Rehabilitation in rheumatoid arthritis: a critical review. Do home-based exercise interventions improve outcomes for frail older people? Findings from a systematic review. Yoga-based exercise improves health-related quality of life and mental well-being in older people: a systematic review of randomised controlled trials Valerian for insomnia: a systematic review of randomized clinical trials. Task-Oriented Training with Computer Games for People with Rheumatoid Arthritis or Hand Osteoarthritis: A Feasibility Randomized Controlled Trial. Exercise for people with cancer: a clinical practice guideline. Efficacy of postural and neck-stabilization exercises for persons with acute whiplash-associated disorders: a systematic review. Resting blood pressure reductions following isometric handgrip exercise training and the impact of age and sex: protocol for a systematic review Dietetic guidelines: diet in secondary prevention of cardiovascular disease. Patients' perceptions of fatigue in rheumatoid arthritis: overwhelming, uncontrollable, ignored. Tai Chi exercise and auricular acupressure for people with rheumatoid arthritis: an evaluation study. Efficacy of physical conditioning exercise in patients with rheumatoid arthritis and osteoarthritis.
This article considers the evidence for effectiveness and timing of rehabilitation  for people with rheumatoid arthritis ( RA ) . The Cochrane Library , DARE , Medline , Embase , CINAHL and AMED were search ed to identify systematic review s and r and omized controlled trials evaluating rehabilitation interventions for people with rheumatoid arthritis . Many trials identified had method ological limitations ( e.g. short follow-up periods , small sample sizes ) . Evidence to date is that symptomatic relief results from thermotherapy , laser therapy , acupuncture and assistive devices . In the short-term , comprehensive occupational therapy ( in established rheumatoid arthritis ) , orthoses , and mind-body approaches can help maintain function . Over at least a one-year period , the following are effective in reducing pain and maintaining function :  patient education and joint protection training using behavioural approaches ; dynamic exercise therapy , h and exercises and hydrotherapy ; and cognitive-behavioural therapy ( in people with poorer psychological status ) . Many trials have recruited people with moderate to severe , established RA and relatively little is known about the long-term effectiveness of early rehabilitation , although this is becoming much more common in practice . Despite the increased availability of guidelines and systematic review s , most conclude there is insufficient evidence for many areas of rheumatology rehabilitation . Further well- design ed clinical trials are needed recruiting people with early disease using patient-centred outcomes BACKGROUND Frailty is common in older age , and is associated with important adverse health outcomes including increased risk of disability and long-term care admission . OBJECTIVES To evaluate whether home-based exercise interventions improve outcomes for frail older people . DATA SOURCES We search ed systematic ally for r and omised controlled trials ( RCTs ) and cluster RCTs , with literature search ing to February 2010 . STUDY SELECTION All trials that evaluated home-based exercise interventions for frail older people were eligible . Primary outcomes were mobility , quality of life and daily living activities . Secondary outcomes included long-term care admission and hospitalisation . RESULTS Six RCTs involving 987 participants met the inclusion criteria . Four trials were considered of high quality . One high quality trial reported improved disability in those with moderate but not severe frailty . Meta- analysis of long-term care admission rates identified a trend towards reduced risk . Inconsistent effects on other primary and secondary outcomes were reported in the other studies . CONCLUSIONS There is preliminary evidence that home-based exercise interventions may improve disability in older people with moderate , but not severe , frailty . There is considerable uncertainty regarding effects on important outcomes including quality of life and long-term care admission .  Home-based exercises are a potentially simple , safe and widely applicable intervention to prevent dependency decline for frail older people OBJECTIVE health-related quality of life ( HRQOL ) and mental well-being are associated with healthy ageing . Physical activity positively impacts both HRQOL and mental well-being .  