Impact of resistance training in chronic obstructive pulmonary disease patients during periods of acute exacerbation. Muscle strength and physical performance as predictors of mortality, hospitalization, and disability in the oldest old. A randomized trial on the effect of a multimodal intervention on physical capacity, functional performance and quality of life in adult patients undergoing allogeneic SCT Resistance training prevents deterioration in quadriceps muscle function during acute exacerbations of chronic obstructive pulmonary disease. Early nutritional support and physiotherapy improved long-term self-sufficiency in acutely ill older patients. Physical Complications in Acute Lung Injury Survivors: A Two-Year Longitudinal Prospective Study Skeletal muscle adaptation in response to supervised exercise training for intermittent claudication. Inpatient rehabilitation improves functional capacity, peripheral muscle strength and quality of life in patients with community-acquired pneumonia: a randomised trial. The effect of physical exercise following acute disease exacerbation in patients with dermato/polymyositis Effects of a Group-Based Exercise and Educational Program on Physical Performance and Disease Self-Management in Rheumatoid Arthritis: A Randomized Controlled Study Effects of a multimodal exercise program for people with ankylosing spondylitis. Home exercise and compliance in inflammatory rheumatic diseases--a prospective clinical trial. Effects of a targeted multimodal exercise program incorporating high-speed power training on falls and fracture risk factors in older adults: a community-based randomized controlled trial. An early rehabilitation intervention to enhance recovery during hospital admission for an exacerbation of chronic respiratory disease: randomised controlled trial Impact of Very Early Physical Therapy During Septic Shock on Skeletal Muscle: A Randomized Controlled Trial The effect of physical training on patients with rheumatoid arthritis: changes in disease activity, muscle strength and aerobic capacity. A clinically controlled minimized cross-over study. A pilot study on the effects of exercise in patients with systemic lupus erythematosus.
OBJECTIVE To evaluate the effects of whole-body resistance training on exercise capacity , health-related quality of life ( HRQOL ) , and muscle strength in patients hospitalized for exacerbation of chronic obstructive pulmonary disease . DESIGN R and omized controlled trial . SETTING University hospital . PARTICIPANTS Patients ( N=46 ) were r and omized to either a control group ( CG ) or training group ( TG ) , and 29 patients completed the study . INTERVENTION Training consisted of weight-lifting exercises for 6 muscle groups in the upper and lower limbs ( 2 sets of 8 repetitions each ) , and the initial load was set at 80 % of the 1-repetition maximum load . MAIN OUTCOME MEASURES Patients were evaluated on the second day of hospitalization , at hospital discharge , and 30 days postdischarge . Patients were evaluated on the basis of the 6-minute walking distance ( 6MWD ) , HRQOL , muscle strength , systemic inflammatory markers , and level of physical activity in daily life ( PADL ) . RESULTS The CG showed a reduction in the strength of lower-limb muscles ( P<.05 ) but not in the 6MWD ( P>.05 ) . In contrast , patients from the TG improved strength in the lower-limb muscles and 6MWD during and 30 days after hospitalization ( P<.05 ) . The TG also improved the impact domain in HRQOL after hospitalization . No improvement in PADL was observed in the TG . Finally , a reduction in the blood levels of inflammatory markers was observed only in the TG after hospitalization . CONCLUSIONS Our results suggest that resistance training during hospitalization improves the 6MWD , HRQOL , and lower-limb muscle strength , without altering the levels of systemic inflammation . However , future research should explore this intervention in larger r and omized trials OBJECTIVES To evaluate the predictive value of muscle strength and physical performance in the oldest old for all-cause mortality ; hospitalization ; and the onset of disability , defined as a decline in activities of daily living ( ADLs ) , independent of muscle mass , inflammatory markers , and comorbidities . DESIGN A prospect i ve , observational , population -based follow-up study . SETTING Three well-circumscribed areas of Belgium . PARTICIPANTS Five hundred sixty participants aged 80 and older were followed for 33.5 months ( interquartile range 31.1 - 35.6 months ) . MEASUREMENTS  Grip strength , Short Physical Performance Battery ( SPPB ) score , and muscle mass  were measured at baseline ; ADLs at baseline and after 20 months ; and all-cause mortality and time to first hospitalization from inclusion onward . Kaplan-Meier curves and Cox proportional hazards models were calculated for all-cause mortality and hospitalization . Logistic regression analysis was used to determine predictors of decline in ADLs . RESULTS Kaplan-Meier curves showed significantly higher all-cause mortality and hospitalization in subjects in the lowest tertile of grip strength and SPPB score . The