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AIM This paper reports a study of the effects of aquatic exercise on physical fitness ( flexibility , strength and aerobic fitness ) , self-reported physical functioning and pain in adults with osteoarthritis of the hip or knee . BACKGROUND Osteoarthritis is a common cause of disability and a primary reason for hip and knee joint replacement . Exercise is important for preventing and /or managing the functional limitations associated with joint disease . Aquatic exercise is thought to be beneficial and is often recommended for people with osteoarthritis ; however , few studies have examined the effects on people with osteoarthritis , and these have yielded inconsistent results . METHODS A two-group r and omized controlled trial with a convenience sample was used . Participants were recruited from community sources and r and omly assigned to a 12-week aquatic programme or a non-exercise control condition . Data for 38 participants were collected at baseline , week 6 , and week 12 during 2003 and 2004 . Instruments were a st and ard plastic goniometer , a h and held dynamometer , the 6-minute walk test , the multidimensional Health Assessment Question naire , and a visual analogue scale for pain . RESULTS Repeated measures analysis of variance showed that aquatic exercise statistically significantly improved knee and hip flexibility , strength and aerobic fitness , but had no effect on self-reported physical functioning and pain . The exercise adherence rate was 81.7 % , and no exercise-related adverse effect was observed or reported . CONCLUSIONS Beneficial short-term effects of aquatic exercise were found in adults with osteoarthritis of the hip or knee . Although the programme may not offer pain relief or self-reported improvements in physical functioning , results suggest that aquatic exercise does not worsen the joint condition or result in injury . Nurses engaging in disease management and health promotion for these patients should consider recommending or implementing aquatic classes for patients 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 OBJECTIVE Twelve forms of Sun-style tai chi exercise have been developed specifically to reduce the symptoms and improve the physical functioning of arthritic patients , and this r and omized study examined the changes in symptoms and physical characteristics in older women with osteoarthritis ( OA ) at the completion of a 12-week tai chi exercise program . METHODS Seventy-two patients with OA were r and omly assigned into 2 groups . Due to a 41 % overall dropout rate , 22 experimental subjects and 21 controls completed pre- and post-test measures over a 12 week interval . Outcome variables were physical symptoms and fitness , body mass index , cardiovascular functioning , and perceived difficulties in physical functioning . The independent t test was used to examine group differences . RESULTS The homogeneity test confirmed that there were no significant group differences in demographic data and pretest measures . Mean comparisons of the change scores revealed that the experimental group perceived significantly less pain ( t = -2.19 , p = 0.034 ) and stiffness ( t = -2.13 , p = 0.039 ) in their joints , and reported fewer perceived difficulties in physical functioning ( t = -2.81 , p = 0.008 ) , while the control group showed no change or even deterioration in physical functioning after 12 weeks . In the physical fitness test , there were significant improvements in balance ( t = 3.34 , p = 0.002 ) and abdominal muscle strength ( t = 2.74 , p = 0.009 ) for the tai chi exercise group . No significant group differences were found in flexibility and upper-body or knee muscle strength in the post-test scores . CONCLUSION Older women with OA were able to safely perform the 12 forms of Sun-style tai chi exercise for 12 weeks , and this was effective in improving their arthritic symptoms , balance , and physical functioning . A longitudinal study with a larger sample size is now needed to confirm the potential use of tai chi exercise in arthritis management Adults with intellectual disability ( ID ) have decreased cardiovascular fitness and strength present with lower rates of physical activity ( PA ) , and often have balance and functional impairments . The purpose of this study was to investigate the effect of a combined PA program ( CPAP ) utilizing aerobic , strength and balance training on cardiovascular fitness , strength , balance and functional measures in a controlled clinical trial . Adults with mild to moderate ID were assigned into either the intervention group ( IG ; n=37 ) or the control group ( CG ; n=29 ) . The IG trained 3 day/week , 1 h/day over 14 weeks , while the CG did not participate in any exercise program .  Cardiovascular fitness , strength , balance , flexibility and functional ability were assessed pre-post training . The IG increased cardiovascular fitness ( 26.8 vs. 29.3 ml kg(-1 ) min(-1 ) ) , h and grip strength ( 19.2 vs. 21.9 kg ) , leg strength , and balance following the training period ( p<.05 ) . Body weight ( 70.1 vs. 68.1 kg ) and body mass index ( 27.4 vs. 26.6 kg m(-2 ) ) decreased ( p<.05 ) in the IG group . The CG showed no changes in any parameter . These data suggest a combined aerobic , strength and balance exercise training program is beneficial among individuals with ID OBJECTIVE Patients with rheumatoid arthritis ( RA ) are more at risk for the development of osteoporosis and osteoporotic fractures than are their healthy peers . In this r and omized , controlled , multicenter trial , the effectiveness of a 2-year high-intensity weight-bearing exercise program ( the Rheumatoid-Arthritis- Patients -In-Training [ RAPIT ] program ) on bone mineral density ( BMD ) was compared with usual care physical therapy , and the exercise modalities associated with changes in BMD were determined . METHODS Three hundred nine patients with RA were assigned to an intervention group , either the RAPIT program or usual care physical therapy . The primary end points were BMD of the hip and spine . The exercise modalities examined were aerobic fitness , muscle strength , and , as a surrogate for those effects not directly measured by the RAPIT program , attendance rate . RESULTS The data on the 136  RAPIT participants and 145 usual care participants who completed the study were analyzed . The mean rate of decrease in hip BMD , but not in lumbar spine BMD , was smaller in patients participating in the RAPIT program when compared with that in the usual care group , with a mean decrease of 1.6 % ( 95 % confidence interval [ 95 % CI ] 0.8 - 2.5 ) over the first year and 0.5 % ( 95 % CI 1.1 - 2.0 ) over the second year . The change in hip BMD was significantly and independently associated with changes in both muscle strength ( multivariate odds ratio [ OR ] 1.75 , 95 % CI 1.07 - 2.86 ) and aerobic fitness ( OR 1.79 , 95 % CI 1.10 - 2.90 ) , but not with the attendance rate ( OR 1.00 , 95 % CI 0.99 - 1.00 ) . CONCLUSION A long-term high-intensity weight-bearing exercise program for RA patients is effective in slowing down the loss of BMD at the hip . The exercise modalities associated with this effect are muscle strength and aerobic fitness OBJECTIVE To examine effects of activity strategy training ( AST ) , a structured rehabilitation program taught by occupational therapists and design ed to teach adaptive strategies for symptom control and engagement in physical activity ( PA ) . METHODS A r and omized controlled pilot trial was conducted at 4 sites ( 3 senior housing facilities and 1 senior center ) in southeastern , lower Michigan . Fifty-four older adults with hip or knee osteoarthritis ( mean + /- SD age 75.3+/-7.1 years ) participated . At each site , older adults were r and omly assigned to 1 of 2 programs : exercise plus AST ( Ex + AST ) or exercise plus health education ( Ex + Ed ) . The programs involved 8 sessions over 4 weeks with 2 followup sessions over a 6-month period , and were conducted concurrently within each site . Pain , total PA and PA intensity ( measured objective ly by actigraphy and subjectively by the Community Healthy Activities Model Program for Seniors question naire ) , arthritis self-efficacy , and physical function were assessed at baseline and posttest . RESULTS At posttest , participants who received Ex + AST had significantly higher levels of objective peak PA ( P=0.02 ) compared with participants who received Ex + Ed . Although not statistically significant , participants in Ex + AST tended to have larger pain decreases , increased total objective and subjective PA , and increased physical function . No effects were found for arthritis self-efficacy . CONCLUSION Although participants were involved in identical exercise programs , participants who received AST tended to have larger increases in PA at posttest compared with participants who received health education . Future studies will be needed to examine larger sample s and long-term effects of AST 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 Abstract Objective . To investigate the efficacy of a guided and grade d home-based exercise program for improving a range of physical outcomes in older people . Design . Controlled clinical trial of 16 weeks Setting . Two geographical areas in Gent , Belgium Participants . 66 independent-living older people ( age : 71 - 98 ) with a history of falls and moderate physical impairment Intervention . Twenty-four 30-minute training sessions were given by a trained physiotherapist over a period of 16 weeks in the participant ’s home . Different types of exercises on balance , aerobic performance , flexibility , and muscle strength were provided . Main outcome measures . Muscle strength , static and dynamic balance , aerobic performance , activities in daily living , fear of falling and avoidance of daily activities were assessed at baseline and after 16 weeks intervention . Results : At baseline , there were no significant differences in the measured variables between exercise and control groups . After 16 weeks , the exercise group showed significantly improved ankle muscle strength , balance performance and aerobic capacity , and decreased fear of falling , dependency in daily activities and avoidance of daily activities compared to the control group . The improvements in knee muscle strength , timed chair st and s , and functional reach were not significant . Conclusion : The home-based , individualized exercise program was effective in reducing several physical factors associated with falls in community-dwelling older people with moderate physical impairment . The decrease in fear of falling and other behavioural variables needs to be considered with care and needs further investigation Objective : To examine the effectiveness of a 12-month community-based water exercise programme on measures of self-reported health and physical function in people aged over 60 years old with knee-hip osteoarthritis ( OA ) . Design : A quasi-experimental design consisting of an exercise group and an age-matched control group . Setting : Public community swimming pool in Sheffield , UK . Subjects : One hundred and six community-dwelling sedentary older people , with confirmed knee-hip osteoarthritis , enrolled in an experimental controlled trial for 12 months . Sixty-six subjects in the exercise group were offered a water-exercise programme .  