A progressive exercise and structured advice program does not improve activity more than structured advice alone following a distal radial fracture: a multi-centre, randomised trial. Improvement in aerobic fitness during rehabilitation after hip fracture. A community-based upper-extremity group exercise program improves motor function and performance of functional activities in chronic stroke: a randomized controlled trial. Randomized clinical trial of therapeutic exercise in subacute stroke. Effectiveness of a physical exercise intervention program in improving functional mobility in older adults after hip fracture in later stage rehabilitation: protocol of a randomized clinical trial (REATIVE Study) Home-based, upper-arm exercise training for patients with chronic obstructive pulmonary disease. Can elderly patients who have had a hip fracture perform moderate- to high-intensity exercise at home? Exercise intervention to prevent falls and enhance mobility in community dwellers after stroke: a protocol for a randomised controlled trial The Role of Caregiver Involvement in Upper-Limb Treatment in Individuals With Subacute Stroke Effects of Constraint-Induced Therapy Versus Bilateral Arm Training on Motor Performance, Daily Functions, and Quality of Life in Stroke Survivors Impact of the fit and strong intervention on older adults with osteoarthritis. Effects of extended outpatient rehabilitation after hip fracture: a randomized controlled trial. Mobility training after hip fracture: a randomised controlled trial. Motor Training of Upper Extremity With Functional Electrical Stimulation in Early Stroke Rehabilitation Long term effects of intensity of upper and lower limb training after stroke: a randomised trial The effects of a community exercise program on fracture risk factors in older women Upper- versus lower-limb aerobic exercise training on health-related quality of life in patients with symptomatic peripheral arterial disease.
QUESTION Does a program of exercise and structured advice implemented during the rehabilitation phase following a distal radial fracture achieve better recovery of upper limb activity than structured advice alone ? DESIGN A phase I/II , multi-centre , r and omised , controlled trial with concealed allocation , assessor blinding and intention-to-treat analysis . PARTICIPANTS Thirty-three adults ( 25 female , mean age 54 years ) following distal radial fracture managed in a cast . INTERVENTION The experimental intervention was a 6-week program of progressive exercise and structured advice implemented over three consultations by a physiotherapist . The control intervention was a program of structured advice only , delivered by a physiotherapist over three consultations . OUTCOME MEASURES The primary outcome was upper limb activity limitations , assessed by the Patient-Rated Wrist Evaluation and the shortened version of the Disabilities of the Arm , Shoulder and H and outcome measure ( QuickDASH ) . The secondary outcomes were wrist range of movement , grip strength and pain . All measures were completed at baseline ( week 0 ) , after the intervention ( week 7 ) and at 6 months ( week 24 ) . RESULTS There were no significant between-group differences in upper limb activity as measured by the Patient-Rated Wrist Evaluation at week 7 and week 24 assessment s ( mean difference -4 units , 95 % CI -10 to 2 ; mean difference 0 units , 95 % CI -3 to 3 , respectively ) , or QuickDASH at week 7 and week 24 assessment s ( mean difference -5 units , 95 % CI -16 to 6 ; mean difference 0.3 units , 95 % CI -6 to 7 , respectively ) . The secondary outcomes did not demonstrate any significant between-group effects . CONCLUSION The prescription of exercise in addition to a structured advice program over three physiotherapy consultations may convey no extra benefit following distal radial fracture managed in a cast . TRIAL REGISTRATION ACTRN12612000118808 . [ Bruder AM , Shields N , Dodd KJ , Hau R , Taylor NF ( 2016 ) A progressive exercise and structured advice program does not improve activity more than structured advice alone following a distal radial fracture : a multi-centre , r and omised trial . Journal of Physiotherapy62 : 145 - 152 ] OBJECTIVE To evaluate the effect of an upper-body exercise program on cardiorespiratory fitness in older adults with hip fracture during inpatient rehabilitation . DESIGN R and omized controlled trial using a convenience sample . SETTING An inpatient rehabilitation unit . PARTICIPANTS Twenty older patients ( age , 81.3+/-7.2y ; 14 women ) . INTERVENTION Patients were r and omly assigned to a control group ( n=10 ) or a training group ( n=10 ) . Both groups attended physical and occupational therapy sessions 5 times a week during rehabilitation ( mean length of stay , 32.9+/-5.3d ) . Patients in the training program used an arm crank ergometer 3 times a week for 4 weeks . MAIN OUTCOME MEASURE Peak oxygen consumption ( Vo(2)peak ) . RESULTS Vo(2)peak increased significantly in the training group ( 8.9+/-1.4 to 10.8+/-1.7mL x kg(-1 ) x min(-1 ) ) and did not change in the control group ( 8.9+/-1.2 to 8.8+/-1.6mL x kg(-1).min(-1 ) ) . At