adjusted Cox proportional hazards model showed that participants with high grip strength or a high SPPB score had a lower risk of mortality and hospitalization , independent of muscle mass , inflammatory markers , and comorbidity . A relationship was found between SPPB score and decline in ADLs , independent of muscle mass , inflammation , and comorbidity . CONCLUSION In people aged 80 and older , physical performance is a strong predictor of mortality , hospitalization , and disability , and muscle strength is a strong predictor of mortality and hospitalization . All of these relationships were independent of muscle mass , inflammatory markers , and comorbidity The aim of this r and omized controlled trial was to investigate the effect of a 4- to 6-week multimodal program of exercise , relaxation and psychoeducation on physical capacity , functional performance and quality of life ( QOL ) in allogeneic hematopoietic cell transplantation ( allo-HSCT ) adult recipients . In all , 42 patients were r and omized to a supervised multimodal intervention or to a control group receiving usual care .  The primary end point was on aerobic capacity measured in VO2 max . Secondary end points were muscle strength , functional performance , physical activity level , QOL , fatigue , psychological well-being and clinical outcomes . The multimodal intervention had a significant effect on physical capacity : VO2 max ( P<0.0001 ) and muscle strength : chest press ( P<0.0001 ) , leg extension ( P=0.0003 ) , right elbow flexor ( P=0.0009 ) , right knee extensor ( P<0.0001 ) and functional performance ( stair test ) ( 0.0008 ) . Moreover , the intervention group showed significantly better results for the severity of diarrhea ( P=0.014 ) and fewer days of total parenteral nutrition ( P=0.019 ) . Longitudinal changes in QOL , fatigue and psychological well-being favored the intervention group , but did not reach statistical significance . Assignment of a multimodal intervention during allo-HSCT did not cause untoward events , sustained aerobic capacity and muscle strength and reduced loss of functional performance during hospitalization RATIONALE Exacerbations of chronic obstructive pulmonary disease ( COPD ) acutely reduce skeletal muscle strength and result in long-term loss of functional capacity . OBJECTIVES To investigate whether resistance training is feasible and safe and can prevent deteriorating muscle function during exacerbations of COPD . METHODS Forty patients ( FEV(1 ) 49 + /- 17 % predicted ) hospitalized with a severe COPD exacerbation were r and omized to receive usual care or an additional resistance training program during the hospital admission . Patients were followed up for 1 month after discharge . Primary outcomes were quadriceps force and systemic inflammation . A muscle biopsy was taken in a subgroup of patients to assess anabolic and catabolic pathways . MEASUREMENTS AND MAIN RESULTS Resistance training did not yield higher systemic inflammation as indicated by C-reactive protein levels and could be completed uneventfully . Enhanced quadriceps force was seen at discharge ( + 9.7 + /- 16 % in the training group ; -1 + /- 13 % in control subjects ; P = 0.05 ) and at 1 month follow-up in the patients who trained . The 6-minute walking distance improved after discharge only in the group who received resistance training ( median 34 ; interquartile range , 14 - 61 m ; P = 0.002 ) . In a subgroup of patients a muscle biopsy showed a more anabolic status of skeletal muscle in patients who followed training . Myostatin was lower ( P = 0.03 ) and the myogenin/MyoD ratio tended to be higher ( P = 0.08 ) in the training group compared with control subjects . CONCLUSIONS Resistance training is safe , successfully counteracts skeletal muscle dysfunction during acute exacerbations of COPD , and may up-regulate the anabolic milieu in the skeletal muscle . Clinical trial registered with www . clinical trials.gov ( NCT00877084 ) OBJECTIVE An acute disease is regularly associated with inflammation , decreased food intake , and low physical activity ; the consequence is loss of muscle mass . However , the restoration of muscle tissue is problematic , especially in older patients . Loss of muscle mass leads to further decrease of physical activity which leads , together with recurring disease , to the progressive muscle mass loss accompanied by loss of self-sufficiency . Early nutrition support and physical activity could reverse this situation . Therefore , the aim of this study was to determine whether an active approach based on early nutritional therapy and exercise would influence the development of sarcopenia and impaired self-sufficiency during acute illness . METHODS Two hundred patients > 78 y were admitted to a hospital internal medicine department and participated in a prospect i ve , r and omized controlled study . The patients were r and omized to a control group receiving st and ard treatment ( n = 100 ) or to an intervention group ( n = 100 ) . The intervention consisted of nutritional supplements ( 600 kcal , 20 g/d protein ) added to a st and ard diet and a simultaneous intensive rehabilitation program . The tolerance of supplements and their influence on spontaneous food intake , self-sufficiency , muscle strength , and body composition were evaluated during the study period . The patients were then regularly monitored for 1 y post-discharge . RESULTS The provision of nutritional supplements together with early rehabilitation led to increased total energy and protein intake while the intake of st and ard hospital food was not reduced . The loss of lean body mass and a decrease in self-sufficiency were apparent at discharge from the hospital and 3 mo thereafter in the control group . Nutritional supplementation and the rehabilitation program in the study group prevented these alterations . A positive effect of nutritional intervention and exercise during the hospital stay was apparent at 6 mo post-discharge . CONCLUSIONS The early nutritional intervention together with early rehabilitation preserves muscle mass and independence in ill older patients hospitalized because of acute disease Objective : Survivors of severe critical illness frequently develop substantial and persistent physical complications , including muscle weakness , impaired physical function , and decreased health-related quality of life . Our objective was to determine the longitudinal epidemiology of muscle weakness , physical function , and health-related quality of life and their associations with critical illness and ICU exposures . Design : A multisite prospect i ve study with longitudinal follow-up at 3 , 6 , 12 , and 24 months after acute lung injury . Setting : Thirteen ICUs from four academic teaching hospitals . Patients : Two hundred twenty-two survivors of acute lung injury . Interventions : None . Measurements and Main Results : At each time point , patients underwent st and ardized clinical evaluations of extremity , h and grip , and respiratory muscle strength ; anthropometrics ( height , weight , mid-arm circumference , and triceps skin fold thickness ) ; 6-minute walk distance , and the Medical Outcomes Short-Form 36 health-related quality of life survey . During their hospitalization , survivors also had detailed daily evaluation of critical illness and related treatment variables . Over one third of survivors had objective evidence of muscle weakness at hospital discharge , with most improving within 12 months . This weakness was associated with substantial impairments in physical function and health-related quality of life that persisted at 24 months . The duration of bed rest during critical illness was consistently associated with weakness throughout 24-month follow-up . The cumulative dose of systematic corticosteroids and use of neuromuscular blockers in the ICU were not associated with weakness . Conclusions : Muscle weakness is common after acute lung injury , usually recovering within 12 months . This weakness is associated with substantial impairments in physical function and health-related quality of life that continue beyond 24 months . These results provide valuable prognostic information regarding physical recovery after acute lung injury . Evidence -based methods to reduce the duration of bed rest during critical illness may be important for improving these long-term impairments OBJECTIVES There is evidence that the improvement following supervised exercise for claudication results from skeletal muscle adaptation . The myosin heavy chain ( MHC ) determines muscle fibre type and therefore efficiency . Immunohistochemical analysis has failed to take account of hybrid MHC expression within myofibres . This study sought evidence of differential MHC protein expression following supervised exercise for claudication . DESIGN 38 claudicants were recruited . Subjects undertook a three-month supervised exercise programme .  Controls were patients awaiting angioplasty for claudication . MATERIAL S AND METHODS Subjects underwent paired gastrocnemius biopsy . Relative expression of MHC proteins was determined by SDS-PAGE electrophoresis . Non-parametric data is presented as median with the inter-quartile range and parametric as the mean ± st and ard deviation . RESULTS Upon completion of the exercise programme there was a 94 % increase ( 124 ( 106 - 145 ) to 241 ( 193 - 265 ) metres , p = 0.002 ) in maximum walking distance , which was not evident in the control group . An 11.1 % ( p = 0.02 ) increase in MHC I expression was observed in the exercise but not the control group ( 34.3 % ± 6.8 to 45.4 % ± 4.4 ) . There was a positive correlation between the change in MHC I expression and the improvement in claudication distance ( r = 0.69 , p < 0.05 ) . CONCLUSIONS Supervised exercise training for claudication results in an increase in the proportion of MHC type I expression within the symptomatic gastrocnemius muscle QUESTION Among people who are hospitalised for community-acquired pneumonia , does an inpatient exercise-based rehabilitation program improve functional outcomes , symptoms , quality of life and length of hospital stay more than a respiratory physiotherapy regimen ? DESIGN R and omised trial with concealed allocation , intention-to-treat analysis and blinding of some outcomes . PARTICIPANTS Forty-nine