Effect of therapeutic exercise for hip osteoarthritis pain: results of a meta-analysis

OBJECTIVE: Recommendations for lower extremity osteoarthritis (OA) and exercise have been primarily based on knee studies. To provide more targeted recommendations for the hip, we gathered evidence for the efficacy of exercise for hip OA from randomized controlled trials. METHODS: A bibliographic search identified trials that were randomized, controlled, completed by >or=60% of subjects, and involved an exercise group (strengthening and/or aerobic) versus a non exercise control group for pain relief in hip OA. Two reviewers independently performed the data extraction and contacted the authors when necessary. Effect sizes (ES) of treatment versus control and the I(2) statistic to assess heterogeneity across trials were calculated. Trial data were combined using a random-effects meta-analysis. RESULTS: Nine trials met the inclusion criteria (1,234 subjects), 7 of which combined hip and knee OA; therefore, we contacted the authors who provided the data on hip OA patients. In comparing exercise treatment versus control, we found a beneficial effect of exercise with an ES of -0.38 (95% confidence interval [95% CI] -0.68, -0.08; P = 0.01), but with high heterogeneity (I(2) = 75%) among trials. Heterogeneity was caused by 1 trial consisting of an exercise intervention that was not administered in person. Removing this study left 8 trials (n = 493) with similar exercise strategy (specialized hands-on exercise training, all of which included at least some element of muscle strengthening), and demonstrated exercise benefit with an ES of -0.46 (95% CI -0.64, -0.28; P < 0.0001). CONCLUSION: Therapeutic exercise, especially with an element of strengthening, is an efficacious treatment for hip OA.

Does land-based exercise reduce pain and disability associated with hip osteoarthritis? A meta-analysis of randomized controlled trials

Objective To determine if clinical guidelines recommending therapeutic exercise for people with hip osteoarthritis (OA) are supported by rigorous scientific evidence. Methods A meta-analysis of randomized controlled trials (RCTs) recruiting people with hip OA and comparing some form of land-based exercise program (as opposed to exercises conducted in the water) with a non-exercise group in terms of hip pain and/or self-reported physical function. Results Thirty-two RCTs were identified, but only five met the inclusion criteria. Only one of the five included RCTs restricted recruitment to people with hip OA, the other four RCTs also recruiting participants with knee OA. The five included studies provided data on 204 and 187 hip OA participants for pain and physical function, respectively. Combining the results of the five included RCTs using a fixed-effects model demonstrated a small treatment effect for pain (standardized mean difference (SMD) −0.38; 95% confidence interval (CI) −0.67 to −0.09). No significant benefit in terms of improved self-reported physical function was detected (SMD −0.02; 95% CI −0.31 to 0.28). Conclusion Currently there is only silver level evidence (one small RCT) supporting the benefit of land-based therapeutic exercise for people with symptomatic hip OA in terms of reduced pain and improved physical function. The limited number and small sample size of the included RCTs restricts the confidence that can be attributed to these results.

Exercise for osteoarthritis of the hip

BACKGROUND: Current international treatment guidelines recommending therapeutic exercise for people with symptomatic hip OA report are based on expert opinion only. OBJECTIVES: To determine whether land-based therapeutic exercise is beneficial for people with hip OA in terms of reduced joint pain and/or improved physical function. SEARCH STRATEGY: Five databases were searched from 1966 up until August 2008. SELECTION CRITERIA: All randomised controlled trials (RCTs) recruiting people with hip OA and comparing some form of land-based therapeutic exercise (as opposed to exercises conducted in the water) with a non-exercise group. DATA COLLECTION AND ANALYSIS: Three reviewers independently extracted data and assessed methodological quality. All analyses were conducted on continuous outcomes. MAIN RESULTS: Combining the results of the five included RCTs demonstrated a small treatment effect for pain, but no benefit in terms of improved self-reported physical function. Only one of these five RCTs exclusively recruited people with symptomatic hip OA. AUTHORS' CONCLUSIONS: The limited number and small sample size of the included RCTs restricts the confidence that can be attributed to these results. Adequately powered RCTs evaluating exercise programs specifically designed for people with symptomatic hip OA need to be conducted.

Exercise for osteoarthritis of the hip.