discharge , both groups were significantly improved in all functional outcome measures ( Timed Up & Go [ TUG ] test , Berg Balance Scale [ BBS ] , FIM instrument , two-minute walk test [ 2MWT ] , and ten-minute walk test [ 10MWT ] ) . The training group performed significantly better in mobility ( TUG , 2MWT , 10MWT ) and balance ( BBS ) compared with the control group . There was a significant correlation between Vo(2)peak and the 2MWT ( r=.81 ) and 10MWT ( r=.85 ) in the training group at discharge . CONCLUSIONS The upper-body exercise program had a significant effect on aerobic power . Our results suggest that aerobic endurance exercise should be integrated into st and ard rehabilitation to enhance patients ' aerobic fitness and mobility after hip fracture surgery OBJECTIVE To assess the effects of a community-based exercise program on motor recovery and functional abilities of the paretic upper extremity in persons with chronic stroke . DESIGN R and omized controlled trial . SETTING Rehabilitation research laboratory and a community hall . PARTICIPANTS A sample of 63 people ( > or = 50y ) with chronic deficits result ing from stroke ( onset > or = 1y ) . INTERVENTIONS The arm group underwent an exercise program design ed to improve upper-extremity function ( 1h/session , 3 sessions/wk for 19wk ) . The leg group underwent a lower-extremity exercise program . MAIN OUTCOME MEASURES The Wolf Motor Function Test ( WMFT ) , Fugl-Meyer Assessment ( FMA ) , h and -held dynamometry ( grip strength ) , and the Motor Activity Log . RESULTS Multivariate analysis showed a significant group by time interaction ( Wilks lambda=.726 , P=.017 ) , indicating that overall , the arm group had significantly more improvement than the leg group . Post hoc analysis demonstrated that gains in WMFT ( functional ability ) ( P=.001 ) and FMA ( P=.001 ) scores were significantly higher in the arm group . The amount of improvement was comparable to other novel treatment approaches such as constraint-induced movement therapy or robot-aided exercise training previously reported in chronic stroke . Participants with moderate arm impairment benefited more from the program . CONCLUSIONS The pilot study showed that a community-based exercise program can improve upper-extremity function in persons with chronic stroke . This outcome justifies a larger clinical trial to further assess efficacy and cost effectiveness BACKGROUND AND PURPOSE Rehabilitation care after stroke is highly variable and increasingly shorter in duration . The effect of therapeutic exercise on impairments and functional limitations after stroke is not clear . The objective of this study was to determine whether a structured , progressive , physiologically based exercise program for subacute stroke produces gains greater than those attributable to spontaneous recovery and usual care . METHODS This r and omized , controlled , single-blind clinical trial was conducted in a metropolitan area and 17 participating healthcare institutions . We included persons with stroke who were living in the community . One hundred patients ( mean age , 70 years ; mean Orpington score , 3.4 ) consented and were r and omized from a screened sample of 582 . Ninety-two subjects completed the trial . Intervention was a structured , progressive , physiologically based , therapist-supervised , in-home program of thirty-six 90-minute sessions over 12 weeks targeting flexibility , strength , balance , endurance , and upper-extremity function . Main outcome measures were postintervention strength ( ankle and knee isometric peak torque , grip strength ) , upper- and lower-extremity motor control ( Fugl Meyer ) , balance ( Berg and functional reach ) , endurance ( peak aerobic capacity and exercise duration ) , upper-extremity function ( Wolf Motor Function Test ) , and mobility ( timed 10-m walk and 6-minute walk distance ) . RESULTS In the intention-to-treat multivariate analysis of variance testing the overall effect , the intervention produced greater gains than usual care ( Wilk 's lambda=0.64 , P=0.0056 ) . Both intervention and usual care groups improved in strength , balance , upper- and lower-extremity motor control , upper-extremity function , and gait velocity . Gains for the intervention group exceeded those in the usual care group in balance , endurance , peak aerobic capacity , and mobility . Upper-extremity gains exceeded those in the usual care group only in patients with higher baseline function . CONCLUSIONS This structured , progressive program of therapeutic exercise in persons who had completed acute rehabilitation services produced gains in endurance , balance , and mobility beyond those attributable to spontaneous recovery and usual care Background Hip fractures result ing from falls increase substantially with advancing age and less than half of older hip fracture survivors regain their former levels of mobility . There is increasing evidence that rehabilitation interventions with exercises that goes beyond the sub-acute phase or even in a later stage of care have a positive impact on various functional abilities . The purpose of this study is to determine if