adults hospitalised for community-acquired pneumonia . INTERVENTION The experimental group ( n=32 ) underwent a physical training program that included warm-up , stretching , peripheral muscle strength training and walking at a controlled speed for 15 minutes . The control group ( n=17 ) underwent a respiratory physiotherapy regimen that included percussion , vibrocompression , respiratory exercises and free walking . The intervention regimens lasted 8 days . OUTCOME MEASURES The primary outcome was the Glittre Activities of Daily Living test , which assesses the time taken to complete a series of functional tasks ( eg , rising from a chair , walking , stairs , lifting and bending ) . Secondary outcomes were distance walked in the incremental shuttle walk test , peripheral muscle strength , quality of life , dyspnoea , lung function , C-reactive protein and length of hospital stay . Measures were taken 1 day before and 1 day after the intervention period . RESULTS There was greater improvement in the experimental group than in the control group on the Glittre Activities of Daily Living test ( mean between-group difference 39 seconds , 95 % CI 20 to 59 ) and the incremental shuttle walk test ( mean between-group difference 130 m , 95 % CI 77 to 182 ) . There were also significantly greater improvements in quality of life , dyspnoea and peripheral muscle strength in the experimental group than in the control group . There were no between-group differences in lung function , C-reactive protein or length of hospital stay . CONCLUSION The improvement in functional outcomes after an inpatient rehabilitation program was greater than the improvement after st and ard respiratory physiotherapy . The exercise training program led to greater benefits in functional capacity , peripheral muscle strength , dyspnoea and quality of life . REGISTRATION Clinical Trials.gov , NCT02103400 Objective : To study the effect of physical exercise shortly after an acute episode of dermato/polymyositis ( DM/PM ) . Design : Pilot study of a descriptive nature . Setting : Rehabilitation unit of a large general hospital . Subjects : Ten patients 2–3 weeks after an acute phase of DM/PM ( early recovery group ) and 11 patients in the inactive stage of DM/PM for at least three months ( chronic stage group ) . Interventions : Isotonic muscle training consisted of several series of different repeated movements at 65–70 % of individual maximal repetition limit . Special training was applied for the respiratory muscles . Relaxing baths , mud packs and massages were also applied . Outcome measures : Dynamometer and spirometer were used for measuring the changes in muscle strength and respiratory function . Disability tests were done before and after therapy . Results : No disease relapses or decreases in muscle function were seen . In the early recovery group , the average muscle strength improvement was 17 ± 31 % ( p > 0.05 ) in the proximal muscles and 37 ± 23 % ( p < 0.05 ) in the distal muscles , while the vital capacity also increased by 17 ± 21 % ( p < 0.05 ) . In the chronic stage group the average improvement in muscle strength was 46 ± 34 % ( p < 0.05 ) in the proximal muscles and 37 ± 29 % ( p < 0.05 ) in the distal muscles . By the end of the therapy both groups showed improvements in disability tests ( p < 0.05 ) . Conclusions : Physical training started 2–3 weeks following an acute exacerbation of the disease seems to be useful and safe . Some improvement in muscle strength and respiratory function can be obtained , muscle atrophy due to inactivity may be partially prevented and the level of disability can be decreased Background Evidence supports the use of educational and physical training programs for people with rheumatoid arthritis ( RA ) . Objective The purpose of this study was to evaluate the effects of a group-based exercise and educational program on the physical performance and disease self-management of people with RA . Design This was a r and omized controlled trial . Setting The study was conducted at a rehabilitation center in the Netherl and s. Participants Thirty-four people diagnosed with RA participated in the study . Participants were r and omly assigned to either an intervention group ( n=19 ) or a waiting list control group ( n=15 ) . Intervention The intervention in this study was an 8-week , multidisciplinary , group therapy program for people with RA , consisting of physical exercise design ed to increase aerobic capacity and muscle strength ( force-generating capacity ) together with an educational program to improve health status and self-efficacy for disease-self-management . Measurements The main outcome measures were maximum oxygen uptake ( V̇o2max ) , muscle strength of the elbow and knee flexors and extensors , health status , and perceived self-efficacy . All data were recorded before intervention in week 1 , after intervention in week 9 , and at follow-up in week 22 . Results The intervention group showed significant improvement ( 12.1 % ) in V̇o2max at week 9 compared with the control group ( −1.7 % ) . Although significant within-group changes were found over time for muscle strength