The effects of foot massage on hemodialysis patients’ sleep quality and restless leg syndrome: a comparison of lavender and sweet orange essential oil topical application

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Khodayar Oshvandi ◽  
Fariba Mirzajani Letomi ◽  
Ali Reza Soltanian ◽  
Morteza Shamsizadeh
Keyword(s):  
Essential Oil ◽  
Sleep Quality ◽  
Repeated Measures ◽  
Sweet Orange ◽  
Controlled Trial ◽  
Control Group ◽  
Poor Sleep ◽  
Random Allocation ◽  
Restless Leg Syndrome ◽  
Orange Essential Oil

Abstract Objectives Hemodialysis (HD) patients suffer more sleep problems (poor sleep quality and restless leg syndrome [RLS]). Complementary therapy, especially massage with aromatherapy oil is one of the non-pharmacological treatment options with less adverse effects than routine methods. The purpose of this study was to determine the effects of foot massage with of lavender and orange essential oil on HD patients’ sleep quality and RLS. Methods This is a double blind randomized controlled trial on 105 HD patients was conducted at a large educational hospital in Iran, Hamadan province between January and September 2017. Patients divided into three groups with random allocation (35 participants per groups in lavender, orange, and control group). Foot massage during HD with lavender and orange essential oil was administered to the patients three times a week for three weeks, and every massage lasted half an hour. The control group received routine care. Before the intervention, the end of the first, second, and third weeks Pittsburgh Sleep Quality Index (PSQI) and RLS questionnaire were completed for all three groups. Data were statistically analyzed with Independent Samples t-test, chi-square test and repeated-measures analysis of variance (ANOVA) by SPSS version 16. Results The mean score of sleep quality and RLS in the intervention groups were significantly different compare with the control group in all three time of data collecting (p<0 001). Conclusions Aromatherapy prepared with lavender oil and sweet orange may be recommended to increase sleep quality and RLS level of the HD patients.

scholarly journals 0824 Improving Subjective Sleep Quality Measures Through Mindfulness Training in the Elderly: Preliminary Data from the Mindfulness Sleep Therapy (MIST) Study

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A314-A314
Author(s):  
F Perini ◽  
K Foong Wong ◽  
J Teng ◽  
Z Hassirim ◽  
J Lin ◽  
...  
Keyword(s):  
Sleep Quality ◽  
Repeated Measures ◽  
Controlled Trial ◽  
Quality Measures ◽  
The Elderly ◽  
Behavioural Intervention ◽  
Poor Sleep ◽  
Subjective Sleep Quality ◽  
Significant Group ◽  
Subjective Sleep

Abstract Introduction Poor sleep is a modifiable risk factor for multiple chronic disorders. Mindfulness-based therapies potentially improve sleep by enhancing awareness and acceptance of internal and external experiences, thus reducing pre-sleep hyper-arousal. In this pre-registered, randomized controlled trial, we tested the effect of mindfulness-based treatment for insomnia (MBTI) on subjective sleep quality measures (Pittsburgh Sleep Quality Questionnaire, PSQI) in the elderly. Methods Participants above 50 years old with sleep difficulties (PSQI ≥ 5) (mean (sd) age = 62.0 (6.35), 44 female) attended either an 8-week MBTI (N = 34) or sleep hygiene education and exercise program (SHEEP; N = 35). Before and after the interventions, we collected PSQI, insomnia symptoms and features measures (Pre-Sleep Arousal Scale, PSAS; Insomnia Severity Index, ISI; Dysfunctional Beliefs and Attitudes about Sleep, DBAS-30), mindfulness (Five-Facets Mindfulness Questionnaire, FFMQ), and mood and anxiety (Back Depression Inventory, BDI; State-Trait Anxiety Inventory, STAI). PSQI and PSAS (N = 26 to date) were collected at 6-month follow-up. Data were analysed with repeated-measures ANCOVA with group as a between-subject variable for the first 69 participants who completed the study. Results We observed significant improvement across both groups for sleep measures (PSQI: F1,67=36.442, p&lt;.01; PSAS-Cognitive: F1,67=12.664, p&lt;.01; ISI: F1,67=36.442, p&lt;.0; DBAS: F1,67=28.749, p&lt;.01) and mood (BDI: F1,67=26.393, p&lt;.01; STAI-State: F1,67=4.608, p=.04; STAI-Trait: F1,67=7.687, p&lt;.01), but not for Mindfulness (F1,67=2.256, p=.14) nor PSAS-somatic. No significant group by time interactions were found. We observed a correlation between PSQI decreases and FFMQ increases in MBTI (r=-.53, p&lt;.01), but not in SHEEP (r=-.07, p=.70) participants. ANCOVA of 6-month PSQI data revealed a significant group by time interaction (F1,24=19.525, p=.03), with reduction from baseline in MBTI (t12=4.769, p&lt;.01), but not in SHEEP group (t12=3.813, p=.08). Conclusion Preliminary results support MBTI as an accessible but effective behavioural intervention with potential long-term benefits for improving sleep and mood, and reducing cognitive-emotional arousal in the elderly. Support This study was supported by an award from the 7th grant call of the Singapore Millennium Foundation Research Grant Programme