BACKGROUND Current international treatment guidelines recommending therapeutic exercise for people with symptomatic hip osteoarthritis (OA) report are based on limited evidence. OBJECTIVES To determine whether land-based therapeutic exercise is beneficial for people with hip OA in terms of reduced joint pain and improved physical function and quality of life. SEARCH METHODS We searched five databases from inception up to February 2013. SELECTION CRITERIA All randomised controlled trials (RCTs) recruiting people with hip OA and comparing some form of land-based therapeutic exercise (as opposed to exercises conducted in water) with a non-exercise group. DATA COLLECTION AND ANALYSIS Four review authors independently selected studies for inclusion. We resolved disagreements through consensus. Two review authors independently extracted data, assessed risk of bias and the quality of the body of evidence for each outcome using the GRADE approach. We conducted analyses on continuous outcomes (pain, physical function and quality of life) and dichotomous outcomes (proportion of study withdrawals). MAIN RESULTS We considered that seven of the 10 included RCTs had a low risk of bias. However, the results may be vulnerable to performance and detection bias as none of the RCTs were able to blind participants to treatment allocation and, while most RCTs reported blinded outcome assessment, pain, physical function and quality of life were participant self reported. One of the 10 RCTs was only reported as a conference abstract and did not provide sufficient data for the evaluation of bias risk.High-quality evidence from nine trials (549 participants) indicated that exercise reduced pain (standardised mean difference (SMD) -0.38, 95% confidence interval (CI) -0.55 to -0.20) and improved physical function (SMD -0.38, 95% CI -0.54 to -0.05) immediately after treatment. Pain and physical function were estimated to be 29 points on a 0- to 100-point scale (0 was no pain or loss of physical function) in the control group; exercise reduced pain by an equivalent of 8 points (95% CI 4 to 11 points; number needed to treat for an additional beneficial outcome (NNTB) 6) and improved physical function by an equivalent of 7 points (95% CI 1 to 12 points; NNTB 6). Only three small studies (183 participants) evaluated quality of life, with overall low quality evidence, with no benefit of exercise demonstrated (SMD -0.07, 95% CI -0.23 to 0.36). Quality of life was estimated to be 50 points on a norm-based mean (standard deviation (SD)) score of 50 (10) in the general population in the control group; exercise improved quality of life by 0 points. Moderate-quality evidence from seven trials (715 participants) indicated an increased likelihood of withdrawal from the exercise allocation (event rate 6%) compared with the control group (event rate 3%), but this difference was not significant (risk difference 1%; 95% CI -1% to 4%). Of the five studies reporting adverse events, each study reported only one or two events and all were related to increased pain attributed to the exercise programme.The reduction in pain was sustained at least three to six months after ceasing monitored treatment (five RCTs, 391 participants): pain (SMD -0.38, 95% CI -0.58 to -0.18). Pain was estimated to be 29 points on a 0- to 100-point scale (0 was no pain) in the control group, the improvement in pain translated to a sustained reduction in pain intensity of 8 points (95% CI 4 to 12 points) compared with the control group (0 to 100 scale). The improvement in physical function was also sustained (five RCTs, 367 participants): physical function (SMD -0.37, 95% CI -0.57 to -0.16). Physical function was estimated to be 24 points on a 0- to 100-point scale (0 was no loss of physical function) in the control group, the improvement translated to a mean of 7 points (95% CI 4 to 13) compared with the control group.Only five of the 10 RCTs exclusively recruited people with symptomatic hip OA (419 participants). There was no significant difference in pain or physical function outcomes compared with five studies recruiting participants with hip or knee OA (130 participants). AUTHORS' CONCLUSIONS Pooling the results of these 10 RCTs demonstrated that land-based therapeutic exercise programmes can reduce pain and improve physical function among people with symptomatic hip OA.

Changes in disability, physical/mental health states and quality of life during an 8-Week multimodal physiotherapy programme in patients with chronic non-specific neck pain: A prospective cohort study

