Rheumatology Practitioners' View of Exercise in Adults With Systemic Sclerosis or Systemic Lupus Erythematosus

ABSTRACT Background Exercise is part of the general recommendations for care of people with most arthropathies or connective tissue diseases, but it does not feature specifically in the clinical guidelines for management of systemic lupus erythematosus (SLE) and systemic sclerosis (SSc) by rheumatology practitioners. In this study, we sought to explore rheumatologists' (RHs') and rheumatology nurses' (RNs') perspectives and use of exercise interventions for adults with SLE or SSc. Methods Semistructured interviews were conducted with Australian RHs and RNs online using Zoom (video conferencing software). Interviews were transcribed verbatim, then coded and analyzed using NVivo for content analysis of themes. Results Seventeen participants completed the interviews (RHs n = 12, RNs n = 5). Five themes were identified: rheumatology practitioners perceive that (1) exercise is beneficial for adults with SLE or SSc, especially in managing fatigue, pain, and wellbeing; (2) exercise presents some general, structural, and disease-related barriers for adults with SLE or SSc; (3) rheumatology practitioners are confident in providing general exercise advice but lack time and confidence in prescribing exercise; (4) rheumatology practitioners' concerns about exercise are limited to those with heart and lung disease, inflamed joints, ulcerated fingertips, and severe contractures; and (5) to facilitate safe and attainable exercise, rheumatology practitioners recommend long-term, supervised, gradual, and affordable exercise options. There were no clear differences identified between the views of RNs and RHs. Conclusion Rheumatology practitioners require information and options for long-term and affordable exercise for adults with SLE or SSc that are supervised, individualized, and focus on a gradual progressive approach.

The effect of integrative rehabilitation treatment on upper extremity ability of patients with central nervous system injury

Purpose: The aim of this study was to test and develop a rehabilitation treatment protocol that maximizes the improvement of upper limb. In addition, this study was conducted to present a basic protocol for an integrative rehabilitation treatment method. Methods: Patients diagnosed with stroke and exhibiting movement disorders in paralyzed limbs were randomly assigned to an experimental group and a control group. The experimental group received proprioceptive neuromuscular facilitation, extracorporeal shock wave therapy, and taping therapy. The control group received general exercise therapy and functional electrical stimulation. The treatment program for each group was conducted two times a week for four weeks, and exercise was performed for 60 minutes per session. Results: There were statistically significant differences in the grip power with muscular strength of the shoulder joint flexor, extensor, adductor and abductor muscles before and after treatment in the experimental group and control group. Conclusion: In conclusion, in order to improve upper extremity ability, a treatment method that can be applied at the same time and a method for managing the cause of the patient's limitations must be applied together.

From Exercise to Cognitive Performance: Role of Irisin

The beneficial effects of exercise on the brain are well known. In general, exercise offers an effective way to improve cognitive function in all ages, particularly in the elderly, who are considered the most vulnerable to neurodegenerative disorders. In this regard, myokines, hormones secreted by muscle in response to exercise, have recently gained attention as beneficial mediators. Irisin is a novel exercise-induced myokine, that modulates several bodily processes, such as glucose homeostasis, and reduces systemic inflammation. Irisin is cleaved from fibronectin type III domain containing 5 (FNDC5), a transmembrane precursor protein expressed in muscle under the control of peroxisome proliferator-activated receptor-γ coactivator-1α (PGC-1α). The FNDC5/irisin system is also expressed in the hippocampus, where it stimulates the expression of the neurotrophin brain-derived neurotrophic factor in this area that is associated with learning and memory. In this review, we aimed to discuss the role of irisin as a key mediator of the beneficial effects of exercise on synaptic plasticity and memory in the elderly, suggesting its roles within the main promoters of the beneficial effects of exercise on the brain.

