. Implications for Rehabilitation Distal radius fractures are one of the most common upper limb fractures that cause activity limitations and participation restrictions.After a distal radius fracture patients are often referred to therapy (physiotherapy, occupational therapy, hand therapy) for rehabilitation to return to pre-injury function and activity levels.Activity monitors may be a valid and reliable measurement tool that therapists can use with their patients to quantify gross arm activity to enable monitoring of injury recovery and rehabilitation adherence.Activity monitors may not be sufficiently reliable and valid to monitor fine movements of the wrist and hand after distal radius fracture. [ABSTRACT FROM AUTHOR]

Question What is the effect of exercise on increasing participation and activity levels and reducing impairment in the rehabilitation of people with upper limb fractures? Design Systematic review of controlled trials. Participants Adults following an upper limb fracture. Intervention Any exercise therapy program, including trials where exercise was delivered to both groups provided that the groups received different amounts of exercise. Outcome measures Impairments of body structure and function, activity limitations and participation restrictions. Results Twenty-two trials were identified that evaluated 1299 participants with an upper limb fracture. There was insufficient evidence from 13 trials to support or refute the effectiveness of home exercise therapy compared with therapist-supervised exercise or therapy that included exercise following distal radius or proximal humeral fractures. There was insufficient evidence from three trials to support or refute the effectiveness of exercise therapy compared with advice/no exercise intervention following distal radius fracture. There was moderate evidence from five trials (one examining distal radius fracture, one radial head fracture, and three proximal humeral fracture) to support commencing exercise early and reducing immobilisation in improving activity during upper limb rehabilitation compared with delayed exercise and mobilisation. There was preliminary evidence from one trial that exercise to the non-injured arm during immobilisation might lead to short-term benefits on increasing grip strength and range of movement following distal radius fracture. Less than 40% of included trials reported adequate exercise program descriptions to allow replication according to the TIDieR checklist. Conclusion There is emerging evidence that current prescribed exercise regimens may not be effective in reducing impairments and improving activity following an upper limb fracture. Starting exercise early combined with a shorter immobilisation period is more effective than starting exercise after a longer immobilisation period. Registration CRD42016041818. [Bruder AM, Shields N, Dodd KJ, Taylor NF (2017) Prescribed exercise programs may not be effective in reducing impairments and improving activity during upper limb fracture rehabilitation: a systematic review. Journal of Physiotherapy 63: 205–220] [ABSTRACT FROM AUTHOR]

Purpose: To explore the perceived effects of an aerobic exercise program delivered in specialist schools for young people with cerebral palsy with high support needs. Methods: In-depth interviews were completed with 8 students with cerebral palsy, 10 parents, 8 teachers and 7 physiotherapists. Interviews were audio-recorded, transcribed verbatim and independently coded by two researchers. Data were analyzed using thematic analysis. Results: Two themes emerged: one about program impact and the second about influential design features. Exercise was perceived as important, and participants indicated that the program had resulted in positive physical (e.g., improved ease of mobility, fitness and stamina) and psychosocial (e.g., happiness, social experience, challenge) impacts. The school setting, program staff and student attitudes were key features of the program. Conclusions: These data converge with those from a randomized controlled trial and attribute physical and psychosocial benefits to a specialist school-based exercise program for young people with cerebral palsy. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the safety, adherence, and estimates of effect of an aerobic exercise program in specialist schools for young people with cerebral palsy. Methods: Nineteen students with cerebral palsy were randomly allocated to an intervention group who completed an aerobic exercise program (27 sessions over nine weeks) or a control group who completed social/art activities over the same time. Results: There were no serious adverse events and the exercise program was completed with high rates of attendance (77%) and adherence to target heart rate zones (79%). Effect sizes favored the intervention group for measures of cardiovascular performance (sub-maximal treadmill test, effect size d = 0.7; muscle power sprint test, d = 0.9) and participation (Preference for Active-Physical Activities, d = 0.6). Conclusions: An aerobic exercise program in specialist schools for young people with cerebral palsy, that may improve measures of cardiovascular performance, can be completed safely, with moderately high levels of adherence. [ABSTRACT FROM AUTHOR]

