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PURPOSE We investigated the effectiveness, safety and compliance of Zheng's Supine Rehabilitation Exercise (ZSRE) as a rehabilitation programme among elderly patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). PATIENTS AND METHODS About 82 elderly patients with AECOPD were divided into a rehabilitation group and control group on their admission day, and both groups received routine medical treatment. Patients in the rehabilitation group started ZSRE on the second day of admission and continued until 8 weeks after discharge. RESULTS At the 9th week after discharge, the COPD Assessment Test (CAT), 6-minute walking distance (6MWD) and Modified Medical Research Council Dyspnea Scale (mMRC) in the rehabilitation group were all significantly better than those in the control group (P

Bedridden patients usually stay in bed for long periods, presenting several problems caused by immobility, leading to a long recovery process. Thus, identifying physical rehabilitation programs for bedridden patients with prolonged immobility requires urgent research. Therefore, this scoping review aimed to map existing physical rehabilitation programs for bedridden patients with prolonged immobility, the rehabilitation domains, the devices used, the parameters accessed, and the context in which these programs were performed. This scoping review, guided by the Joanna Briggs Institute’s (JBI) methodology and conducted in different databases (including grey literature), identified 475 articles, of which 27 were included in this review. The observed contexts included research institutes, hospitals, rehabilitation units, nursing homes, long-term units, and palliative care units. Most of the programs were directed to the musculoskeletal domain, predominantly toward the lower limbs. The devices used included lower limb mobilization, electrical stimulation, inclined planes, and cycle ergometers. Most of the evaluated parameters were musculoskeletal, cardiorespiratory, or vital signs. The variability of the programs, domains, devices and parameters found in this scoping review revealed no uniformity, a consequence of the personalization and individualization of care, which makes the development of a standard intervention program challenging., This research was co-financed by the European Regional Development Fund (ERDF) through the partnership agreement Portugal 2020—Operational Programme for Competitiveness and Internationalization (COMPETE2020) under the project POCI-01-0247-FEDER-047087 ABLEFIT: Desenvolvimento de um Sistema avançado para Reabilitação.

Background and Objectives: Rotator cuff tear is the most common cause of shoulder pain. If nonsurgical treatment fails, arthroscopic rotator cuff repair (ARCR) is recommended. Since the standards for rehabilitation after ARCR are not clear, various rehabilitation methods have been suggested. This study intends to investigate the effect on the recovery phase of ARCR patients through a postoperative rehabilitation protocol (PRP) that considers the healing process and rehabilitation trend. Materials and Methods: This single-arm, pragmatic intervention study was conducted on 30 patients, two weeks postoperative day (POD) after ARCR. ARCR patients received intervention for six weeks from POD two-week, and pain intensity and shoulder function were evaluated at two-week intervals until POD 12-week, and range of motion (ROM) was evaluated at POD four-week and eight-week. Results: In this study, all variables improved over time (p < 0.05). As a result of the comparison between time points, a significant improvement was found in shoulder function at POD 6-week. In addition, the effect size had a large effect on ROM (flexion, scaption flexion, abduction, and external rotation) and shoulder function. Conclusions: Management through the PRP based on scientific evidence in the strategy of postoperative rehabilitation of patients with ARCR is effective for pain intensity, ROM, and shoulder function.

Introduction: The knee joint is a complex and important joint in the human body. It plays an active role in maintaining posture balance of the human body in sports, allowing one to bear a larger load and complete various complex technical movements. Objective: To investigate the stability and influence of kinemechanics in knee joint rehabilitation training. Methods: A total of 80 patients with anterior cruciate ligament injury who received treatment in Henan Provincial People's Hospital were selected and divided into control group and observation group according to the random number table method, with 40 cases in each group. Results: Six months after surgery, the peak torque (PT), peak torque to body weight ratio (PT/BWT), total work (TWT), Lysholm score and Tegner score, and knee circumference of the two groups were significantly improved compared with those before surgery (P

A rehabilitation program after anterior cruciate ligament reconstruction is of great importance to obtain a satisfactory prognosis after surgery. However, there is still an onging debate over whether closed kinetic chain or open kinetic chain exercises should be chosen. Our study was designed to compare the in vivo tibiofemoral kinematics during closed kinetic chain and open kinetic chain exercises. Eighteen healthy volunteers were asked to perform box squat and unloaded/10 kg-loaded seated knee extension. In vivo 3-dimensional analysis of tibiofemoral kinematics of different motions were determined using a dual fluoroscopic imaging system. The study found significantly more tibial anterior displacement during loaded seated knee extension than during unloaded seated knee extension from 25 degrees-50 degrees of knee flexion (p < 0.031). The knees exhibited significantly more internal tibial rotation and lateral tibial translation during the box squat than both seated knee extensions during mid-flexion. In addition, the knees showed less internal-external (IE) range of motion (ROM) from 20 degrees- 75 degrees of flexion (p < 0.001) and medial-lateral (ML) ROM from 75 degrees to full extension (p < 0.006) during box squat than both extensions. This knowledge may help optimize rehabilitation plans for patients post ACL reconstruction.

A rehabilitation program after anterior cruciate ligament reconstruction is of great importance to obtain a satisfactory prognosis after surgery. However, there is still an onging debate over whether closed kinetic chain or open kinetic chain exercises should be chosen. Our study was designed to compare the in vivo tibiofemoral kinematics during closed kinetic chain and open kinetic chain exercises. Eighteen healthy volunteers were asked to perform box squat and unloaded/10 kg-loaded seated knee extension. In vivo 3-dimensional analysis of tibiofemoral kinematics of different motions were determined using a dual fluoroscopic imaging system. The study found significantly more tibial anterior displacement during loaded seated knee extension than during unloaded seated knee extension from 25 degrees-50 degrees of knee flexion (p < 0.031). The knees exhibited significantly more internal tibial rotation and lateral tibial translation during the box squat than both seated knee extensions during mid-flexion. In addition, the knees showed less internal-external (IE) range of motion (ROM) from 20 degrees- 75 degrees of flexion (p < 0.001) and medial-lateral (ML) ROM from 75 degrees to full extension (p < 0.006) during box squat than both extensions. This knowledge may help optimize rehabilitation plans for patients post ACL reconstruction.