of the upper and lower extremities and health status that favored the intervention group , no between-group changes were found regarding these outcomes . Limitations An important limitation was the small number of participants included in our study , which may have result ed in a lack of power . Conclusions The present group-based exercise and educational program for people with RA had a beneficial effect on aerobic capacity but not on muscle strength , health status , or self-efficacy BACKGROUND AND PURPOSE Few r and omized controlled studies have examined the effects of exercise in patients with ankylosing spondylitis ( AS ) . This study investigated the effects of a 12-week , multimodal exercise program in patients with AS . SUBJECTS A convenience sample of 30 patients with AS ( 18 male , 12 female ) , with a mean age of 34.9 years ( SD=6.28 ) , participated in the study . Twenty-six subjects were classified as having stage I AS and 4 subjects were classified as having stage II AS according to the modified New York Criteria . METHODS This study was a r and omized controlled trial . Subjects were assigned to either a group that received an exercise program or to a control group . The exercise program consisted of 50 minutes of multimodal exercise , including aerobic , stretching , and pulmonary exercises , 3 times a week for 3 months . Subjects in both groups received medical treatment for AS , but the exercise group received the exercise program in addition to the medical treatment . All subjects received a physical examination at baseline and at 12 weeks . The examinations were conducted under the supervision of a physician who specialized in physical medicine and rehabilitation and included the assessment of spinal mobility using 2 methods : clinical measurements ( chin-to-chest distance , Modified Schober Flexion Test , occiput-to-wall distance , finger-to-floor distance , and chest expansion ) and inclinometer measurements ( gross hip flexion , gross lumbar flexion , and gross thoracic flexion ) . In addition , vital capacity was measured by a physiologist , and physical work capacity was evaluated by a doctorally prepared exercise instructor . RESULTS The measurements of the exercise group for chest expansion , chin-to-chest distance , Modified Schober Flexion Test , and occiput-to-wall distance were significantly better than those of the control group after the 3-month exercise period . The spinal movements of the exercise group improved significantly at the end of exercise program , but those of the control group showed no significant change . In addition , the results showed that the posttraining value of gross thoracic flexion of the exercise group was significantly higher than that of the control group . Physical work capacity and vital capacity values improved in the exercise group but decreased in the control group . DISCUSSION AND CONCLUSION In this study , a multimodal exercise program including aerobic , stretching , and pulmonary exercises provided in conjunction with routine medical management yielded greater improvements in spinal mobility , work capacity , and chest expansion OBJECTIVE To survey and to compare the one year effects of dynamic muscle training and progressive muscle relaxation as home exercise for patients with inflammatory rheumatic diseases ; and to identify predictors for compliance with a longterm home exercise regimen . METHODS Fifty-four patients ( mean age 54 yrs , mean symptom duration 14 yrs ) were assessed for health related quality of life , exercise motivation , joint tenderness , and physical capacities .  After r and omization into 2 groups , every patient was instructed on one occasion in a 30 min program of either dynamic training or muscle relaxation to carry out at home , 5 times a week during 3 months , and then 2 - 3 times a week for another 9 months . RESULTS Seventeen patients in each group completed the one year exercise protocol , while 10 from each group did not . Compliance with the one year exercise regimen seemed to be predicted by high self-efficacy for exercise , regular range-of-motion exercises before the intervention , and being unmarried . After one year , minor improvements in physical effect ( p < or = 0.05 ) and work effect ( p < or = 0.05 ) were found in the dynamic training group , while minor improvements in pain effect ( p < or = 0.05 ) , emotional reactions ( p < or = 0.05 ) , and arm endurance ( p < or = 0.01 ) were found in the muscle relaxation group . No differences between the groups regarding changes in health status , joint tenderness , or physical capacities during the intervention period were found . CONCLUSION These results may improve the selection of patients for home exercise , and form a basis for improved administration of home exercise programs Multimodal exercise programs incorporating traditional progressive resistance training ( PRT ) , weight-bearing impact training and /or balance training are recommended to reduce risk factors for falls and fracture . However , muscle power , or the ability to produce force rapidly , has emerged as a more crucial variable to functional decline than muscle strength or