Question: Does a program of exercise and structured advice implemented during the rehabilitation phase following a distal radial fracture achieve better recovery of upper limb activity than structured advice alone? Design: A phase I/II, multi-centre, randomised, controlled trial with concealed allocation, assessor blinding and intention-to-treat analysis. Participants: Thirty-three adults (25 female, mean age 54 years) following distal radial fracture managed in a cast. Intervention: The experimental intervention was a 6-week program of progressive exercise and structured advice implemented over three consultations by a physiotherapist. The control intervention was a program of structured advice only, delivered by a physiotherapist over three consultations. Outcome measures: The primary outcome was upper limb activity limitations, assessed by the Patient-Rated Wrist Evaluation and the shortened version of the Disabilities of the Arm, Shoulder and Hand outcome measure (QuickDASH). The secondary outcomes were wrist range of movement, grip strength and pain. All measures were completed at baseline (week 0), after the intervention (week 7) and at 6 months (week 24). Results: There were no significant between-group differences in upper limb activity as measured by the Patient-Rated Wrist Evaluation at week 7 and week 24 assessments (mean difference –4 units, 95% CI –10 to 2; mean difference 0 units, 95% CI –3 to 3, respectively), or QuickDASH at week 7 and week 24 assessments (mean difference –5 units, 95% CI –16 to 6; mean difference 0.3 units, 95% CI –6 to 7, respectively). The secondary outcomes did not demonstrate any significant between-group effects. Conclusion: The prescription of exercise in addition to a structured advice program over three physiotherapy consultations may convey no extra benefit following distal radial fracture managed in a cast. Trial registration: ACTRN12612000118808. [Bruder AM, Shields N, Dodd KJ, Hau R, Taylor NF (2016) A progressive exercise and structured advice program does not improve activity more than structured advice alone following a distal radial fracture: a multi-centre, randomised trial. Journal of Physiotherapy 62: 145-152] [ABSTRACT FROM AUTHOR]

Understanding the perceptions of stakeholders is critical for determining acceptability and feasibility of volunteer-mediated programs. This study evaluated the feasibility and acceptability for staff, volunteers, patients and their carers, of a volunteer diversional therapy program for patients with cognitive impairment undergoing inpatient rehabilitation. Post-program structured interviews were conducted with the volunteers (n = 10), patients (n = 30) and their carers (n = 3); and nursing staff (n = 6) participated in a focus group. Thematic analysis identified five themes (values, attitudes, knowledge, purpose, support) in two dimensions (personal, team culture). Overall, patients, carers, staff and volunteers were satisfied with the volunteer program and perceived benefits for quality of care. Recommendations for improvements to the program related to staff engagement with the program and the volunteers’ education and training. The volunteer diversional therapy pilot program for patients with cognitive impairment on a sub-acute ward was acceptable and feasible for patients, carers, staff and volunteers. [ABSTRACT FROM AUTHOR]

Question: What is the effect of exercise on reducing impairment and increasing activity in the rehabilitation of people with upper limb fractures? Design: Systematic review of controlled trials. Participants: Adults following an upper limb fracture. Intervention: Any exercise therapy program, including trials where exercise was delivered to both groups providing there was an expectation of different amounts of exercise. Outcome measures: Body structure and function, and activity limitations. Results: 13 relevant trials involving 781 participants with an upper limb fracture were identified. 12 of the 13 trials included exercise of different duration and administration in both intervention and comparison groups. In support of the role of exercise there is evidence that: exercise and advice compared to no intervention reduce pain and improve upper limb activity in the short term after distal radius fracture; starting exercise earlier after conservatively managed proximal humeral fractures can reduce pain and improve shoulder activity; and physiotherapy that included supervised exercise and home exercise increased wrist movement after distal radius fracture when compared to home exercise alone. There is contrary evidence from two trials one after distal radius fracture and one after proximal humeral fracture that a home exercise program was superior to a supervised plus home exercise program. Only a single meta-analysis was conducted due to clinical heterogeneity and a lack of common outcome measures among the included trials. Conclusion: There is evidence to support the role of specific exercise regimens in reducing impairments and improving upper limb function following specific upper limb fractures. [Copyright &y& Elsevier]

