Exercise training in COPD: how to distinguish responders from nonresponders. Efficacy of a physical exercise training programme COPD in primary care: study protocol of a randomized controlled trial Inspiratory Muscle Training in Patients with Heart Failure: A Systematic Review Early Rehabilitation Exercise Program for Inpatients During an Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A RANDOMIZED CONTROLLED TRIAL Effect of a preoperative protocol of aerobic physical therapy on the quality of life of patients with adolescent idiopathic scoliosis: a randomized clinical study. Home-based pulmonary rehabilitation in patients with chronic obstructive pulmonary disease: a randomized clinical trial The Impact of a Multidimensional Exercise Intervention on Physical and Functional Capacity, Anxiety, and Depression in Patients With Advanced-Stage Lung Cancer Undergoing Chemotherapy Rehabilitation therapy and outcomes in acute respiratory failure: an observational pilot project. Evaluation of the effectiveness of a home-based inspiratory muscle training programme in patients with chronic obstructive pulmonary disease using multiple inspiratory muscle tests Physical training and relaxation therapy in cardiac rehabilitation assessed through a composite criterion for training outcome. Exercise training for heart failure patients improves respiratory muscle endurance, exercise tolerance, breathlessness, and quality of life. Supervised physical exercise to improve the quality of life of cancer patients: the EFICANCER randomised controlled trial An evaluation of two approaches to exercise conditioning in pulmonary rehabilitation. A phase III clinical trial of exercise modalities on treatment side-effects in men receiving therapy for prostate cancer Effects of a Community-Based, Post-Rehabilitation Exercise Program in COPD: Protocol for a Randomized Controlled Trial With Embedded Process Evaluation Effects of adjunctive exercise on physiological and psychological parameters in depression: a randomized pilot trial. Effects of Physical Training on Functional Status in Patients With Prolonged Mechanical Ventilation
PURPOSE Pulmonary rehabilitation programs consistently have improved exercise capacity , quality of life , and symptoms over the past decade . Although training has been shown to be an essential component of the rehabilitation program , individual patients do not always benefit to the same extent . The present study was design ed to investigate which patients were achieving significant benefit of exercise training . METHODS Forty-nine stable out patients with moderate to severe COPD ( FEV1 37 (15)%pred ) were evaluated before and after 12 weeks of exercise training ( 3 times per week ) . Responders in exercise capacity were defined as having 15 % increase in maximal workload and /or 25 % increase in walking distance , while responders in quality of life showed an improvement of at least 10 points on the chronic respiratory disease question naire . With multivariate discriminant analysis , responders were distinguished from nonresponders based upon their initial characteristics . RESULTS Thirty-two patients were responders in terms of improved exercise capacity . Ventilatory reserve ( VE/MVV ) , inspiratory muscle strength ( Plmax ) , and peripheral muscle strength ( h and grip force and quadriceps force ) were significant predictors of the training response ( P < 0.05 ) ( accuracy 80 % P < 0.001 ) . Although the explained variance was modest , patients that were clearly ventilatory limited and had normal skeletal muscle strength were not likely to benefit from exercise training in terms of exercise capacity . No physiologic variables predicted whether a patient would increase quality of life after exercise training . CONCLUSION Patients with reduced exercise capacity who experience less ventilatory limitation to exercise and more reduced respiratory and peripheral muscle strength  are more likely to improve with exercise training . Improvements in quality of life after exercise training were significant but remained unpredictable with variables included in the present trial Background Chronic obstructive pulmonary disease ( COPD ) is recognized as a systemic illness with significant extra-pulmonary features , such as exercise intolerance and muscle weakness . Pulmonary rehabilitation has been shown to be very effective in counteracting these consequences in patients with more advanced COPD . However , limited data is available on the efficacy of a physical exercise training programme in patients with mild to moderate COPD in primary care . Furthermore , it is unknown if improved exercise capacity translates into enhanced daily physical activities . The aim of this paper is to describe the design of a r and omized controlled trial to assess the efficacy of a physical exercise training programme in patients with mild to moderate COPD . Methods / design In this r and omized controlled trial situated in the primary care setting , 102 patients with mild to moderate airflow obstruction ( FEV1 ≥ 50 % of predicted ) , dyspnoea and a physically inactive lifestyle will be r and omized to an intervention or control group . The intervention group receives a 4-month physical exercise training programme at a local physiotherapy practice , which includes exercise training , resistance training , breathing exercises and advises on how to increase the level of physical activity . The control group receives usual care , i.e. advises on how to increase the level of physical activity and a sham treatment at a local physiotherapy practice of which no physiological training stimulus can be expected . Primary outcome is functional exercise capacity at 4-months measured on the six-minute walk distance . Secondary outcomes include peripheral muscle strength , physical activity in daily life , health related quality of life , Medical Research Council ( MRC ) dyspnoea score and patients ’ perceived effectiveness . Follow-up measurement will take place at 6 months after baseline . Discussion This will be one of the first studies to evaluate the efficacy of a physical exercise training programme in patients with mild to moderate COPD completely recruited and assessed in primary care . The results of this trial may give a unique insight into the potential of the implementation of an easy , close-to-home rehabilitation programme . Trial registration The Netherl and s National Trial Register NTR1471 Purpose : The purpose of this review was to assess the quality of evidence on inspiratory muscle training ( IMT ) in patients with heart failure and to provide an overview on subject selection , training protocol s , and outcome achieved with IMT . Methods : Literature search was first performed via the PubMed data base , and additional references were identified from the Scopus citation index . Articles of the review type and of clinical trials published in English were included . Quality of the articles was assessed using Sackett 's levels of evidence and rigor of methodology was assessed using PEDro ( Physiotherapy Evidence Data base ) criteria for r and omized controlled trials and the Downs & Black tool for cohort studies . Results : Twelve articles of clinical trials were included . Typical training protocol s involved daily training with intensity greater than 30 % of maximal inspiratory pressure ( Plmax ) , duration of 20 to 30 minutes ( continuous or incremental ) and using a pressure threshold muscle trainer . The effect sizes of Plmax , walk test distance , and dyspnea were moderate to large across these studies . Effects on quality of life scores were inconsistent . Conclusion : Inspiratory muscle training is beneficial for improving respiratory muscle strength , functional capacity , and dyspnea in patients with stable heart failure and respiratory muscle weakness PURPOSE : To determine whether an early rehabilitation program was safe and feasible for patients during an acute exacerbation of chronic obstructive pulmonary disease ( COPD ) . METHODS : In this phase 1 r and omized controlled trial , patients with an acute exacerbation of COPD admitted to the hospital were r and omly allocated to a low-intensity exercise group , a moderate- to high-intensity exercise group , or a control group , who received routine physical therapy . In addition to routine physical therapy , patients in the exercise group had to participate in an exercise program . The program consisted of twice-daily aerobic and resistance exercise sessions . Primary outcomes were the number and classification of adverse events and program adherence . RESULTS : In 174 exercise sessions , there was 1 serious adverse event of arrhythmia in the low-intensity exercise group that resolved within 1 hour . There were 12 other minor adverse events involving 5 patients with no significant differences between groups . Patients completed an average of 80 % of their scheduled sessions with no significant between-group differences . The exercise groups improved significantly in walking distance ; however , no significant between-group differences were observed . CONCLUSIONS : There was preliminary evidence that it was safe and feasible to implement an exercise program for patients during an acute exacerbation of COPD . Additional studies with larger sample sizes are required to accurately evaluate program effectiveness Patients with adolescent idiopathic scoliosis ( AIS ) have lower potential for physical activity because of lung dysfunction and lower muscle strength , which can be reversed by the cardiorespiratory and musculoskeletal conditioning provided by st and ardized physical activities . We conducted a study to determine if a preoperative protocol of aerobic exercise would improve quality of life ( QoL ) both before and after training and if there would be any differences between patients who received the therapy and those who did not . Patients with the indication of surgical correction of AIS were r and omized to receive or not receive a 4-month preoperative course of aerobic physical training . At baseline and after 4 months , they were evaluated with the Short Form-36 