Evaluating the impact of a training program to support transitioning from the hospital to the community for people after stroke: a community case study

Background The transitions in care along the stroke recovery path are challenging, particularly in finding mechanisms to continue one’s recovery once at home. We aim to evaluate the impact of training physiotherapists and fitness instructors from one regional community together to deliver an evidence-based group exercise program starting in the hospital and transitioning to the community using an implementation approach. Methods The evidenced based exercise program Fitness and Mobility Exercise (FAME) for stroke was chosen as the intervention. Data from interviews with stakeholders (community centre and health authority hospital staff including a physiotherapy navigator) was transcribed and themes evaluated using the RE-AIM (Reach, Efficacy, Adoption, Implementation, Maintenance) framework. These data were supplemented by information collected as a quality assurance project within the health authority. Results Two programs were established; one in the community centre (run over 15 months by fitness instructors) and one in the regional hospital (run over 12 months by a rehabilitation assistant under the direction from a physiotherapist). Transitions in care were facilitated by implementing the same evidence-based group exercise class in both the hospital and community setting, so people living with stroke could seamlessly move from one to another. An existing physiotherapist navigator service also was valued as a support for the transitions between the two centres for people with stroke. The hospital group accessed group-based physiotherapy service on average 31 days earlier than they were able to in a one-to-one format. Conclusions This case study described the implementation of the Fitness and Mobility Exercise (FAME) program in one community and the use of a physiotherapist navigator to assist transition between them. After a community training workshop, FAME programs were established within the health authority and the community centre. FAME program participants within the health authority benefited from reduced wait times to access hospital outpatient physiotherapy service. Improvements in function were measured in and reported by the people after stroke attending either the health authority or community centre FAME groups.

The influence of a supervised group exercise intervention combined with active lifestyle recommendations on breast cancer survivors’ health, physical functioning, and quality of life indices: study protocol for a randomized and controlled trial

Background Most cancer patients, under active treatment or not, are sedentary, despite increasing scientific and clinical understanding of the benefits of exercise and physical activity, such as improving quality of life, limiting disease symptoms, decreasing cancer recurrence, and increasing overall survival. Studies have shown that both supervised exercise and unsupervised physical activity programs have low adherence and limited long-term benefits among cancer survivors. Therefore, interventions focused on increasing physical activity levels have clinical and psychological relevance. The present study will examine the feasibility and efficacy of an intervention that combines supervised group exercise with active lifestyle recommendations, analyzing its clinical, psychological, physiological, functional, and immunological effects in breast cancer survivors. Methods Women aged 35–75 years who have completed chemotherapy, radiotherapy, and surgery for breast cancer will be recruited from the Cancer Institute of the State of Sao Paulo (ICESP) and take part in a 16-week, parallel-group, randomized, and controlled trial. They will receive a booklet with recommendations for achieving a physically active lifestyle by increasing overall daily movement and undertaking at least 150 min/week of structured exercise. Then, they will be randomized into two groups: the supervised group will take part in two canoeing group exercise sessions every week, and the unsupervised group will increase their overall physical activity level by any means, such as active commuting, daily activities, or home-based exercise. Primary outcome includes aerobic capacity. Secondary outcomes are physical activity, physical functioning, self-reported quality of life, fatigue, presence of lymphedema, body composition, immune function, adherence to physical activity guidelines, and perceptions of self-image. Discussion Results should contribute to advance knowledge on the impact of a supervised group exercise intervention to improve aspects related to health, physical functioning, and quality of life in female breast cancer survivors. Trial registration Brazilian Registry of Clinical Trials Number: RBR-3fw9xf. Retrospectively Registered on 27 December 2018. Items from the World Health Organization Trial Registration Data Set can be accessed on http://www.ensaiosclinicos.gov.br/rg/RBR-3fw9xf/.

A Cross-Sectional Study on the Characteristics of Physical Activity in Pre-Frail Older Adults

This cross-sectional study aimed to characterize the physical activity (PA) of older adults with pre-frail status by examining sedentary behavior (SB) and PA using triaxial accelerometer data, with non-frail older adults as the control group. In this study, we divided the study participants into older adults who regularly participated in self-initiated citizen group exercise activities and those who did not. Data were collected between September and December 2017. We analyzed data from 256 older adults (women: 86.3%) aged ≥65 years. The interaction effect of participation status (participation and non-participation group) and frailty status (pre-frail and non-frail group) for moderate-to-vigorous PA (F = 9.178, p = 0.003) and daily mean number of steps (F = 9.351, p = 0.002) was significant. For the participation group, there was no difference between pre-frail older adults and non-frail older adults regarding length of SB and PA time, indicating that PA level was maintained in the participating pre-frail older adults. In contrast, moderate-to-vigorous PA and daily mean number of steps were low in pre-frail older adults who did not participate in the activities. The opportunity to participate in self-initiated group exercise activities and other PAs in the community may help pre-frail older adults maintain their PA.

Does Intradialytic Group Exercise Influence Malnutrition and Quality of Life in Maintenance Hemodialysis Patients? Evidence From an Experimental Study Using a Single-group Repeated-measures Design

BackgroundMaintenance hemodialysis (MHD) patients is the representative of the sedentary group and often suffer from physical inactivity. Exercise rehabilitation is not widely included in dialysis care despite demonstrated health benefits. This study aimed to evaluate the effectiveness of intradialytic group exercise in MHD patients.MethodsThis was a single center, single-group repeated-measures design study, which included MHD patients in the hemodialysis center in Taizhou, China. The 12-week, 3 times per week intradialytic group exercise programme was conducted around 30 min during the first 2 hours of each dialysis session. Anthropometric indicators, including Body Mass Index (BMI), Triceps Skinfold Thickness (TSF), Mid-upper Arm Circumference (MUAC), Mid-arm Muscle Circumference (MAMC) Handgrip Strength (HGS), and quality of life were measured at baseline, 4-week follow up and 12-week follow up. Laboratory indicators, including Hemoglobin level (Hb), Total Protein (TP) and Albumin (Alb) were measured at baseline and 12-week follow up. The repeated-measures analysis of variance and Friedman test were used to compare the parametric and non‐parametric data at three time points, respectively. Paired t test was used to compare the continuous parametric between two time points.ResultsNinety patients were enrolled at baseline and seventy-five patients finished the whole 12-week exercise programme. There were 7 patients dropped out for losing of motivation and sample churn rate for losing of motivation was 7.8% (7/90). Participants reported significant improvements in most of the outcomes, TSF (F (2, 148) = 28.908, p = 0.000), MUMC (F (2, 148) = 3.1821, p = 0.044), MAMC (F (2, 148) = 27.795, p = 0.000), HGS (F (2, 148) = 42.383, p = 0.000), TP (F (t = -2.417, p = 0.018), ALB (t -3.190, p = 0.002), Hb (t = -2.353, p = 0.021), and QOL (F (2, 148) = 10.48, p = 0.000).ConclusionsThe positive results from this research suggest that intradialytic group exercise programme including aerobic exercise and resistance exercise is a safe and suitable exercise way for maintenance hemodialysis patients. This exercise can help keep patients’ motivation and improve nutritional status and quality of life in maintenance hemodialysis patients.