scholarly journals 0519 Mindfulness Based Therapy for Insomnia Improves Objective Markers of Sleep in the Elderly: Preliminary Data from the Mindfulness Sleep Therapy (MIST) Study

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A198-A199
Author(s):  
K F Wong ◽  
F Perini ◽  
S L Henderson ◽  
J Teng ◽  
Z Hassirim ◽  
...  
Keyword(s):  
Preliminary Data ◽  
Repeated Measures ◽  
Mixed Model ◽  
Controlled Trial ◽  
Sleep Onset ◽  
Sleep Diary ◽  
Control Group ◽  
Poor Sleep ◽  
Sleep Onset Latency ◽  
Time In Bed

Abstract Introduction Mindfulness-based treatment for insomnia (MBTI) is a viable intervention for improving poor sleep. We report preliminary data from an ongoing pre-registered, randomized controlled trial which investigates the effect of MBTI on elderly adults. Methods Participants above 50 years old with PSQI ≥ 5 were recruited and randomised into either MBTI or an active control group (Sleep hygiene education and exercise program, SHEEP) in sequential cohorts with about 20 participants per cohort (10 per group). Before and after the intervention, 1 night of portable polysomnography (PSG) and 1 week of actigraphy (ACT) and sleep diary (DIARY) data were collected. We report the ACT and DIARY results of the first 3 cohorts (n = 46, male = 23, mean age = 62.3, std = 6.3) and PSG data of the first 2 cohorts (n = 29, male = 12, mean age = 62.5, std = 5.7). Time in bed (TIB), total sleep time (TST), sleep onset latency (SOL), wake after sleep onset (WASO), and sleep efficiency (SE) were analysed with mixed-model repeated-measures ANOVA. Results We observed increases in TIBDIARY (F1,44 = 5.151, p &lt; .05) and SEDIARY (F1,44 = 22.633, p &lt; .0001), and significant reductions in SOLDIARY (F1,44 = 7.031, p &lt; .05) and WASODIARY (F1,39 = 7.411, p &lt; .05). In the actigraphy data, we found a significant interaction in SOLACT (F1,39 = 4.273, p &lt; .05) with an increase in SHEEP SOLACT (t18= 2.36, p &lt; .05). Significant reductions were also observed in WASOACT (F1,44 = 16.459, p &lt; .0001) Finally, we observed a reduction in SOLPSG (F1,26 = 5.037, p &lt;. 05). All other tests were non-significant. Conclusion Preliminary results suggest that both interventions lead to improvements in sleep with more pronounced effects in subjective sleep reports. Objective sleep data suggest that improvements in sleep is a result of improved sleep quality and not simply extending sleep opportunity. These preliminary data shows that MBTI may be a promising intervention for elderly individuals with sleep difficulties. Support This study was supported by an award from the 7th grant call of the Singapore Millennium Foundation Research Grant Programme

scholarly journals The Impact of 5-Hydroxytryptophan Supplementation on Sleep Quality of Older Adults in Singapore: A Randomized Controlled Trial

2021 ◽  
Vol 5 (Supplement_2) ◽  
pp. 372-372
Author(s):  
Clarinda Sutanto ◽  
Chin Wee Heng ◽  
Alicia Xinli Gan ◽  
Xianfang Wang ◽  
Johnson Fam ◽  
...  
Keyword(s):  
Older Adults ◽  
Sleep Quality ◽  
Sleep Latency ◽  
Controlled Trial ◽  
Control Group ◽  
Poor Sleep ◽  
Poor Sleep Quality ◽  
Significant Treatment ◽  
Randomized Controlled ◽  
The Impact