question naire ( SF-36 ) . QoL scores improved for the study group but did not change for the control group . In all QoL domains , the study group 's mean score increased significantly between baseline and 4 months . We concluded that the proposed preoperative physical therapy protocol improved the QoL of patients with AIS Introduction Pulmonary rehabilitation ( PR ) is a multidisciplinary program of care for patients with chronic obstructive pulmonary disease ( COPD ) with the goal of improving the functional capacity and quality of life , as well as maintaining the clinical stability of COPD sufferers . However , not all patients are available for such a program despite discomfort with their condition . The aim of this study was to evaluate the effects of a home-based PR ( HBPR ) program on functional ability , quality of life , and respiratory muscle strength and endurance . Patients and methods Patients with COPD according to the Global Initiative of Chronic Obstructive Lung Disease were r and omized ( double-blind ) into two groups . One group performed a protocol at home with aerobic and muscle strength exercises and was called the intervention group ; the other group received only instructions to perform breathing and stretching exercises , characterizing it as the control group ( CG ) . We assessed the following variables at baseline and 2 months : exercise tolerance ( incremental shuttle walk test and upper limb test ) , respiratory muscle ( strength and endurance test ) , and health-related quality of life ( Airways Question naire 20 ) . Results There were no significant changes after the intervention in either of the two groups in exercise tolerance and quality of life . However , the intervention group had improved respiratory endurance compared with the CG , while the CG presented a decrease in the load sustained by the respiratory muscles after the HBPR . Conclusion A program of HBPR with biweekly supervision ( although not enough to provide significant improvements in physical capacity or quality of life ) played an important role in maintaining the stability of the clinical features of patients with COPD ; the patients had no worsening of symptoms during the intervention period according to the daily log Introduction . Patients with advanced-stage lung cancer face poor survival and experience co-occurring chronic physical and psychosocial symptoms . Despite several years of research in exercise oncology , few exercise studies have targeted advanced lung cancer patients undergoing chemotherapy . The aim of the present study was to investigate the benefits of a 6-week supervised group exercise intervention and to outline the effect on aerobic capacity , strength , health-related quality of life ( HRQoL ) , anxiety , and depression . Methods . VO2peak was assessed using an incremental exercise test .  Muscle strength  was measured with one repetition maximum test ( 1RM ) . HRQoL , anxiety , and depression were assessed using Functional Assessment of Cancer Therapy – Lung ( FACT-L ) scale and the Hospital Anxiety and Depression Scale ( HADS ) . Results . One hundred and forthteen patients with advanced stage lung cancer were recruited . Forty-three patients dropped out . No serious adverse events were reported . Exercise adherence in the group training was 68 % . Improvements in VO2peak ( P < .001 ) and 6-minute walk distance ( P < .001 ) and muscle strength measurements ( P < .05 ) were seen . There was a reduction in anxiety level ( P = .0007 ) and improvement in the emotional well-being parameter ( FACT-L ) but no statistically significant changes in HRQoL were observed . Conclusion . The results of the present study show that during a 6-week hospital-based supervised , structured , and group-based exercise program , patients with advanced-stage lung cancer ( NSCLC IIIb-IV , ED-SCLC ) improve their physical capacity ( VO2peak , 1RM ) , functional capacity , anxiety level , and emotional well-being , but not their overall HRQoL. A r and omized controlled trial testing the intervention including 216 patients is currently being carried out PURPOSE The aim of this study was to describe the frequency , physiologic effects , safety , and patient outcomes associated with traditional rehabilitation therapy in patients who require mechanical ventilation . MATERIAL S AND METHODS Prospect i ve observational report of consecutive patients ventilated 4 or more days and eligible for rehabilitation in a single medical intensive care unit ( ICU ) during a 13-week period was conducted . RESULTS Of the 32 patients who met the inclusion criteria , only 21 ( 66 % ) received physician orders for evaluation by rehabilitation services ( physical and /or occupational therapy ) . Fifty rehabilitation treatments were provided to 19 patients on a median of 12 % of medical ICU days per patient , with deep sedation and unavailability of rehabilitation staff representing major barriers to treatment . Physiologic changes during rehabilitation therapy were minimal . Joint contractures were frequent in the lower extremities