Aim The aim of this study was to analyse the effect of an 8-week multimodal physiotherapy programme (MPP), integrating physical land-based therapeutic exercise (TE), adapted swimming and health education, as a treatment for patients with chronic non-specific neck pain (CNSNP), on disability, general health/mental states and quality of life. Methods 175 CNSNP patients from a community-based centre were recruited to participate in this prospective study. Intervention: 60-minute session (30 minutes of land-based exercise dedicated to improving mobility, motor control, resistance and strengthening of the neck muscles, and 30 minutes of adapted swimming with aerobic exercise keeping a neutral neck position using a snorkel). Health education was provided using a decalogue on CNSNP and constant repetition of brief advice by the physiotherapist during the supervision of the exercises in each session. Study outcomes: primary: disability (Neck Disability Index); secondary: physical and mental health states and quality of life of patients (SF-12 and EuroQoL-5D respectively). Differences between baseline data and that at the 8-week follow-up were calculated for all outcome variables. Results Disability showed a significant improvement of 24.6% from a mean (SD) of 28.2 (13.08) at baseline to 16.88 (11.62) at the end of the 8-week intervention. All secondary outcome variables were observed to show significant, clinically relevant improvements with increase ranges between 13.0% and 16.3% from a mean of 0.70 (0.2) at baseline to 0.83 (0.2), for EuroQoL-5D, and from a mean of 40.6 (12.7) at baseline to 56.9 (9.5), for mental health state, at the end of the 8-week intervention. Conclusion After 8 weeks of a MPP that integrated land-based physical TE, health education and adapted swimming, clinically-relevant and statistically-significant improvements were observed for disability, physical and mental health states and quality of life in patients who suffer CNSNP. The clinical efficacy requires verification using a randomised controlled study design.

Effect of accelerated rehabilitation on function after ankle sprain: randomised controlled trial

Objective: To compare an accelerated intervention incorporating early therapeutic exercise after acute ankle sprains with a standard protection, rest, ice, compression, and elevation intervention.

Design: Randomised controlled trial with blinded outcome assessor.

Setting: Accident and emergency department and university based sports injury clinic.

Participants: 101 patients with an acute grade 1 or 2 ankle sprain.

Interventions: Participants were randomised to an accelerated intervention with early therapeutic exercise (exercise group) or a standard protection, rest, ice, compression, and elevation intervention (standard group).

Main outcome measures: The primary outcome was subjective ankle function (lower extremity functional scale). Secondary outcomes were pain at rest and on activity, swelling, and physical activity at baseline and at one, two, three, and four weeks after injury. Ankle function and rate of reinjury were assessed at 16 weeks.

Results: An overall treatment effect was in favour of the exercise group (P=0.0077); this was significant at both week 1 (baseline adjusted difference in treatment 5.28, 98.75% confidence interval 0.31 to 10.26; P=0.008) and week 2 (4.92, 0.27 to 9.57; P=0.0083). Activity level was significantly higher in the exercise group as measured by time spent walking (1.2 hours, 95% confidence interval 0.9 to 1.4 v 1.6, 1.3 to 1.9), step count (5621 steps, 95% confidence interval 4399 to 6843 v 7886, 6357 to 9416), and time spent in light intensity activity (53 minutes, 95% confidence interval 44 to 60 v 76, 58 to 95). The groups did not differ at any other time point for pain at rest, pain on activity, or swelling. The reinjury rate was 4% (two in each group).

Conclusion: An accelerated exercise protocol during the first week after ankle sprain improved ankle function; the group receiving this intervention was more active during that week than the group receiving standard care.

Efeitos de dois programas de exercício na endurance de tronco, controlo lombo-pélvico, perceção de dor lombar e fadiga, funcionalidade e qualidade de vida: Pilates Clínico vs Exercícios segundo McGill