Background Despite the proven benefits of exercise rehabilitation for numerous health conditions, musculoskeletal injuries and recovery from surgery, patient adherence to such programs is reported to often be less than 35%. Increasing patient engagement therefore has the potential to improve patient health outcomes, benefiting the patient, their carers and the services that support them. The aims of this review were to identify the factors that contribute to ‘patient’ engagement in prescribed exercise rehabilitation using the COM-B (capability, opportunity, motivation-behaviour) framework of behavioural analysis. Methods Five electronic databases (PubMed, Embase, Cochrane, Web of Science, and ClinicalTrials.gov) were searched. ‘COM-B’ was the key word searched for specifically within titles and abstracts, combined with either ‘physical activity’ OR ‘exercise’ included using the ‘AND’ operation. Records were then filtered and excluded following full-text screening based on the predetermined eligibility criteria. Results Twenty studies were included in the review. The main COM-B themes highlighted for improving patient engagement were: capability—improving patient knowledge and cognitive skills for behavioural regulation, such as ‘action planning’ and ‘action control’, which could also benefit time-management; opportunity—a balanced life situation that enabled time to be devoted to the exercise program, social support, easily accessible and affordable resources and services; and motivation—increasing patient levels of self-efficacy and autonomous motivation, which were noted to be influenced by levels of perceived ‘capability’, additionally ‘motivation’ was noted to be influenced by patients perceiving the benefits of the exercise, and adherence to the program was promoted by ‘goal-setting’. Other issues in the ‘capability’ domain included a fear and/or dislike of exercise. Conclusion Patient engagement behavior has been shown to be influenced by both external (opportunity) and intrapersonal variables (capability and motivation). Those prescribing exercises within a rehabilitation program need to discuss these factors with their patients and co-design the exercise rehabilitation program in partnership with the patient, since this is likely to improve patient engagement, and thereby result in superior health outcomes. Furthermore, these factors need to be a consideration in clinical trials, if the findings from such trials are to translate into mainstream healthcare settings.

Research Letter

Musculoskeletal disorders (MSKDs) are the most common causes of disabilities for older adults. The aim of this systematic review and meta-analysis is to assess the effectiveness of multimodal interventions including exercise rehabilitation for older adults with chronic MSKDs.A literature search was conducted up to February 2019 in 5 bibliographical databases to identify randomized controlled trials (RCTs) that compared multimodal interventions including exercise rehabilitation with usual medical care or no intervention. Randomized controlled trials were assessed with the Cochrane risk-of-bias tool. Meta-analyses were performed and pooled mean differences (MDs) or standardized mean differences (SMDs) were calculated.Sixteen RCTs (n = 2322 participants) were included. One RCT was considered at low risk of bias, 8 had some concerns of bias, and 7 had a high risk of bias. Participants suffered from hip or knee osteoarthritis (OA) (n = 12 RCTs), low back pain (LBP) (n = 2 RCTs) and generalized chronic pain (GCP) (n = 2 RCTs). Multimodal interventions were significantly more effective than usual care to decrease pain (visual analog scale, out of 10 points) in the short term, MD: -0.71 (95% confidence interval [CI] -1.08 to -0.34, n = 900), and in the long term: MD: -0.52 (95% CI -0.98 to -0.05, n = 575), but these differences are not considered clinically important. In terms of disabilities, multimodal interventions were also significantly more effective than usual care. The SMDs were -0.47 (95% CI -0.61 to -0.34, n = 903) and -0.29 (95% CI -0.46 to -0.13, n = 568) for OA trials in the short and long terms, respectively, and -0.47 (95% CI -0.81 to -0.12, n = 211) for LBP and GCP trials in the short term. The magnitude of these effects may be considered as small to moderate.Multimodal intervention including exercise rehabilitation combined with usual medical care is an efficacious therapeutic option to reduce disabilities in older adults with chronic MSKDs. A significant but not clinically important effect was observed for pain. The most beneficial component of the multimodal interventions in terms of education, exercises, or medication remains to be determined.

BACKGROUND: COVID-19 has become a significant healthcare issue, particularly challenging for patients with ankylosing spondylitis (AS), because immune-related diseases and their treatments could adversely affect the susceptibility to or severity of a viral infection. OBJECTIVE: This study is conducted to present an exercise rehabilitation program that patients older than 60 years with AS can do at home during the COVID-19 pandemic. METHODS: Three Delphi surveys were conducted to reach a consensus on home-based rehabilitation programs. This study recruited ten experts and performed three Delphi rounds for a month. RESULTS: The expert panel suggested that home-based rehabilitation for the patients should be carried out with a clear rehabilitation goal. Their final recommendations are to institute a program aimed to ease symptoms, such as pain and stiffness; encourage patients to consult with experts regularly to ensure that they perform exercise rehabilitation properly at home; add fast walking and stretching to the rehabilitation program; and see if indoor cycling, Pilates, or yoga could be appropriate. CONCLUSIONS: This study suggests that patients with AS over 60 should repeat low-intensity exercises, such as stretching, for an hour a day, four to six times a week during the COVID-19 pandemic.

Bedridden patients usually stay in bed for long periods, presenting several motor problems caused by immobility, such as reductions in muscle mass, bone mineral density and physical impairment, resulting in a long recovery process. Thus, identifying physical rehabilitation programs for bedridden patients with prolonged immobility is a matter of urgent research for a solution that will help health professionals and stakeholders to develop more adjusted programs and identify possible gaps. To date, no previous scoping reviews addressing this purpose have been found. This scoping review will be guided by the Joanna Briggs Institute (JBI) methodology, will focus on physical rehabilitation programs for bedridden patients with prolonged immobility and aims to map the programs, the devices used, and the parameters assessed. A relevant set of electronic databases and grey literature will be searched. Data extraction will be conducted using a tool developed by the research team that will address the review objectives and questions. Data synthesis will be presented in tabular form and a narrative summary aligned with the review’s objective. This scoping review will contribute to the improvement of clinical practice, identifying key challenges that might justify the need to develop new programs suitable in clinical and organizational contexts.