exercise program training for people who have suffered a fall-related hip fracture will improve functional mobility when compared with usual care . Methods A r and omized controlled trial with blinded assessors and intention-to-treat analysis will be undertaken . We will recruit 82 older adults , 60 years or over who have suffered a hip fracture due to a fall in the previous 6 to 24 months . Participants r and omized to the Intervention Group ( IG ) will undertake a physical exercise program involving progressive and challenging balance training and neuromuscular and functional training of the lower limbs , conducted at home by physiotherapists , once a week , lasting about one hour , in the first , second and third month after r and omization and will be taught to perform exercises at home , twice a week , using a booklet . Visits to monitor and progress the home exercise program will be conducted once a month , from the fourth to the sixth month and each 2 months until the end of the follow up at the 12th month , i.e. , a total of 18 sessions . Participants will receive monthly phone calls to encourage exercise adherence . The control group will receive usual care . The primary outcome will be mobility-related disability and participants will be assessed at baseline , and at 3 months , 6 and 12 months . Participants will receive monthly phone calls to ask about falls and exercise adherence . Adverse effects will be monitored . Discussion This study proposes a home-based exercise program , which may in part overcome some barriers for rehabilitation , such as difficulties with public transportation and lack of a caregiver to accompany older patients to sessions . If a positive effect is observed this program has the potential to be incorporated into the public health system and contribute to building a pathway of care for older people with hip fracture . Trial registration Clinical trials.gov Identifier : NCT02295527 Prior studies demonstrate the ability of upper extremity training to increase arm strength and endurance when incorporated into a pulmonary rehabilitation program . However , patients with severe chronic obstructive pulmonary disease ( COPD ) may have transportation or mobility problems that make it difficult to travel to a rehabilitation site to obtain this training . This pilot study was design ed to determine whether a home-based , upper-arm exercise program could increase arm strength and endurance , and decrease perceptions of breathlessness and fatigue during five activities of daily living . Twenty patients with severe COPD ( FEV1 0.80 + /- 0.42 ) were r and omized to an experimental ( n = 10 ) or control group ( n = 10 ) . The experimental-group training included three upper arm exercises five times a week for 8 weeks , with training level incremented during weekly home visits . Control-group subjects were contacted weekly to equalize attention from health care providers . During the upper-extremity endurance test for number of rings moved , no significant differences between groups were seen for interaction or treatment . However , there was a significant interaction between treatment and time for perceived fatigue ( p = 0.0012 ) , with the experimental group perceiving less fatigue during upper arm work than did the control group . No change was seen in perceived breathlessness . Findings of this study suggest that a home-based , upper-arm exercise program can reduce perceptions of fatigue for patients with severe COPD during activities involving upper arm work . Testing in a larger sample is indicated to determine whether this training can also improve ability to perform unsupported arm work BACKGROUND AND PURPOSE The majority of patients after a hip fracture do not return to prefracture functional status . Depression has been shown to affect recovery . Although exercise can reduce impairments , access issues limit elderly people from participating in facility-based programs . The primary purpose of this study was to determine the effects and feasibility of a home exercise program of moderate- or high-intensity exercise . A secondary purpose was to explore the relationship of depression and physical recovery . SUBJECTS Thirty-three elderly people ( 24 women , 9 men ; mean = 78.6 years of age , SD = 6.8 , range = 64 - 89 ) who had completed a regimen of physical therapy following hip fracture participated in the study . Subjects were r and omly assigned to a resistance training group , an aerobic training group , or a control group . METHODS Subjects were tested before and upon completion of the exercise trial . Isometric lower-extremity force , 6-minute-walk distance , free gait speed , mental status , and physical function were measured . Each exercise session was supervised by a physical therapist , and subjects received 20 visits over 12 weeks . The control group received biweekly mailings . The resistance training group performed 3 sets of 8 repetitions at the 8-repetition maximum intensity using a portable progressive resistance exercise machine . The aerobic training group performed activities that increased heart rate 65 % to 75 % of their age-predicted