Abstract Objectives Sleep quality has been associated with a number of health conditions such as cognitive impairment and cardiovascular disease. 5-Hydroxytryptophan (5-HTP) is known as a precursor of the sleep regulating serotonin and melatonin. However, 5-HTP's efficacy for improving sleep in older adults is unclear. The aim of this study is to assess the impact of 5-HTP on sleep quality in older Singaporean adults. Methods This study is a single-blinded, 12-week parallel randomized controlled trial, where 20 older adults (67 ± 4 years, mean ± SD; 8 M, 12 F) were randomly assigned to either consume or not consume 100 mg 5-HTP daily. Sleep quality data were collected every 4 weeks via both subjective and objective measures such as Pittsburg Sleep Quality Index (PSQI) questionnaire and actigraphy watch. A global sleep score (GSS) was obtained from the PSQI, where a GSS &gt; 5 has been validated to be associated with poor sleep quality. In addition, other sleep quality components that were also extracted include total sleep time (TST), sleep latency (SL) and sleep efficiency (SE). The main effect and interaction of 5-HTP on sleep were evaluated by repeated-measure analysis of variance (ANOVA). Results At baseline, subjects had an overall GSS of 5.9 ± 3.1 a.u. (5-HTP group: 6.3 ± 3.8 a.u.; Control group: 5.5 ± 2.3 a.u.) and this indicated poor sleep quality. Consumption of 5-HTP after 4 and 8 weeks showed a favorable decrease in their objective SL (SLObj) from their baseline (week 4: −18.2 ± 21.1 min; week 8: −17.8 ± 19.2 min). On the other hand, the control group did not display desirable change in SLObj (week 4: 2.4 ± 21.6 min; week 8: 1.5 ± 21.4 min). Repeated-measures ANOVA revealed a significant treatment-by-time effect between 5-HTP consumption and SLObj at week 4 (P = 0.045) and week 8 (P = 0.033), but not at week 12 (P = 0.135). A significant treatment-by-time decrease in subjective TST (−0.1 ± 0.4 hrs, P = 0.027) observed at week 12. No changes in GSS and other subjective and objective measures of sleep quality were detected. Conclusions Older adults had poor sleep quality and 5-HTP supplementation helped reduce sleep latency for up to 8 weeks. Prolonged effects were not observed, and this may be due to acclimation of the body to longer-term 5-HTP supplementation. Funding Sources NUS iHealthtech Microbiome in Health, Disease and Ageing.

scholarly journals Effect of Aromatherapy on Dental Anxiety and Pain in Children Undergoing Local Anesthetic Administrations: A Randomized Clinical Trial

2021 ◽  
Vol 10 (3) ◽  
pp. 111-120
Author(s):  
Kamalapuram Nirmala ◽  
Rekhalakshmi Kamatham
Keyword(s):  
Clinical Trial ◽  
Essential Oil ◽  
Local Anesthetic ◽  
Behavioral Problems ◽  
Sweet Orange ◽  
Dental Anxiety ◽  
Pain Scale ◽  
Control Group ◽  
Significant Difference ◽  
Orange Essential Oil

Introduction: In dentistry, local anesthetic (LA) administration in children is often associated with behavioral problems. Hence, the present study evaluated the efficacy of aromatherapy in reducing the dental anxiety and pain during LA procedure. Methods: This clinical trial was conducted upon 150 children in the age range of 8-12 years. Subjects were randomly divided into five groups; Group 1: Lavender essential oil using nebulizer; Group 2: Lavender essential oil using inhaler; Group 3: Orange essential oil using nebulizer; Group 4: Orange essential oil using inhaler; Group 5: Control (without aromatherapy). For all the children, baseline anxiety was recorded followed by aromatherapy (except for children in the control group). Following the standard protocol, LA was administered. The procedural pain was assessed using Faces, Legs, Activity, Cry and Consolability scale (FLACC) and Faces Pain Scale-Revised (FPS-R). Finally, anxiety was again recorded. Data were analyzed using SPSS version 17.0. Results: A significant difference in ANOVA test was observed among anxiety scores after LA in aromatherapy groups 1, 3, and 4 compared to control. When the FLACC scores were analyzed using Kruskal-Wallis, there were significantly lower values in aromatherapy groups compared to the control group. The pain scores, as reported in FPS-R, were also lower in aroma groups 1, 3, and 4. Conclusion: Aromatherapy with lavender or sweet orange, using either nebulizer or inhaler, decreased the dental anxiety of children, whereas, only sweet orange could reduce the pain as self-reported by children.