The effects of combined motor control and isolated extensor strengthening versus general exercise on paraspinal muscle morphology and function in patients with chronic low back pain: a randomised controlled trial protocol

Background Exercise is a common approach for the management of patients with chronic non-specific low back pain (LBP). However, there is no clear mechanistic evidence or consensus on what type of exercise is more effective than others. While considerable evidence suggests a link between lumbar muscle health (e.g., atrophy and fatty infiltration) with functional deficits, it is unknown whether exercises targeting the lumbar spine can lead to noticeable improvements in muscle health and functional outcomes. The primary aim of this study is to compare the effect of combined motor control and isolated strengthening lumbar exercises (MC + ILEX) versus a general exercise group (GE) on multifidus muscle morphology (size and composition). Secondary aims include assessing the effect of the interventions on overall paraspinal muscle health, pain and disability, as well as psychological factors as possible effect modifiers. Methods A total of 50 participants with chronic non-specific LBP and moderate to severe disability, aged between 18 and 60, will be recruited from the local orthopaedic clinics and university community. Participants will be randomised (1:1) to either the MC + ILEX or GE group. Participants will undergo 24 individually supervised exercise sessions over a 12-week period. The primary outcome will be multifidus morphology (atrophy) and composition (fatty infiltration). Secondary outcomes will be muscle function (e.g., % thickness change during contraction), morphology, lumbar extension strength, pain intensity and disability. Potential treatment effect modifiers including maladaptive cognitions (fear of movement, catastrophizing), anxiety, depression, physical activity, and sleep quality will also be assessed. All measurements will be obtained at baseline, 6-week and 12-week; self-reported outcomes will also be collected at 24-week. Between-subjects repeated measure analysis of variance will be used to examine the changes in paraspinal muscle morphology over the different time points. Linear mixed models will be used to assess whether baseline scores can modify the response to the exercise therapy treatment. Discussion The results of this study will help clarify which of these two common interventions promote better results in terms of overall paraspinal muscle heath, back pain, disability and psychological factors in adults with chronic LBP. Trial registration NTCT04257253, registered prospectively on February 5, 2020.

Multicomponent Home-Based Training Program for Chronic Kidney Disease Patients during Movement Restriction

Both intradialytic and out-of-clinic exercise programs (EP) have been proven to be a safe and effective way to increase fitness levels in end-stage chronic kidney disease (CKD) patients. The actual COVID-19 pandemic situation has forced the suspension of EP offered in hemodialysis centers in many countries; as well as all activities considered as “non-essential” (i.e., sport facilities and fitness centers). Therefore, there is a high risk that movement restrictions would promote physical inactivity and its associated diseases in CKD patients; especially those undergoing domiciliary confinement situations. Given the importance for CKD patients’ overall health to maintain exercise levels and reach physical activity recommendations, the aim of this Protocol was to design a personalized, well-structured, multicomponent physical EP that CKD patients can safely follow at home. We also aimed to provide an initial fitness evaluation tool that allows patients to adapt the EP to their fitness level. Current general exercise recommendations for people living with chronic conditions have been analyzed to develop the present home-based EP proposal.

Effect of Core Stabilization Exercise for Non-Specific Low Back Pain among Athletes

This study aimed to analyze the effect of core stabilization exercise compared to general exercise for non-specific low back pain among athletes. There were 16 athletes with non-specific low back pain participated in this study. They were divided randomly into two groups after the screening process: core stabilization exercise group (CSG) and general exercise group (GEG). They were required to finish three sessions per week for six weeks. The pre-test and post-test were recorded using the Numeric Rating Scale (NRS) and Oswestry Low Back Pain Disability Questionnaire (ODQ). The study revealed that the core stabilization exercise group is influential and has significant pain relief (p=0.000) and disability reduced (p=0.001) compared to the general exercise group after six weeks of intervention. This study demonstrated that core stabilization exercise is effective in reducing pain relief and reduce functional disability. Thus, prescribing core stabilization exercise may be beneficial to be used as therapeutic exercises for patients who suffer low back pain as it relieves pain and reduces functional disability.