This review hypothesizes that the neurologist represents the linchpin of exercise behavior change within comprehensive multiple sclerosis (MS) care settings. This is based on a series of recent articles that developed actionable practice models for accomplishing such behavior change through the neurologist as the primary agent. This provides tangible, next steps for exercise promotion in MS.

Conventional ankle rehabilitation exercises can be monotonous and repetitive. The use of robots and games can complement the existing practices, provide an engaging environment for the patient and alleviate the physiotherapist’s workload. This paper presents an ankle rehabilitation robot that uses two nitinol wire actuators and a Pong game to provide foot plantarflexion and dorsiflexion exercises. Nitinol is a type of smart material that has high volumetric mechanical energy density and can produce translational motion. A two-state discrete antagonistic control is proposed to manipulate the actuators. The system was tested on healthy participants and stroke patients. The results showed that the robot was safe and compliant. The robot did not forcefully plantarflex or dorsiflex the foot when the participant exerted opposing force. The actuators worked antagonistically to flex to the foot as intended, in sync with the up and down motions of the player’s bat in the game. These behaviors demonstrated the feasibility of a nitinol-based ankle rehabilitation robot and a simple and yet intuitive game in providing interactive rehabilitation exercise. The robot is expected to enhance the patient’s experience, participation and compliance to the rehabilitation routine and to quantitatively monitor the patient’s recovery progress.

It is well recognized that chronic heart failure (CHF) is a multifactorial syndrome that reduces physical exercise tolerance. Exercise-based cardiac rehabilitation program is on the frontline of non-pharmacological therapies for CHF patients, counterbalancing the disease-induced issues of physical capacity. Since a successful exercise rehabilitation program should be efficient and safe, the search for optimal combinations of exercise volume and intensity has sparked interest in the current literature. Although studies have shown feasible combinations of low volume and high intensity, and [...]

Physical activity, a key component of maintaining health, is becoming an essential alternative in reducing medical expenses for the old people. This research was intended to analyze 51 research papers published in the Journal of Exercise Rehabilitation (JER) through semantic network analysis. The subjects of the study were the keywords that the authors of each paper used in journal search sites from 2013 to 2019. The present researcher analyzed the frequency, density, and centrality of the keywords of the indicators through semantic network analysis and then visualized them on the basis of findings using UCINET6 and the NetDraw program. Also, the researcher classified the hidden clusters by CONCOR (Convergence of iterated Correlations) analysis, which is a kind of cluster analysis. As a result, it was found that the keyword with the highest frequency was "exercise," followed by "cognition, "physicalactivity," "old-women," "Korean," "fall," and "training." It was also found that most of the high-frequency keywords, such as "exercise," "cognition," "old-women," "program" and "depression" had high centrality. These keywords were classified into four clusters: (a) mental health research, (b) physical health research, (c) social behavior research, and (d) leisure efficacy research. This suggests that the old people-related research papers published in the JER have derived effective methods of maintaining physical and mental health using scientific exercise programs, and especially address the effects of exercise intervention for old women.

Objectives We aimed to compare the outcomes of exercise rehabilitation and conventional treatment in patients with knee osteoarthritis. Methods This trial included a total of 166 patients diagnosed with knee osteoarthritis; they were randomly divided into groups. The experimental group underwent systematic exercise rehabilitation, while the control group received naproxen ( n = 28), diclofenac ( n = 27), or celecoxib ( n = 19). Improvement in symptoms, knee function, and quality of life were compared. SPSS Statistics 24.0 was used for the data analysis. Results The mean age of patients was 56.0 ± 10.5 years, and the average follow-up time was 12 ± 2.3 weeks. No statistically significant differences were seen in age, body mass index, and sex ( P > 0.05) between the groups. The average Western Ontario and MacMaster Universities (WOMAC) scores after treatment were 84.4 ± 15.2, 108.3 ± 3.9, 107.4 ± 5.4, and 107 ± 6.0 in the exercise rehabilitation, diclofenac, naproxen, and celecoxib groups, respectively. The mean Lysholm scores were 60.3 ± 14.9, 41.0 ± 0.1, 43.5 ± 5.3, and 41.7 ± 3.6 in the exercise rehabilitation, diclofenac, naproxen, and celecoxib groups, respectively. The mean SF-36 (Short Form-36 Survey) scores were 105.4 ± 21.5, 82.5 ± 3.7, 84.2 ± 3.5, and 83.7 ± 5.0 in the exercise rehabilitation, naproxen, celecoxib, and diclofenac groups, respectively. The average ranges of knee motion were 125.0 ± 6.2°, 116.4 ± 1.4°, 114.7 ± 1.1°, and 115.7 ± 0.8° after exercise rehabilitation, diclofenac, naproxen, and celecoxib treatments, respectively. These data presented statistical differences between the groups. Conclusion Exercise better improved symptoms and quality of life in patients with knee osteoarthritis over a 12-week follow-up period than that achieved with nonsteroidal anti-inflammatory drugs and COX-2 inhibitors.

Healthcare for the increasing senior population is a significant challenge. To address this problem, the use of healthcare robot is increasingly being recognized to have strong potential in addressing older adult and psychiatric patients' healthcare and welfare needs. The purpose of this preliminary study is to evaluate the changes in the autonomic nervous activity of an elderly patient with schizophrenia during upper limb range of motion (ROM) exercises led by Pepper (SoftBank Robotics) with the application program of Care Prevention Gymnastics Exercises (Pepper-CPGE) made by Xing Company in Japan. A Pepper-CPGE-led three-minute radio gymnastics program (Radio Exercises #1, consisted of three types of exercises) and instructions were developed. The normal aging 69-year old schizophrenic subject followed instructions from Pepper throughout the intervention. Electrocardiography (ECG) records, heart rate, acceleration score, and ROM exercises of upper limb were collected and analyzed using the GSM's Bonaly Light instrument and Image-J analysis. (1) The high-frequency (HF) (indicative of parasympathetic nervous activity), and low-frequency (LF)/HF ratio (indicative of sympathetic nerve activity) were increased in reference from the baseline data before the exercise stretching the chest. (2) The momentum decreased as the ROM of shoulder joint flexion declined. Declines in both parasympathetic and sympathetic nervous activity were observed. Also, (3) when the exercise "bend the body forward" was performed, the HF and LF/HF also decreased. Evaluation of robot-based rehabilitation exercise program effectiveness by the ROM exercises image analysis and autonomic nervous activity is essential for the futurist programming of ROM exercise among patients with schizophrenia.

