Randomized clinical trial of therapeutic exercise in subacute stroke. Improvement in aerobic fitness during rehabilitation after hip fracture. 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. Long term effects of intensity of upper and lower limb training after stroke: a randomised trial A community-based upper-extremity group exercise program improves motor function and performance of functional activities in chronic stroke: a randomized controlled trial. The Role of Caregiver Involvement in Upper-Limb Treatment in Individuals With Subacute Stroke Home-based, upper-arm exercise training for patients with chronic obstructive pulmonary disease. Upper- versus lower-limb aerobic exercise training on health-related quality of life in patients with symptomatic peripheral arterial disease. Can elderly patients who have had a hip fracture perform moderate- to high-intensity exercise at home? How should we train the upper limbs? Exercise intervention to prevent falls and enhance mobility in community dwellers after stroke: a protocol for a randomised controlled trial Influence of upper- and lower-limb exercise training on cardiovascular function and walking distances in patients with intermittent claudication. Effects of an Exercise Intervention in Frail Older Patients with Chronic Obstructive Pulmonary Disease Hospitalized due to an Exacerbation: A Randomized Controlled Trial Effects of extended outpatient rehabilitation after hip fracture: a randomized controlled trial. Recovery of physical function after limb injuries in independent older people living at home. Results of a home exercise program for patients with osteoporosis resulting from neurological disorders. Effect of upper limb, lower limb and combined training on health-related quality of life in COPD
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 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 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 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 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 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 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 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 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 The article by McKeough and colleagues in this issue of Chronic Respiratory Disease is the first study to compare different modes of upper extremity training in individuals with chronic obstructive pulmonary disease ( COPD ) . Limitations during exercise and daily activity in individuals with COPD are not limited to lower extremity activities such as walking or stair climbing ; most of the patients experience difficulty during activities that involve their arms due to the sensation of dyspnea and /or arm fatigue . Upper extremity training for patients with COPD is an important component of pulmonary rehabilitation ( PR ) , result ing in improvements in arm exercise capacity , arm function and muscle strength . However , there is limited evidence on what type of training should be performed . The study by McKeough and colleagues adds to the growing body of evidence in the area of upper extremity training in COPD and provides support for the inclusion of arm endurance and strength training as a part of PR . The study is a r and omized controlled trial ( RCT ) that aim ed to compare the effects of arm endurance training ; arm strength training , a combination of arm endurance and strength training ; and no arm training ( control group ) on endurance arm exercise capacity , functional arm exercise capacity and health-related quality of life ( HRQL ) in individuals with mild-tovery severe COPD . The authors found a significant improvement in arm endurance time ( arm endurance capacity ) between the endurance group and control group . There were nonsignificant trends in arm endurance time favoring the strength training and combined groups compared with the control group . In terms of symptoms , the authors demonstrated that the combined group had a significantly greater reduction in dyspnea and rate of perceived exertion at the end of the functional arm exercise test compared with the control and with each of the intervention groups . When the combined group was compared with the other two intervention groups , the improvement in HRQL ( measured using the St George ’s Respiratory Question naire ) exceeded the minimum clinical ly important difference of 4 units , although it did not reach statistical significance . Until the beginning of the century , several RCTs had been conducted to examine the effects of upper extremity training in individuals with COPD . However , there were considerable variations in the exercise protocol s rendering it impossible to determine the optimal training regimen for these patients . Moreover , the impact of upper extremity training on other clinical outcomes besides arm exercise capacity was unclear as shown consistently by four systematic review s. More recently , four RCTs examining the effects of arm exercise training in individuals with COPD have been published . Holl and and colleagues compared the effects of unsupported upper limb endurance training with lower extremity training alone . The authors found that unsupported upper limb endurance training improved upper limb exercise capacity but had no additional effects on the symptoms or HRQL compared with lower extremity training alone . Costi and colleagues examined the effects of upper extremity resistance training in patients with COPD compared with st and ard PR . The authors demonstrated improvement in arm functional exercise capacity ( measured using the 6-minute pegboard and ring test ) and in performance during activities of daily living ( ADL ) measured by an ADL field test . In addition , the authors found a decrease in arm fatigue at the end of the ADL test in the intervention group . 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 ) PURPOSE The effects of upper-limb ( arm cranking ) and lower-limb ( leg cranking ) exercise training on walking distances in patients with intermittent claudication was assessed . METHODS Sixty-seven patients ( 33 to 82 years old ) with moderate to severe intermittent claudication were recruited , and the maximum power generated during incremental upper- and lower-limb ergometry tests was determined , as were pain-free and maximum walking distances ( by using a shuttle walk test ) . Patients were r and omly assigned to an upper-limb training group ( n = 26 ) or a lower-limb training group ( n = 26 ) . An additional  untrained group ( n = 15 ) was recruited on an ad hoc basis in parallel with the main trial by using identical inclusion criteria . This group was subsequently shown to possess a similar demographic distribution to the two exercise groups . Supervised training sessions were held twice weekly for 6 weeks . RESULTS Both training programs significantly improved the maximum power generated during the incremental upper- and lower-limb ergometry tests ( P < . 