mass . The aim of this 12-month community-based r and omized controlled trial , termed Osteo-cise : Strong Bones for Life , was to evaluate the effectiveness and feasibility of a multimodal exercise program incorporating high-velocity (HV)-PRT , combined with an osteoporosis education and behavioral change program , on bone mineral density ( BMD ) , body composition , muscle strength and functional muscle performance in older adults . Falls incidence was evaluated as a secondary outcome . A total of 162 older adults ( mean ± SD ; 67 ± 6 years ) with risk factors for falls and /or low BMD were r and omized to the Osteo-cise program ( n = 81 ) or a control group ( n = 81 ) . Exercise consisted of fitness center-based HV-PRT , weight-bearing impact and challenging balance/mobility activities performed three times weekly . After 12 months , the Osteo-cise program led to modest but significant net gains in femoral neck and lumbar spine BMD ( 1.0 % to 1.1 % , p < 0.05 ) , muscle strength ( 10 % to 13 % , p < 0.05 ) , functional muscle power ( Timed Stair Climb , 5 % , p < 0.05 ) and dynamic balance ( Four Square Step Test 6 % , p < 0.01 ; Sit-to-St and , 16 % , p < 0.001 ) relative to controls . There was no effect on total body lean mass or mobility ( timed-up- and -go ) , and no difference in falls rate ( incidence rate ratio [ IRR ] , 1.22 ; 95 % confidence interval [ CI ] , 0.72 - 2.04 ) . In conclusion , this study demonstrates that the Osteo-cise : Strong Bones for Life community-based , multimodal exercise program represents an effective approach to improve multiple musculoskeletal and functional performance measures in older adults with risk factors for falls and /or low BMD . Although this did not translate into a reduction in the rate of falls , further large-scale trials are needed to evaluate the efficacy of this multimodal approach on reducing falls and fracture Objective To investigate whether an early rehabilitation intervention initiated during acute admission for exacerbations of chronic respiratory disease reduces the risk of readmission over 12 months and ameliorates the negative effects of the episode on physical performance and health status . Design Prospect i ve , r and omised controlled trial . Setting An acute cardiorespiratory unit in a teaching hospital and an acute medical unit in an affiliated teaching district general hospital , United Kingdom . Participants 389 patients aged between 45 and 93 who within 48 hours of admission to hospital with an exacerbation of chronic respiratory disease were r and omised to an  early rehabilitation intervention ( n=196 ) or to usual care ( n=193 ) . Main outcome measures The primary outcome was readmission rate at 12 months . Secondary outcomes included number of hospital days , mortality , physical performance , and health status . The primary analysis was by intention to treat , with prespecified per protocol analysis as a secondary outcome . Interventions Participants in the early rehabilitation group received a six week intervention , started within 48 hours of admission . The intervention comprised prescribed , progressive aerobic , resistance , and neuromuscular electrical stimulation training . Patients also received a self management and education package . Results Of the 389 participants , 320 ( 82 % ) had a primary diagnosis of chronic obstructive pulmonary disease . 233 ( 60 % ) were readmitted at least once in the following year ( 62 % in the intervention group and 58 % in the control group ) . No significant difference between groups was found ( hazard ratio 1.1 , 95 % confidence interval 0.86 to 1.43 , P=0.4 ) . An increase in mortality was seen in the intervention group at one year ( odds ratio 1.74 , 95 % confidence interval 1.05 to 2.88 , P=0.03 ) . Significant recovery in physical performance and health status was seen after discharge in both groups , with no significant difference between groups at one year . Conclusion Early rehabilitation during hospital admission for chronic respiratory disease did not reduce the risk of subsequent readmission or enhance recovery of physical function following the event over 12 months . Mortality at 12 months was higher in the intervention group . The results suggest that beyond current st and ard physiotherapy practice , progressive exercise rehabilitation should not be started during the early stages of the acute illness . Trial registration Current Controlled Trials IS RCT N05557928 Objectives : As the catabolic state induced by septic shock together with the physical inactivity of patients lead to the rapid loss of muscle mass and impaired function , the purpose of this study was to test whether an early physical therapy during the onset of septic shock regulates catabolic signals and preserves skeletal muscle mass . Design : R and omized controlled trial . Setting : Tertiary mixed ICU . Patients : Adult patients admitted for septic shock within the first 72 hours . Interventions : Patients were assigned r and omly into two groups . The control group benefited from manual mobilization once a day . The intervention group had twice daily sessions of both manual mobilization and 30-minute