Yoga is a physical activity that can be modified to suits the needs of older people and is growing in popularity . We conducted a systematic review with meta- analysis to determine the impact of yoga-based exercise on  HRQOL and mental well-being in people aged 60 + . METHODS search es were conducted for relevant trials in the following electronic data bases ; MEDLINE , EMBASE , Cochrane Central Register of Controlled Trials , CINAHL , Allied and Complementary Medicine Data base , PsycINFO and the Physiotherapy Evidence Data base ( PEDro ) from inception to January 2017 . Trials that evaluated the effect of physical yoga on HRQOL and /or on mental well-being  in people aged 60 + years were included . Data on HRQOL and mental well-being were extracted . St and ardised mean differences and 95 % confidence intervals ( CI ) were calculated using r and om effects models . Method ological quality of trials was assessed using the PEDro scale . RESULTS twelve trials of high method ological quality ( mean PEDro score 6.1 ) , totalling 752 participants , were identified and provided data for the meta- analysis . Yoga produced a medium effect on HRQOL ( Hedges ' g = 0.51 , 95 % CI 0.25 - 0.76 , 12 trials ) and a small effect on mental well-being ( Hedges ' g = 0.38 , 95 % CI 0.15 - 0.62 , 12 trials ) . CONCLUSION yoga interventions result ed in small to moderate improvements in both HRQOL and mental well-being in people aged 60 + years . Further , research is needed to determine the optimal dose of yoga to maximise health impact . PROSPERO REGISTRATION NUMBER ( CRD42016052458 ) Objective : To systematic ally review the evidence for the effects of the herb valerian ( Valeriana officinalis ) on  insomnia  , based on r and omized , placebo-controlled , double-blind trials . Background : Valerian has long been advocated and used for promoting sleep but until quite recently evidence was solely anecdotal . However , during the last two decades a number of clinical trials have been conducted . Material s and methods : Systematic literature search es were performed to locate r and omized , placebo-controlled , double-blind trials measuring the effect of  valerian monopreparations on sleep in human participants . Data were extracted in a st and ardized manner and method ological quality was assessed by the Jadad score . Results : Nine trials were located meeting the selection criteria . The findings of the studies were contradictory and there was great inconsistency between trials in terms of patients , experimental design and procedures and method ological quality . Conclusion : The evidence for valerian as a treatment for  insomnia  is inconclusive . There is a need for rigorous trials to determine its efficacy OBJECTIVES To examine the feasibility of a clinical trial on a novel , home-based task-oriented training with conventional h and exercises in people with rheumatoid arthritis or h and osteoarthritis . To explore the experiences of participants who completed their respective home exercise programmes .  MATERIAL S AND METHODS Thirty volunteer participants aged between 30 and 60 years and diagnosed with rheumatoid arthritis or h and osteoarthritis were proposed for a single-center , assessor-blinded , r and omized controlled trial ( Clinical Trials.gov : NCT01635582 ) . Participants received task-oriented training with interactive computer games and objects of daily life or finger mobility and strengthening exercises . Both programmes were home based and were done four sessions per week with 20 minutes each session for 6 weeks . Major feasibility outcomes were number of volunteers screened , r and omized , and retained ; completion of blinded assessment s , exercise training , and home exercise sessions ; equipment and data management ; and clinical outcomes of h and function . Reaching the recruitment target in 18 months and achieving exercise compliance > 80 % were set as success criteria . Concurrent with the trial , focus group interviews explored experiences of those participants who completed their respective programmes . RESULTS After trial initiation , revisions in inclusion criteria were required to promote recruitment . A total of 17 participants were r and omized and 15 were retained . Completion of assessment s , exercise training , and  home exercise  sessions ; equipment and data collection and management demonstrated excellent feasibility . Both groups improved in h and function outcomes and exercise compliance was above 85 % . Participants perceived both programmes as appropriate and acceptable . Participants who completed task-oriented training also agreed that playing different computer games was enjoyable , engaging , and motivating . CONCLUSIONS Findings demonstrate initial evidence on recruitment , feasibility of trial procedures , and acceptability of task-oriented training in people with rheumatoid arthritis or h and osteoarthritis . Since the pilot trial was unsuccessful in participant recruitment , a large trial will not follow BACKGROUND Development of this guideline was undertaken by the Exercise for People with Cancer Guideline Development Group , a group organized by Cancer Care Ontario 's Program in Evidence -Based Care ( pebc ) . The purpose of the guideline was to provide guidance for clinicians with respect to exercise for patients living with cancer , focusing on the benefits of specific types of exercise , recommendations about screening requirements for new referrals , and safety concerns . METHODS Consistent with the pebc 's st and ardized approach , a systematic search was conducted for existing guidelines , and systematic literature search es were performed in medline and embase for both systematic review s and primary literature . Content and methodology experts performed an internal review , which was followed by an external review by targeted experts and intended users . RESULTS The search identified three guidelines , eighteen systematic review s , and twenty-nine r and omized controlled trials with relevance to the topic . The present guideline provides recommendations for the duration , frequency , and intensity of exercise appropriate for people