and did not improve during hospitalization . In 53 % and 79 % of initial ICU assessment s , muscle weakness was present in upper and lower extremities , respectively , with a decreased prevalence of 19 % and 43 % at hospital discharge , respectively . New impairments in physical function were common at hospital discharge . CONCLUSIONS This pilot project illustrated important barriers to providing rehabilitation to mechanically ventilated patients in an ICU and impairments in strength , range of motion , and functional outcomes at hospital discharge Abstract Purpose : To evaluate the effectiveness of a home-based inspiratory muscle training ( IMT ) programme using multiple inspiratory muscle tests . Method : Sixty-eight patients ( 37 M ) with moderate to severe chronic obstructive pulmonary disease ( COPD ) ( Mean [ SD ] , FEV1 36.1 [13.6]% pred . ; FEV1/FVC 35.7 [11.2]% ) were r and omised into an experimental or control group and trained with a threshold loading device at intensity > 30 % maximum inspiratory pressure ( PImax ) or < 15 % PImax , respectively , for 7 weeks . Thirty-nine patients ( 23 M ) completed the study . The following measures were assessed pre- and post-IMT : PImax , sniff inspiratory nasal pressure ( SNIP ) , diaphragm contractility ( Pdi , tw ) , incremental shuttle walk test ( ISWT ) , respiratory muscle endurance ( RME ) , chronic respiratory disease question naire ( CRDQ ) , the hospital anxiety and depression scale ( HADS ) and the SF-36 . Between-group changes were assessed using one-way analysis of variance ( ANOVA ) . Results : PImax and perception of well-being improved significantly post-IMT [ p = 0.04 and < 0.05 in four domains , respectively ] . This was not reflected in SNIP [ p = 0.7 ] , Pdi , tw [ p = 0.8 ] , RME [ p = 0.9 ] or ISWT [ p = 0.5 ] . Conclusions : A seven-week , community-based IMT programme , with realistic use of health-care re sources , improves PImax and perception of well-being but a different design may be required for improvement in other measures . Multiple tests provide a more comprehensive evaluation of changes in muscle function post-IMT . Implication s for Rehabilitation A seven-week , home-based inspiratory muscle training programme improves maximal inspiratory pressure and perception of well-being in patients with moderate to severe COPD but not sniff nasal inspiratory pressure or diaphragm contractility , respiratory muscle endurance and exercise capacity . Multiple tests are recommended for a more comprehensive assessment of changes in muscle function following inspiratory muscle training programmes . Therapists need to explore different community-based inspiratory muscle training regimes for COPD patients and identify the optimal exercise protocol that is likely to lead to improvements in diaphragm contractility and exercise capacity One hundred fifty-six myocardial infa rct ion patients were r and omly assigned to either exercise plus relaxation and breathing therapy ( treatment A , n = 76 ) or to exercise training only ( treatment B , n = 80 ) . Effects on exercise testing showed a more pronounced training bradycardia and a remarkable improvement in ST abnormalities in treatment A ( p less than 0.005 ) . A model was developed to integrate the various exercise parameters into a single measure for training benefit . Approximately half the patients showed a training success , with a more positive and less negative outcome in treatment A ( p = 0.09 ) . The odds for failure were 0.25 for treatment A and 0.51 for treatment B ( odds ratio : 2.04 ; 95 % confidence interval , 0.94 to 4.6 ) . Thus the risk of failure was reduced by half when relaxation was added to exercise training . These results indicate that exercise training is not successful in all MI patients and that relaxation therapy enhances training benefit PURPOSE Increased respiratory muscle endurance and peak oxygen consumption ( VO(2peak ) ) induced by respiratory muscle training support the relationship between respiratory muscle function and exercise capacity in patients with heart failure . This raises the question whether exercise-training results in increased respiratory muscle function contributing to an increased exercise tolerance , a decreased perception of breathlessness , and an improved quality of life . METHODS Prospect i ve cohort analysis was completed on 24 patients with New York Heart Association ( NYHA ) Class III heart failure [ 18 men , 6 women ; aged = 64 ( SD 7.9 ) years ; percent ejection fraction ( % EF ) = 24.0 ( SD 7.8 ) ] .  