Cerebral blood flow during exercise is impaired in patients with heart failure implanted with left ventricular assist devices (LVADs). Our aim was to determine whether a 3-mo exercise training program could mitigate cerebrovascular dysfunction. Internal carotid artery (ICA) blood flow and intracranial middle (MCA v) and posterior cerebral (PCA v) artery velocities were measured continuously using Doppler ultrasound, alongside cardiorespiratory measures at rest and in response to an incremental cycle ergometer exercise protocol in 12 LVAD participants (5 female, 53.6 ± 11.8 yr; 84.2 ± 15.7 kg; 1.73 ± 0.08) pre- (PreTR) and post- (PostTR) completion of a 3-mo supervised exercise rehabilitation program. At rest, only PCAv was different PostTR (38.1 ± 10.4 cm/s) compared with PreTR (43.0 ± 10.8 cm/s; P < 0.05). PreTR, the reduction in PCAv observed from rest to exercise (5.2 ± 1.8%) was mitigated PostTR ( P < 0.001). Similarly, exercise training enhanced ICA flow during submaximal exercise (~8.6 ± 13.7%), resulting in increased ICA flow PostTR compared with a reduced flow PreTR ( P < 0.001). Although both end-tidal partial pressure of carbon dioxide and mean arterial pressure responses during incremental exercise were greater PostTR than PreTR, only the improved [Formula: see text] was related to the improved ICA flow ( R2 = 0.14; P < 0.05). Our findings suggest that short-term exercise training improves cerebrovascular function during exercise in patients with LVADs. This finding should encourage future studies investigating long-term exercise training and cerebral and peripheral vascular adaptation. NEW & NOTEWORTHY Left ventricular assist devices, now used as destination therapy in end-stage heart failure, enable patients to undertake rehabilitative exercise training. We show, for the first time in humans, that training improves cerebrovascular function during exercise in patients with left ventricular assist devices. This finding may have implications for cerebrovascular health in patients with heart failure.

Aim of the study Binge ethanol drinking causes liver damage and decreased paraoxonase-1 (PON-1) gene expression. On the other hand, regular physical activity and curcumin consumption as non-invasive interventions can have liver protective effects through enhancing antioxidant defense, and improving PON-1 and NF-kβ (nuclear factor kappa B) gene expression. The aim of this study was to investigate the interactive effect of exercise rehabilitation and curcumin consumption on hepatocyte damage as well as NF-kβ and PON-1 gene expression in rats. Material and methods Fifty-six male Wistar rats were randomly selected and equally divided into seven groups: dextrose-control (Dext-Con), ethanol-control (Eth-Con), ethanol-saline (Eth-sal), ethanol-DMSO (Eth-DMSO), ethanol-curcumin (Eth-Cur), ethanol-swimming training (Eth-SWT) and ethanol-SWT + curcumin (Eth-SWT + Cur). After four days of the binge drinking protocol followed by six days of quitting, the interventions of SWT and curcumin (50 mg/kg) were employed for 14 days. Afterwards, the rats' liver tissues were collected and sent to the laboratory for biochemical assays. Results The interaction of SWT and curcumin caused an increase in PON-1 gene expression (p = 0.02). In addition, curcumin consumption (p = 0.003) and its interaction with SWT (p = 0.004) resulted in a reduction in NF-kβ gene expression. Also, liver tissue damage was observed in the Eth-Con group compared to other groups. Conclusions The combination of curcumin and SWT may be used to reduce the side effects of binge ethanol drinking and improve recovery in the quitting period.

Purpose: This study examined the effects of golf rehabilitation exercise on swing power, swing speed, X-factor and club head speed between novice and expert golfer. Methods: The participants were 12 novice and 12 experts. They participated in a golf rehabilitation exercise program for 6 weeks. This program consisted of 5 steps and 4 items (sleeper stretch, full side plank, push-up to plank, high plank knee unders). A three-dimensional motion analyzer was used to measure the X-factor (angle between shoulder and pelvis at top of backswing). Primus RS was used to measure the swing power and swing speed. The golf simulator was used to measure the clubhead speed. In the study, we compared the dependent variables before and after the exercise between the novice and expert. Results: Swing power, swing speed, X-factor, and clubhead speed were significantly increased after the exercise in both groups. There was no significant difference in swing power, swing speed, and X-factor between the groups, but the clubhead speed of expert golfers was significantly increased than that of the novice. Conclusion: This study exhibits that the rehabilitation exercise for golfers was effective for increasing swing power, swing speed, X-factor, and club head speed for both novice and expert golfers.

The aim of this study was to investigate the effects of telemonitored exercise rehabilitation on patients with coronary heart disease (CHD) in China. Ninety-six patients with stable CHD were included and analyzed (48 in telemonitored group and 48 in control group). All patients received routine follow-up, and patients in telemonitored group participated in smartphone-based telemonitored cardiac rehabilitation. Patients’ demographic information, medical history, diagnosis and treatment of CHD, and laboratory results were collected. The difference of cardiopulmonary exercise testing (CPET), blood test, and echocardiographic parameters; exercise habits; control rate of blood lipid and blood glucose; and incidence of adverse events between the two groups during 6 months of follow-up was analyzed. After intervention, the subjects in the telemonitored group performed significantly better in VO2peak, exercise compliance, and some other parameters than those in the control group. Telemonitored exercise rehabilitation is an effective rehabilitation mode for CHD patients in China.