001 ) , which may reflect an increase in central cardiovascular function that was independent of the training mode . More importantly , pain-free and maximum walking distances also improved in both training groups ( P < .001 ) . The improvements in the training groups were similar ; there were no changes in the untrained control group . These findings suggest that the symptomatic improvement after upper-limb exercise training may result , in part , from systemic cardiovascular effects rather than localized metabolic or hemodynamic changes . CONCLUSION Carefully prescribed upper-limb exercise training can evoke a rapid symptomatic improvement in patients with claudication , while avoiding the physical discomfort experienced when performing lower-limb weight-bearing exercise ABSTRACT The objective of this study was to determine whether an exercise intervention using a pedal exerciser is able to reduce disability in frail older patients with chronic obstructive pulmonary disease ( COPD ) during hospitalization due to an acute exacerbation . This study was a r and omized , single-blind clinical trial . Fifty-eight frail older patients admitted to hospital due to an acute exacerbation of COPD ( AE COPD ) were included in this study . All patients received st and ard medical and pharmacological care . Patients assigned to the intervention group also received an exercise intervention . The main outcome measures were balance , muscle strength , and exercise capacity . Significant between-group differences were found in muscle strength ( p = 0.028 ) and balance ( p = 0.013 ) after the intervention . All the variables improved significantly ( p < 0.05 ) in the exercise intervention group . In the intervention group , the mean difference in muscle strength between baseline and discharge was 10.47 N. Balance also improved , showing a mean difference of 7.56 seconds on the right leg and 6.57 seconds on the left leg . Exercise capacity improved as well , with a difference of 4.97 st and s between baseline and discharge . All the variables showed impairment in the control group . In conclusion , an exercise intervention using a pedal exerciser during the hospital stay of frail elderly patients with an AE COPD improves muscle strength , balance , and exercise capacity 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 OBJECTIVES to describe changes in physical functioning after fall-related injuries to the limbs in independently living older people . DESIGN prospect i ve cohort study , including a pre-injury assessment and post-injury assessment s at 8 weeks and 5 and 12 months . SETTING the study is part of the larger , population -based prospect i ve and longitudinal Groningen Longitudinal Aging Study on the determinants of health-related quality of life of people aged 57 and over , who are living independently in the north of the Netherl and s. SUBJECTS 171 patients who sustained injuries at various sites on the limbs and who had completed all four assessment s ( 66 % of the eligible population ) . Patients were grouped according to injury site . OUTCOME MEASURE self-reported grade s of difficulties with performing basic and instrumental activities of daily living as measured by the Groningen Activity Restriction Scale . RESULTS 1 year after the injury , pre-injury ( mean ) levels of functioning were not regained in any of the groups studied . However , only those with fractures of the wrist or hip experienced a substantial decrease in ability to perform basic and instrumental activities of daily living between baseline and the final assessment . Furthermore , of the 44 subjects with wrist fractures , seven ( 15.9 % ) needed help with at least one relevant activity at baseline and 18 ( 40.9 % ) at 12 months . Of the 34 subjects with hip fractures , four ( 11.8 % ) needed help with at least one activity at baseline and 18 ( 52.9 % ) at 12 months . Practically no changes were found in any of the groups after 5 months post-injury . CONCLUSIONS not only hip fractures , but also wrist fractures may reduce older people 's chances of remaining independent . Prospect s of further recovery are minimal 5 - 6 months after the injury There are no studies in the literature on the effect of exercise in reversing osteoporosis of the upper extremities for people with neurological disorders . The purpose of this study was to explore what conditions respond to a home exercise program for the upper extremities . Sixteen patients , divided r and omly into experimental and control groups , were recruited for this trial for at least one year . Both upper extremities of the patients , affected and unaffected , were tested pre and post trial with the Hologic QDR for bone area , bone mineral content ( BMC ) , bone mineral density ( BMD ) , fat , muscle mass , muscle mass plus BMD , total weight , and relative fat content ( percent ) . The home exercise program involved the subject squeezing a ball , one h and at a time , 20 times each , three times a day , at least three times a week , while sitting with the elbow flexed and the arm resting comfortably at the side of the trunk or on an armrest . A significant difference ( p < 0.02 ) was found in bone area , BMC , BMD or relative fat content between the affected and sound sides both before and after the study , although all parameters were much different for each patient . We found a statistically significant difference in a change in the bone area for the affected upper extremities of the control group , but not of the experimental group . Subjective reactions of the subjects were positive . They stated that they felt they were improving and contributing to their recovery . Patients with Parkinson 's disease , but not those with cerebral infa rct ion , seemed to react to the exercise with an increase in bone mineral content , although the difference was not significant due to the scarce number of subjects . This is a preliminary pilot study to help develop further research on what condition is likely to respond to exercise for protection against osteoporosis Objectives : To study the effect of unsupported upper limb and lower limb exercise training and their combined influence on the exercise performance and health-related quality of life in COPD patients . Material s and Methods : Thirty patients were r and omly assigned to one of the three groups , through block r and omization . Of the three groups , group A received upper limb training , group B received lower limb training , and group C received both upper and lower limb training . Patients in group A , B , and C underwent exercise training five times a week for four weeks . The outcome measures used in the study were unsupported upper limb endurance test ( UULEX ) , Six-Minute Walk Test ( 6-MWT ) , and a Chronic Respiratory Question naire . Statistical analysis was performed with analysis of variance , Wilcoxon scale , and a Kruskal Wallis one way ANOVA test , and a P value of .05 was used in the study . Conclusion : The combined upper limb and lower limb training group showed a significant improvement in the exercise performance and health-related quality of life
There is evidence to support the role of specific exercise regimens in reducing impairments and improving upper limb function following specific upper limb fractures
QUESTION What is the effect of exercise on reducing impairment and increasing activity in the rehabilitation of people with upper limb fractures ?