Maximal sustainable ventilatory capacity ( MSVC ) , submaximal and peak exercise responses , perception of breathlessness , and quality of life were measured before ( baseline ) and after ( end of study ) 12 weeks of exercise training . RESULTS As a result of exercise training , VO(2peak ) ( P=.01 ) and MSVC ( P<.001 ) increased , with MSVC contributing to a larger proportion of the variability for VO(2peak ) at study completion ( r=0.57 vs 0.42 ) . Although stroke volume did not increase beyond exercise at 25 W and did not change with exercise training , ventilation decreased during exercise ( P<.05 ) , perception of breathing difficulty ( P<.05 ) was reduced , and quality of life was enhanced ( P=.008 ) . CONCLUSIONS Despite no increase in cardiac output and stroke volume , respiratory muscle endurance improved with exercise training , contributing to increased exercise capacity , decreased breathlessness , and decreased perception of breathlessness . Practical implication s can include less frequent rest periods and fatigue , greater confidence , maintenance of independence , and enhanced quality of life Background The optimal form of exercise for individuals with cancer has yet to be identified , but there is evidence that exercise improves their quality of life . The aim of this study is to assess the efficacy and efficiency of an innovative physical exercise programme , for individuals undergoing chemotherapy for breast , gastrointestinal or non-small cell lung tumours , for improving quality of life , reducing level of fatigue , and enhancing functional capacity over time . Design / Methods We will conduct a clinical trial in 66 patients with stage IV breast , gastrointestinal or non-small cell lung cancer , recruited by the Department of Oncology of the referral hospital from 4 primary care health centres of the Basque Health Service ( Osakidetza ) . These patients will be r and omised to one of two groups . The treatment common to both groups will be the usual care for cancer : optimized usual drug therapies and strengthening of self-care ; in addition , patients in the intervention group will participate in a 2-month exercise programme , including both aerobic and strength exercises , supervised by nurses in their health centre . The principal outcome variable is health-related quality of life , measured blindly with the 30-item European Organization for the Research and Treatment of Cancer Core Quality of Life Question naire and Short Form-36 four times : at baseline , and 2 , 6 and 12 months later . The secondary outcome variables are fatigue ( Functional Assessment of Chronic Illness Therapy-Fatigue question naire ) , functional capacity ( 6-Minute Walk Test and cardiorespiratory test ) , muscle strength ( h and -held dynamometry and sit-to-st and test ) , radiological response to treatment ( Response Evaluation Criteria In Solid Tumors ) and progression-free and overall survival . Age , sex , diagnosis , chemotherapy regimen , Eastern Cooperative Oncology Group performance status and smoking status will be considered as predictive variables . Data will be analysed on an intention-to-treat basis , comparing changes at each time point between groups , adjusting for baseline values by analysis of covariance . Discussion As well as achieving the objectives set , this study will provide us with information on patient perception of the care received and an opportunity to develop a project based on collaborative action between the primary care and oncology professionals . Trial registration Clinical Trials.gov Identifier : NCT01786122 Registration date : 02/05/2013 STUDY OBJECTIVES To compare the effectiveness of two forms of exercise training in pulmonary rehabilitation . DESIGN A prospect i ve , r and omized , unblinded , 8-week trial . SETTING A hospital-based outpatient pulmonary rehabilitation program . PATIENTS Forty patients ( 20 patients in each group ) with COPD who were referred for pulmonary rehabilitation . INTERVENTIONS We compared the short-term effectiveness of a high-intensity , lower-extremity endurance program with a low-intensity , multicomponent calisthenics program for the rehabilitation of patients with COPD . The high-intensity group trained predominately on the stationary bicycle and treadmill , with a goal of exercising at > or = 80 % of maximal level determined from incremental testing for 30 min per session . The low-intensity group performed predominately classroom exercises for approximately 30 min per session . For both groups , twice-weekly sessions were held for 8 weeks . The primary outcome measure was health status , measured using the Chronic Respiratory Disease Question naire . Other outcomes included peak oxygen consumption on incremental treadmill exercise testing , exertional dyspnea , treadmill endurance time , the number of sit-to-st and repetitions and arm lifts in 1 min , overall dyspnea , and question naire-rated functional status . MEASUREMENTS AND RESULTS Both groups showed significant postrehabilitation improvement in exercise variables , exertional and overall dyspnea , functional performance , and health status . Patients in the high-intensity group showed greater increases in treadmill endurance and greater reductions in exertional dyspnea , whereas those in the low-intensity group showed greater increases in arm-endurance testing . Both groups had similar improvements in overall dyspnea , functional performance , and health status . CONCLUSIONS Despite differences in exercise performance , both high-intensity , lower-extremity endurance training and low-intensity calisthenics