Posterior-Chain Resistance Training Compared to General Exercise and Walking Programmes for the Treatment of Chronic Low Back Pain in the General Population: A Systematic Review and Meta-Analysis

Background While chronic exercise training has been demonstrated to be an effective non-pharmacological treatment for chronic low back pain (CLBP), there has been a relative lack of evidence or clinical guidelines for whether a posterior chain resistance training programme provides any benefits over general exercise (GE). Objectives To determine if chronic posterior chain resistance training (PCRT), defined as exercise programmes of ≥6 weeks duration focused on the thoracic, lumbar and hip extensor musculature, is more effective than GE in improving pain, level of disability, muscular strength and the number of adverse events in recreationally active and sedentary individuals with CLBP. Methods Four electronic databases were systematically searched from 25 September 2019 until 30 August 2020. Using the Joanna Briggs Institute (JBI) Critical Appraisal Tools checklist for randomized controlled trials (RCTs), articles were critically appraised and compared against the inclusion/exclusion criteria. Standardized mean difference (SMD), risk difference (RD) and confidence interval (CI) were calculated using Review Manager 5.3. Results Eight articles were included, with a total of 408 participants (203 PCRT, 205 GE). Both PCRT and GE were effective in improving a number of CLBP-related outcomes, but these effects were often significantly greater in PCRT than GE, especially with greater training durations (i.e. 12–16 weeks compared to 6–8 weeks). Specifically, when compared to GE, PCRT demonstrated a greater reduction in pain (SMD = − 0.61 (95% CI − 1.21 to 0.00), p = 0.05; I2 = 74%) and level of disability (SMD = − 0.53 (95% CI − 0.97 to − 0.09), p = 0.02; I2 = 52%), as well as a greater increase in muscle strength (SMD = 0.67 (95% CI 0.21 to 1.13), p = 0.004; I2 = 0%). No differences in the number of adverse events were reported between PCRT and GE (RD = − 0.02 (95% CI − 0.10 to 0.05), p = 0.57; I2 = 72%). Conclusion Results of the meta-analysis indicated that 12–16 weeks of PCRT had a statistically significantly greater effect than GE on pain, level of disability and muscular strength, with no significant difference in the number of adverse events for recreationally active and sedentary patients with CLBP. Clinicians should strongly consider utilizing PCRT interventions for 12–16 weeks with patients with CLBP to maximize their improvements in pain, disability and muscle strength. Future research should focus on comparing the efficacy and adverse events associated with specific PCRT exercise training and movement patterns (i.e. deadlift, hip lift) in treating this population. Trial registration PROSPERO CRD42020155700.

The Efficiency of Dynamic vs General Exercise for Posture Control Dealing with Low Back Pain

Mechanical low back pain is brought on by associated factors, such as muscular imbalances, excess muscular stress, and improper posture. Proper posture is vital for treating low back pain because of its unloading effects on the spine. Thus, the purpose of this critiqued article is to explore which is an effective and functional exercise that can be done at any time for posture. Thirty adults (20-30 years old, 14 males and 16 females) with chronic as opposed to acute or surgery, mechanical low back pain were splitted into Dynamic Sitting Exercise (DSE) and Spinal Extension Exercise (SEE). DSE subject is unloading the spine using the arms while sitting in an upright position. SEE subject is laying prone in elbow position doing a press up with straight arms. Testing was conducted 3 days per week for 6 weeks. Back pain was measured by Visual Analogue Scale (VAS), lumbar mobility by Modified-Modified Schober Test (MMST), and quality of life through subject self-reporting using the (SF-36) health survey before and after the examination. Data were analyzed using paired t-test and Mann-Whitney U-test. A greater improvement has been shown in pain (VAS; z = 3.81, p < .05) with DSE in comparison to SEE. Greater lumbar mobility (MMST; z = 1.99, p < 0.05) increase with DSE in comparison to SEE. A higher quality of life (SF-36; z = 4.16, p < 0.05) with DSE in comparison to SEE was reported. Overall, the DSE proved more effective (see Table 1). DSE works better because of its decompressing action unloading the disc in the spine without straining the lumbar muscles through excess abdominal activation compared to SEE. 6 weeks of DSE training is more efficient for adults with mechanical low back pain compared to SEE. DSE relieves more pressure off the mechanoreceptors leading to greater reduction in pain while also increasing blood flow to the lumbar muscles. The study demonstrates the efficiency advantage of DSE in comparison to SEE with their improvements in pain, lumbar mobility, and quality of life. Defining comparisons were made between the two methods allowing us to understand DSE’s decompression effect on intervertebral disc as opposed to SEE’s strain on lumbar muscles. The results can be interpreted and used by anyone with mechanical low back pain so they may implement the DSE routine into their daily life. The only limitations include self-reporting quality of life with SF-36 survey and sample size. Adding a different means of measuring quality of life and larger sample size (100+) would improve experiment for a follow up study.