Background and objective: Approximately one-third of stroke patients remain disabled and post-stroke rehabilitation is required. Adherence to an exercise rehabilitation program is considered an important area of interest in the wake of optimizing long-term participation in physical activities after stroke. This study aims to explore the barriers to adherence to exercise program among post-stroke patients.Methods: A qualitative study was conducted in the Physiotherapy units of Hawler and Rizgary Teaching Hospitals, Erbil, the Kurdistan Region of Iraq including twelve post-stroke participants with limited/ inadequate adherence to a post-stroke exercise program schedule from March to December 2018. Data was collected through face-to-face interviews. All of the interviews were conducted at a time and place that was the most convenient for the participants. Within two months, the categories emerging from the analysis of the inter-views began to repeat, and no new categories emerged, leading to an enrollment of 14 participants. One month after the first interview, the second interview was conducted which included 12 participants. This was done to confirm their previous answers and ensuring that there were no new concepts about this limited adherence. Software for Qualitative Data Analysis was used for managing the data.Results: More than half of the participants were over 70 years old, male, illiterate, married, and housekeepers from urban areas. Most of the participants had an ischemic stroke for more than four weeks. The barriers to adherence to post-stroke exercise program were categorized into the four main categories of the barriers related to environment and facility, personal (physical and psychological) factors, organizational policies, and contents of exercise program.Conclusion: Barriers to adherence are different in nature. Environmental barriers and lack of facilities show that a well-organized rehabilitation program in health care system at directorate of health-Erbil is very important to improve and facilitate adherence...

Zusammenfassung Hintergrund Trotz einer steigenden Anzahl an Rehabilitationssportgruppen für Krebspatienten wird häufig von Schwierigkeiten beim Zugang zu entsprechenden wohnortnahen Angeboten berichtet. Ziel der Untersuchung war daher die Erhebung von Zugangswegen sowie wahrgenommenen Barrieren und Einflussgrößen für den Einstieg und die langfristige Teilnahme am Rehabilitationssport für Krebspatienten. Methode An der quantitativen und qualitativen Befragung beteiligten sich 189 Teilnehmer aus 21 ambulanten Rehabilitationssportgruppen (63±10 J.; 96 % weiblich; 82 % Brustkrebs; Rehasport-Teilnahme seit im Median 29 Monaten). Mittels standardisiertem Instrument (offene und geschlossene Fragen; validierte Skalen) wurden systematisch Faktoren erfasst, die Einstieg und Teilnahme am Rehabilitationssport potenziell beeinflussen können (z. B. Barrieren, Motive). Ergebnisse Vor dem Einstieg hatten 151 (80 %) der Befragten eine Empfehlung für die Teilnahme am Rehabilitationssport bekommen (40 % Stationäre Rehabilitation / Anschlussheilbehandlung; 24 % Familie / Freunde; 16 % Onkologe; 11 % Personal der onkologischen Einrichtung; 10 % Hausarzt / Gynäkologe). Hindernisse / Bedenken vor dem Einstieg umfassten insbesondere eine als zu starke wahrgenommene Müdigkeit / Erschöpfung (37 %), zu starke Schmerzen / Unwohlsein (15 %) und das Gefühl einer therapie- / erkrankungsbedingt zu geringen Fitness (14 %) sowie fehlende Kenntnisse über passende Angebote (19 %) und unzureichende Empfehlungen (13 %). Primäre Motive für den Einstieg und die Teilnahme am Rehabilitationssport liegen in einer Verbesserung von Gesundheit und Wohlbefinden (97 bzw. 93 %) sowie einer Reduktion von (Krankheits-)Beschwerden (96 %) und Rezidivrisiko (82 %). Fast alle Teilnehmer (n = 185; 98 %) wollen nach der Teilnahme am Rehasport weiterhin regelmäßig körperlich-sportlich aktiv bleiben (74 % im Sportverein, davon 36 % zusätzlich privat; 17 % ausschließlich privat). Gut 2 / 3 der Befragten (68 %) haben Interesse, an weiteren regulären Vereinssport-Angeboten teilzunehmen, 38 % kennen keine anderen Angebote bzw. Möglichkeiten im Verein. Diskussion Konkrete Empfehlungen und adäquate Aufklärung über Durchführbarkeit, Nutzen und Möglichkeiten von Rehabilitationssport scheinen für den Einstieg in eine entsprechende Krebssportgruppe relevant. Informationen zu Angeboten und Möglichkeiten, bestenfalls bereits während der Krebstherapie, könnten den Einstieg in den Rehasport und konsekutiv einen aktiven Lebensstil sowie die Nutzung des Potenzials von Bewegung unterstützen.

A growing body of research evidence supports the benefit of exercise for cancer survivors both during and after cancer treatment. The purpose of this paper is to provide an update on our previously published review in 2006 on the state of the evidence supporting exercise for survivors of cancer as well as guidelines for integrating exercise programming in the cancer clinical setting. First, we provide a brief overview on the benefits of exercise as well as preliminary evidence supporting the implementation of community-based exercise programs. Second, we summarize the principles and goals of exercise, and the identified barriers to exercise among cancer survivors. Finally, we propose an interdisciplinary model of care for integrating exercise programming into clinical care including guidelines for medical and pre-exercise screening, exercise testing and programming considerations.

Background: Vibration exercise after ankle surgery improves proprioception and ankle muscle strength through vibration stimulation. Objective: To examine the effects of vibration exercise on the ankle stability. Design: Randomized controlled clinical trial (single blind) Methods: Twenty soccer players were randomly divided into experimental group and control group. The Vibration exercise program was conducted 12 weeks and 3 times a week. Ankle joint proprioceptive sensory test and Isokinetic muscle strength test were performed using Biodex system pro Ⅲ to measure plantar flexion / dorsiflexion and eversion / inversion motion. Results: The result of isokinetic test of ankle joint is showed significant improvement in all measurement items, such as leg flexion, lateral flexion, external and internal muscle forces, compared to previous ones by performing vibration movements for 12 weeks. However, in the comparison group, plantar flexor (30°), eversion muscle (120°), inversion (30°) of limb muscle strength were significantly improvedcompared with the previous phase; was no significant difference in dorsi-flexion. There was no significant difference between groups in all the items. Conclusions: In this study, we analyzed the effects of rehabilitation exercise on soccer players who had reconstructed with an ankle joint ligament injury through vibration exercise device. As a result, we could propose an effective exercise method to improve the ability, and confirmed the applicability as an appropriate exercise program to prevent ankle injuries and help quick return.