Forty age-matched , nonexercising , ‘ control ’ subjects received monthly education material and quarterly telephone calls . Interventions : Participants in the exercise group were asked to attend two exercise sessions a week of 1 hour duration led by specially trained swimming instructors . Main measures : Primary outcome measure was the disease-specific Western Ontario and McMaster University Osteoarthritis Index ( WOMAC ) . Secondary outcomes included a battery of performance-based physical function tests . Results : Adherence to exercise averaged 70 % ( ±14 % ) over the year : 77 % of the exercising subjects and 89 % control subjects completed both pre- and post- outcome measures . After one year , participants in the exercise group experienced a significant improvement in physical function ( 4.0 ± 9.1 versus -0.4 ± 7.3 units ; 95 % confidence interval ( CI ) 0.96–7.96 , p < 0.05 ) and reduction in the perception of pain ( 1.3 ± 3.7 versus 0.2 ± 2.5 units ; 95 % CI -0.19 - 2.52 , p < 0.05 ) compared with the control group , as measured by the WOMAC Osteoarthritis Index . In addition , the exercise group performed significantly better in the ascending and descending stairs tests ( p < 0.05 ) , had significantly greater improvements in knee range of movement ( p < 0.01 ) and hip range of movements ( p < 0.005 ) . There were no significant differences in the two groups for quadriceps muscle strength and psychosocial well-being ( Arthritis Impact Measurement Scales 2 question naire ) . Conclusions : Older people with knee/hip osteoarthritis gained modest improvements in measures of physical function , pain , general mobility and flexibility after participating in 12 months of community-based water exercise To investigate if spa water is superior to tap water ( TW ) in relieving the symptoms of pain , joint motion , life quality in knee osteoarthritis ( KOA ) patients . In this r and omized placebo-controlled trial , 52 patients with KOA were followed in two groups . In group I ( n = 27 ) , patients were treated in the pool full of spa water at 37 ° C for 20 min a day , 5 days a week , for a period of 2 weeks . In group II ( n = 25 ) , the same protocol was used but spa water was replaced by TW heated to 37 ° C . Patients in both groups were given a home-based st and ardized exercise program . Evaluation parameters were pain ( pVAS ) , tenderness score ( TS ) , 50-ft walking duration , quadriceps muscle strength ( QMS ) , active flexion degree ( AFD ) , WOMAC OA index , and Nottingham Health Profile ( NHP ) . The first evaluation was done after the informed consent was obtained . Second and third evaluations were done at the 2nd and 12th week . PVAS , 50-ft walking duration , AFD , TS , WOMAC , and NHP variables improved in group I. Same variables except QMS improved also in group II . Comparison of the groups just after treatment showed that only pVAS ( P = 0.015 ) , NHP pain score ( P = 0.020 ) , and TS ( P = 0.002 ) differed significantly in favor of group I at the 2nd or 12th week . Both of the thermal treatment modalities were found to be effective in the management of the clinical symptoms and quality of life in KOA patients . However , pain and tenderness improved statistically better with balneotherapy . There were no significant differences between the groups for the other variables Background A large proportion of patients with knee and /or hip osteoarthritis ( OA ) do not meet the recommended levels of physical activity ( PA ) . Therefore , we developed a web-based intervention that provides a tailored PA program for patients with knee and /or hip OA , entitled Join2move . The intervention incorporates core principles of the behaviour grade d activity theory ( BGA ) . The aim of this study was to investigate the preliminary effectiveness , feasibility and acceptability of Join2move in patients with knee and /or hip OA . Methods A non-r and omized pilot study was performed among patients with knee and /or hip OA . Primary outcomes were PA ( SQUASH Question naire ) , physical function ( HOOS and KOOS question naires ) and self-perceived effect ( 7-point Likert scale ) . Baseline , 6 and 12 week follow-up data were collected via online question naires . To assess feasibility and acceptability , program usage ( modules completed ) and user satisfaction ( SUS question naire ) were measured as secondary outcomes . Participants from the pilot study were invited to be interviewed . The interviews focused on users ’ experiences with Join2move . Besides the pilot study we performed two usability tests to determine the feasibility and acceptability of Join2move . In the first usability test , software experts evaluated the website from a list of usability concepts . In the second test , users were asked to verbalize thoughts during the execution of multiple tasks . Results Twenty OA patients with knee and /or hip OA between 50 and 80 years of age participated in the pilot study . After six weeks , pain scores increased from 5.3 to 6.6 ( p=0.04 ) . After 12 weeks this difference disappeared ( p=0.5 ) . Overall , users were enthusiastic about Join2move . In particular , performing exercise at one 's own pace without time or travel restrictions was cited as convenient . However , some minor flaws were observed . Users perceived some difficulties in completing the entire introduction module and rated the inability to edit and undo actions as annoying . Conclusions This paper outlines the preliminary effectiveness , feasibility and acceptability of a web-based PA intervention . Preliminary results from the pilot study revealed that PA scores increased , although differences were not statistically significant . Interviews and usability tests suggest that the intervention is feasible and acceptable in promoting PA in patients with knee and /or hip OA . The intervention was easy to use and the satisfaction with the program was high . Trial registration The Netherl and s National Trial Register . Trial number : OBJECTIVE To examine the effect of a targeted balance training program on dynamic balance and self-reported physical function in people with medial tibiofemoral osteoarthritis ( OA ) . DESIGN Single-blind r and omized controlled trial . SETTING Exercise gymnasium and community dwellings . PARTICIPANTS Individuals with medial compartment knee OA ( N=40 ) . INTERVENTIONS Ten weeks of partially supervised exercises targeting dynamic balance and strength performed 4 times per week or no intervention ( nonintervention group ) . MAIN OUTCOME MEASURES Dynamic balance was measured using the Community Balance and Mobility Scale ( CB&M ) , and self-reported physical function was measured using the Western Ontario and McMaster Universities Arthritis Index physical function subscale . Secondary outcomes included knee pain , fear of movement , knee joint proprioception , and muscle strength . RESULTS Forty individuals underwent baseline testing , with 36 participants completing follow-up testing .  Adherence to exercise in the training group was high , with 82.2 % of all home-based exercise sessions completed . No significant changes were observed in any outcome in the nonintervention group at follow-up . Significant improvements in self-reported pain , physical function , and fear of movement were observed in the training group when compared with the nonintervention group . No other within- or between-group differences were observed . CONCLUSIONS A 10-week dynamic balance training program for people with knee OA significantly improved self-reported knee pain , physical function , and fear of movement ; however , there was no change in dynamic balance as quantified by the CB&M. Further research is needed to investigate how exercise may result in improvement on objective measures of dynamic balance OBJECTIVE To examine the reliability , validity , and responsiveness of a continuous ambulatory activity monitor in patients with rheumatoid arthritis ( RA ) . METHODS Forty-one patients with RA , participating in a r and omized controlled trial examining the effect of an intensive exercise program  , were assessed by means of the  Dynaport ADL ( activities of daily living ) monitor ( AM ) .  The time spent on activities ( locomotion , st and ing , and active sitting ) during 24 hours and the intensity of trunk movement during these activities were recorded . To determine test-retest reliability 20 patients were reassessed with the AM one week after the first assessment . Construct validity of the AM was determined by comparing the AM results with physical fitness measures ( muscle strength , endurance , joint mobility ) , disease activity , and functional status . As well , 37 patients were assessed 18 months after the first assessment to determine responsiveness . RESULTS All AM measurements showed satisfactory test-retest reliability ( ICC 0.63 - 0.76 ) . AM measures were significantly associated with physical fitness , functional status , and disease activity , indicating construct validity of the AM . The AM could discriminate between patients with improvement and deterioration in physical fitness , indicating sufficient responsiveness of AM variables . CONCLUSION This study shows the value of an ambulatory activity monitor to quantify both the amount and intensity of physical activity of patients with RA during a day in their own environment . The ambulatory activity monitor seems to be a promising instrument for research into rehabilitation of patients with RA OBJECTIVE To investigate the effects of a dynamic , intensive exercise regimen on pain , disease activity , and physical functioning in active rheumatoid arthritis ( RA ) . METHODS 64 patients with RA with a mean age of 60 ( 13 ) years and mean disease duration of 8 ( 8) years , admitted to hospital because of active disease , were r and omly assigned to an  intensive exercise programme or to a  conservative exercise programme during their period in hospital with a mean length of 30 ( 14 ) days . The intensive exercise programme consisted of knee and shoulder dynamic and isometric muscle strengthening exercises against resistance five times a week and conditioning bicycle training three times a week and was supplemental to the conservative exercise programme of range of motion and isometric exercises . Indices of disease activity , pain , muscle strength , and functional ability were assessed at 0 , 3 , 6 , 12 , and 24 weeks by a blinded observer . RESULTS The medical treatment during the study was the same in both groups . Both groups improved in measures of disease activity , differences between groups were not statistically significant . The mean improvement in disease activity score at 24 weeks in the intensive and conservative exercise group was −1.4 ( 1.5 ) and −0.7 ( 1.4 ) , respectively . Measures of physical functioning improved significantly for patients in the intensive exercise group , and differences between groups were statistically significant for measures of muscle strength . CONCLUSION A short term intensive exercise programme in active RA is more effective in improving muscle strength than a conservative exercise programme and does not have deleterious effects on disease activity The effects of detraining subsequent to strength training on neuromuscular function were examined in 39 recent-onset rheumatoid arthritis ( RA ) patients . Eighteen age- and sex-matched healthy people ( H ) served as controls . Patients were r and omly allocated either to the experimental group ( PE ) , who carried out progressive strength training for 6 months , or to the control group ( PC ) , who maintained only their habitual physical activities . After 6 months , PE returned to their earlier physical activities and strength training was terminated . At baseline , the maximal strength of the trunk extensors ( not significant ) , grip strength and maximal dynamic strength and the shape of the force-time curve of the knee extensors were lower in PE and PC ( P < 0.05 - 0.001 ) than in H. Strength training in PE led to remarkable increases ( P < 0.05 - 0.001 ) in the maximal strength of all muscle groups without changes in the shape of the force-time curve . The increases in muscle strength in PE obtained by strength training were lost to a great degree during the detraining period for the isometric trunk extension ( P < 0.01 ) and flexion ( P < 0.01 ) strength and for the dynamic knee extension strength ( P < 0.05 ) , but not for the grip strength . In PC , trunk extension and flexion strength decreased significantly throughout the study period . At the post-test , all the strength values in both patient groups were much lower than in H. RA is a chronic disease which seems to need continuous physical exercise with sufficient intensity to minimize/prevent the loss of muscle strength and functional capacity STUDY DESIGN Prospect i ve cohort study . OBJECTIVES To characterize knee cartilage change in individuals with knee osteoarthritis ( KOA ) who have completed a therapeutic exercise program .  BACKGROUND While therapeutic exercise is frequently used successfully to improve pain and function in individuals with KOA , no studies have reported the volume of cartilage change or individual factors that may impact volume of cartilage change in those completing an exercise program  for KOA . METHODS Thirteen individuals with KOA underwent  magnetic resonance imaging to quantify cartilage volume change in the weight-bearing regions of the medial and lateral femoral condyles and the entire surface of the tibial plateaus from baseline to 1-year follow-up . Body structure and function measures were taken for body mass index , knee axis alignment , knee motion , and knee strength . Activity limitations and activity levels were also measured prior to the therapeutic exercise program , using the Western Ontario and McMaster Universities Osteoarthritis Index and the Physical Activity Scale for the Elderly . At 6 months from baseline , follow-up clinical measurements of knee strength and motion were performed . At 1 year from baseline , imaging of the knee cartilage and knee alignment were performed , and participants completed the Western Ontario and McMaster Universities Osteoarthritis Index and Physical Activity Scale for the Elderly . RESULTS The central region of the medial femoral condyle ( cMF ) had a median volume of cartilage loss of 3.8 % . The other 3 knee tibiofemoral articular surfaces had minimal median cartilage volume change . Individuals were dichotomized into progressors ( n = 6 ) and nonprogressors ( n = 7 ) , based on the st and ard error of measurement of cartilage volume change for the cMF . Progressors were younger , had a larger body mass index , had a higher Kellgren-Lawrence grade in the medial compartment of the knee , and had a greater increase in knee varus alignment from baseline to 1-year follow-up . The progressors also had frontal plane hip and knee kinetics during baseline gait analysis that potentially increased medial knee joint loading . CONCLUSION The loss of cMF cartilage volume was highly variable and the median loss of cartilage was within the range previously reported . Seven of the 13 individuals did not have cMF cartilage volume loss greater than the st and ard error of measurement . Change in cartilage volume of the cMF may be influenced to a greater extent by personal factors than by completion of a therapeutic exercise program . Additional research is needed to decipher the interactions among therapeutic exercise and personal characteristics that impact knee cartilage loss Kloubec , JA . Pilates for improvement of muscle endurance , flexibility , balance , and posture . J Strength Cond Res 24(3 ) : 661 - 667 , 2010-Many cl aims have been made about the effectiveness of Pilates exercise on the basic parameters of fitness . The purpose of this study was to determine the effects of Pilates exercise on abdominal endurance , hamstring flexibility , upper-body muscular endurance , posture , and balance .  