maximum for 20 continuous minutes . RESULTS Resistance and aerobic training were performed without apparent adverse effects , and adherence was 98 % . All groups improved in distance walked , force produced , gait speed , and physical function . Isometric force improved to a greater extent in the intervention groups than in the control group . Depressive symptoms interacted with treatment group in explaining the outcomes of 6-minute-walk distance and gait speed . DISCUSSION AND CONCLUSION High-intensity exercise performed in the home is feasible for people with hip fracture . Larger sample sizes may be necessary to determine whether the exercise regimen is effective in reducing impairments and improving function . Depression may play a role in the level of improvement attained Background Stroke is the most common disabling neurological condition in adults . Falls and poor mobility are major contributors to stroke-related disability . Falls are more frequent and more likely to result in injury among stroke survivors than among the general older population . Currently there is good evidence that exercise can enhance mobility after stroke , yet ongoing exercise programs for general community-based stroke survivors are not routinely available . This r and omised controlled trial will investigate whether exercise can reduce fall rates and increase mobility and physical activity levels in stroke survivors . Methods and design Three hundred and fifty community dwelling stroke survivors will be recruited . Participants will have no medical contradictions to exercise and be cognitively and physically able to complete the assessment s and exercise program .  After the completion of the pre-test assessment , participants will be r and omly allocated to one of two intervention groups . Both intervention groups will participate in weekly group-based exercises and a home program for twelve months . In the lower limb intervention group , individualised programs of weight-bearing balance and strengthening exercises will be prescribed . The upper limb/cognition group will receive exercises aim ed at management and improvement of function of the affected upper limb and cognition carried out in the seated position . The primary outcome measures will be falls ( measured with 12 month calendars ) and mobility . Secondary outcome measures will be risk of falling , physical activity levels , community participation , quality of life , health service utilisation , upper limb function and cognition . Discussion This study aims to establish and evaluate community-based sustainable exercise programs for stroke survivors . We will determine the effects of the exercise programs in preventing falls and enhancing mobility among people following stroke . This program , if found to be effective , has the potential to be implemented within existing community services . Trial registration The protocol for this study is registered with the Australian New Zeal and Clinical Trials Registry ( ACTRN12606000479505 ) Background Initial severity of upper-limb motor impairment and exercise intensity are important predictors of improved upper-limb function during stroke rehabilitation . Initial severity of motor impairment , however , is not modifiable by rehabilitation , and increased one-on-one treatment is not always feasible . Alternative methods to increase intensity and improve upper-limb function are needed . Objective The purpose of this study was to examine  caregiver involvement in upper-limb treatment as a method to improve upper-limb function . Design This study was a secondary analysis of a multi-site r and omized controlled trial for upper-limb recovery during subacute inpatient stroke rehabilitation . Methods Data from 50 individuals with subacute stroke who were r and omly assigned to the experimental group ( upper-limb exercise )  were used for the analysis . Outcome variables were measured at baseline and at completion of the 4-week intervention . Group comparisons between participants with caregiver support and participants without caregiver support were done using an analysis of variance . Using the Fugl-Meyer Upper-Limb Motor Impairment Scale and time spent in treatment ( intensity ) as covariates , a multivariate regression analysis was performed to determine the additive value of caregiver support on upper-limb function , as measured by change scores on the Chedoke Arm and H and Activity Inventory and the Motor Activity Log . Results Group comparisons revealed that participants with caregiver support had improved upper-limb function compared with those without caregiver support and were more likely to increase the amount of time spent doing exercise . The multiple regression analysis showed that Fugl-Meyer score , treatment intensity , and caregiver support were significant predictors of upper-limb improvement ( R2=.240–.292 ) . In the regression models , caregiver support accounted for 5 % to 9 % of upper-limb improvement . Limitations Support was coded as a dichotomous variable , and thus the degree of support or qualitative nature of support was not captured . Conclusions Involvement of caregivers was