The aim of the study was to analyze the effect of muscle mass asymmetric between upper and lower limbs on postural stability and shock attenuation during landing. Twenty adults (without lower limb disorders and who could land from a 35-cm height) participated in this study (mean age, 21.85±2.97 years; mean height, 1.68±0.10 m; mean weight: 68.64±17.36 kg). Subjects performed one-leg landing from 36-cm vertical heights. Ground reaction force components and medial-lateral, anterior-posterior, vertical and dynamic postural stability index were obtained from force platform recordings. We found that muscle mass in right limbs more increased than that of left limbs. Medial-lateral force, vertical force, vertical stability index, and dynamic postural stability index in left leg showed higher value than that of right leg during landing. The asymmetry of muscle mass (%) and ground reaction force variables showed a similar correlation, including dynamic postural stability index (r=0.316). These findings allow us to conclude that the factor of muscle mass asymmetric is a contributor to impulse control and dynamic postural stability index asymmetry. Therefore, knowledge of bilateral limbs asymmetry may provide insights into exercise rehabilitation and performance.

Chronic kidney disease patients are characterized by impaired physical function. The goal of exercise-based interventions is an improvement in functional performance. However, improvements are often determined by "statistically significant" changes. We investigated the "minimum clinically important difference," "the smallest change that is important to the patient," for commonly reported physical function tests.Nondialysis chronic kidney disease patients completed 12-wks of a combined aerobic (plus resistance training). The incremental shuttle walking test, sit-to-stand 5 and 60, estimated 1-repetition maximum for the knee extensors, and VO2peak were assessed. After the intervention, patients rated their perceived change in health. Both anchor- and distribution-based minimum clinically important difference approaches were calculated.The minimum clinically important difference was calculated as follows: incremental shuttle walking test, +45 m; sit-to-stand 5, -4.2 secs; VO2peak, +1.5 ml/kg per min. Because of comparable increases in "anchor" groups, no minimum clinically important difference was estimated for the sit-to-stand 60 or estimated 1-repetition maximum.We have established the minimum clinically important difference in chronic kidney disease for common tests of physical function. These values represent the minimum change required for patients to perceive noticeable and beneficial change to their health. These scores will help interpret changes after exercise interventions where these tests are used. These minimum clinically important differences can be used to power future studies to detect clinically important changes.Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this article, the reader should be able to: (1) Define the "minimum clinically important difference"; (2) Distinguish between concepts of minimum clinically important difference, "minimal detectable change,", and "statistically significant change"; and (3) Interpret other study findings and their own results in the context of the minimum clinically important difference rather than statistically significant changes.Advanced ACCREDITATION: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

In this paper, a 7R spatial linkage for ankle rehabilitation was proposed. Thanks to its kinematic geometry, the output joint, which is accommodated by the patient’s ankle, of the linkage can possess an arbitrary joint axis at any configuration. This advantage allows the patient achieving a flexible ankle motion in 3-D space while performing the rehabilitation exercise. The design concept of the 7R linkage is explained, and the displacement and force relationships between the input and output joints (i.e., the motor and patient’s ankle) are analyzed through an equivalent RSSR linkage. A prototype is built to validate the proposed design concept.

Purpose: The purpose of this study is to analyze the effects of participation into rehabilitation exercise on the change of health fitness in the elderly with hemiplegia. Methods: The subjects of this study were 6 elderly people with hemipgleia physical disability who participated in the rehabilitation exercise program in the province o fK. Before and after 12 weeks (once a week and 60 minutes exercise) of rehabilitation exercise program weer analysed in change of basic physical fitness (muscular strength and muscular endurance, dynamic balance, flexibility and cardiopulmonary endurance) and medical examination (systolic and diastolic blood pressure andb lood glucose). The results were analyzed by frequency analysis and independent t-test using Windows SPSS 2.00. All statistical significance levels were set to α=.05. The following conclusions were obtained. Results: The results of this study are as follows. 1) Rehabilitation exercise program was not able to improve the basic physical fitness tests (muscular strength and muscula r endurance, flexibility, dynamic balance, and cardiopulmonary endurance) of the elderly with hemiplegia physical disability. 2) Rehabilitation exercise program showed a positive change due to a decrease in systolic blood pressure of the elderly with hemiplegia physical disability, but did not lead to a positive change in medical examination (diastolic blood pressure and blood glucose). Conclusion: In a follow-up study, when more frequent exercise is performed compared to one week’s exercise in this study, and more subjects is selected to make ao cmparison between the non-disabled and the hemiplegic disabled, it will provide important background material that can emphasize the need for rehabilitation exercise programs.

Chronic low back pain is a major health problem worldwide, particularly in elderly population. Interventions based on exercise have been the most commonly used treatments for patients with this condition. Over the past few years, the Pilates method has been one of the most popular rehabilitation exercise programs used in clinical practice. Therefore, the purpose of this study was to confirm the effects of regular Pilates exercise on balance, mobility and pain in elderly patients with chronic low back pain. Fourteen elderly participants with chronic low back pain (age, 66.7 ± 1.4 years; height, 157.0 ± 4.1 cm; weight, 59.0 ± 4.6 kg; BMI, 23.9 ± 1.6 kg/m²) were randomly allocated to either a Pilates exercise group (EX, n=7) or a control group (CON, n=7). EX group performed exercise sessions with physiotherapy conducted over an 12-week period (3 sessions/week), while CON group attended only physiotherapy over the same period. The level of static balance, mobility and pain were measured 48-hours before and after the exercise program and compared to assess training effects. Static balance ability by MFT of EX group was significantly improved after the Pilates program (p=.003, -21%), whereas there was no change in CON group (p>.05). The MFT score was significantly lower in EX group than in CON group (p=.009, -21%). Likewise, mobility was improved by reducing TUG score in EX group (p=.001, -21%) after the program and the score was lower in EX group compared to CON group (p=.001, -17%). The level of pain was lowered both in EX group (p=.001, 42%) and CON group (p=.014, 11%), but there was no significant difference between groups (p>.05). These results provide initial evidence that regular Pilates rehabilitation exercise may enhance balance and mobility and reduce pain in elderly patients with chronic low back pain.