Fifty subjects were recruited to participate in a 12-week Pilates class , which met for 1 hour 2 times per week . Subjects were r and omly assigned to either the experimental ( n = 25 ) or control group ( n = 25 ) . Subjects performed the essential ( basic ) mat routine consisting of ∼25 separate exercises focusing on muscular endurance and flexibility of the abdomen , low back , and hips each class session . At the end of the 12-week period , a 1-way analysis of covariance showed a significant level of improvement ( p ≤ 0.05 ) in all variables except posture and balance . This study demonstrated that in active middle-aged men and women , exposure to Pilates exercise for 12 weeks , for two 60-minute sessions per week , was enough to promote statistically significant increases in abdominal endurance , hamstring flexibility , and upper-body muscular endurance . Participants did not demonstrate improvements in either posture or balance when compared with the control group . Exercise-training programs that address physical inactivity concerns and that are accessible and enjoyable to the general public are a desirable commodity for exercise and fitness trainers . This study suggests that individuals can improve their muscular endurance and flexibility  using relatively low-intensity Pilates exercises that do not require equipment or a high degree of skill and are easy to master and use within a personal fitness routine 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 INTRODUCTION There is a need to establish a framework and exercise level for patients with early rheumatoid arthritis ( RA ) . The aim of this study was to compare the effect of a partly supervised and a self-administered exercise programme for patients with early RA . METHODS A total of 51 patients with early ( ≤ 5 years ) RA were r and omised to either a six-week supervised , progressive , high-intensity exercise programme followed by a six-week self-administered exercise programme or a 12-week self-administered exercise programme . RESULTS A total of 36 patients completed the study . Following the 12 weeks of exercises , patients in the two groups had improved both their muscle strength and their physical fitness . There was a significant difference in Disease Activity Score in 28 joints calculated with C-reactive protein between the two exercise groups , but no significant differences in physical fitness , pain perception , Health Assessment Question naire , Short Form 36 health survey question naire , Fear-Avoidance Beliefs Question naire , or in muscle strength , except from a significant difference in trunk extensors . The dropout was 40 % in the supervised group versus 20 % in the self-administered group . CONCLUSION A progressive , high-intensity exercise programme is feasible for patients with early RA , although we observed an elevated number of dropouts for reasons not related to the intervention . The partly supervised exercise programme with follow-up after 12 weeks does not seem to be more effective than the self-administered exercise programme . FUNDING none . TRIAL REGISTRATION The trial was registered with www . clinical trials.gov ( NCT01553305 ) OBJECTIVE To determine the effect of a low load resistance exercise training program on muscle strength , functional outcome , and cardiovascular endurance . METHODS Forty-nine patients , 37 women and 12 men between the ages of 35 - 76 yrs ( mean 60.5 yrs ) , with definite rheumatoid arthritis ( RA ) functional class II and III ( mean disease duration of 10.5 yrs ) were r and omly assigned to exercise and control groups for a 12 wk resistive muscle training program . A circuit weight bearing form of training was incorporated using light loads with high repetitions . A video tape demonstrating the exercises was given to all exercising participants to enable them to continue the program at home at least 3 times per wk with a biweekly self-report evaluation . Baseline and post-intervention evaluations included joint activity , muscle strength , endurance , functional outcome , and self-report . Cardiovascular fitness measured by treadmill time , anaerobic threshold and peak oxygen consumption ( VO2 ) in this group were assessed at baseline and 12 wks . RESULTS A significant improvement at 12 wks was noted in the exercise group for self-reported joint count ( p = 0.02 ) , number of painful joints ( p = 0.004 ) , HAQ ( p = 0.012 ) , sit-to-st and time ( p = 0.02 ) , grip strength ( p = 0.05 ) knee extension 60 degrees ( p = 0.03 ) , Arthritis Impact Measurement Scales dexterity ( p = 0.02 ) , and time to anaerobic threshold ( p = 0.03 ) . Significant improvement in the exercise group compared to the control group was noted for self-reported joint count ( p = 0.02 ) , night time pain ( p = 0.05 ) , and sit-to-st and time ( p = 0.02 ) . Increase in treadmill time was not statistically significant nor was a change in peak oxygen consumption ( VO2 ) noted . Abnormalities on initial treadmill screening were detected in 2 of 49 asymptomatic patients . They were excluded from the study and subsequent workup revealed significant coronary artery disease . CONCLUSION Low load resistive muscle training increased functional capacity as reported by patients and is a clinical ly safe form of exercise in functional class II and III RA . Screening this population for dormant coronary artery disease is recommended OBJECTIVE To examine the value of the  Health Assessment Question naire ( HAQ ) as an outcome measure in short term exercise trials . We studied the association of the objectives of exercise , namely joint mobility , muscle strength , and physical condition , with the HAQ . METHODS Data for 100 patients with rheumatoid arthritis ( RA ) included in a study to examine the effect of exercise therapy were used for secondary analysis . Disease activity was determined by the disease activity score ( DAS3 ) , pain was scored on a visual analog scale ( VAS ) , and depression was measured by the Dutch Arthritis Impact Measurement Scale . Aerobic capacity ( VO2max ) estimated from a submaximal ergometer test , grip strength ( kPa ) ,  isokinetic muscle strength of the knee  ( Nm/kg ) , and the  Escola Paulista de Medicina range of motion ( EPM-ROM ) score , a measure of general flexibility , were used as indicators for physical impairments . All variables were entered in a forward multiple regression analysis with the HAQ as dependent variable . RESULTS The HAQ was significantly correlated with the DAS3 score ( r = 0.53 ) , pain ( r = 0.51 ) , depression ( r = 0.40 ) , joint mobility ( r = 0.27 ) , quadriceps strength ( r = -0.35 ) , and grip strength ( r = -0.50 ) , but not with physical condition . The DAS3 score was first entered in the multiple regression analysis model , followed by pain , quadriceps strength , and grip strength ( R2 = 0.45 ) . After 12 weeks of exercise therapy changes in the HAQ were significantly correlated with changes in pain ( r = 0.41 ) , in depression ( r = 0.33 ) , and in quadriceps strength ( r = -0.25 ) , but not with changes in joint mobility or physical condition . CONCLUSION Physical impairments are weakly associated with the HAQ .  The HAQ is not an appropriate instrument to detect changes in physical impairments due to short term exercise therapy OBJECTIVE To compare prevalent cardiovascular disease , conventional cardiovascular risk factors and thrombotic variables in a cohort with well-controlled rheumatoid arthritis ( RA ) and in population controls . METHODS Seventy-six RA patients and 641 controls , r and omly sample d from the local population in the North Glasgow MONICA study . Conventional cardiovascular risk factors ( blood pressure , smoking , cholesterol ) and thrombotic variables [ fibrinogen , von Willebr and factor ( vWF ) , tissue plasminogen activator antigen ( t-PA ) , fibrin D-dimer , plasminogen activator inhibitor ( PAI-1 ) , plasma viscosity ] were measured by st and ard procedures . RESULTS RA patients had a significantly higher prevalence of angina pectoris ( P=0.03 ) . Stroke also tended to be more common in the RA group , but the difference did not reach statistical significance ( P=0.08 ) . Diastolic blood pressure was significantly higher and serum cholesterol significantly lower in the RA group than in controls . Current smoking habits and exercise history were similar in the two groups , although RA patients were more likely to have previously smoked . Significant elevations in several thrombotic predictors of cardiovascular disease ( fibrinogen , vWF , t-PA antigen and fibrin D-dimer ) were found in the RA group . CONCLUSIONS In this RA patient population , diastolic blood pressure was higher than in controls and thrombotic variables were elevated compared with controls . These features are identified as potential additional cardiovascular risk factors in the RA patients studied . Prospect i ve studies of risk modification may permit the identification of factors which could lead to a reduction in the known increased cardiovascular risk in RA Purpose . Evaluate the effects of weight loss on muscle mass and area , muscle fat infiltration , strength , and their association with physical function . Methods . Thirty-six overweight to moderately obese , sedentary older adults were r and omized into either a physical activity plus weight loss ( PA+WL ) or physical activity plus successful aging health education ( PA+SA ) program . Measurements included body composition by dual-energy X-ray absorptiometry , computerized tomography , knee extensor strength , and short physical performance battery ( SPPB ) . Results . At 6 months , PA+WL lost greater thigh fat and muscle area compared to PA+SA . PA+WL lost 12.4 % strength ; PA+SA lost 1.0 % . Muscle fat infiltration decreased significantly in PA+WL and PA+SA . Thigh fat area decreased 6-fold in comparison to lean area in PA+WL . Change in total SPPB score was strongly inversely correlated with change in fat but not with change in lean or strength . Conclusion . Weight loss result ed in additional improvements in function over exercise alone , primarily due to loss of body fat Introduction There is a lack of data on  physical activity ( PA ) and fitness of adolescent and young adult very long-term survivors of childhood acute lymphoblastic leukemia ( ALL ) . Methods We studied 21 childhood ALL long-term survivors ( aged 16–30 years , median time since diagnosis 15.9y ) , diagnosed in 1986–1996 , with age- and sex-matched controls . Peak oxygen uptake ( VO2peak ) and muscle strength were measured and  physical activity index ( PAI ; MET h/week ) calculated . Results Mean VO2peak of the ALL survivors was 34.8 ± 9.3 ml/kg/min . This was 14 % lower than that of the controls ( −5.7 ml/kg/min , 95 % CI −9.4 to −1.9 , p = 0.01 ) , and all the 11 female survivors performed below the age-adjusted reference values . The survivors also performed poorer in the sit-up and maximal jump tests ( p = 0.02 and p = 0.004 ) . Body mass index and PAI were similar in survivors and controls ( p = 0.34 and p = 0.52 ) . Nonetheless , as much as 30 % of the male survivors and 36 % of the female survivors had PAI ≤ 5 indicating very low  levels of physical activity ( PA )  . Conclusions Insufficient PA and poor physical fitness are clinical ly important issues in childhood ALL long-term survivors treated with modern protocol s. Girls seem to be especially at risk . PA  and better physical fitness decrease cardiovascular mortality irrespective of weight . Thus , PA should be promoted throughout and after the treatment for ALL . Implication s for cancer survivorsSince insufficient PA and poor physical fitness are an issue in very long-term ALL survivors , they should be informed on the benefits of physical activity , and be strongly encouraged to adopt a physically active lifestyle OBJECTIVE To determine the effect of education on the exercise habits of patients with rheumatoid arthritis ( RA ) after 6 and 12 months . METHODS We studied 208 out patients recruited between June 2001 and December 2002 . This was a prospect i ve controlled r and omized trial . The active group received a multidisciplinary education program , including