Introdução: A lombalgia crónica assume uma elevada prevalência e graves repercussões a nível socioeconómico, sendo inúmeras as abordagens terapêuticas para o seu tratamento e prevenção. Existindo forte evidência da eficácia dos exercícios terapêuticos no seu tratamento, importa saber quais os mais efetivos. Objectivos: Comparar a efetividade de dois programas de exercício terapêutico na endurance do tronco, no controlo lombo-pélvico, na perceção de dor lombar e fadiga, na funcionalidade e na qualidade de vida em mulheres com lombalgia crónica não especifica, cuidadoras de idosos. Métodos: 24 mulheres foram divididas aleatoriamente em três grupos de 8. Durante 6 semanas, um grupo serviu de controlo (GC) e os outros dois grupos realizaram um programa de exercícios: Pilates Clínico (GP) ou exercícios segundo McGill (GM), com os outcomes medidos em ternos de endurance de tronco pelos testes de McGill, controlo lombo-pélvico pelos testes Active Straight Leg Raise e teste de controlo lombo-pélvico segundo McGill, dor lombar pela Numerical Rating Scale, fadiga pela escala de Borg, funcionalidade através do Questionário de Incapacidade de Roland Morris e qualidade de vida através do Questionário de Estado de Saúde (SF36-V2). Resultados: Relativamente à endurance, verificaram-se diferenças entre grupos no rácio flexores/extensores (p=0,005), e no rácio lateroflexores à esquerda/extensores (p=0,027), sendo que o GP apresentou um rácio estatisticamente inferior ao GC em ambos. Não existiram diferenças estatisticamente significativas entre os 3 grupos no controlo lombo-pélvico, perceção de dor, fadiga e funcionalidade, apesar das melhorias observadas intra-grupos. Relativamente à qualidade de vida, a dimensão saúde em geral aumentou significativamente no GP (p=0,020) e a função social no GM (p=0,045). Conclusão: A implementação dos programas de exercício Pilates Clínico e Exercícios segundo McGill numa amostra de cuidadoras de idosos com lombalgia crónica não especifica, parece ter um efeito positivo quando comparados com os do grupo de controlo sobre a endurance do tronco, controlo lombo-pélvico, perceção de dor lombar e fadiga, funcionalidade e qualidade de vida.

Principios y métodos para el entrenamiento de la fuerza muscular

Comprender la fuerza como fenómeno fisiológico y mecánico es un elemento fundamental para aumentar el conocimiento de las técnicas y métodos de entrenamiento muscular basados en distintas formas de aplicar cargas de trabajo. En este sentido la fuerza muscular debe ser considerada como una cualidad física básica físico, de generar desplazamiento de los segmentos corporales o de vencer una resistencia se considera parte fundamental del Fitness físico, ya que se ha demostrado dentro de la evidencia científica sus beneficios para mantener y mejorar la condición de salud de las personas. El texto está divido en dos partes: la primera, presenta aspectos fisiológicos y mecánicos básicos del sistema músculo esquelético y la segunda, se centra en los distintos métodos de entrenamiento muscular; basados en esta propuesta conceptual lo estudiantes de pregrado podrán comprender de una manera sencilla los principios y métodos de entrenamiento de la fuerza.

Avaluació dels efectes d'un programa d'exercici físic individualitzat sobre la Qualitat de Vida (QdV), la incontinència urinària, la fatiga i la resistència muscular amb malalts del càncer de pròstata

El cáncer de próstata es el cáncer más frecuente en los hombres en muchos países industrializados. Considerando el porcentaje de supervivencia relativa a los 5 años (76,5%) y el estado de morbilidad que generan los tratamientos vigentes, el concepto de Calidad de Vida (CdV) del hombre mayor con cáncer de próstata pasa a ser un objetivo prioritario en la intervención sociosanitaria. Clásicamente la evaluación del impacto que generan los síntomas se ha determinado por la frecuencia y el número de síntomas asociados a la enfermedad y al tratamiento. A nuestro parecer, lo más apropiado es realizar el análisis objetivando además el impacto que generan en la actividad de vida diaria de los afectados. Este artículo tiene un doble objetivo. Primero, evaluar los beneficios de un programa de ejercicio de fuerza adaptado a la enfermedad y al tratamiento de cáncer de próstata. Segundo, identificar los síntomas más relevantes del cáncer de próstata desde la perspectiva del paciente y el impacto que generan a la Calidad de Vida del hombre mayor. La propuesta metodológica se basa en la triangulación metodológica entre métodos secuencial, (cuantitativo y cualitativo). En los resultados se observa una mejora significativa de la Calidad de Vida del enfermo, mediado indirectamente por la mejora del síntoma de incontinencia y el dolor. Así mismo se observa una mejora de la capacidad de la fuerza y resistencia muscular más evidente en las extremidades inferiores. Queda científicamente demostrada la eficacia de un programa de ejercicio físico de fuerza adaptado a los síntomas que genera la enfermedad y el tratamiento de cáncer de próstata en la mejora de la Calidad de Vida de la persona mayor.