living with cancer . It also provides recommendations for pre-exercise assessment , safety concerns , and delivery models . CONCLUSIONS There is sufficient evidence to show that exercise provides benefits in quality of life and muscular and aerobic fitness for people with cancer both during and after treatment , and that it does not cause harm . The present guideline is intended to support the Canadian Society for Exercise Physiology 's Canadian physical activity guidelines . The recommendations are intended for clinicians and institutions treating cancer patients in Ontario , and for policymakers and program planners involved in the delivery of exercise programs for cancer patients PURPOSE We systematic ally review ed r and omized and quasi-r and omized clinical trials in the literature to assess the efficacy of neck stabilization and postural exercises on pain , neck range of motion , and time off work in adults with acute whiplash-associated disorders . METHODS Electronic data bases , reference lists of relevant Cochrane review s , reference lists of studies selected for inclusion , and tables of contents of relevant journals were systematic ally search ed for r and omized and quasi-r and omized controlled trials . Two independent review ers selected studies for inclusion , assessed method ological quality , and extracted data . Because of the heterogeneity of the interventions , a qualitative synthesis was performed using " levels of evidence " as recommended by van Tulder et al. RESULTS Eight studies representing five clinical trials were selected for inclusion . Two trials were grade d as high quality , two as moderate quality , and one as low quality . Many of these studies had mixed results , demonstrating significant differences on some outcome measures but not on others . CONCLUSIONS There is moderate evidence to support the use of postural exercises for decreasing pain and time off work in the treatment of patients with acute whiplash-associated disorders . However , no evidence exists to support the use of postural exercises for increasing neck range of motion . There is conflicting evidence in support of neck stabilization exercises in the treatment of patients with acute whiplash-associated disorders Background The risk of developing cardiovascular disease is directly correlated to one ’s resting blood pressure ( BP ) , age , and biological sex . Resting BP can be reduced using h and grip exercise training , but the impact of age and sex on the effectiveness of training is not well documented . Methods / design A systematic search of the literature will be conducted for all experimental studies ( including r and omized controlled trials and prospect i ve experiments ) that report the influence of isometric h and grip exercise training on resting systolic blood pressure . The data bases Medline , Embase , Cochrane Review s , Cumulative Index to Nursing and Allied Health Literature ( CINAHL ) , SPORTD iscus , Web of Science , Allied and Complementary Medicine ( AMED ) , PubMed , and Scopus will be search ed until 1 December 2015 . Screening of potential articles , data abstract ion , and quality appraisal will be completed in duplicate independently . When necessary , corresponding authors will be contacted in order to facilitate the separation of pooled data into age and sex categories . Method ological quality will be determined using the Quality Assessment Framework developed by the Cochrane Collaboration and the Newcastle-Ottawa Quality Assessment Scale as appropriate . Any discrepancies will be resolved by a third author . Findings will be presented in accordance with the preferred reporting items for systematic review s and meta- analysis ( PRISMA ) guidelines . Discussion This systematic review will determine the overall effectiveness  of h and grip exercise training in improving resting blood pressure . A novel , focused assessment will contrast  effectiveness of h and grip training  based on the age ( younger 18–54 years , older > 55 years ) and the sex ( men , women ) of study participants . This information is essential to consoli date before moving forward with the development and implementation of h and grip exercise training programmes which are design ed to best meet the needs of particular cohorts . Systematic review registration PROSPERO AIM To produce dietetic guidelines summarizing the systematic review evidence on dietary advice for secondary prevention of cardiovascular disease . METHODS The Cochrane Library , MEDLINE and EMBASE were comprehensively search ed for systematic review s on aspects of diet and heart health . Review s were included if they search ed systematic ally for r and omised controlled trials relating to diet and secondary prevention of cardiovascular disease . Two members of the UK Heart Health and Thoracic Dietitians Group critically appraised each review . The quality and results of each review were discussed and summarized in a whole group meeting . The guidelines were trialled in seven dietetic departments and modified where necessary . RESULTS Providing evidence -based dietary information ( including increasing omega-3 fat plus fruit and vegetable intake ) to all people after myocardial infa rct ion will save more lives than concentrating dietary advice on those in need of weight loss or lipid lowering . The practice of prioritizing dietetic time to those with raised lipids is out of date since the advent of statin therapy . CONCLUSION There is good systematic review evidence that dietary advice to those with cardiovascular disease can reduce mortality and morbidity as well as modify risk factors .  