training in home-based exercises and guidelines for leisure physical activity ( PA ) . The control group received a booklet added to usual medical care . Compliance with home-based exercises was defined as a practice rate > or= 30 % of the prescribed training . Compliance with leisure PA was defined as > or= 20 % increase in Baecke question naire score . Additional assessment s involved possible predictors of compliance and changes with regard to the compliance . RESULTS At 6-month followup , home-based exercise and leisure PA compliance were significantly higher [ 13.5 % vs 1 % , respectively ( p = 0.001 ) ; and 28.2 % vs 13.8 % ( p = 0.02 ) ] , but were not at 12 months . Predictors of leisure PA compliance at 6 months included participating in the active group ( odds ratio 2.74 , 95 % CI 1.17 to 6.38 ) and previous low leisure PA ( OR 6.01 , 95 % CI 2.47 to 14.61 ) , with decreased fatigue ( FACIT-F mean -2.94 + /- 8.04 vs -0.1 + /- 7.25 for noncompliant subjects ; p = 0.04 ) and improved psychological status ( Arthritis Impact Measurement Scale mean -1.25 + /- 3.12 vs 0.11 + /- 3.39 ; p = 0.03 ) . CONCLUSION Education of patients with RA may increase compliance especially with leisure PA , particularly when it is poor at baseline , but these effects are limited and short-term 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 Arthritis has been identified as the most common cause of disability in the United States ( 1 , 2 ) . Thirty-three percent of persons 63 to 94 years of age are affected by osteoarthritis of the knee , which often limits the ability to rise from a chair , st and comfortably , walk , and use stairs ( 3 , 4 ) . Acetaminophen and nonsteroidal anti-inflammatory drugs ( NSAIDs ) are commonly used to treat osteoarthritis . Use of NSAIDs can lead to gastric complications , increased risk for hospitalization , and death ( 5 ) . Other treatment options for persons with osteoarthritis of the knee include physical therapy exercise and treatment programs , cortisone injections , and joint replacement surgery . Puett and Griffin ( 6 ) review ed 15 controlled trials of nonmedicinal , noninvasive therapies for hip and knee osteoarthritis from 1966 through 1993 ( 6 ) . The authors concluded that exercise reduces pain and improves function in patients with osteoarthritis of the knee , but the optimal exercise regimen has not been determined . Fitness walking , aerobic exercise , and strength training have all been reported to result in functional improvement in patients with osteoarthritis of the knee ( 6 - 12 ) . Unweighted treadmill walking has not been shown to decrease pain associated with osteoarthritis of the knee ( 13 ) . Other research ers ( 14 , 15 ) have concluded that exercise may benefit patients with osteoarthritis but advise that long-term studies are required to determine the appropriate amounts of exercise to avoid accelerating the underlying process of arthritis . Active and passive range-of-motion exercise is considered an important part of rehabilitation programs for patients with osteoarthritis ( 16 - 18 ) . Physical therapists frequently use manual therapy procedures as part of comprehensive rehabilitation programs to help patients regain joint mobility and function ( 19 ) . We evaluated the effectiveness of manual physical therapy for osteoarthritis of the knee , as applied by physical therapists with formal training in such an approach ( 20 ) . Our hypothesis was that physical therapy consisting of manual therapy to the knee , hip , ankle , and lumbar spine combined with range-of-motion , strengthening , and cardiovascular exercises would be more effective than placebo for improving function , decreasing pain and stiffness , and increasing the distance walked in 6 minutes . Methods Patients Eighty-three patients with osteoarthritis of the knee were r and omly assigned to receive treatment ( n=42 ; 15 men and 27 women [ mean age , 60 11 years ] ) or placebo ( n=41 ; 19 men and 22 women [ mean age , 62 10 years ] ) . All patients were referred by physicians to physical therapy for osteoarthritis of the knee . Physicians at the various clinics in the medical center who normally see patients with osteoarthritis of the knee were informed of the study so that appropriate referrals could be made . If the patients met our inclusion criteria , they were offered the opportunity to participate . The main inclusion criterion was a diagnosis of osteoarthritis of the knee based on fulfillment of one of the following clinical criteria developed by Altman and colleagues [ 21 ] : 1 ) knee pain , age 38 years or younger , and bony enlargement ; 2 ) knee pain , age 39 years or older , morning stiffness for more than 30 minutes , and bony enlargement ; 3 ) knee pain , crepitus on active motion , morning stiffness for more than 30 minutes , and bony enlargement ; or 4 ) knee pain , crepitus on active motion , morning stiffness for more than 30 minutes , and age 38 years or older . Altman and colleagues found this criteria to be 89 % sensitive and 88 % specific ( 21 - 23 ) . Patients were required to be eligible for military health care , have had no surgical procedure on either lower extremity in the past 6 months , and have no physical impairment unrelated to the knee that would prevent safe participation in a timed 6-minute walk test or any other aspect of the study . Patients had to have sufficient English- language skills to comprehend all explanations and to complete the assessment tools . They were also required to live within a 1-hour drive of the physical therapy clinic . Patients who could not attend the required number of visits or had received a cortisone injection to the knee joint within the previous 30 days were not enrolled . Patients were instructed to keep taking any current medications and not to start taking new medications for osteoarthritis during the clinical treatment and 8-week follow-up . Therapy with any osteoarthritis medication must have been initiated at least 30 days before participation in the study . The study was approved by the institutional review board of Brooke Army Medical Center , Fort Sam Houston , Texas . All patients completed an informed consent form and were advised of the risks of the study , including increased symptoms , injuries from falls , and cardiovascular events . No external funding was received for this study . Procedure Patients who met the inclusion criteria were r and omly assigned to one of two groups . Blank folders were numbered from 1 to 100 and were given concealed codes for the group of assignment , determined by a r and om-number generator . When a patient was eligible and gave consent to participate , the treating therapist drew the next folder from the file , which determined the group of assignment . The treatment group received a combination of manual physical therapy and supervised exercise . The placebo group received ultrasound at a subtherapeutic intensity . Neither group was aware of the treatment that the other group was receiving . Demographic data collected for each patient included age , sex , occupation , height , weight , duration of symptoms , presence of symptoms in one or both knees , previous knee surgery , medications , and present activity level . Knee radiographs were obtained and read by a radiologist who assigned a radiographic severity rating for osteoarthritis ( 24 ) . Dependent variables measured in this study were the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) score ( 25 ) and distance covered during a timed 6-minute walk test . The WOMAC Osteoarthritis Index consists of 24 questions , each corresponding to a visual analogue scale . This test has been shown to be a reliable , valid , and responsive multidimensional outcome measure for evaluation of patients with osteoarthritis of the hip or knee ( 26 ) . The timed 6-minute walk test measures the distance a patient walks in 6 minutes and has been demonstrated to be a reliable measurement of functional exercise capacity ( 27 ) . All measurements of dependent variables were obtained by a trained research assistant who was blinded to group assignment . After research assistants obtained pretreatment values for the dependent variables , patients returned to the treating physical therapist for thorough st and ardized clinical examination of the knee , hip , ankle , and lumbar spine . Treatment was initiated according to group assignment . The treatment group received manual physical therapy as indicated by the results of the examination . The manual therapy treatment techniques , consisting of passive physiologic and accessory joint movements , muscle stretching , and soft-tissue mobilization , were applied primarily to the knee . The same treatments were also administered to the lumbar spine , hip , or ankle if these areas showed limitation in active or passive movement , were symptomatic , or were contributing to overall lower limb dysfunction ( 28 - 31 ) . A minimal pain level was not exceeded in any treatment . The treatment group also performed a closely supervised st and ardized knee exercise program at each of the eight treatment sessions . This program consisted of active range-of-motion exercises for the knee , muscle strengthening exercises for the hip and knee , muscle stretching for the lower limbs , and riding a stationary bike . All of the activities were mutually reinforcing , with repeated gentle challenges to the end ranges of movement . An outline of the exercise program is shown in the Appendix Figure . The physical therapist increased the number of strengthening exercise bouts and the stationary bike riding time on the basis of patient tolerance . The current literature provides efficient methods to produce the desired effects of increasing strength , flexibility , and range of motion ( 32 - 35 ) . At each session , the physical therapist examined the patient for adverse signs and symptoms , such as increased pain , joint effusion , and increased skin temperature over knee joints . These signs and symptoms of osteoarthritis had to be stable or decreasing before manual therapy or exercise was progressed . Patients exercised in a painless or minimally painful manner . If any post-treatment or exercise soreness lasted more than a few hours , the regimen was decreased accordingly for that patient . The placebo group received treatment by the physical therapist that consisted of subtherapeutic ultrasound for 10 minutes at an intensity of 0.1 W/cm2 and 10 % pulsed mode ( lowest setting and greatest cycle interruption ) to the area of knee symptoms . The placebo group received the same subjective and h and s-on objective reevaluation before and after each session as the treatment group . The amount of time directly spent with the treating therapist was approximately 30 minutes for both groups . The treatment group required an additional 30 to 45 minutes to perform their exercises in the clinic . Both groups were treated twice weekly for 4 weeks , for a total of eight clinic treatments . Patients in the treatment group also performed the same exercises at home , except for the closed-chain strengthening exercises , on the days on which they were not treated in the physical therapy clinic . They also walked at home each day at a comfortable pace and distance . The treating physical therapist instructed each patient in the performance of the exercises and provided a detailed h and out containing instructions and photographs of the exercises . Each patient maintained a home exercise Purpose This study examined the effects of a giant ( 4 × 3 m ) exercising board game intervention on  ambulatory physical activity ( PA ) and a broader array of physical and psychological outcomes among nursing home residents . Material s and methods A quasi-experimental longitudinal study was carried out in two comparable nursing homes . Ten participants ( aged 82.5±6.3 and comprising 6 women ) meeting the inclusion criteria took part in the 1-month intervention in one nursing home , whereas 11 participants ( aged 89.9±3.1 with 8 women ) were assigned to the control group in the other nursing home . The giant exercising board game required participants to per-form strength , flexibility , balance and endurance activities . The assistance provided by an exercising specialist decreased gradually during the intervention in an autonomy-oriented approach based on the self-determination theory . The following were assessed at baseline , after the intervention and after a follow-up period of 3 months : PA ( steps/day and energy expenditure/day with ActiGraph ) , cognitive status ( mini mental state examination ) , quality of life ( EuroQol 5-dimensions ) , motivation for PA ( Behavioral Regulation in Exercise Question naire-2 ) , gait and balance ( Tinetti and Short Physical Performance Battery ) , functional mobility ( timed up and go ) , and the muscular isometric strength of the lower limb muscles . Results and conclusion In the intervention group , PA increased from 2,921 steps/day at baseline to 3,358 steps/day after the intervention ( + 14.9 % , P=0.04 ) and 4,083 steps/day ( + 39.8 % , P=0.03 ) after 3 months . Energy expenditure/day also increased after the intervention ( + 110 kcal/day , + 6.3 % , P=0.01 ) and after 3 months ( + 219 kcal/day , + 12.3 % , P=0.02 ) . Quality of life ( P<0.05 ) , balance and gait ( P<0.05 ) , and strength of the ankle ( P<0.05 ) were also improved after 3 months . Such improvements were not observed in the control group . The preliminary results are promising but further investigation is required to confirm and evaluate the long-term effectiveness of PA interventions in nursing homes Background Osteoarthritis of the knee involving predominantly the medial tibiofemoral compartment is common in older people , giving rise to pain and loss of function . Many people experience progressive worsening of the disease over time , particularly those with varus malalignment and increased medial knee joint load . Therefore , interventions that can reduce excessive medial knee loading may be beneficial in reducing the risk of structural progression . Traditional quadriceps strengthening can improve pain and function in people with knee osteoarthritis but does not appear to reduce medial knee load . A neuromuscular exercise program , emphasising optimal alignment of the trunk and lower limb joints relative to one another , as well as quality of movement performance , while dynamically and functionally strengthening the lower limb muscles , may be able to reduce medial knee load . Such a program may also be superior to traditional quadriceps strengthening with respect to improved pain and physical function because of the functional and dynamic nature . This r and omised controlled trial will investigate the effect of a neuromuscular exercise program on medial knee joint loading , pain and function in individuals with medial knee joint osteoarthritis . We hypothesise that the neuromuscular program will reduce medial knee load as well as pain and functional limitations to a greater extent than a traditional quadriceps strengthening program . Methods / Design 100 people with medial knee pain , radiographic medial compartment osteoarthritis and varus malalignment will be recruited and r and omly allocated to one of two 12-week exercise programs : quadriceps strengthening or neuromuscular exercise . Each program will involve 14 supervised exercise sessions with a physiotherapist plus four unsupervised sessions per week at home . The primary outcomes are medial knee load during walking ( the peak external knee adduction moment from 3D gait analysis ) , pain , and self-reported physical function measured at baseline and immediately following the program . Secondary outcomes include the external knee adduction moment angular impulse , electromyographic muscle activation patterns , knee and hip muscle strength , balance , functional ability , and quality -of-life . Discussion The findings will help determine whether neuromuscular exercise is superior to traditional quadriceps strengthening regarding effects on knee load , pain and physical function in people with medial knee osteoarthritis and varus malalignment . Trial Registration Australian New Zeal and Clinical Trials Registry reference : OBJECTIVE To evaluate the impact of a 2-year program of strength training on muscle strength , bone mineral density ( BMD ) , physical function , joint damage , and disease activity in patients with recent-onset ( < 2 years ) rheumatoid arthritis ( RA ) . METHODS In this prospect i ve trial , 70 RA patients were r and omly assigned to perform either strength training ( all major muscle groups of the lower and upper extremities and trunk , with loads of 50 - 70 % of repetition maximum ) or range of motion exercises ( without resistance ) twice a week ; all were encouraged to engage in recreational activities 2 - 3 times a week . All patients completed training diaries  ( evaluated bi-monthly ) and were examined at 6-month intervals . All were treated with medications to achieve disease remission . Maximum strength of the knee extensors , trunk flexors and extensors , and grip strength was measured with dynamometers . BMD was measured at the femoral neck and lumbar spine by dual x-ray densitometry . Disease activity was determined by the Disease Activity Score , the extent of joint damage by the Larsen score , and functional capacity by the Health Assessment Question naire ( HAQ ) ; walking speed was also measured . RESULTS Sixty-two patients ( 31 per group ) completed the study .  Strength training  compliance averaged 1.4 - 1.5 times/week . The maximum strength of all muscle groups examined increased significantly ( 19 - 59 % ) in the strength-training group , with statistically significant improvements in clinical disease activity parameters , HAQ scores , and walking speed . While muscle strength , disease activity parameters , and physical function also improved significantly in the control group , the changes were not as great as those in the strength-training group . BMD in the femoral neck and spine increased by a mean + /- SD of 0.51 + /- 1.64 % and by 1.17 + /- 5.34 % , respectively , in the strength-training group , but decreased by 0.70 + /- 2.25 % and 0.91 + /- 4.07 % in the controls . Femoral neck BMD in the 17 patients with high initial disease activity ( and subsequent use of oral glucocorticoids ) remained constantly at a statistically significantly lower level than that in the other 45 patients . CONCLUSION Regular dynamic strength training combined with endurance-type physical activities improves muscle strength and physical function , but not BMD , in patients with early RA , without detrimental effects on disease activity Our aim is to analyse the effect on bone mass of : ( 1 ) physical fitness performance on a specific group of physical activity ( PA ) and , ( 2 ) PA on a specific physical fitness performance group . Bone mineral content ( BMC ) by dual energy X-ray absorptiometry ( DXA ) and PA by accelerometers was assessed in 373 Spanish adolescents ( 182 males ) . Adolescents were classified as : active and non-active ( ≥60 or < 60 min day−1 of moderate-vigorous PA ) . Fitness was assessed through speed/agility , strength and cardiorespiratory tests . Adolescents were classified by tertiles ( T1 , T2 and T3 ) . ANCOVA was used for the analysis with sex , height , lean mass , calcium intake and pubertal status as covariates . Adolescents with lower strength , speed/agility and cardiorespiratory fitness ( CRF ) showed lower BMC in the whole body and extremities compared with adolescents with better results in these tests , mainly those non-active adolescents . Non-active adolescents with high fitness levels showed higher BMC ( whole body and upper limbs ) than active ones . The conclusions included : ( 1 ) within the non-active group , lower levels of fitness were associated with lower BMC ; this might be through PA or trough an effect of PA on muscle mass . ( 2 ) Non-active adolescents with high level of fitness in most fitness tests showed higher BMC than their active peers , in spite of their lower PA levels . These unexpected results could be influenced by several factors such as genetics , nutrition , type of exercise or sport , hormones and skeletal age Background The effect of exercise on specific impairments and activity limitations in people with hip osteoarthritis ( OA ) is limited . Objective The study objective was to evaluate the long-term effect of exercise therapy and patient education on range of motion ( ROM ) , muscle strength , physical fitness , walking capacity , and pain during walking in people with hip OA . Design This was a secondary outcome analysis of a r and omized clinical trial . Setting The setting was a university hospital . Participants One hundred nine people with clinical ly and radiographically evident hip OA were r and omly allocated to receive both exercise therapy and patient education ( exercise group ) or patient education only ( control group ) . Intervention All participants attended a patient education program consisting of 3 group meetings led by 2 physical therapists . Two other physical therapists were responsible for providing the exercise therapy program , consisting of 2 or 3 weekly sessions of strengthening , functional , and stretching exercises over 12 weeks . Both interventions were conducted at a sports medicine clinic . Measurements Outcome measures included ROM , isokinetic muscle strength , predicted maximal oxygen consumption determined with the Astr and bicycle ergometer test , and distance and pain during the Six-Minute Walk Test ( 6MWT ) . Follow-up assessment s were conducted 4 , 10 , and 29 months after enrollment by 5 physical therapists who were unaware of group allocations . Results No significant group differences were found for ROM , muscle strength , predicted maximal oxygen consumption , or distance during the 6MWT over the follow-up period , but the exercise group had less pain during the 6MWT than the control group at 10 months ( mean difference=−8.5 mm ; 95 % confidence interval=−16.1 , −0.9 ) and 29 months ( mean difference=−9.3 mm ; 95 % confidence interval=−18.1 , −0.6 ) . Limitations Limitations of the study were reduced statistical power and 53 % rate of adherence to the exercise therapy program . Conclusions The previously described effect of exercise on self-reported function was not reflected by beneficial results for ROM , muscle strength , physical fitness , and walking capacity , but exercise in addition to patient education result ed in less pain during walking in the long term This study compared the effects of a resistance training protocol and a moderate-impact aerobic training protocol on bone mineral density ( BMD ) , physical ability , serum osteoprotegerin ( OPG ) , and receptor activator of nuclear factor kappa B lig and ( RANKL ) levels .  Seventy-one older women were r and omly assigned to resistance exercise ( RE ) , aerobic exercise ( AE ) or a control group ( CON ) . Both interventions were conducted 3 times per week for 8 months . Outcome measures included proximal femur BMD , muscle strength , balance , body composition , serum OPG , and RANKL levels . Potential confounding variables included dietary intake , accelerometer-based physical activity ( PA ) , and molecularly defined lactase nonpersistence . After 8 months , only RE group exhibited increases in BMD at the trochanter ( 2.9 % ) and total hip ( 1.5 % ) , and improved body composition . Both RE and AE groups improved balance . No significant changes were observed in OPG and RANKL levels , and OPG/RANKL ratio . Lactase nonpersistence was not associated with BMD changes . No group differences were observed in baseline values or change in dietary intakes and daily PA . Data suggest that 8 months of RE may be more effective than AE for inducing favourable changes in BMD and muscle strength , whilst both interventions demonstrate to protect against the functional balance control that is strongly related to fall risk This study aim ed to evaluate the effectiveness of an innovative exercise program on muscle strength , balance , and gait kinematics in elderly community-dwellers . The exercise program included strength and balance training and the 8-form Tai Chi Chuan . The measurements were carried out at baseline and 12 weeks , and consisted of four physical performance tests , joint isokinetic strength tests , and three-dimensional gait analysis . Fifty-six community-dwelling older adults aged 60–80 years old were r and omly assigned to an intervention or control group . After 12 weeks , the intervention group showed a 17.6 % improvement in the timed up and go test , accompanied by a 54.7 % increase in the 30-second chair st and test score . Significant increases in the score of star excursion balance tests , and the strength of the extensor and flexor muscles at knee and ankle joints were also observed . In addition , the intervention group walked at a faster speed with a longer step length , shorter support phase , and a greater sagittal plane range of motion at the hip and ankle joints . No statistical improvements were seen in the control group . This study provided an effective , evidence -based falls prevention program that can be implemented in community setting s to improve physical fitness and reduce fall risks among community-dwelling older adults .  