led to similar short-term improvements in question naire-rated dyspnea , functional performance , and health status Background And rogen deprivation therapy ( ADT ) is accompanied by a number of adverse side effects including reduced bone mass and increased risk for fracture , reduced lean mass and muscle strength , mood disturbance and increased fat mass compromising physical functioning , independence , and quality of life . The purpose of this investigation is to examine the effects of long term exercise on reversing musculoskeletal-related side effects , and cardiovascular and diabetes risk factors in men receiving and rogen deprivation for their prostate cancer . Specifically , we aim to investigate the effects of a 12-month exercise program design ed to load the musculoskeletal system and reduce cardiovascular and diabetes disease progression on the following primary endpoints : 1 ) bone mineral density ; 2 ) cardiorespiratory function and maximal oxygen capacity ; 3 ) body composition ( lean mass and fat mass ) ; 4 ) blood pressure and cardiovascular function ; 5 ) lipids and glycemic control ; and 6 ) quality of life and psychological distress . Methods / Design Multi-site r and omized controlled trial of 195 men ( 65 subjects per arm ) undergoing treatment for prostate cancer involving ADT in the cities of Perth and Brisbane in Australia . Participants will be r and omized to ( 1 ) resistance/impact loading exercise , ( 2 ) resistance/cardiovascular exercise groups and ( 3 ) usual care/delayed exercise . Participants will then undergo progressive training for 12 months . Measurements for primary and secondary endpoints will take place at baseline , 6 and 12 months ( end of the intervention ) . Discussion The principal outcome of this project will be the determination of the strength of effect of exercise on the well established musculoskeletal , cardiovascular and insulin metabolism side effects of and rogen deprivation in prostate cancer patients . As this project is much longer term than previous investigations in the area of exercise and cancer , we will gain knowledge as to the continuing effects of exercise in this patient population specifically targeting bone density , cardiovascular function , lean and fat mass , physical function and falls risk as primary study endpoints . In terms of advancement of prostate cancer care , we expect dissemination of the knowledge gained from this project to reduce fracture risk , improve physical and functional ability , quality of life and ultimately survival rate in this population . Clinical Trial RegistryA Phase III clinical trial of exercise modalities on treatment side-effects in men receiving therapy for prostate cancer ; Background : Chronic obstructive pulmonary disease ( COPD ) is a leading cause of death across the world and will become increasingly common with an aging population . Pulmonary rehabilitation ( PR ) is an evidence -based , nonpharmacological intervention for individuals with COPD , targeting the secondary impairments of the disease . Although the benefits of participation in PR are well established , improvements in exercise tolerance and health status typically deteriorate following discharge . Challenges with long-term adherence to recommended exercise regimens are thought to explain much of this decline . Therefore , we developed a community-based exercise maintenance program for patients with COPD following discharge from PR . Objectives This manuscript ( 1 ) outlines the intervention , ( 2 ) describes how its effectiveness is being evaluated in a pragmatic r and omized controlled trial , and ( 3 ) summarizes the embedded process evaluation aim ing to underst and key barriers and facilitators for implementation in new environments . Methods Participating centers refer eligible individuals with COPD following discharge from their local PR program . Consenting patients are assigned to a year-long community exercise program or usual care using block r and omization and stratifying for supplemental oxygen use . Patients in the intervention arm are asked to attend an exercise session at least twice per week at their local community facility where their progress is supervised by a case manager . Each exercise session includes a component of aerobic exercise , and activities design ed to optimize balance , flexibility , and strength . All study participants will have access to routine follow-up appointments with their respiratory physician , and additional health care providers as part of their usual care . Assessment s will be completed at baseline ( post-PR ) , 6 , and 12 months , and include measures of functional exercise capacity , quality of life , self-efficacy , and health care usage . Intervention effectiveness will be assessed by comparing functional exercise capacity between intervention and control groups . A mixed- methods process evaluation will be conducted to better underst and intervention implementation , guided by Normalization Process Theory and the Consoli date d Framework for Implementation Research . Results