Abstract: Willoughby KL, Dodd KJ, Shields N, Foley S. Efficacy of partial body weight–supported treadmill training compared with overground walking practice for children with cerebral palsy: a randomized controlled trial. Objective: To evaluate the efficacy of 9 weeks of twice-weekly partial body weight–supported treadmill training (PBWSTT) for children with cerebral palsy (CP) and moderate to severe walking difficulty compared with overground walking. Design: Randomized controlled trial. Setting: Metropolitan Specialist School for children with moderate to severe physical and/or intellectual disabilities. Participants: Thirty-four children classified level III or IV by the Gross Motor Function Classification System were recruited and randomly allocated to experimental or control groups. Of these, 26 (15 girls, 11 boys; mean age 10y, 10mo ± 3y, 11mo [range, 5–18y]) completed training and testing. Interventions: Both groups completed 9 weeks of twice-weekly walking training. The experimental group completed PBWSTT, and the control group completed overground walking practice. Main Outcome Measures: Ten-meter walk test (self-selected walking speed), 10-minute walk (walking endurance), School Function Assessment. Results: The overground walking group showed a trend for an increase in the distance walked over 10 minutes (F=3.004, P=.097). There was no statistically significant difference in self-selected walking speed over 10 meters or in walking function in the school environment as measured by the School Function Assessment. Conclusions: PBWSTT is safe and feasible to implement in a special school setting; however, it may be no more effective than overground walking for improving walking speed and endurance for children with CP. Continued emphasis on progressive reduction of body weight support along with adding concurrent overground walking practice to a treadmill training protocol may increase the intensity of training and assist with carryover of improvements to overground walking. Treadmill training programs that include concurrent overground walking as an additional key feature of the training protocol need to be rigorously evaluated for children with CP. [Copyright &y& Elsevier]

Abstract: Shields N, Taylor NF, Dodd KY. Effects of a community-based progressive resistance training program on muscle performance and physical function in adults with Down syndrome: a randomized controlled trial. Objective: To determine whether progressive resistance training improves muscle strength, muscle endurance, and physical function in adults with Down syndrome. Design: Single-blind randomized controlled trial. Setting: General community. Participants: Adults (N=20) with Down syndrome (13 men, 7 women; mean age, 26.8±7.8y) were randomly assigned through a concealed allocation block randomized method to either an intervention group (n=9) or a control group (n=11). Intervention: The intervention was a supervised, group progressive resistance training program, consisting of 6 exercises using weight machines performed twice a week for 10 weeks. Participants completed 2 to 3 sets of between 10 to 12 repetitions of each exercise until they reached fatigue. The control group continued with their usual activities. Main Outcome Measures: The outcomes measured by blinded assessors were muscle strength (1-repetition maximum [1-RM]), muscle endurance (number of repetitions at 50% of 1-RM) for chest press and leg press, timed stairs test, and the grocery shelving task. Results: The intervention group showed significant improvement in upper-limb muscle endurance compared with the control group (mean difference in the number of repetitions of the chest press at 50% of 1-RM was 16.7, 95% confidence interval, [CI] 7.1–26.2); and a trend toward an improvement in upper-limb muscle strength (mean difference in chest press 1-RM, 8.6kg; 95% CI, −1.3 to 18.5kg) and in upper-limb function (mean difference in grocery shelving task, −20.3s; 95% CI, −45.7 to 5.2s). There were no significant differences between the groups for lower-limb muscle performance or physical function measures. No major adverse events for the intervention were noted. Conclusions: Progressive resistance training is a safe and feasible fitness option that can improve upper-limb muscle endurance in adults with Down syndrome (ACTR identifier ACTRN 012606000515594.) [Copyright &y& Elsevier]

Abstract: Mackintosh SF, Hill KD, Dodd KJ, Goldie PA, Culham EG. Balance score and a history of falls in hospital predict recurrent falls in the 6 months following stroke rehabilitation. Objective: To investigate predictors of recurrent falls in adults who return to community dwelling after stroke rehabilitation. Design: Prospective observational study. Setting: Community. Participants: Fifty-five adults with stroke (mean age ± standard deviation, 68.1±12.8y). Interventions: Not applicable. Main Outcome Measures: Baseline measures included balance, gait speed, muscle strength and tone, activity level, hemianopia, visual contrast sensitivity, hemineglect, medication use, fear of falling, and depression. Participants kept a 6-month prospective falls diary after discharge from rehabilitation. Results: Twenty-five (45%) participants reported falling, 12 had recurrent falls (≥2 falls), and 13 fell once. Participants who fell recurrently had histories of falling during hospitalization or rehabilitation, poorer physical function measures, were taking more medications, and were more likely to have hemineglect than participants who fell once or did not fall (P<.05). A history of falling in the hospital or during rehabilitation, combined with poor balance (either Berg Balance Scale score <49 or step test score <7), predicted recurrent falls with sensitivity and specificity values greater than 80%. Conclusions: Falls are a common occurrence after stroke. The predictive model developed can be used to identify people who are likely to have recurrent falls in the 6 months after stroke rehabilitation. [Copyright &y& Elsevier]