a determinant of improved upper-limb function over and above initial severity of motor impairment and exercise intensity . Further research is needed to determine the optimal qualitative and quantitative elements of caregiver involvement in stroke rehabilitation in order to maximize results Background and Objective . This study investigated the relative effects of distributed constraint-induced therapy ( CIT ) and bilateral arm training ( BAT ) on motor performance , daily function , functional use of the affected arm , and quality of life in patients with hemiparetic stroke . Methods . A total of 60 patients were r and omized to  distributed CIT , BAT , or a control intervention of less specific but active therapy . Each group received intensive training for 2 hours/day , 5 days/week , for 3 weeks . Pretreatment and posttreatment measures included the Fugl — Meyer Assessment ( FMA ) , Functional Independence Measure ( FIM ) , Motor Activity Log ( MAL ) , and Stroke Impact Scale ( SIS ) . The proximal and distal scores of FMA were used to examine separate upper limb ( UL ) elements of movement . Results . The distributed CIT and BAT groups showed better performance in the overall and the distal part score of the FMA than the control group . The BAT group exhibited greater gains in the proximal part score of the FMA than the distributed CIT and control groups . Enhanced performance was found for the distributed CIT group in the MAL , the subtest of locomotion in the FIM , and certain domains of the SIS ( eg , ADL/IADL ) . Conclusion . BAT may uniquely improve proximal UL motor impairment . In contrast , distributed CIT may produce greater functional gains for the affected UL in subjects with mild to moderate chronic hemiparesis PURPOSE This study assessed the impact of a low cost , multicomponent physical activity intervention for older adults with lower extremity osteoarthritis . DESIGN AND METHODS A r and omized controlled trial compared the effects of a facility-based multiple-component training program followed by home-based adherence  ( n = 80 ) to a  wait list control group ( n = 70 ) . Assessment s were conducted at baseline and at 2 and 6 months following r and omization . The training program consisted of range of motion , resistance training , aerobic walking , and education-group problem solving regarding self-efficacy for exercise and exercise adherence . All training group participants developed individualized plans for posttraining adherence . RESULTS Relative to the persons in the control group , individuals who participated in the exercise program experienced a statistically significant improvement in exercise efficacy , a 48.5 % increase in exercise adherence , and a 13.3 % increase in 6-min distance walk that were accompanied by significant decreases in lower extremity stiffness at 2 and 6 months . Program participants also experienced a significant decrease in lower extremity pain and a borderline significant improvement in efficacy to adhere to exercise over time at 6 months ( p = .052 ) . In contrast , persons in the control group deteriorated over time on the efficacy and adherence measures and showed no change on the other measures . No adverse health effects were encountered . IMPLICATION S These benefits indicate that this low-cost intervention may hold great promise as one of a growing number of public health intervention strategies for older adults in the United States with osteoarthritis CONTEXT Hip fractures are common in the elderly , and despite st and ard rehabilitation , many patients fail to regain their prefracture ambulatory or functional status . OBJECTIVE To determine whether extended outpatient rehabilitation that includes progressive resistance training improves physical function and reduces disability compared with low-intensity home exercise among physically frail elderly patients with hip fracture . DESIGN , SETTING , AND PATIENTS R and omized controlled trial conducted between August 1998 and May 2003 among 90 community-dwelling women and men aged 65 years or older who had had surgical repair of a proximal femur fracture no more than 16 weeks prior and had completed st and ard physical therapy .  INTERVENTION Participants were r and omly assigned to 6 months of either supervised physical therapy and exercise training ( n = 46 ) or home exercise ( control condition ; n = 44 ) . MAIN OUTCOME MEASURES Primary outcome measures were total scores on a modified Physical Performance Test ( PPT ) , the Functional Status Question naire physical function subscale ( FSQ ) , and activities of daily living scales . Secondary outcome measures were st and ardized measures of skeletal muscle strength , gait , balance , quality of life , and body composition . Participants were evaluated at baseline , 3 months , and 6 months . RESULTS Changes over time in the PPT and FSQ scores favored the physical therapy group ( P = .003 and P = .01 , respectively ) . Mean change ( SD ) in PPT score for physical therapy was + 6.5 ( 5.5 ) points ( 95 % confidence interval [ CI ] , 4.6 - 8.3 ) , and for the control condition was + 2.5 ( 3.7 ) points ( 95 % CI , 1.4 - 3.6 points ) . Mean change ( SD ) in FSQ score for physical therapy was + 5.2 ( 5.4 ) points ( 95 % CI , 3.5 - 6.9 ) and for the control condition was + 2.9 ( 3.8 ) points ( 95 % CI , 1.7 - 4.0 ) . Physical therapy also had significantly greater improvements than the control condition in measures of muscle strength , walking speed , balance , and perceived health but not bone mineral density or fat-free mass . CONCLUSION In community-dwelling frail elderly patients with hip fracture , 6 months of extended outpatient rehabilitation that includes progressive resistance training can improve physical function and quality of life and reduce disability compared with low-intensity home exercise OBJECTIVE to compare the effects of two different exercise programmes after hip fracture . DESIGN assessor-blinded r and omised controlled trial . SETTING hospital rehabilitation units , with continued intervention at home . SUBJECTS 160 people with surgical fixation for hip fracture transferred to inpatient rehabilitation . METHOD in addition to other rehabilitation strategies , the intervention group received a higher dose ( 60 min/day ) exercise programme conducted whilst st and ing and the control group received a lower dose exercise programme ( 30 min/day ) primarily conducted whilst seated/supine . The primary outcome measures were knee extensor muscle strength in the fractured leg and walking speed , measured at 4 and 16 weeks . RESULTS 150 participants ( 94 % of those recruited ) completed the trial . There were no differences between the groups for the two primary outcome measures . Post hoc analyses revealed increased walking speed among those in the higher dose , weight-bearing exercise group with cognitive impairment at 4 and 16 weeks . CONCLUSIONS there was no benefit ( or harm ) due to the higher dose , weight-bearing exercise programme with respect to the primary outcome measures . However , people with hip fracture and cognitive impairment gained greater benefit from the higher dose programme than from the lower dose programme Background . Functional electrical stimulation ( FES ) allows active exercises in stroke patients with upper extremity paralysis . Objective . To investigate the effect of motor training with FES on motor recovery in acute and subacute stroke patients with severe to complete arm and /or h and paralysis . Methods . For this pilot study , 23 acute and subacute stroke patients were r and omly assigned to the intervention ( n = 12 ) and control group ( n = 11 ) . Distributed over 4 weeks , FES training replaced 12 conventional training sessions in the intervention group . An Extended Barthel Index ( EBI ) subscore assessed the performance of activities of daily living ( ADL ) . The Chedoke McMaster Stroke Assessment ( CMSA ) measured h and and arm function and shoulder pain . The Modified Ashworth Scale ( MAS ) assessed resistance to passive movement . Unblinded assessment s were performed prior to and following the end of the training period . Results . The EBI subscore and CMSA arm score improved significantly in both groups . The CMSA h and function improved significantly in the FES group . Resistance to passive movement of finger and wrist flexors increased significantly in the FES group . Shoulder pain did not change significantly . None of the outcome measures , however , demonstrated significant gain differences between the groups . Conclusions . We did not find clear evidence for superiority or inferiority of FES . Our findings , and those of similar trials , suggest that the number of sessions should be at least doubled to test for superiority of FES in these highly impaired patients and approximately 50 participants would have to be assigned to each therapeutic intervention to find significant differences Objective : To assess long term effects at 1 year after stroke in patients who participated in an upper and lower limb intensity training programme in the acute and subacute rehabilitation phases . Design : A three group r and omised controlled trial with repeated measures was used . Method : One hundred and one patients with a primary middle cerebral artery stroke were r and omly allocated to one of three groups for a 20 week rehabilitation programme with an emphasis on ( 1 ) upper limb function , ( 2 ) lower limb function or ( 3 ) immobilisation with an inflatable pressure splint ( control group ) . Follow up assessment s within and between groups were compared at 6 , 9 , and 12 months after stroke . Results : No statistically significant effects were found for treatment assignment from 6 months onwards . At a group level , the significant differences in efficacy demonstrated at 20 weeks after stroke in favour of the lower limb remained . However , no significant differences in functional recovery between groups were found for Barthel index ( BI ) , functional ambulation categories (FAC),action research arm test ( ARAT ) , comfortable and maximal walking speed , Nottingham health profile part 1(NHP-part 1 ) , sickness impact profile-68 ( SIP-68 ) , and Frenchay activities index ( FAI ) from 6 months onwards . At an individual subject level a substantial number