passive/active cycling therapy . Measurements and Main Results : Skeletal muscle biopsies and electrophysiology testing were performed at day 1 and day 7 . Muscle biopsies were analyzed for histology and molecular components of signaling pathways regulating protein synthesis and degradation as well as inflammation markers . Hemodynamic values and patient perception were collected during each session . Twenty-one patients were included . Three died before the second muscle biopsy . Ten patients in the control and eight in the intervention group were analyzed . Markers of the catabolic ubiquitin-proteasome pathway , muscle atrophy F-box and muscle ring finger-1 messenger RNA , were reduced at day 7 only in the intervention group , but without difference between groups ( muscle atrophy F-box : –7.3 % ± 138.4 % in control vs –56.4 % ± 37.4 % in intervention group ; p = 0.23 and muscle ring finger-1 : –30.8 % ± 66.9 % in control vs –62.7 % ± 45.5 % in intervention group ; p = 0.15 ) . Muscle fiber cross-sectional area ( µm2 ) was preserved by exercise ( –25.8 % ± 21.6 % in control vs 12.4 % ± 22.5 % in intervention group ; p = 0.005 ) . Molecular regulations suggest that the excessive activation of autophagy due to septic shock was lower in the intervention group , without being suppressed . Markers of anabolism and inflammation were not modified by the intervention , which was well tolerated by the patients . Conclusions : Early physical therapy during the first week of septic shock is safe and preserves muscle fiber cross-sectional area For decades , physical training of rheumatoid arthritis (RA)- patients has been controversial , especially for patients with active disease . The aim of this study was to investigate whether RA- patients could receive graduated training without increasing the activity of the disease . In a controlled cross-over study the effect of graduated progressive training has been evaluated in 18 RA- patients with moderately active disease . The training was performed twice weekly with aerobic conditioning and strength exercises progressing to strenuous exercises over an 8-week period . The design was a crossover project with two groups obtained by minimisation . After training the patients had significantly fewer swollen joints than before . Training of the muscles acting over the swollen joints result ed in more than a 35 % decrease in the number of swollen joints . The hemoglobin level increased significantly after the training period . The erythrocyte sedimentation rate , the complement factor C3d , and the number of sore joints remained unchanged . A decrease in the need for medicine was non-significant . From this study it appears that RA- patients with some activity are trainable without aggravating the disease , even in the chronically swollen joints . The rheumatoid arthritis activity decreased with fewer swollen joints and higher hemoglobin level after training OBJECTIVE A pilot study was design ed to assess the efficacy and safety of different exercise therapies on  patient-reported fatigue and functional status .  METHODS Ten patients with systemic lupus erythematosus ( SLE ) were r and omly placed in either an aerobic exercise group ( group 1 : n = 5 ) or a range of motion/muscle strengthening ( ROM/MS ) exercise group ( group 2 : n = 5 ) . Outcome measures assessed at baseline and the end of the study were fatigue , functional status , disease activity , cardiovascular fitness , isometric strength , bone mineral density ( BMD ) of the lumbar spine and femoral neck , and parathyroid hormone and osteocalcin as representative bone biochemical markers for bone resorption and bone formation , respectively . RESULTS Both aerobic and ROM/MS types of exercise were safe and did not worsen SLE disease activity . Patients in both exercise groups showed some improvement in fatigue , functional status , cardiovascular fitness , and muscle strength . Both groups showed increased bone turnover , but BMD was unchanged . Eighty percent of the patients met the compliance st and ard for the study . CONCLUSIONS This pilot study shows the feasibility of exercise for SLE patients . The potential value of this approach shows promise in the routine management of these patients
Inflammation appeared to be associated with greater loss of muscle strength .
There was inconclusive evidence that the level of physical activity affects change in skeletal muscle .
In regard to the effect of interventions , only exercise interventions were consistently associated with improved skeletal muscle outcomes .
CONCLUSIONS Adult patients who undergo an unplanned hospital admission may experience a small reduction in knee extension strength and mid-arm muscle mass .
OBJECTIVES The primary objective of the review was to describe change that occurs in skeletal muscle during periods of unplanned hospitalisation in adult patients .
The secondary objective was to examine the relationship between both physical activity and inflammation with the change in skeletal muscle .
A further objective was to investigate the effect of interventions on change in skeletal muscle during periods of unplanned hospitalisation .