Dietary advice that does this most effectively should be prioritized OBJECTIVE Fatigue is commonly reported by patients with rheumatoid arthritis ( RA ) but is rarely a treatment target . The aim of this study was to explore the concept of fatigue as experienced by patients with RA . METHODS Fifteen patients with RA and fatigue ( > or = 7 on a 10-cm visual analog scale ) were individually interviewed and asked about the description , cause , consequence , and management of fatigue . Transcripts were systematic ally analyzed by 2 research ers independently , relevant phrases were coded , and earlier transcripts were checked for the emerging codes . A r and om sample of analyses were independently review ed . A total of 191 codes arising from the data were grouped into 46 categories and overarching themes . RESULTS Vivid descriptions reflect 2 types of fatigue : severe weariness and dramatic overwhelming fatigue . RA fatigue is different from normal tiredness because it is extreme , often not earned , and unresolving . Participants described physical , cognitive , and emotional components and attributed fatigue to inflammation , working the joints harder , and unrefreshing sleep . Participants described far-reaching effects on physical activities , emotions , relationships , and social and family roles . Participants used self-management strategies but with limited success . Most did not discuss fatigue with clinicians but when they did , they felt it was dismissed . Participants held negative views on the management of fatigue . CONCLUSION The data show that RA fatigue is important , intrusive , and overwhelming , and patients struggle to manage it alone . These data on the complexity of fatigue experiences will help clinicians design measures , interventions , and self-managment guidance AIMS AND OBJECTIVES ( i ) To assess the effectiveness of Tai Chi exercise in people with rheumatoid arthritis ( RA ) . ( ii ) To ascertain if Tai Chi and auricular acupressure have a potentiation effect in controlling pain . ( iii ) To evaluate the acceptability and enjoyment of the classes . BACKGROUND Tai Chi has been suggested as a suitable exercise for people with arthritis and specific programmes have been developed . Auricular acupressure is a therapeutic method by which points on the ear are stimulated to treat various disorders . DESIGN A pragmatic non-r and omised before/after study to compare the effects of the interventions . METHODS People with RA ( n=21 ) were recruited and allocated into two groups . Both groups followed a Tai Chi exercise programme , twice a week for 12 weeks , but one group ( n=14 ) had , in addition , the auricular acupressure .  Physical symptoms and function , pain , quality of life and self-efficacy were measured in both groups before and after the programme . Acceptability and enjoyment were assessed at the end . RESULTS At 12 weeks , both groups had achieved statistically significant improvements in balance , grip strength , pinch strength , 50 foot walk time self reported joint pain , swollen joint count , tender joint count and in self efficacy in relation to pain control . All participants stated that they enjoyed the classes . There was no evidence to suggest that the auricular acupressure enhanced the effects of the Tai Chi intervention . CONCLUSION The classes appeared to be mentally as well as physically helpful to participants . RELEVANCE TO CLINICAL PRACTICE People with a chronic debilitating disease such as RA should be encouraged to undertake gentle strengthening exercise such as Tai Chi because of its potential for physical and psychological improvements A group of 120 patients with rheumatoid arthritis or osteoarthritis volunteered to be subjects for this study of aerobic versus nonaerobic exercise . Patients were stratified by diagnosis and r and omized into an exercise program of aerobic walking , aerobic aquatics , or nonaerobic range of motion ( controls ) . The retention rate for the 12-week program was 83 % . Exercise tolerance , disease-related measures , and self-reported health status were assessed . The aquatics and walking exercise groups showed significant improvement over the control group in aerobic capacity , 50-foot walking time , depression , anxiety , and physical activity after the 12-week exercise program . There were no significant between-group group differences in the change scores for flexibility , number of clinical ly active joints , duration of morning stiffness , or grip strength . Our findings document the feasibility and efficacy of conditioning exercise for people who have rheumatoid arthritis or osteoarthritis
This review could find no consistent or conclusive evidence on whether exercise impacts on sleep in people who have rheumatoid arthritis , therefore no firm conclusions can be made .
However , there is some indication that exercise may have positive benefits on sleep in people who have rheumatoid arthritis .
To systematic ally search for the availability of evidence for exercise impacting on sleep for people who have rheumatoid arthritis .