Home-based resistance training is not sufficient to maintain improved glycemic control following supervised training in older individuals with type 2 diabetes

OBJECTIVE—To examine whether improvements in glycemic control and body composition resulting from 6 months of supervised high-intensity progressive resistance training could be maintained after an additional 6 months of home-based resistance training.

RESEARCH DESIGN AND METHODS—We performed a 12-month randomized controlled trial in 36 sedentary, overweight men and women with type 2 diabetes (aged 60–80 years) who were randomly assigned to moderate weight loss plus high-intensity progressive resistance training (RT&WL group) or moderate weight loss plus a control program (WL group). Supervised gymnasium-based training for 6 months was followed by an additional 6 months of home-based training. Glycemic control (HbA_1c), body composition, muscle strength, and metabolic syndrome abnormalities were assessed at 0, 3, 6, 9, and 12 months.

RESULTS—Compared with the WL group, HbA_1c decreased significantly more in the RT&WL group (–0.8%) during 6 months of supervised gymnasium-based training; however, this effect was not maintained after an additional 6 months of home-based training. In contrast, the greater increase in lean body mass (LBM) observed in the RT&WL group compared with the WL group (0.9 kg, P < 0.05) after the gymnasium-based training tended to be maintained after the home-based training (0.8 kg, P = 0.08). Similarly, the gymnasium-based increases in upper body and lower body muscle strength in the RT&WL group were maintained over the 12 months (P < 0.001). There were no between-group differences for changes in body weight, fat mass, fasting glucose, or insulin at 6 or 12 months.

CONCLUSIONS—In older adults with type 2 diabetes, home-based progressive resistance training was effective for maintaining the gymnasium-based improvements in muscle strength and LBM but not glycemic control. Reductions in adherence and exercise training volume and intensity seem to impede the effectiveness of home-based training for maintaining improved glycemic control.

Preliminary study of the effect of low-intensity home-based physical therapy in chronic stroke patients

This study was a preliminary examination of the effect of low-intensity home-based physical therapy on the performance of activities of daily living (ADL) and motor function in patients more than 1 year after stroke. Twenty patients were recruited from a community stroke register in Nan-Tou County, Taiwan, to a randomized, crossover trial comparing intervention by a physical therapist immediately after entry into the trial (Group I) or after a delay of 10 weeks (Group II). The intervention consisted of home-based physical therapy once a week for 10 weeks. The Barthel Index (BI) and Stroke Rehabilitation Assessment of Movement (STREAM) were used as standard measures for ADL and motor function. At the first follow-up assessment at 11 weeks, Group I showed greater improvement in lower limb motor function than Group II. At the second follow-up assessment at 22 weeks, Group II showed improvement while Group I had declined. At 22 weeks, the motor function of upper limbs, mobility, and ADL performance in Group II had improved slightly more than in Group I, but the between-group differences were not significant. It appears that low-intensity home-based physical therapy can improve lower limb motor function in chronic stroke survivors. Further studies will be needed to confirm these findings.

Effect of a low-resource-intensive lifestyle modification program incorporating gymnasium-based and home-based resistance training on type 2 diabetes risk in Australian adults

OBJECTIVE--The purpose of this study was to assess the effectiveness of a low-resource-intensive lifestyle modification program incorporating resistance training and to compare a gymnasium-based with a home-based resistance training program on diabetes diagnosis status and risk.

RESEARCH DESIGN AND METHODS--A quasi-experimental two-group study was undertaken with 122 participants with diabetes risk factors; 36.9% had impaired glucose tolerance (1GT) or impaired fasting glucose (IFG) at baseline. The intervention included a 6-week group self-management education program, a gymnasium-based or home-based 12-week resistance training program, and a 34-week maintenance program. Fasting plasma glucose (FPG) and 2-h plasma glucose, blood lipids, blood pressure, body composition, physical activity, and diet were assessed at baseline and week 52.

RESULTS--Mean 2-h plasma glucose and FPG fell by 0.34 mmol/1 (95% CI--0.60 to--0.08) and 0.15 mmol/l (-0.23 to -0.07), respectively. The proportion of participants with IFG or IGT decreased from 36.9 to 23.0% (P = 0.006). Mean weight loss was 4.07 kg (-4.99 to -3.15). The only significant difference between resistance training groups was a greater reduction in systolic blood pressure for the gymnasium-based group (P = 0.008).

CONCLUSIONS--This intervention significantly improved diabetes diagnostic status and reduced diabetes risk to a degree comparable to that of other low-resource-intensive lifestyle modification programs and more intensive interventions applied to individuals with IGT. The effects of home-based and gymnasium-based resistance training did not differ significantly.