The star excursion balance test could be a sensitive measure of physical performance for fall risk assessment in older people Background Physical activity ( PA ) reduces pain and improves functioning in people with knee osteoarthritis ( OA ) , but few people with the condition meet recommended PA guidelines . Successful intervention strategies to increase PA include goal setting , action planning , self-monitoring , and follow-up feedback from a healthcare professional . Recently developed consumer wearable activity trackers allow users to set activity goals , self-monitor daily goal -progress , and provide feedback on goal attainment . It is hypothesized that a multi-component physiotherapist-led intervention that includes a short ( 40-min ) education module , guided goal - setting and action planning , the use of a wristb and activity tracker , and weekly follow-up phone calls will lead to increased PA outcomes . Methods / design Thirty-six participants will be recruited from the community for a two-group pilot r and omized controlled trial with a stepped-wedge design using an intention-to-treat analysis . Computer-generated block r and omization will be performed using varying block sizes and a 1:1 allocation ratio . The 4-week intervention will be delivered immediately ( immediate-intervention group ) or after a 5-week delay ( delayed-intervention group ) . Outcome measures of pain and disability ( Knee Injury and OA Outcome Score ) , disease self-management ability ( Partners in Health Scale ) , and objective bouted moderate-to-vigorous PA and sedentary time ( BodyMedia SenseWear Mini Armb and ) will be collected at baseline ( week 0 ) and two follow-ups ( weeks 5 and 10 ) , for a total study duration of 11 weeks . Feasibility data relating to process , re source , management , and scientific elements of the trial will be collected . Outcome measure and feasibility data will be summarized , and an estimate of intervention efficacy will be obtained by regression model with planned comparisons . The trial began recruiting in February 2015 . To date , 34 subjects have been recruited . Discussion This study will evaluate the feasibility and preliminary efficacy of a novel intervention to promote  PA in people living with knee OA . The results will provide valuable information to inform a larger r and omized trial to assess intervention effectiveness . Trial registration Clinical Trials.gov Identifier : NCT02313506 ( registration date 8 December 2014 ) . First participant r and omized 20 February 2015 OBJECTIVE To evaluate the impact of a 2-year home-based strength-training program on physical function in patients with early rheumatoid arthritis ( RA ) after a subsequent 3-year followup . METHODS Seventy patients with early RA were r and omized to perform either strength training ( experimental group [ EG ] ) or range-of-motion exercises ( control group [ CG ] ) . Maximal strength values were recorded by dynamometers . The Modified Disease Activity Score ( DAS28 ) , pain , Health Assessment Question naire ( HAQ ) , walking speed , and stair-climbing speed were also measured . RESULTS The maximum strength of assessed muscle groups increased by 19 - 59 % in the EG during the training period and remained at the reached level throughout the subsequent 3 years . Muscle strength improved in the CG by 1 - 31 % , but less compared with the EG . During the 2-year training period , DAS28 decreased by 50 % and 45 % and pain by 67 % and 39 % in the EG and CG , respectively . The differences in muscle strength , DAS28 , and HAQ were significantly in favor of the EG both at the 2-year and 5-year followup assessment s. CONCLUSIONS The improvements achieved during the 2-year strength-training period were sustained for 3 years in patients with early RA BACKGROUND This study aim ed to test the effects of yoga exercises on the physical and mental health of elderly people with dementia living in long-term care facilities . METHODS A quasi-experimental , pretest-post-test design was used . A convenience sample of 68 residents in long-term care facilities in southern Taiwan , aged 60 years and above with mild to moderate dementia , was selected . An experimental group of 33 elders participated in a 12-week yoga training program of three 55-minute sessions a week ; a control group of 35 elders maintained their usual daily activities . Data were collected before and after completing the 12-week study . Measurements included body composition , cardiopulmonary functions , body flexibility , muscle strength and endurance , balance , joints motion , depression , and problem behaviors . RESULTS The yoga-trained participants had better physical and mental health than those who did not participate , including lowered blood pressure , reduced respiration rate , strengthened cardiopulmonary fitness , enhanced body flexibility , improved muscle strength and endurance , improved balance , and increased joints motion ( all p values < 0.05 ) . In addition , the depression state ( p < 0.001 ) and problem behaviors ( p < 0.001 ) of these demented elders were significantly reduced . CONCLUSION Yoga exercise has positive benefits for both the physical and mental health of elders with dementia living in long-term care facilities . It is recommended that yoga be included as one of the routine activities in these long-term care facilities Patients with rheumatoid arthritis ( RA ) suffer from muscle loss , causing reduced muscle strength and endurance . The current study aim ed to : ( 1 ) evaluate the effects of combined strength and endurance training ( CT ) on disease activity and functional ability in patients with RA and ( 2 ) investigate the benefits of a 6-month supervised CT program on muscle strength , cardio-respiratory fitness , and body composition of RA patients . Forty patients with RA , aged 41–73 years , were recruited for the current study . Twenty of these patients ( 19 females , one male ) were r and omly assigned to a 6-month supervised CT program ; 20 patients ( 17 females , three males ) served as controls . Within the CT program , strength training consisted of sets of weight bearing exercises for all major muscle groups . In addition to strength training , systematic endurance training was performed on a cycle ergometer two times per week . For RA patients involved in CT , disease activity ( p = 0.06 ) and pain ( p = 0.05 ) were reduced after the 6-month training period while general health ( p = 0.04 ) and functional ability ( p = 0.06 ) improved . Cardio-respiratory endurance was found to have improved significantly ( by 10 % ) after 6 months of CT ( p < 0.001 ) . The overall strength of patients undertaking CT increased by an average of 14 % . Lean body mass increased , and the percentage of body fat was found to decrease significantly ( p < 0.05 ) . A combination of strength and endurance training result ed in considerable improvements in RA  patients ’ muscle strength and cardio-respiratory endurance , accompanied by positive changes in body composition and functional ability . Long-term training appears to be effective in reducing disease activity and associated pain and was found to have no deleterious effects Forty-one patients with rheumatoid arthritis were treated for 2 weeks at a Tiberias spa hotel . R and omized into 2 groups , Group 1 received a combination of mineral baths and mud packs , and Group 2 had tap water baths only . Both groups had a significant but temporary improvement in Ritchie index . Group 1 showed a significant improvement in grip strength . No improvement was noticed in morning stiffness , 15 meter walk time and laboratory variables of disease activity in either group . Twelve patients with osteoarthritis ( OA ) received 2 weeks of treatment with mineral baths and mud packs . Statistically significant improvement for a period of 6 months was noticed in night pain , pain on passive motion , tenderness on palpation and in the index of severity of OA of the knee The purpose of this study is to evaluate the effects of targeting both the motivation and action phases of behaviour change in a 5-week intervention to increase physical activity ( PA )  among patients with rheumatoid arthritis ( RA ) not meeting current PA recommendations . In a r and omised controlled trial , a control group — which received a group-based patient education session led by a physical therapist — was compared to a treatment group which received the education session plus a motivational interview from a physical therapist and two self-regulation coaching sessions from a rheumatology nurse . Outcomes included  leisure-time PA , days per week with at least 30 min of moderate-intensity PA , self-efficacy and autonomous motivation ( cognitions which predict PA initiation and maintenance ) , disease activity , functional status , depressive symptoms and fatigue . Effects were assessed using mixed models repeated measures . Of the 78 patients r and omised , 76 and 67 completed the post-treatment and follow-up assessment s , respectively . Significant treatment effects were found for leisure-time PA  ( p = 0.022 ) , active days/week ( p = 0.016 ) , self-efficacy ( p = 0.008 ) and autonomous motivation ( p = 0.001 ) . At post-treatment and 6-months follow-up , significantly more treated patients than controls met current PA recommendations . No significant effects were found for disease activity , functional status , depressive symptoms or fatigue . Combining motivation- and action-focused intervention approaches improved PA-related cognitions and led to improved uptake and maintenance of leisure-time PA . However , further research is necessary to identify ways of helping patients with RA transition to— and maintain — more intensive forms of PA which are more likely to improve disease activity and functional status Abstract Background : Exercising is recommended for people with h and osteoarthritis ( HOA ) , but there is no consensus regarding the design of exercise programmes . Objective : To describe the development and content of an evidence -based exercise programme for people with HOA . Methods : The development was based on research evidence , professional expertise , and client evidence and adhered to the new Medical Research Council framework for design and evaluation of complex interventions . The process included literature search and appraisal , discussion s with clinicians and patient research partners , and piloting , followed by a revision of the programme based on feedback from pilot participants . Results : The programme contains three exercises to increase the strength and stability of the shoulder , arm and wrist muscles , and four exercises to maintain or increase range of motion , grip strength , and joint stability in the finger joints . It starts with a warm-up period , ends with a finger stretch exercise , and follows the American College of Sports Medicine ’s recommendations regarding exercise intensity , session frequency , and length of exercise period . An exercise diary is included as part of the programme . Conclusions : An evidence -based exercise programme for people with HOA has been developed . The effect of the programme has recently been evaluated in a r and omized controlled trial OBJECTIVE To confirm , in a r and omized controlled trial ( RCT ) , the efficacy of high-intensity progressive resistance training ( PRT ) in restoring muscle mass and function in patients with rheumatoid arthritis ( RA ) . Additionally , to investigate the role of the insulin-like growth factor ( IGF ) system in exercise-induced muscle hypertrophy in the context of RA . METHODS Twenty-eight patients with established , controlled RA were r and omized to either 24 weeks of twice-weekly PRT ( n = 13 ) or a range of movement home exercise control group ( n = 15 ) . Dual x-ray absorptiometry-assessed  body composition ( including lean body mass [ LBM ] , appendicular lean mass [ ALM ] , and fat mass ) ; objective physical function ; disease activity ; and muscle IGFs were assessed at weeks 0 and 24 . RESULTS Analyses of variance revealed that PRT increased LBM and ALM ( P < 0.01 ) ; reduced trunk fat mass by 2.5 kg ( not significant ) ; and improved training-specific strength by 119 % , chair st and s by 30 % , knee extensor strength by 25 % , arm curls by 23 % , and walk time by 17 % ( for objective function tests , P values ranged from 0.027 to 0.001 versus controls ) . In contrast , body composition and physical function remained unchanged in control patients . Changes in LBM and regional lean mass were associated with changes in objective function ( P values ranged from 0.126 to < 0.0001 ) . Coinciding with muscle hypertrophy , previously diminished muscle levels of IGF-1 and IGF binding protein 3 both increased following PRT ( P < 0.05 ) . CONCLUSION In an RCT , 24 weeks of PRT proved safe and effective in restoring lean mass and function in patients with RA . Muscle hypertrophy coincided with significant elevations of attenuated muscle IGF levels , revealing a possible contributory mechanism for rheumatoid cachexia . PRT should feature in disease management Abstract The present study examined the effects of Zumba training ( group fitness based on salsa and aerobics ) on endurance , trunk strength , balance , flexibility , jumping performance and quality of life ( QoL ) in female college students . Thirty female participants were r and omly assigned ( strata : age , BMI and physical activity ) to  an intervention ( INT , n = 15 : age : 21.0 ± 2.3 years ; BMI : 21.8 ± 3.0 kg/m2 ; physical activity ( PA ) : 7.6 ± 4.6 h/week )  or control group ( CON , n = 14 : age : 21.0 ± 2.8 years ; BMI : 21.0 ± 2.1 kg/m2 ; PA : 7.3 ± 3.6 h/week ) . Instructed Zumba training was provided twice a week for 8 weeks ( training attendance : 100 % ) . QoL was assessed using the WHO-QoL-BREF question naire . Endurance was measured with the 6-min walking test ( 6MWT ) . Trunk flexibility was assessed with the st and - and -reach-test and lower-extremity strength with the jump- and -reach-test . The star excursion balance test ( SEBT ) was employed to assess dynamic balance . Trunk strength endurance was