scholarly journals The Effect of Foot Massage with Lavender Essential Oil on The Sleep Quality of The Elderly in Banjar Gelumpang, Sukawati Village

2021 ◽  
Vol 2 (2) ◽  
pp. 47-51
Author(s):  
Ni Luh Putu Dewi Puspawati ◽  
Ni Kadek Ari Santi ◽  
Ni Luh Gede Intan Saraswati
Keyword(s):  
Essential Oil ◽  
Sleep Quality ◽  
The Elderly ◽  
Rank Test ◽  
Control Group ◽  
Poor Sleep ◽  
Wilcoxon Sign Rank Test ◽  
Wilcoxon Sign Rank ◽  
Sign Rank Test

Aging process in the elderly will cause health problems such as immobilization, incontinence, depression, malnutrition, decreased immune system, and sleep quality disorders. The puspose of this study was to determine the effect of foot massage with lavender essential oil on the sleep quality of the elderly. This research design used a pre-experimental with one group pre-test post-test design without a control group. The number of samples used was 20 respondents selected by purposive sampling and data collection using the pitsburgh sleep quality index questionnaire with the test result analyzed with Wilcoxon Sign Rank Test. The result showed that in pretest all respondents experienced poor sleep quality, and posttest data obtained that 13 respondents (65%) experienced good sleep quality. The results of data analysis using the Wilcoxon Sign rank test showed that the p-value = 0,000 <a (0,05) which means that there is an effect of foot massage with lavender essential oil on the sleep quality of the elderly in Banjar Gelumpang Sukawati village. Emphasis on certain points and the aroma of lavender will make the elderly feel relaxed so that the quality of sleep improved. It is suggests that the elderly and families to perform foot massage.

Effect of aromatherapy massage with orange essential oil on postoperative pain after cesarean section: a randomized controlled trial

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Seyedmohammad Mirhosseini ◽  
Ali Abbasi ◽  
Nastaran Norouzi ◽  
Fatemeh Mobaraki ◽  
Mohammad Hasan Basirinezhad ◽  
...  
Keyword(s):  
Side Effects ◽  
Essential Oil ◽  
Cesarean Section ◽  
Statistical Tests ◽  
Intervention Group ◽  
Nursing Intervention ◽  
Anxiety Score ◽  
Control Group ◽  
And Control ◽  
Orange Essential Oil

Abstract Objectives Many women in recent years have been willing to undergo puncture surgery for childbirth, which, like other surgeries, has physical and psychological side effects such as incision, infertility, chronic pain, and anxiety. Therefore, it is important to reduce and improve these side effects. The aim of this study was to determine the effect of foot massage with orange essential oil on pain and anxiety in women undergoing cesarean section. Methods This randomized clinical trial study was conducted in 2019 on 80 women referred to Bahar Shahroud Hospital after cesarean section surgery. The samples were divided into two groups by intervention (foot massage with orange essential oil) and control (foot massage without orange essential oil). The Spielberger scale was used to determine anxiety scores after cesarean section. In the intervention group, the feet were massaged with orange essential oil, and in the control group, the orange essential oil massage was performed without oil. Anxiety before, immediately after, and 60 min after the intervention was measured and evaluated in both groups. Data analysis was performed using descriptive and inferential statistics. Significant levels were considered for all statistical tests (p<0.05). Results The anxiety score before the intervention in the two groups of intervention and control was 57.12 ± 3.12 and 57.07 ± 3.54, respectively, which were not significantly different, but immediately after the intervention, the anxiety scores in both groups decreased significantly so that there was a further decrease in the intervention group (52.10 ± 4.75 and 56.02 ± 3.77), 1 h after the intervention, the anxiety score in the intervention group decreased compared to the previous stage and increased in the control group (50.40 ± 3.74 and 56.85 ± 4.27). Conclusions Foot massage with orange essential oil can probably be effective as a proper nursing intervention in reducing anxiety after cesarean section surgery.