Based on results from our pilot work , we anticipate a maintenance of exercise capacity and improved health-related quality of life in the intervention group , compared with a decline in exercise capacity in the usual care group . Discussion Findings from this study will improve our underst and ing of the effectiveness of community-based exercise programs for maintaining benefits following PR in patients with COPD and provide information on how best to implement them . If effective , the intervention represents an opportunity to transition patients from institutionally-based rehabilitative management to community-based care . The results of the process evaluation will contribute to the science of translating evidence -based programs into regular practice OBJECTIVE Major depressive disorder ( MDD ) is associated with decreased physical activity and increased rates of the metabolic syndrome ( MetS ) , a risk factor for the development of type 2 diabetes and cardiovascular disorders . Exercise training has been shown to improve cardiorespiratory fitness and metabolic syndrome factors . Therefore , our study aim ed at examining whether patients receiving an exercise program as an adjunct to inpatient treatment will benefit in terms of physiological and psychological factors . METHOD Fourty-two in patients with moderate to severe depression were included . Twenty-two patients were r and omized to additional 3x weekly exercise training ( EXERCISE ) and compared to treatment as usual ( TAU ) . Exercise capacity was assessed as peak oxygen uptake ( VO2peak ) , ventilatory anaerobic threshold ( VAT ) and workload expressed as Watts ( W ) . Metabolic syndrome was defined according to NCEP ATPIII panel criteria . RESULTS After 6 weeks of treatment , cardiorespiratory fitness ( VO2peak , VAT , Watt ) , waist circumference and HDL cholesterol were significantly improved in EXERCISE participants . Treatment response expressed as ≥50 % MADRS reduction was more frequent in the EXERCISE group . CONCLUSIONS Adjunctive exercise training in depressed in patients  improves physical fitness , MetS factors , and psychological outcome . Given the association of depression with cardiometablic disorders , exercise training is recommended as an adjunct to st and ard antidepressant treatment Background and Purpose . Patients requiring prolonged mechanical ventilation ( PMV ) are frequently deconditioned because of respiratory failure precipitated by the underlying disease , the adverse effects of medications , and a period of prolonged immobilization . The effects of 6 weeks of physical training on the strength of respiratory and limb muscles , on ventilator-free time , and on functional status in patients requiring PMV were examined . Subjects . Thirty-nine patients with PMV were initially enrolled in the study and were assigned to either a treatment group ( n=20 ) or a control group ( n=19 ) . Three subjects in the treatment group and 4 subjects in the control group died during the 6-week intervention period and thus their data were excluded from the final analysis . Methods . Subjects in the treatment group received physical training 5 days a week for 6 weeks . Strength of respiratory and limb muscles , ventilator-free time , and functional status , which was measured by the Barthel Index of Activities of Daily Living ( BI ) and Functional Independence Measure ( FIM ) , were examined at baseline and at the third and sixth weeks of the study period . Results . Respiratory and limb muscle strength improved significantly at the third and sixth weeks in the treatment group compared with baseline measurements . Total BI and FIM scores increased significantly in the treatment group and remained unchanged in the control group . Effect sizes of the BI and FIM scores were 2.02 and 1.93 , respectively , at the sixth week . Discussion and Conclusion . The results show that a 6-week physical training program may improve limb muscle strength and ventilator-free time and thus improve functional outcomes in patients requiring PMV
Exercise therapy is effective for patients with knee osteoarthritis , sub-acute ( 6 to 12 weeks ) and chronic ( > or = 12 weeks ) low back pain , cystic fibrosis , chronic obstructive pulmonary disease , and intermittent claudication .
Furthermore , there are indications that exercise therapy  is effective for patients with ankylosing spondylitis , hip osteoarthritis , Parkinson 's disease , and for patients who have suffered a stroke .
There is insufficient evidence to support or refute the effectiveness of exercise therapy  for patients with neck pain , shoulder pain , repetitive strain injury , rheumatoid arthritis , asthma , and bronchiectasis .
Exercise therapy is not effective for  patients with acute low back pain .
It is concluded that exercise therapy is effective for a wide range of chronic disorders
The purpose of this project was to summarise the available evidence on the effectiveness of exercise therapy  for patients with disorders of the musculoskeletal , nervous , respiratory , and cardiovascular systems .