examined using the Swiss global trunk strength test in prone and lateral ( left , right ) positions . All testings were performed before and after the training period . We observed large statistically significant between-group effects of total QoL score ( INT : + 9.8 % , CON : + 0.4 % , p < 0.001 ; partial eta squared ) , 6MWT distance ( INT : + 21 % , CON : −2 % , p < 0.001 , ) , trunk strength endurance ( prone , INT : + 48 % , CON : + 11 % , p = 0.04 , ; lateral-left , INT : + 71 % , CON : + 11 % , p = 0.01 , , lateral-right , INT : + 54 % , CON : + 11 % , p = 0.01 , ) and dynamic balance ( all eight reaching distances of the SEBT , INT : + 11−26 % , CON : + 1.1−3.8 % , 0.001 < p < 0.04 , 0.14 < ) with significantly larger improvements for INT . Flexibility and jump performance were not relevantly affected ( p > 0.05 ) . Instructed Zumba training can be applied to improve well-being , aerobic fitness and neuromuscular function in female college students Decreased ability to perform activities of daily living ( ADLs ) associated with deterioration in physical capacity are key determinants of the poor quality of life and loss of independence of patients with Alzheimer 's disease ( AD ) . The purpose of this study was to determine the effects of a 12-week training program ( including resistance , flexibility , joint mobility and balance/coordination exercises ) for Spanish patients with AD on their i ) overall functional capacity ( muscle strength and flexibility , agility and balance while moving , and endurance fitness ) , and ii ) ability to perform ADLs . Using a r and omized block design , 16 patients were assigned to a training ( mean [ SD ] age : 76 [ 4 ] yrs ) or control group ( 73 [ 4 ] yrs ) ( n = 8 subjects [ 3 male , 5 female ] per group ) . The results showed significant improvements after training ( p < 0.05 ) in upper and lower body muscle strength and flexibility , agility and dynamic balance , and endurance fitness ( using the Senior Fitness test ) , gait and balance abilities ( with subsequent decrease in risk of falls ) ( Tinetti scale ) and in the ability to perform ADLs independently ( Katz and Barthel scores ) . No changes ( p > 0.05 ) were found in the control group over the 12-week period . Exercise training could be included in the overall medical/nursing care protocol for patients with AD BACKGROUND The Hip & Knee Book : Helping you cope with osteoarthritis was developed to change disadvantageous beliefs and encourage physical activity in people with hip or knee osteoarthritis . AIM To assess the feasibility of conducting a definitive r and omised controlled trial ( RCT ) of this evidence -based booklet in people with hip or knee osteoarthritis . DESIGN Phase II feasibility r and omised controlled trial ( RCT ) . METHOD Computerised search es of patients ' record data bases identified people with osteoarthritis of the hip or knee , who were invited to participate in the RCT comparing the new booklet with a control booklet . Outcomes were measured at baseline , 1 month , and 3 months , and included : beliefs about hip and knee pain , exercise , and fear avoidance ; level of physical activity ; and health service use . RESULTS The trial methods were feasible in terms of recruitment , r and omisation , and follow-up , but most participants recruited had longst and ing established symptoms . After one and 3 months , there was a small relative improvement in illness , exercise , and fear-avoidance beliefs and physical activity level in The Hip & Knee Book group ( n = 59 ) compared with the control group ( n = 60 ) , which provides some proof of principle for using these outcomes in future trials . CONCLUSION This feasibility study provided proof of principle for testing The Hip & Knee Book in a larger definitive RCT To evaluate the predictive effects of subjective measures of physical activity ( PA ) and objective measures of physical fitness ( PF ) on dementia risk , Participants of the prospect i ve population -based ILSE- study ( * 1930 - 1932 ; 12-year follow-up ) were examined at three examination waves ( t1 : 1993/94 ; t2 : 1997/98 ; t3 : 2005/07 ) . 381 subjects of the original cohort ( n = 500 ) were re-examined at t3 . 29 % of the subjects who were cognitively healthy at baseline received the diagnosis of mild cognitive impairment ( MCI ) and 7 % of Alzheimer 's disease ( AD ) . Subjects were screened for physical and mental health using medical interviews , physical , and neuropsychological examinations . Participants completed a question naire on their current and past PA at t1 . Subjects were classified as physically active if they reported a regular sport activity for at least 2 hours per week in the past year . Muscular strength ( h and grip ) and motor coordination ( balance ) served as objective indicators of PF . Subjects who passed the balance-test at t1 had a reduced risk of developing MCI/AD at t3 ( OR = 0.35 , 95%CI 0.19 - 0.66 , p < 0.01 ) and performed significantly better on various neuropsychological measures . Muscular strength or subjective reports of PA did not predict MCI/AD development . Our results confirm the hypothesis that PF acts as a protective factor for the development of cognitive disorders . In our study , context , motor coordination served as a better predictor than muscular strength or self-rated PA . Since subjects with cognitive disorders due to cerebral and /or systemic disorders were excluded from the analyses , our findings suggest that the effect of skill-related PF extends beyond the reduction of cardiovascular risk factors OBJECTIVE To ascertain the effectiveness of the National Arthritis Foundation ( NAF ) aquatic and on-l and exercise programs on functional fitness and perceived ability to perform activities of daily living ( ADL ) measures in older adults with arthritis . DESIGN The effects of aquatic and on-l and exercise intervention programs were analyzed by repeated- measures analysis of variance by using a planned comparison approach with an independent 3 x 2 ( group by test ) design . omega(2 ) analyses were used to ascertain the relative treatment magnitude of each dependent variable . SETTING Testing in an indoor track facility ; exercise programs conducted in community setting s. PARTICIPANTS A volunteer sample of 30 men and women with arthritis ( osteoarthritis , n=22 ; rheumatoid arthritis , n=8 ) , r and omly assigned into either an aquatic exercise ( n=10 ) , on-l and exercise ( n=10 ) , or control group ( n=10 ) . INTERVENTION Eight-week on-l and and aquatic exercise program . MAIN OUTCOME MEASURES Functional fitness , ADLs , and h and -held dynamometry measures assessed on a 1-day pretest and posttest session , before and after an 8-week exercise program . RESULTS Aquatic and on-l and exercise subjects showed significant improvements on 9 of 12 functional fitness , 3 of 4 ADLs , and 7 of 8 h and -held isometric strength tests after their respective exercise programs . No significant changes were found in any of these measures for the control group . CONCLUSION Both NAF exercise programs appear to be effective in improving functional physical fitness and perceived ability to perform ADL measures in older adults with arthritis OBJECTIVE To assess the effects of 12 months ' dynamic strength training on muscle strength and bone mineral density ( BMD ) at the lumbar spine and femoral neck in patients with early rheumatoid arthritis ( RA ) . METHODS Thirty-two subjects in the training group ( EG ) and 33 in the control group ( CG ) completed the study . EG carried out strength training 2 times a week with moderate loads of 50 - 70 % of repetition maximum . They were also encouraged to do recreational physical activities . CG performed recreational physical activities and range of motion exercises .  Maximal strength of the knee extensors , trunk extensors and flexors , and grip strength were recorded with dynamometers . BMD was measured using dual x-ray absorptiometry . Modified Disease Activity Score , erythrocyte sedimentation rate , and pain were used for the estimation of disease activity , and Stanford Health Assessment Question naire to measure functional disability . RESULTS The 12 month resistance training in EG led to statistically significant mean increases of 22 - 35 % in all muscle groups examined . CG patients were also able to increase their strength to some degree ( 3 - 24 % ) , but at the end of the study strengths in CG were significantly lower than in EG . By the end of the study lumbar spine BMD had changed by + 0.19 % ( 4.24 ) in EG and by -1.14 % ( 4.36 ) in CG . The corresponding changes of femoral BMD were + 1.10 % ( 3.71 ) and -0.03 % ( 3.58 ) . The changes in BMD were minor and statistically not significant in both groups . However , femoral BMD was found to be decreased among those patients treated periodically with oral glucocorticoids ( n = 15 , 3 subjects from EG and 12 from CG ) compared with changes in BMD among those not treated with systemic glucocorticoids ( n = 50 ) . CONCLUSION Minimally supervised strength training result ed in significant improvements in muscle strength without detrimental effects on disease activity . The detected annual changes in central BMD were minor and statistically insignificant in both groups . Special attention should be focused on those patients with RA with high disease activity and concomitant glucocorticoid treatment OBJECTIVE To evaluate the effect of an 8-week , water-based exercise program ( experimental group ) with that of an upper-extremity function program ( control group ) to increase cardiovascular fitness within a community setting for people with stroke . DESIGN Single-blind r and omized controlled trial . SETTING Public community center . PARTICIPANTS A volunteer sample of 12 community-dwelling people with stroke with mild to moderate residual motor deficits . INTERVENTION Study subjects participated in group exercise programs for 1 hour , 3 times a week for 8 weeks . The experimental group exercised in chest-deep water at targeted heart rates . The control group performed arm and h and exercises while sitting . Main outcome measures The primary outcome measure was cardiovascular fitness ( V(O2)max ) . Secondary measures were maximal workload , muscle strength , gait speed , and the Berg Balance Scale score . RESULTS The experimental group attained significant improvements over the control group in cardiovascular fitness , maximal workload , gait speed , and paretic lower-extremity muscle strength . The relatively short program ( 8 wk ) of water-based exercise result ed in a 22 % improvement in cardiovascular fitness in a small group of people with stroke who had relatively high function . CONCLUSIONS A water-based exercise program undertaken as a group program may be an effective way to promote fitness in people with stroke OBJECTIVE To investigate physical fitness and work capacity in women with rheumatoid arthritis ( RA ) . METHODS The 42 subjects were a subset of a prospect i ve trial of conditioning exercise in rheumatic disease . Assignment to an exercise or nonexercise group was determined by proximity to the intervention , a 3-month supervised group exercise program . Physical fitness and work capacity were assessed at baseline , 3 months , and 12 months . RESULTS At baseline , subjects were deconditioned and limited in h and function , lifting ability , and lower extremity mobility . Only the exercise group improved their aerobic capacity and exercise tolerance . There were no significant changes in measured work capacity in either group . Moderate to strong correlations were found between aerobic capacity , mobility , h and function , and work capacity . Grip strength was a strong and consistent correlate of work capacity . CONCLUSION Our findings suggest that physical capacity , particularly h and function , may be important in the complex phenomenon of work disability in RA OBJECTIVES To examine the effects of a community-based group exercise program for older individuals with chronic stroke . DESIGN Prospect i ve , single-blind , r and omized , controlled intervention trial . SETTING Intervention was community-based . Data collection was performed in a research laboratory located in a rehabilitation hospital . PARTICIPANTS Sixty-three older individuals ( aged > or = 50 ) with chronic stroke ( poststroke duration > or = 1 year ) who were living in the community . INTERVENTION Participants were r and omized into intervention group ( n=32 ) or control group ( n=31 ) . The intervention group underwent a fitness and mobility exercise ( FAME ) program design ed to improve cardiorespiratory fitness , mobility , leg muscle strength , balance , and hip bone mineral density ( BMD ) ( 1-hour sessions , three sessions/week , for 19 weeks ) . The control group underwent a seated upper extremity program . MEASUREMENTS Cardiorespiratory fitness ( maximal oxygen consumption ) , mobility ( 6-minute walk test ) , leg muscle strength ( isometric knee extension ) , balance ( Berg Balance Scale ) , activity and participation ( Physical Activity Scale for Individuals with Physical Disabilities ) , and femoral neck BMD ( using dual-energy x-ray absorptiometry ) . RESULTS