Background Exercise-based interventions have become part of the standard of care in rehabilitation programs for cardiovascular risk reduction and the promotion of a healthy lifestyle. The systematic review describes the current state of knowledge of the effects of preoperative exercise training (prehabilitation) on perioperative clinical outcomes in patients undergoing cardiac and vascular interventions. Methods Studies were systematically searched within 14 databases from inception to October 2016. Only studies that assessed a preoperative exercise program in adult patients undergoing cardiac or vascular interventions with clinical or patient-centered endpoints were included in the review. Two independent reviewers selected studies for inclusion, extracted data, and assessed quality using Cochrane Collaboration's tool for RCTs11111111111111111 and ROBINS-I tool for nonrandomized studies. Results Nine studies met our inclusion criteria and were stratified for qualitative analyses by cardiac (n = 7) and vascular (n = 2) procedures. Prehabilitation was associated with decreased length of stay, reduced postoperative complications, improved objective physical functioning, and improved subjective quality of life (SF-36 physical and mental health domains) measures in patients undergoing cardiac and vascular procedures. Given the amount of heterogeneity that was present in the designs, populations, and comparators among the included studies, we were unable to statistically pool data across trials. Conclusions Our qualitative findings suggest that prehabilitation may improve clinical outcomes, physical performance, and health-related quality-of-life measures in patients undergoing cardiac and vascular surgery procedures.

The main purpose of this article is to suggest orthopaedic-basic knowledge on evidence-based injury prevention and rehabilitation exercise for overhead sports activity population such as throwing, tennis, resistance training. Overhead sports activity population have glenohumeral joint internal rotation deficit (GIRD), excessive external rotation, posterior shoulder tightness (PST), abnormal scapular position and dyskinesis. These physical characteristics may elicit common shoulder injury such as subacromial impingement syndrome, rotator cuff tendinopathy, consequently range of motion improvement exercise and rotator cuff strengthening are needed in order to prevent it. Especially, sleeper stretching and horizontal adduction stretching are sports-specific technique to improve for GIRD and PST, external rotator cuff strengthening in side-lying position is recommended to adjust a balance strong internal rotator compared with weak external rotator for rotator cuff exercise. Therefore, exercise specialist should examine shoulder joint strength and range of motion before practical application, these exercise maneuvers can be used extensively for shoulder injury prevention as well as rehabilitation exercise.

Background: Despite frequent shoulder injuries of rotator cuff muscle of golfers by the result of overuse and poor swing mechanics, there is little research on shoulder specific rehabilitation exercises for injured rotator cuff muscle and golf swing Objective: To examined the effect of rehabilitation exercise for golfers on the X factor and ground reaction force (GRF) according to phase of the golf swing. Design: Crossover study Methods: The participants were 13 amateur golfers selected for a 4 week rehabilitation exercise for golfers. A rehabilitation exercise for golfers consisting of 5 steps and 4 items (sleeper stretch, full side plank, push up to plank, high plank knee unders) were applied to all participants. A three dimensional motion analyzer and force platform (SMART-E, BTS, Italy) were used to measure the X factor (angle between shoulder and pelvis at top of back swing) and GRF according to phase of the golf swing. All dependent variables were measured before and after exercise. The collected data was analyzed using the paired t test and SPSS 21.0. Results: The GRF had a statistically significant increase in the impact phase and ratio impact/weight after rehabilitation exercise for golfers (p .05). Conclusions: These results suggested that rehabilitation exercise for golfers was effective for increasing GRF in the impact phase and ratio impact/weight for amateur golfer.

The purpose of this study was to compare the effects of unilateral ankle fatigue versus the knee muscles with and without vision on bipedal postural control. Elite judo athletes who competed at the national level with at least 10 years of training experience, were randomised into KNEE (n = 10; 20 ± 2 years) and ANKLE (n = 9; 20 ± 3 years) groups, who performed dynamic isokinetic fatiguing contractions (force decreased to 50% of initial peak torque for three consecutive movements) of the knee flexors and extensors or ankle dorsiflexors and plantar flexors, respectively. Static bipedal postural control (French Posturology Association normative standards) with eyes open and eyes closed was examined before and immediately after the fatiguing task. Postural variables examined were the centre of pressure (CoP) sway in the medio-lateral and antero-posterior directions, total CoP area sway and CoP sway velocity. Although unilateral ankle and knee fatigue adversely affected all bipedal postural measures, with greater disturbances with eyes closed, there were no significant main group or interaction effects between KNEE and ANKLE groups. Unilateral lower limb fatigue adversely affected bipedal balance, with knee extension/flexion fatigue affecting bipedal postural control to a similar extent as unilateral ankle dorsiflexion/plantar flexion fatigue. Hence unilateral fatigue can affect subsequent bilateral performance or also have implications for rehabilitation exercise techniques. Our findings may be limited to judo athletes as other populations were not tested.

Straight leg raise rehabilitation exercises (for both lying and seated position) for lower limb injuries play a critical role in terms of stress on joints after the injury. The primary objective of the paper is to find how accurately and efficiently a single and a two inertial measurement unit (IMU) sensor-based system could classify seated straight leg raise (SSLR) and lying straight leg raise (LSLR) exercises using machine learning. Inertial measurement units (IMUs) that include accelerometer and gyroscope were calibrated and tested, individual and combined, for classified seating as well as lying exercise and for different demanded personalities. Individual IMUs achieved about 96 % accuracy in binary classification. However, the combined (two) IMUs achieved about 96.8% accuracy. The merits of the proposed IMU based sensor system are that it is easy to install, cost effective and very useful for telemedical operations in pandemic situations like COVID-19. On the basis of these results, it could be concluded that the accuracy of a single IMU sensor system and a two IMU sensor-based system is approximately 96% and both were efficiently able to classify SSLR and LSLR exercises as well as identify the individual performing the exercise.