of patients showed improvement or deterioration in upper limb function ( n=8 and 5 , respectively ) and lower limb function ( n=19 and 9 , respectively ) . Activities of daily living ( ADL ) scores showed that five patients deteriorated and four improved beyond the error threshold from 6 months onwards . In particular , patients with some but incomplete functional recovery at 6 months are likely to continue to improve or regress from 6 months onwards . Conclusions : On average patients maintained their functional gains for up to 1 year after stroke after receiving a 20 week upper or lower limb function training programme . However , a significant number of patients with incomplete recovery showed improvements or deterioration in dexterity , walking ability , and ADL beyond the error threshold One hundred and seventy-nine women aged 60–85 years ( mean age 71.6 years , SD 5.3 years ) were r and omly recruited from the community to participate in a 12-month r and omized controlled trial to determine whether a program of twice-weekly structured exercise has beneficial effects on three factors associated with osteoporotic fractures : quadriceps strength , postural sway and bone density . At initial testing , there were no significant differences in the strength , sway and bone density measures ( assessed at the hip and lumbar spine ) between the exerciser and control groups . The exercise classes included strengthening , coordination and balance exercises , and approximately 35 min of each class comprised weight-bearing exercise . The mean number of classes attended for the 68 exercisers who completed the program was 59.8 of the 82 classes ( 72.9 % ) . At the completion of the trial , the intervention group showed significant improvements in quadriceps strength and sway but not bone mineral density when compared with the control group . Indices of fracture risk , indicated by ( i ) the sum of st and ard score results and ( ii ) the sum of quartile grade s of the femoral neck bone density , sway and strength measures , decreased significantly in the exercisers at the end of the trial compared with the controls . In conclusion , the program of general aerobic exercise may have reduced overall fracture risk , even though it did not significantly increase bone density . Further long-term studies are required that include acceptable weight-loaded exercises to determine optimal programs for reducing fracture risk factors by improving bone density as well as strength and balance OBJECTIVE This r and omized controlled trial investigated the effects of upper- and lower-limb aerobic exercise training on disease-specific functional status and generic health-related quality of life ( QOL ) in patients with intermittent claudication . METHODS The study recruited 104 patients ( mean age , 68 years ; range , 50 - 85 ) from the Sheffield Vascular Institute . Patients were r and omly allocated to groups that received upper-limb ( ULG ) or lower-limb ( LLG ) aerobic exercise training , or to a nonexercise control group . Exercise was performed twice weekly for 24 weeks at equivalent limb-specific relative exercise intensities . Main outcome measures were scores on the Walking Impairment Question naire ( WIQ ) for disease-specific functional status , the Medical Outcomes Study Short Form version 2 ( SF-36v2 ) , and European Quality of Life Visual Analog Scale ( EQ-VAS ) for health-related QOL . Outcomes were assessed at baseline , and at 6 , 24 , 48 , and 72 weeks . RESULTS After 6 weeks , improvements in the perceived severity of claudication ( P = .023 ) and stair climbing ability ( P = .011 ) vs controls were observed in the ULG , and an improvement in the general health domain of the SF-36v2 vs controls was observed in the LLG ( P = .010 ) . After 24 weeks , all four WIQ domains were improved in the ULG vs controls ( P ≤ .05 ) , and three of the four WIQ domains were improved in the LLG ( P < .05 ) . After 24 to 72 weeks of follow-up , more consistent changes in generic health-related QOL domains were apparent in the ULG . CONCLUSIONS These findings support the use of alternative , relatively pain-free forms of exercise in the clinical management of patients with intermittent claudication
There was preliminary evidence from one trial that exercise to the non-injured arm during immobilisation might lead to short-term benefits on increasing grip strength and range of movement following distal radius fracture .
There is emerging evidence that current prescribed exercise regimens may not be effective in reducing impairments and improving activity following an upper limb fracture .
Starting exercise early combined with a shorter immobilisation period is more effective than starting exercise after a longer immobilisation period .
QUESTION What is the effect of exercise on increasing participation and activity levels and reducing impairment in the rehabilitation of people with upper limb fractures ?
Bruder AM , Shields N , Dodd KJ , Taylor NF ( 2017 ) Prescribed exercise programs may not be effective in reducing impairments and improving activity during upper limb fracture rehabilitation : a systematic review .