The intervention group had significantly more gains in cardiorespiratory fitness , mobility , and paretic leg muscle strength than controls . Femoral neck BMD of the paretic leg was maintained in the intervention group , whereas a significant decline of the same occurred in controls . There was no significant time-by-group interaction for balance , activity and participation , nonparetic leg muscle strength , or nonparetic femoral neck BMD . CONCLUSION The FAME program is feasible and beneficial for improving some of the secondary complications result ing from physical inactivity in older adults living with stroke . It may serve as a good model of a community-based fitness program for preventing secondary diseases in older adults living with chronic conditions BACKGROUND Sedentary behavior and impaired cardiovascular reserve capacity are common late effects of cancer therapy emphasizing the need for effective strategies to increase physical activity ( PA ) in cancer survivors . We examined the efficacy of a 12-month exercise-based rehabilitation program on self-reported PA , cardiorespiratory fitness ( VO2peak ) , strength , and patient-reported outcomes . PATIENTS AND METHODS Two hundred fourteen post-treatment cancer survivors were r and omly assigned to a 12-month rehabilitation program consisting of individual ( x3 ) and group-based ( x6 ) counseling in combination with once weekly high-intensity group-based exercise training ( the Copenhagen Physical Activity after Cancer Treatment , PACT ; n = 108 ) or to a health evaluation program ( HE , n = 106 ) . Study outcomes were assessed at baseline , 6 months , and 12 months . RESULTS After 12 months , the percentage of patients reporting meeting PA goal behavior ( ≥3 h/week ) was significantly increased in the PACT group versus the HE group ( 70.4 % versus 43.4 % , P = 0.001 ) . Repeated measures analyses indicated a statistically significant improvement in VO2peak ( l min(-1 ) ) in favour of PACT ( treatment effect ratio = 1.04 ; 95 % confidence interval 1.00 - 1.07 ; P = 0.032 ) . Significant between group differences were also observed for strength ( P < 0.001 ) , depression ( P = 0.020 ) and mental health ( P = 0.040 ) . CONCLUSION A 12-month exercise-based rehabilitation program is an effective strategy to promote PA and improve VO2peak in cancer survivors BACKGROUND Physical activity programs in nursing homes typically consist of seated , range of motion ( ROM ) exercises , regardless of resident abilities . The Functional Fitness for Long-Term Care ( FFLTC ) Program was design ed not only to maintain ROM , but also to improve strength , balance , flexibility , mobility , and function . In addition , it was tailored to meet the needs of both high and low mobility residents . METHODS The feasibility and efficacy of the FFLTC Program were evaluated with 68 residents ( mean age 80 ) from five institutions . Persons were classified as low or high mobility and r and omized into either the FFLTC program or a seated ROM program . Classes were conducted in groups of 4 to 10 residents by trained facility staff for 45 minutes , three times per week . Assessment s at baseline and 4 months consisted of mobility , balance , gait , flexibility , functional capacity , and several upper and lower extremity strength measures . RESULTS Attendance averaged 86 % for the FFLTC and 79 % for the ROM classes . Four months of exercise led to significant improvements in mobility ( 16 % ) , balance ( 9 % ) , flexibility ( 36 % ) , knee ( 55 % ) , and hip ( 12 % ) strength for the FFLTC group . Shoulder strength was the only improvement found for the ROM group . The ROM group significantly deteriorated in some areas , particularly hip strength , mobility , and functional ability . CONCLUSIONS Institutionalized seniors , even those who are physically frail , incontinent and /or have mild dementia , can respond positively to a challenging exercise program . The FFLTC program demonstrated clear benefits over typical , seated ROM exercises . Moreover , with minimal training , the program can be safely delivered at low cost by institutional staff and volunteers Osteoarthritis ( OA ) of the knee leads to restrictions of physical activity and ability to perform activities of daily living . Obesity is a risk factor for knee OA and it appears to exacerbate knee pain and disability . The Arthritis , Diet , and Activity Promotion Trial ( ADAPT ) was developed to test the efficacy of lifestyle behavioral changes on physical function , pain , and disability in obese , sedentary older adults with knee OA . This controlled trial r and omized 316 sedentary overweight and obese older adults in a two-by-two factorial design into one of four 18-month duration intervention groups : Healthy Lifestyle Control ; Dietary Weight Loss ; Structured Exercise ; or Combined Exercise and Dietary Weight Loss . The weight-loss goal for the diet groups was a 5 % loss at 18 months . The intervention was modeled from principles derived from the group dynamics literature and social cognitive theory . Exercise training consisted of aerobic and strength training for 60 minutes , three times per week in a group and home-based setting . The primary outcome measure was self-report of physical function using the Western Ontario and McMaster University Osteoarthritis Index . Other measurements included timed stair climb , distance walked in 6 minutes , strength , gait , knee pain , health-related quality of life , knee radiographs , body weight , dietary intake , and cost-effectiveness of the interventions . We report baseline data stratified by level of overweight and obesity focusing on self-reported physical function and physical performance tasks . The results from ADAPT will provide approaches clinicians should recommend for behavioral therapies that effectively reduce the incidence of disability associated with knee OA Objectives : Physical activity ( PA ) has the potential to improve outcomes in both arthritis and diabetes , but these conditions are rarely examined together . Our objective was to explore whether persons with arthritis alone or those with both arthritis and diabetes could improve amounts of PA  with a home-based counselling intervention . Methods : As part of the Veterans LIFE ( Learning to Improve Fitness and Function in Elders ) Study , veterans aged 70–92 were r and omized to usual care or a 12-month PA counselling programme .  Arthritis and diabetes were assessed by self-report . Mixed models were used to compare trajectories for minutes of endurance and strength training PA for persons with no arthritis ( n = 85 ) , arthritis ( n = 178 ) , and arthritis plus diabetes ( n = 84 ) . Results : Recipients of PA counselling increased minutes of PA per week independent of disease status ( treatment arm by time interaction p < 0.05 for both ; endurance training time p = 0.0006 and strength training time p < 0.0001 ) . Although PA was lower at each wave among persons with arthritis , and even more so among persons with arthritis plus diabetes , the presence of these conditions did not significantly influence response to the intervention ( arthritis/diabetes group × time interactions p > 0.05 for both outcomes ) as each group experienced a nearly twofold or greater increase in PA  . Conclusions : A home-based PA intervention was effective in increasing minutes of weekly moderate intensity endurance and strength training PA in older veterans , even among those with arthritis or arthritis plus diabetes . This programme may serve as a useful model to improve outcomes in older persons with these pervasive diseases OBJECTIVE To evaluate adherence and satisfaction of patients with rheumatoid arthritis ( RA ) in a long-term intensive dynamic exercise program . METHODS A total of 146 RA patients started an intensive ( strength and endurance training for 75 minutes , twice a week , for 2 years ) exercise program ( Rheumatoid Arthritis Patients In Training ) aim ed at improving physical fitness . Program attendance and satisfaction were examined . Additional assessment s at baseline were done to find possible predictors of attendance . RESULTS Median ( interquartile range ) age and disease duration of the patients were 54 ( 45 - 61 ) and 5 ( 3 - 10 ) years , respectively . After 2 years , 118 ( 81 % ) patients still participated in an exercise class . The median attendance rate of all patients was 74 % . Low attendance was weakly associated with high disease activity , low functional ability , and low quality of life at baseline but not with the severity of joint damage at baseline . At the end , 78 % of all participants would ( strongly ) recommend the program to other RA patients . CONCLUSION Adherence and satisfaction of RA patients with an intensive dynamic exercise program over a prolonged time can be high . Disease severity parameters do not strongly predict the compliance of participants in an intensive exercise program PURPOSE This study was done to analyze the effects of an exercise program on body composition and physical fitness of obese female college students . METHOD Data was collected from September 29 , 2003 to December , 29 , 2003 . The research design was a r and omized control group pretest-posttest experimental design . The subjects were college nursing students at K University . Forty four students , 20 in the experimental group and 24 ina control group , with more than 30 % body fat were r and omly assigned . The subjects in the experimental group participated in an exercise program for 12 weeks , sixty minutes per session , five times per week . Body composition and physical fitness was measured by a body composition analyzer , cardiovascular endurance , muscle endurance , muscle strength(grip strength , back strength ) , flexibility , balance , agility(whole body reaction time ) and power(st and ing long jump ) . RESULT Body weight(F=4.76 , p=0.035 ) , body fat(kg)(F=5.68 , p=0.022 ) and body mass index(F=5.73 , p=0.021 ) of the experimental group were significantly different from the control group , but there were no significant differences in body fat(% ) , lean body mass , muscle mass and WHR . Back strength(F=6.50 , p=0.015 ) , flexibility(F=14.62 , p=0.000 ) , muscle endurance(F=7.98 , p=0.007 ) , power(F=5.76 , p=0.021 ) and balance(F=2.46 , p=0.018 ) of the experimental group were significantly different from the control group , but there were no significant differences in cardiovascular endurance , grip strength or agility . CONCLUSION The exercise program was effective in improving body weight , body fat(kg ) , body mass index , back strength , muscle endurance , flexibility , balance and power of obese female college students Background : In patients with knee osteoarthritis ( OA ) , there is a prominent loss in proprioception and kinesthesia sensation compared with control subjects of the same age and gender . Objectives : The aim of this study is the investigation of short-term clinical effects of kinesthesia and balance exercises in patients with knee OA . Methods : This 8-week study was conducted on 66 female patients with knee OA who were r and omized into 2 groups . The first group received kinesthesia and balance exercises ( such as retrowalking , walking on their toes , leaning to the sides , balance board exercises , minitrampoline exercises , plyometric exercises , and so on ) in addition to strengthening exercises . The second group received only strengthening exercises . Results : Statistically significant improvements were observed postexercise for both groups with respect to baseline for WOMAC , SF-36 Form , times for performing activities of daily living , isokinetic quadriceps muscle strength , and proprioceptive sensation levels . In the first group with kinesthesia training , compared with the second group , significantly greater improvements were obtained in all the subparameters that measure functional status ( WOMAC – physical function value , SF-36 Form [ physical function , role limitations –physical and vitality – energy or fatigue variables ] , 10 stairs climbing , and 10-m walking times ) and in isokinetic muscle strength at high angular velocities ( P < 0.05 ) . The absolute angular error percentage ( to assess proprioceptive accuracy ) was significantly improved postexercise in both groups . There were no differences between the groups . Conclusions : Additive positive effects of kinesthesia and balance exercises in knee OA have been demonstrated . Used in clinical applications , they should be able to increase the functional capacities of patients . Long-term studies about efficacy and cost-effectivity of these exercises are needed
Conclusion Exercises and PA promotion according to public health recommendations  for PA improved cardiovascular fitness , muscle strength and PA behaviour , with moderate effect sizes in people with SpA , RA and HOA/KOA .
Objective To evaluate the effectiveness of exercise and physical activity ( PA ) promotion on cardiovascular fitness , muscle strength , flexibility , neuromotor performance ( eg , balance ) and daily PA in people with rheumatoid arthritis ( RA ) , spondyloarthritis ( SpA ) and hip/knee osteoarthritis ( HOA/KOA ) .