scholarly journals A pilot study on essential oil aroma stimulation for enhancing slow-wave EEG in sleeping brain

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Li-Wei Ko ◽  
Cheng-Hua Su ◽  
Meng-Hsun Yang ◽  
Shen-Yi Liu ◽  
Tung-Ping Su
Keyword(s):  
Essential Oil ◽  
Sleep Quality ◽  
Slow Wave ◽  
Slow Wave Sleep ◽  
Sleep Eeg ◽  
Poor Sleep ◽  
Alpha Power ◽  
Poor Sleep Quality ◽  
Healthy Human ◽  
Study Results

AbstractSleep quality is important to health and life quality. Lack of sleep can lead to a variety of health issues and reduce in daytime function. Recent study by Fultz et al. also indicated that sleep is crucial to brain metabolism. Delta power in sleep EEG often indicates good sleep quality while alpha power usually indicates sleep interruptions and poor sleep quality. Essential oil has been speculated to improve sleep quality. Previous studies also suggest essential oil aroma may affect human brain activity when applied awake. However, those studies were often not blinded, which makes the effectiveness and mechanism of aroma a heavily debated topic. In this study, we aim to explore the effect of essential oil aroma on human sleep quality and sleep EEG in a single-blinded setup. The aroma was released when the participants are asleep, which kept the influence of psychological expectation to the minimum. We recruited nine young, healthy participants with regular lifestyle and no sleep problem. All participants reported better sleep quality and more daytime vigorous after exposing to lavender aroma in sleep. We also observed that upon lavender aroma releases, alpha wave in wake stage was reduced while delta wave in slow-wave sleep (SWS) was increased. Lastly, we found that lavender oil promote occurrence of SWS. Overall, our study results show that essential oil aroma can be used to promote both subjective and objective sleep quality in healthy human subjects. This makes aroma intervention a potential solution for poor sleep quality and insomnia.

Fascial treatment versus manual therapy (HVLA) in patients with chronic neck pain: A randomized controlled trial

2021 ◽  
pp. 1-10
Author(s):  
Katrin Brück ◽  
Kirsten Jacobi ◽  
Tobias Schmidt
Keyword(s):  
Neck Pain ◽  
Manual Therapy ◽  
Repeated Measures ◽  
Primary Outcome ◽  
Controlled Trial ◽  
Severity Of Illness ◽  
Chronic Neck Pain ◽  
Secondary Outcome ◽  
Control Group ◽  
Industrialized Nations

BACKGROUND: Chronic neck pain (CNP) is a common health problem in western industrialized nations. In recent years, the fascial tissue has attracted the attention of therapists, and a treatment of the fasciae promises to be a meaningful approach in the therapy of patients with CNP. OBJECTIVE: The aim of this study was to investigate the effectiveness of a fascial treatment (FT) compared to manual therapy (MT) and to no intervention (control group, CG) in patients with CNP. METHODS: Sixty participants with CNP were randomized into three groups. Primary outcome parameters were pain intensity as measured by the visual analogue scale (VAS), and severity of illness as measured by the Neck Pain and Disability Scale (NPAD). Secondary outcome parameter was the range of motion (ROM) of the cervical spine. RESULTS: Repeated measures t-tests demonstrated significant decreases with medium to large effect sizes for the FT (VAS: dR⁢M= 1.14; NPAD: dR⁢M= 0.51) and for the MT (VAS: dR⁢M= 1.15; NPAD: dR⁢M= 0.72). CONCLUSION: Our results confirmed the effectiveness of MT on pain and severity of illness in the treatment of patients suffering from CNP. Furthermore, the results demonstrated the effectiveness and clinical relevance of FT for this population.

scholarly journals A brief sleep focused psychoeducation program for sleep-related outcomes in new mothers: a randomized controlled trial