Every year, the number of motor dysfunction patients has been rising. These patients require physical therapy and continuous observation and assessment of their exercises by a professional therapist. This process can take a longer time, leading to a staff shortage and increasing financial costs. Thus, a reliable rehabilitation framework is necessary to assess these exercises as precisely as possible. In this paper, we have proposed an exercise assessment framework using the 1D Local Binary Pattern (LBP) to extract valuable features from skeleton data and a genetic algorithm (GA) optimized Convolutional Neural Network (CNN) to predict the score. The KIMORE dataset has been used in this study. We have achieved 0.0165 Mean Absolute Deviation (MAD) on the training set and 0.13515 on the validation set.

Background: Although there are numerous investigations regarding the beneficial effects of exercise rehabilitation (ER) or astragaloside (AST) after amyloid-beta (Ab) pathology, the mechanisms are still not well understood. We aim to assess whether ER and/or AST counteract Ab pathology via diminishing brain-derived neurotrophic factor (BDNF) signaling deficits and mitochondrial dysfunction. Methods: Ab1-42 were microinjected into the bilateral ventricles to induce Ab neuropathology in rats. The Alzet osmotic pump containing full of AST was implanted subcutaneously during surgery. The ER group of rats started at seven days post-surgery and lasted for four weeks. The ANA12 was administrated once per day to the endpoint of the experiments to antagonize the BDNF action. Neurobehavioral functions were evaluated by Y-maze, radial maze, and rotarod tests one day before surgery and 14 to 35 days post-surgery. Cortical and hippocampal expressions of both BDNF/TrkB and cathepsin D were determined by Western blotting method. The rat primary cultured cortical neurons were incubated with BDNF and/or AST and ANA12 followed by exposure to aggregated Ab for 24 hours. The cell viability (by MTT assay), mitochondrial membrane permeability and electrochemical potential (by JC-1 stain), DNA fragmentation (sub-G1 and DNA ladder assay), synaptic plasticity (by immunofluorescence stain), and pTrkB/pAkt/pGSK3b/b-catenin signaling (by Western blot) were determined.Results: ER and/or AST reversed neurobehavioral disorders, downregulation of cortical and hippocampal expression of both BDNF/TrkB and cathepsin D, neural pathology, Ab accumulation, and altered microglial polarization caused by Ab. In vitro studies also confirmed that topical application of BDNF and/or AST reversed the Ab-induced cytotoxicity, apoptosis, mitochondrial distress, synaptotoxicity, and decreased expression of p-TrkB, AKT, p-GSK3b, and b-catenin in altered rat cortical neurons. In particular, the beneficial effects of combined ER (or BDNF) and AST therapy in vivo and in vitro were superior to ER (or BDNF) or AST alone. Furthermore, we observed that any gains from ER (or BDNF) and/or AST could be significantly eliminated by ANA-12, a potent BDNF/TrkB antagonist. Conclusion: These results indicate that whereas ER (or BDNF) and/or AST attenuate Ab pathology by reversing BDNF/TrkB signaling deficits and mitochondrial dysfunction. In particular, AST can be an alternative therapy to replace ER.

Faced with the current increasingly serious problem of population aging and the frequent occurrence of neurological diseases. Lower limb rehabilitation exoskeleton can help patients with lower limb exercise rehabilitation. Only the subjective participation of patients in the rehabilitation process can achieve better rehabilitation results. Therefore, this paper proposes to implement a BCI system based on SSVEP to control the exoskeleton of the lower limbs, so that the patient can actively participate in the rehabilitation process. This article uses the flickering of the pixel block on the screen to visually stimulate the patient, and classifies the EEG signal by the CCA method. The classification results are output to the lower limb rehabilitation system described in the article to realize the patient's left leg rehabilitation, right leg rehabilitation, acceleration, deceleration, and stop operations.

Dong Jin, Xiu-Yun Yang, Jie-Sheng Wang Geriatrics Department, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang Province, People’s Republic of ChinaCorrespondence: Dong JinGeriatrics Department, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang Province, 310012, People’s Republic of ChinaTel +86-13958133668Email 2168256719@qq.comObjective: To evaluate the changes of plasma levels of miR-126 in heart failure with a preserved ejection fraction (HFpEF) patients undergoing an exercise rehabilitation intervention.Methods: miR-126 levels in plasma were compared between 60HFpEF patients and 30 healthy volunteers. HFpEF patients underwent exercise rehabilitation for 12 weeks. Before and after rehabilitation, indicators of cardiac function, exercise tolerance, quality of life scores and miR-126 levels were measured and compared. Correlations between plasma levels of miR-126 and HFpEF were evaluated.Results: The plasma levels of miR-126 in HFpEF patients were lower than those in healthy volunteers and increased significantly after exercise rehabilitation. HFpEF patients also showed significantly better cardiac function, exercise tolerance, and quality of life after rehabilitation. The results of Pearson correlation analysis and multiple linear regression showed that miR-126 levels were positively correlated with peak oxygen consumption (peak VO2) and metabolic equivalents (METs), and inversely associated with score on the Minnesota Living with Heart Failure Questionnaire (MLHF) as well as plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels.Conclusion: miR-126 levels are low expressed in plasma among HFpEF patients. Effective exercise rehabilitation in HFpEF patients may positively impact the plasma level of miR-126, which is probably associated with the restoration of cardiac function, exercise tolerance and quality of life. miR-126 may be a potential biomarker for evaluating the efficacy of exercise rehabilitation for HFpEF patients.Keywords: HFpEF, miR-126, exercise rehabilitation

The present paper has considered a task to develop a portable device equipped with the vibro-tactile feedback to support the home physical rehabilitation. The purpose of the paper is to develop a portable device using the vibro-tactile feedback for real-time correction of the physical exercise execution correctness. Such implementation of a portable device allows providing correct adherence to protocols for rehabilitation exercise execution preliminary prescribed by a doctor in order to increase objectivity and reliability of the remote control. Combination of previously implemented algorithms for calculation of exercise execution correctness metrics has been suggested to be used for control of the tactile feedback.