Abstract: Dodd KJ, Shields N. A systematic review of the outcomes of cardiovascular exercise programs for people with Down syndrome. Objective: To determine if cardiovascular exercise programs are beneficial and safe for people with Down syndrome. Data Sources: Electronic databases were searched from the earliest time available through to October 2004 using the following key words: Down syndrome or trisomy 21 in combination with physical fitness, exercise, physical activity, exercise therapy, exercise training, physical training, and aerobic. Additional articles were identified by manual searching and citation tracking. Study Selection: Two reviewers independently assessed the articles identified in the initial search for the following inclusion criteria: (1) participants with Down syndrome, (2) an exercise program that conformed with the American College of Sports Medicine guidelines for increasing cardiovascular fitness, (3) assessed changes in body structure or function, activity limitation, or societal participation, and (4) used a prospective clinical controlled research design with or without random allocation to groups. Trials of low methodologic quality were excluded (PEDro score, <4). Of the 156 articles initially identified, only 4 met the inclusion criteria and underwent detailed review. Data Extraction: Data relating to changes in body structure and function, activity limitation, participation restriction, and contextual factors from the included studies were independently extracted by the reviewers on a standardized form. Study quality was assessed using the PEDro scale. Data Synthesis: Meta-analyses found that cardiovascular exercise programs were effective in increasing peak oxygen consumption (d=.75; 95% confidence interval [CI], 0.34–1.15), peak minute ventilation (d=.71; 95% CI, 0.15–1.28), the maximum workload achieved (d=.96; 95% CI, 0.45–1.45), and the time to exhaustion (d=.72; 95% CI, 0.29–1.15) in people with Down syndrome. No changes were found for body weight (d=.09; 95% CI, −.39 to .57). No adverse effects were reported in any of the studies. Conclusions: The result of our review support the use of programs designed to improve cardiovascular fitness among people with Down syndrome. However, because only 4 studies were included, the findings need to be interpreted cautiously. High-quality randomized controlled trials should be completed in the future to determine the effect of these programs on activity and social participation. [Copyright &y& Elsevier]

Because muscle weakness is a common and persistent complication after bony fracture, we reviewed the literature systematically to find out if strength-training can reduce disability after adult fracture. Searching of electronic databases with inclusion criteria resulted in a final yield of three papers. These three studies were conducted after lower limb fractures and the calculated effect sizes collectively demonstrated that strength training led to increased muscle strength and activity levels. However, subsequent losses of strength and activity were found in the two studies that included a follow-up period. Despite a clear rationale for including strength-training programs as part of fracture rehabilitation to improve muscle weakness, very little research has been carried out. This systematic review provides preliminary evidence that strength-training may be beneficial after fracture and should be considered as a rehabilitation option by physical therapists. Further high quality studies are required to find out if the results can be replicated and generalised. [ABSTRACT FROM AUTHOR]

Background and Purpose. Computerized force platform systems are becoming more widely used in clinical practice to measure balance control; however, their retest reliability has not been documented in people with hip fracture. The present study examined the retest reliability of dynamic weight shift during standing in older people after surgical treatment of hip fractures. Method. This single group test--retest research design employed a computerized force platform system (the Neurocom Pro-Balance Master; PBM) to measure the amplitude and symmetry of weight shift in 14 patients with unilateral hip fracture on three test occasions held one hour and 24 hours apart. Subjects performed six trials of a forward--backward and side-to-side weight shift task at each test session. Results. The results showed that reliability was, at best, moderate for forward--backward and side-to-side weight shift measures taken over an hour and over a day. Conclusions. Clinicians should be cautious when using the computerized balance assessment procedures investigated in this study to assess change in dynamic balance ability in older people during the early stages of rehabilitation after surgical treatment of hip fractures. [ABSTRACT FROM AUTHOR]