SLEEP ◽  
2020 ◽  
Vol 43 (11) ◽  
Author(s):  
Liora Kempler ◽  
Louise A Sharpe ◽  
Nathaniel S Marshall ◽  
Delwyn J Bartlett
Keyword(s):  
Sleep Quality ◽  
Daytime Sleepiness ◽  
Linear Mixed Model ◽  
Intervention Group ◽  
Control Group ◽  
Poor Sleep ◽  
Maternal Sleep ◽  
Pregnancy And Postpartum ◽  
Secondary Outcomes ◽  
Insomnia Symptoms

Abstract Study Objectives Poor sleep is commonly problematic during pregnancy and postpartum and is associated with depression. This trial investigated the efficacy of prenatal brief, group sleep psychoeducation in improving postpartum maternal sleep, and depression. Methods A total of 215 healthy expectant first-time mothers were cluster randomized (1:1) to receive either a 2 × 1.5 h psychoeducation intervention and a set of booklets, or a set of booklets only. Participants completed questionnaires during pregnancy (pre-intervention), and 6 weeks and 4 months postpartum. A post hoc subset of questionnaires was collected at 10 months postpartum. The primary hypothesis was the intervention group would have improved postpartum sleep quality, and reduced levels of insomnia symptoms, fatigue, and daytime sleepiness compared to the control group. Secondary outcomes included depression, anxiety, and stress. Results Linear mixed model analyses failed to confirm a group by time interaction on primary or secondary outcomes across all time points. There was no effect of the intervention on outcomes at 6 weeks, or 10 months postpartum. A significant time by group interaction was found at 4 months, favoring the intervention for sleep quality (p = 0.03) and insomnia symptoms (p = 0.03), but not fatigue or daytime sleepiness. Conclusions Prenatal sleep psychoeducation did not produce a sustained effect on maternal sleep throughout the postpartum period. There was little evidence of benefits on depressive symptoms. Clinical Trial Registration ACTRN12611000859987

Effects of Calisthenics and Pilates Exercises on Coordination and Proprioception in Adult Women: A Randomized Controlled Trial

2012 ◽  
Vol 21 (3) ◽  
pp. 235-243 ◽  
Author(s):  
Derya Ozer Kaya ◽  
Irem Duzgun ◽  
Gul Baltaci ◽  
Selma Karacan ◽  
Filiz Colakoglu
Keyword(s):  
Outcome Measures ◽  
Repeated Measures ◽  
Controlled Trial ◽  
Exercise Group ◽  
Lower Limbs ◽  
Control Group ◽  
Adult Women ◽  
Kinetic Chain ◽  
Randomized Controlled ◽  
Closed Kinetic Chain

Objective:To assess and compare the effects of 6 mo of Pilates and calisthenics on multijoint coordination and proprioception of the lower limbs at the 3rd and 6th mo of training.Design:Randomized, controlled, assessor-blinded, repeated-measures.Setting:University research laboratory.Participants and Intervention:Healthy, sedentary, female participants age 25–50 y were recruited and randomly divided into 3 groups: a calisthenic exercise group (n = 34, mean age ± SD 40 ± 8 y, body-mass index [BMI] 31.04 ± 4.83 kg/m2), a Pilates exercise group (n = 32, mean age ± SD 37 ± 8 y, BMI 31.04 ± 4.83 kg/m2), and a control group (n = 41, mean age ± SD 41 ± 7 y, BMI 27.09 ± 4.77 kg/m2). The calisthenics and Pilates groups underwent related training programs for 6 mo, while the controls had no specific training.Main Outcome Measures:Coordination and proprioception of the lower extremities with concentric and eccentric performances in the closed kinetic chain assessed with the monitored rehab functional squat system at baseline and at the 3rd and 6th mo of training.Results:For the within-group comparison, coordinative concentric and eccentric deviation values were significantly decreased for both dominant and nondominant lower limbs at pretraining and at the 3rd and 6th mo posttraining in the calisthenics group (P < .05). In contrast, there was no improvement in the Pilates group throughout the training. However, for comparisons between groups, the baseline values of coordinative concentric and eccentric deviations were different in the calisthenics group than in Pilates and the controls (P < .05). There were no differences in the proprioception values of either visible or nonvisible movement in any group throughout the training (P > .05).Conclusions:It seems that calisthenic exercises are more likely to improve coordination of the lower extremity after 3 and 6 mo of training than Pilates exercises. Calisthenic exercises may be useful for individuals who require improved coordination.

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