Comparação entre três tratamentos de fisioterapia em indivíduos com lombalgia

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Influência do programa Escola da Coluna em agentes comunitários

Introduction: Low back pain is characterized as a musculoskeletal disorder responsible for loss of productivity and high absenteeism of the affected individuals. Objectives: To analyze the effects of short-and long-term program of health education and therapeutic exercise in relation to quality of life, flexibility and pain intensity of community agents in Marilia city, Sao Paulo, Brazil. Methods: A total of 17 women community workers (40.29+9.97 years) were analysed. Evaluations were made in relation to quality of life, flexibility and intensity of pain before, immediately and 30 weeks after the intervention. Results: We observe the positive results of programs in six domains of quality of life questionnaire and flexibility in the short-and long-term (p<0.005). The intensity of pain showed significant reduction only in the short-term. Conclusion: The methodology used was able to improve the quality of life, flexibility and reduce pain intensity of community agents.

Neck flexor muscle fatigue is side specific in patients with unilateral neck pain

Despite the evidence of greater fatigability of the cervical flexor muscles in neck pain patients, the effect of unilaterality of neck pain on muscle fatigue has not been investigated. This study compared myoelectric manifestations of sternocleidomastoid (SCM) and anterior scalene (AS) muscle fatigue between the painful and non-painful sides in patients with chronic unilateral neck pain. Myoelectric signals were recorded from the sternal head of SCM and the AS muscles bilaterally during sub-maximal isometric cervical flexion contractions at 25% and 50% of the maximum voluntary contraction (MVC). The time course of the mean power frequency, average rectified value and conduction velocity of the electromyographic signals were calculated to quantify myoelectric manifestations of muscle fatigue. Results revealed greater estimates of the initial value and slope of the mean frequency for both the SCM and AS muscles on the side of the patient's neck pain at 25% and 50% of MVC. These results indicate greater myoelectric manifestations of muscle fatigue of the superficial cervical flexor muscles ipsilateral to the side of pain. This suggests a specificity of the effect of pain on muscle function and hence the need for specificity of therapeutic exercise in the management of neck pain patients. (C) 2003 European Federation of Chapters of the International Association for the Study of Pain. Published by Elsevier Ltd. All rights reserved.

Predictors of responsiveness to physiotherapy management of cervicogenic headache

A recent randomized controlled trial tested the effectiveness of therapeutic exercise and manipulative therapy on 200 subjects with cervicogenic headache. Although treatments were efficacious, 25% of patients did not achieve a clinically acceptable outcome - 50% reduction in headache frequency This study aimed to identify predictors from variables in subjects' demographics and headache history which might identify those who did or did not achieve a 50-79% or 80-100% reduction in headache immediately after the active treatments and 12 months postintervention. The results revealed no consistent pattern of predictors, although the absence of light-headedness indicated higher odds of achieving either a 50-79% [odds ratio (OR) = 5.45) or 80-100% (OR = 5.7) reduction in headache frequency in the long term. Headaches of at least moderate intensity, the patient's age and chronicity of headache did not mitigate against a successful outcome from physiotherapy intervention.

Low back pain patients demonstrate increased hip extensor muscle activity during standardized submaximal rotation efforts

Study Design. A comparative study of trunk and hip extensor muscle recruitment patterns in 2 subject groups. Objective. To examine for changes in recruitment of the hip and back extensor muscles during low level isometric trunk rotation efforts in chronic low back pain (CLBP) subjects by comparison with matched asymptomatic control subjects. Summary of Background Data. Anatomic and biomechanical models have provided evidence that muscles attaching to the thoracolumbar fascia (TLF) are important for providing stabilization to the lumbopelvic region during trunk rotation. This has guided rehabilitation programs. The muscles that link diagonally to the posterior layer of the TLF have not previously been examined individually and compared during low-level trunk rotation efforts in CLBP patients and matched controls. Methods. Thirty CLBP patients and 30 matched controls were assessed using surface electromyography (EMG) as they performed low-level isometric rotation efforts while standing upright. Muscles studied included latissimus dorsi, erector spinae, upper and lower gluteus maximus, and biceps femoris. Subjects performed the rotation exertion with various levels of external trunk support, related to different functional tasks. Results. EMG results demonstrated that subjects with CLBP had significantly higher levels of recruitment for the lower and upper gluteus maximus (P < 0.05), hamstrings (P < 0.05), and erector spinae muscles (P < 0.05) during rotation to the left compared with the control subjects. Conclusion. This study provided evidence of increased muscle recruitment in CLBP patients when performing a standardized trunk rotation task. These results may have implications for the design of therapeutic exercise programs for CLBP patients.