Knowledge distribution nodes and home based businesses : role of business associations and local council in Casey LGA

This paper examines the stmcture, function and role of local business associations in home based business development within an urban region. Casey local government area (LOA), Victoria, is the focus, where nine local business associations in the area (as well as the local council) are evaluated in the context of support for local-based business development. The evaluation draws upon primary data co llected by surveys of local home based businesses, and follows up by semi-stmctured interviews of representatives from these business associations and the local council. This paper identifies that local business associations are fragmented and have significant overlap in their activities of which the commonest activity is acting as a knowledge distribution node. The cash strapped local council is the most important node. All are restricted by vision and resources. As a result, the services provided have little impact on sustainable business development in Casey.

Knowledge distribution nodes and home based businesses : role of local business associations and local council in Casey LGA

This paper examines the structure, function and role of local business associations in home based business development within an urban region. Casey local government area (LGA), Victoria, is the focus, where nine local business associations in the area (as well as the local council) are evaluated in the context of support for local-based business development. The evaluation draws upon primary data collected by surveys of local home based businesses, and follows up by semi-structured interviews of representatives from these business associations and the local council. This paper identifies that local business associations are fragmented and have significant overlap in their activities, of which the commonest activity is acting as a knowledge distribution node. The cash strapped local council is the most important node. All are restricted by vision and resources. As a result, the services provided have little impact on sustainable business development in Casey.

Protocol for a home-based integrated physical therapy program to reduce falls and improve mobility in people with Parkinson’s disease

Background The high incidence of falls associated with Parkinson’s disease (PD) increases the risk of injuries and immobility and compromises quality of life. Although falls education and strengthening programs have shown some benefit in healthy older people, the ability of physical therapy interventions in home settings to reduce falls and improve mobility in people with Parkinson’s has not been convincingly demonstrated.
Methods/design 180 community living people with PD will be randomly allocated to receive either a home-based integrated rehabilitation program (progressive resistance strength training, movement strategy training and falls education) or a home-based life skills program (control intervention). Both programs comprise one hour of treatment and one hour of structured homework per week over six weeks of home therapy. Blinded assessments occurring before therapy commences, the week after completion of therapy and 12 months following intervention will establish both the immediate and long-term benefits of home-based rehabilitation. The number of falls, number of repeat falls, falls rate and time to first fall will be the primary measures used to quantify outcome. The economic costs associated with injurious falls, and the costs of running the integrated rehabilitation program from a health system perspective will be established. The effects of intervention on motor and global disability and on quality of life will also be examined.
Discussion This study will provide new evidence on the outcomes and cost effectiveness of home-based movement rehabilitation programs for people living with PD.

Home based business in suburban peripheral regions and government policy: a case study of Casey, Melbourne, Australia

Home based businesses (HBB) are increasingly becoming an alternative to salaried employment. This research explores the potential for HBB to contribute significantly to the economic development of peripheral metropolitan centres. Without economic development, these centres remain dormitory suburbs with unresolved associated social and ecological issues. By mapping the diversity and limitations of HBB in the City of Casey, an outer suburban peripheral area of Melbourne, Australia, this study aims to evaluate what exists and the response by governments at all levels to further business development. This study finds that the role of government is restricted to broad initial start-ups, with no programs or support for the type of innovative HBB that need to be husbanded and encouraged to grow outside of the narrow confines of their home base.

Cost effectiveness of home based population screening for Chlamydia trachomatis in the UK: economic evaluation of chlamydia screening studies (ClaSS) project

OBJECTIVE: To investigate the cost effectiveness of screening for Chlamydia trachomatis compared with a policy of no organised screening in the United Kingdom. DESIGN: Economic evaluation using a transmission dynamic mathematical model. SETTING: Central and southwest England. PARTICIPANTS: Hypothetical population of 50,000 men and women, in which all those aged 16-24 years were invited to be screened each year. MAIN OUTCOME MEASURES: Cost effectiveness based on major outcomes averted, defined as pelvic inflammatory disease, ectopic pregnancy, infertility, or neonatal complications. RESULTS: The incremental cost per major outcome averted for a programme of screening women only (assuming eight years of screening) was 22,300 pounds (33,000 euros; $45,000) compared with no organised screening. For a programme screening both men and women, the incremental cost effectiveness ratio was approximately 28,900 pounds. Pelvic inflammatory disease leading to hospital admission was the most frequently averted major outcome. The model was highly sensitive to the incidence of major outcomes and to uptake of screening. When both were increased the cost effectiveness ratio fell to 6200 pound per major outcome averted for screening women only. CONCLUSIONS: Proactive register based screening for chlamydia is not cost effective if the uptake of screening and incidence of complications are based on contemporary empirical studies, which show lower rates than commonly assumed. These data are relevant to discussions about the cost effectiveness of the opportunistic model of chlamydia screening being introduced in England.