The Efficiency of Dynamic vs. General Exercise for Posture Control Dealing with Low Back Pain

Mechanical low back pain is brought on by associated factors, such as muscular imbalances, excess muscular stress, and improper posture. Proper posture is vital for treating low back pain because of its unloading effects on the spine. Thus, the purpose of this critiqued article is to explore which is an effective and functional exercise that can be done at any time for posture. Thirty adults (20-30 years old, 14 males and 16 females) with chronic as opposed to acute or surgery, mechanical low back pain were splitted into Dynamic Sitting Exercise (DSE) and Spinal Extension Exercise (SEE). DSE subject is unloading the spine using the arms while sitting in an upright position. SEE subject is laying prone in elbow position doing a press up with straight arms. Testing was conducted 3 days per week for 6 weeks. Back pain was measured by Visual Analogue Scale (VAS), lumbar mobility by Modified-Modified Schober Test (MMST), and quality of life through subject self-reporting using the (SF-36) health survey before and after the examination. Data were analyzed using paired t-test and Mann-Whitney U-test. A greater improvement has been shown in pain (VAS; z = 3.81, p < .05) with DSE in comparison to SEE. Greater lumbar mobility (MMST; z = 1.99, p < 0.05) increase with DSE in comparison to SEE. A higher quality of life (SF-36; z = 4.16, p < 0.05) with DSE in comparison to SEE was reported. Overall, the DSE proved more effective (see Table 1). DSE works better because of its decompressing action unloading the disc in the spine without straining the lumbar muscles through excess abdominal activation compared to SEE. 6 weeks of DSE training is more efficient for adults with mechanical low back pain compared to SEE. DSE relieves more pressure off the mechanoreceptors leading to greater reduction in pain while also increasing blood flow to the lumbar muscles. The study demonstrates the efficiency advantage of DSE in comparison to SEE with their improvements in pain, lumbar mobility, and quality of life. Defining comparisons were made between the two methods allowing us to understand DSE’s decompression effect on intervertebral disc as opposed to SEE’s strain on lumbar muscles. The results can be interpreted and used by anyone with mechanical low back pain so they may implement the DSE routine into their daily life. The only limitations include self-reporting quality of life with SF-36 survey and sample size. Adding a different means of measuring quality of life and larger sample size (100+) would improve experiment for a follow up study.

Exercise addiction of individuals receiving sports services and analysis of social appearance anxiety levels

The purpose of this study was to examine exercise addiction and social appearance anxiety levels of students studying at the faculty of sports sciences in terms of various variables. There were 170 participants in the study. “Personal Information Form”, “Exercise Addiction Scale” and “Social Appearance Anxiety Scale” were applied to the participants. Whether the data provided the assumption of normality was evaluated by the skewness and kurtosis test. It was decided that the values obtained as a result of the analysis provided the assumption of normality; therefore it was deemed appropriate to apply parametric tests. Frequency, percentage, t-test, One-Way ANOVA and Post Hoc (Scheffe) test statistics were used to analyze the data. As a result, it was determined that participants who regularly received sports services at least 2 days a week had low levels of general exercise addiction and social appearance anxiety. In this context, it can be said that individuals' exercise addiction and social appearance anxiety levels were low. Therefore, it can be said that the physical and mental benefits individuals got from sports activities enabled them to be more at peace with themselves, as the participants who received sports services made their exercise a habit to protect their health in daily life.